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Lifestyle principles have been advocated for the promotion of health and prevention of disease since antiquity. More than 2000 years ago, Hippocrates asserted, 'Let food be thy medicine and medicine be thy food'. Predating Hippocrates, Levitical health laws mandated lifestyle practices such as hand washing after touching dead bodies or diseased animals, and avoiding pathogenic substances such as blood and mould. The consumption of animal fat was also forbidden, which is intriguing given that chronic disease was not the major health threat at the time.
Notwithstanding the developments in pharmacological and surgical technologies that have profoundly enhanced healthcare, the authors propose that the historical practice of 'lifestyle as medicine' will become increasingly re-emphasised in future healthcare for mitigating and/or managing contemporary concerns relating to chronic and infectious diseases.
Lifestyle as medicine for chronic disease
The value of a healthy lifestyle for primary prevention of chronic disease has been unequivocally demonstrated in large-scale epidemiological studies, including the Framingham Heart Study, Nurses Health Study, and European Prospective Study into Cancer and Nutrition (EPIC). Indeed, an estimated 90% of cardiovascular disease and type 2 diabetes mellitus, as well as one in three cancers, are preventable through healthy lifestyle practices.1,2
While primary prevention is most desirable, patients are often not motivated by the possibility of future pain (physical or emotional), which may account for why lifestyle as a medicine has not been historically emphasised. However, individuals are motivated by present pain, and a growing body of evidence is showing lifestyle interventions to be efficacious for the management and, in some instances, treatment of chronic conditions. Indeed, intensive lifestyle change has been shown to reduce vascular stenosis and associated disorders,3 normalise blood sugar levels without the need for medication,4 and even regress markers of early stage prostate cancer.5 Hence, the view of therapeutic lifestyle change is shifting from that of a nicety - something that might produce better health in years to come - to a necessity. Of course, facilitating patient receptiveness and longterm adherence to therapeutic lifestyle change can be challenging. However, comprehensive lifestyle interventions have reported high levels of engagement and low levels of recidivism5-8 by applying an array of behavioural-change strategies, including education, social support, selfmonitoring, problem solving and nurturing self-efficacy.
The application of therapeutic lifestyle interventions...