Lifestyle change is a first-line treatment for many diseases. However, change is inherently challenging. This difficulty is exacerbated by a lack of lifestyle change “breakthroughs,” whereas multiple pharmaceutical breakthroughs have occurred over the years. Thus, pharmaceutical interventions are emphasized.
For example, the American Academy of Pediatrics issued new obesity treatment guidelines that included medications and surgery. 60 Minutes recently aired a segment with physicians claiming that obesity was mainly genetic and best understood as a “brain disease,” dismissing diet and exercise as outdated and arguing for medication as essential. These represent a semi-abandonment of lifestyle change as treatment. We are losing the obesity epidemic, but instead of bolstering the values underpinning diet, exercise, and other good habits, we lean on impressive new drugs.
And what are those values? For our patients to build healthy lifestyles and well-being, use as few medications as possible, and prevent pharmaceutical dependency. This is as true today as it was decades ago before I started medical school.
This is all said without discussing the immeasurable non-medical benefits of diet and exercise. A person who successfully changes their lifestyle must overcome deeply ingrained habits built for the status quo. Denying oneself of the desires feeding their disease will develop endurance, perseverance, and discipline. These qualities are invaluable not only for living but also for flourishing. Undoubtedly, the process is painful, but it’s not harmful—it’s beneficial. Along with the physical, emotional, and mental gains of losing weight, becoming stronger, etc., these non-physical attributes will enable patients to better contribute to their families and communities. This ability to contribute is often overlooked and undervalued. They change as people and for the better. This “change” is the goal, with a healthier weight as a sought-after side effect.
To be clear, I’m not saying that medication should never be used or that it has no role in treatment. I’m saying we shouldn’t jettison the concept of lifestyle change in place of it. The temptation will be to overprescribe these medications, but choices still matter. If a person continues to make the same obesity-enabling choices while taking medication, prescribing that medication reinforces those choices.
Put differently, if someone has the goal of eating fewer Froot Loops but takes medication that’s effective no matter how many Froot Loops they eat, then the attempt at lifestyle change is rendered useless along with its non-medical advantages. This benefits only two parties: Big Pharma and Toucan Sam. Neither one is our patient.
Instead of promoting better choices, ever-improving medical interventions reinforce poorer ones. We are arriving at a time when medication can potentially make behavior obsolete. This is ultimately detrimental, as the consequences embedded in choices, actions, and behaviors are necessary for growth and flourishing. So, in the spirit of encouraging our patients to grow, it is not enough to promote vague notions of “lifestyle change.” To be as effective as possible, we must first promote a new foundation from which that change can occur.
Tyler Petersen is a medical student.