22 Lifestyle Diseases & Quality of Life
Mary Grace ‘D’ Tungdim
Contents:
Introduction
Who is at risk of Lifestyle Diseases?
Risk factors of Lifestyle Diseases
Culture & Lifestyle Diseases
Quality of life
Health-Related Quality of Life (HRQoL)
Why is it important to track HRQoL?
Impact of Quality of Life on Lifestyle Diseases
Impact of Lifestyle Diseases on Quality of Life
Prevention and control of Lifestyle Diseases
Initiatives taken by WHO to prevent Lifestyle Diseases
Summary
Learning Objectives:
To understand:-
1. the concept of lifestyle disease.
2. the concept of quality of life & its assessment.
3. the impact of quality of life on lifestyle disease.
4. the impact of lifestyle disease on quality of life.
5. the measures taken to control lifestyle diseases
Introduction
Lifestyle disease is a broader term of those non communicable diseases (NCDs) whose occurrence is primarily based on the daily habits of people and which are results of an inappropriate relationship of people with their environment. Lifestyle diseases are also often referred to as chronic diseases because the diseases require long term treatment and may even require a lifelong treatment. Lifestyle diseases can also be defined as diseases linked with the way people live their life. Lifestyle diseases are found to be increasing in frequency as countries become more industrialized and people live longer. It used to be a disease of the industrialized countries and so-called “Western diseases” or “diseases of affluence”, however, it is spreading fast in the developing countries also.
There are numerous lifestyle diseases and are increasing with changing time and with development in all fields of life. Some of the lifestyle diseases are: Alzheimer’s disease, arthritis, atherosclerosis, asthma, cancer, chronic liver disease or cirrhosis, chronic obstructive pulmonary disease (COPD), type 2 diabetes, heart disease, metabolic syndrome, chronic renal failure, osteoporosis, stroke, depression and obesity. This is commonly caused by alcohol, drug and smoking abuse, occupation as well as lack of physical activity and unhealthy eating.
In a way, lifestyle diseases are related to the change in way of living which can occur due to varying causes from occupational lifestyle, habitual lifestyle to leisure lifestyle. The emergence of lifestyle diseases has gained more attention due to its impact on the health of the individual as well as to the community, this is why lifestyle diseases are often referred to as ‘Modern Epidemic’. In countries where the burden of communicable diseases is still high, the emergence of lifestyle diseases poses a major threat to the country’s healthcare.
Globally 14.2 million people between the ages of 30-69 years die prematurely each year from lifestyle diseases. Lifestyle diseases have emerged as bigger killers than infectious or hereditary ones. Lifestyle diseases like hypertension, diabetes mellitus, dyslipidaemia and overweight/obesity are the major risk factors for the development of cardiovascular diseases (CVD). If one considers the global picture, developing countries show high prevalence of lifestyle diseases.
Many studies have reported that prevalence of these diseases has reached alarming proportions among Indians in the recent years due to rapid economic development and increasing westernization of lifestyle in the past few decades including overweight and obesity in recent years even though undernutrition continues to be an important public health issue even in the 21st century. There is paucity of epidemiological data on the overall prevalence of lifestyle diseases in India because of the following reasons:
(i) The country is huge with very diverse population that has different social and cultural characteristics;
(ii) Even today, there is inadequate access to healthcare institutions for many rural communities; and
(iii) Reliance on indigenous healthcare systems such as Ayurveda, Unani and Siddha by many individuals of the country.
Who is at risk for lifestyle diseases?
People of all age groups, regions and countries are affected by lifestyle diseases. Lifestyle disease was often associated with older age groups due to physical immobility with old age, but now there is evidence which shows that 17 millions of all deaths which are attributed to lifestyle diseases occur among younger age groups or before the age of 70. Of these “premature” deaths, 87% are estimated to occur in low and middle income countries. Children, adults and the elderly are all vulnerable to the risk factors contributing to NCDs, whether from unhealthy diets, physical inactivity, exposure to tobacco smoke or the harmful use of alcohol. (WHO, 2017).
These diseases are driven by forces that include rapid unplanned urbanization, globalization of unhealthy lifestyles and population ageing. Unhealthy diets and lack of physical activity, mental stress adds to rise in blood pressure, increased blood glucose, elevated blood lipids and obesity. These are called metabolic risk factors that can lead to cardiovascular disease, the leading NCD in terms of premature deaths.
Lifestyle diseases are also termed as Chronic diseases like: cardiovascular diseases, mental health disorders, diabetes, and cancer which are the leading causes of death in India, and a pronounced increase is projected in their contribution to the burden of disease during the next two and half decades. Most chronic diseases which are the outcome of lifestyle factors and earlier termed as the disease of the industrialized countries are equally prevalent in poor and rural populations and often occur together.
Risk factors of Lifestyle diseases
Modifiable behavioural risk factors
There are many risk factors associated with lifestyle diseases. However, some of the risk factors are modifiable. The modifiable behaviours, such as tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol, all increase the risk of NCDs.
Some account of the impact of uncontrolled modifiable behaviours are as follows:
- Tobacco accounts for 7.2 million deaths every year (including those from passive smoking), and is projected to increase markedly over the coming years. (GBD, 2015)
- 4.1 million annual deaths have been attributed to excess salt/sodium intake. (GBD, 2015)
- More than half of the 3.3 million annual deaths attributable to alcohol use are from NCDs, including cancer.
- 1.6 million deaths annually can be attributed to insufficient physical activity. (GBD, 2015)
Metabolic risk factors
The uncontrolled modifiable behaviours lead to the onset of Metabolic risk factors. The metabolic risk factors contribute to four key metabolic changes that increase the risk of NCDs:
- raised blood pressure
- overweight/obesity
- hyperglycemia (high blood glucose levels) and
- hyperlipidemia (high levels of fat in the blood).
The risk factors are frequently undiagnosed or inadequately managed in health services where the system is designed to treat acute conditions, thereby crippling the management of chronic conditions.
Culture & Lifestyle Diseases
Lifestyle diseases which are often referred to as Chronic diseases or no communicable diseases (NCDs), usually emerge in middle ages after long exposure to an unhealthy lifestyle involving tobacco use, lack of regular physical activity and consumption of diets rich in highly saturated fats, sugars, salt. These factors in the post modern concept is typified by “fast foods”.
Chronic conditions are often incorrectly considered to have limited impact on the burden of disease in India and in most of the developing countries where there is a cultural context to being ‘fat’ and not ‘thin’. For example: In many Sub-Saharan Africa countries, an increased level of body fat is associated with beauty, prosperity, health and prestige, despite its negative impact on health. Thinness, in contrast, is perceived to be a sign of ill health or poverty and is something to be feared and avoided, particularly in recent years, when it has been associated with AIDS (Treloar et al. 1999).
In many disadvantaged communities in South Africa, food is highly valued because food security has not always been ensured. Researchers found it to be socially unacceptable for an individual to refuse to eat food that was offered to them (Mvo et al., 1999). The concept of ‘eat as much as you can for tomorrow you may diet’ is practiced in these communities. They are unaware of the fact that the excess dietary carbohydrate or fat is stored or accumulated as fat.
Brown and Konner (1987) also reported that the majority of the less developed regions had, or still have, ideals of feminine beauty that include plumpness, which is consistent with the hypothesis that fat stores function as a cushion against food shortages during pregnancy and lactation. Studies have shown that black women in South Africa also do not perceive being overweight or obese as a health risk (Ndlovo and Roos, 1999). In these countries thin is associated with poverty. The current burden of chronic diseases reflects the cumulative effects of unhealthy lifestyles and the resulting risk factors over the life span of people. Some of these influences are present before a child is born. As to be fat depends not not only on behavioural and environmental factors but also on the genetic makeup of the individual.
Mtabaji et al. (1992) found salt sensitivity, measured by the blood pressure response on salt loading, in 46.2 percent of the subjects studied in Tanzania. A high intake of sodium is common in Sub-Saharan Africa, as it is used to preserve food or to make food tastier. For example, Cappuccio et al.
(2000) described the diet in Ghana as consisting mostly of unprocessed food and highly salted fish and meat. Substantial amounts of salt are added to food while cooking, and monosodium glutamate–based flavoring cubes or salts are widely used to give food taste. In addition to a high salt intake, people in Sub-Saharan Africa frequently eat little fruit and vegetables, resulting in low potassium intakes.
In a study conducted among the traditional and conservative Aggarwal Baniya community preferring their own traditional diet, which is generally rich in oil and fat predisposing this community to obesity and other cardiovascular risk factors. It was found that the blood pressure of sons showed a significantly higher correlation with their parents than did daughters. Due to this society’s preference for males, boys are likely to enjoy more of the family’s resources and pampering than girls. This results in poor eating habits making them more prone to cardiovascular problems similar to their parents. (Gupta & Kapoor, 2013)
Quality of life
According to the World Health Organization (WHO) quality of life is defined as the living conditions associated with the corresponding goals, expectations, standards, and concerns of each individual living in different cultural systems (WHO, 1993). The quality of life, as a new health indicator, is not only concerned about how long patients can survive, but more concerned about how well patients live. The first measurement of the quality of life is the United States national measurement report in 1960 by the United States Dwight D. Eisenhower National Goal Committee (Spitzer, 1987). After the 1980s, the assessment of the quality of life in the allocation of health resources, the choice of patient (individual) treatments, the comparison of various treatments in clinical trials, and quality of life measurement in healthy people has been widely applied.
The Center for Disease Control & Prevention (CDC) defines ‘Quality of life (QOL) as a broad multidimensional concept that usually includes subjective evaluations of both positive and negative aspects of life’. What makes it challenging to measure is that, although the term “quality of life” has a meaning for nearly everyone and every academic discipline but individuals and groups may define it differently. Health is one of the important domains of overall quality of life, though there are different domains of overall quality of life viz; jobs, housing, schools, the neighborhood, aspects of culture, values, and spirituality that add to the complexity of its measurement. Nevertheless, researchers have developed useful techniques that have helped to conceptualize and quantify these manifold domains and how they relate to each other.
Health-Related Quality of Life (HRQoL)
Health-Related Quality of Life (HRQoL) refers to the physical, emotional, and social impact of disease and treatments and is distinct from physiologic measures of disease. The concept of health-related quality of life (HRQoL) and its determinants have unfolded since the 1980s to include those facets of overall quality of life that can be clearly shown to affect health which may be physical or mental. The SF-36 (Short Form Health Survey) is developed as an indicator of overall health status.
- At the individual level, HRQoL includes physical and mental health perceptions (e.g., energy level, mood) and their correlates—including health risks and conditions, functional status, social support, and socioeconomic status.
- At the community level, HRQoL includes community-level resources, conditions, policies, and practices that influence a population’s health perceptions and functional status.
- On the basis of a synthesis of the scientific literature and advice from its public health partners, CDC has defined HRQoL as “an individual’s or group’s perceived physical and mental health over time”.
The HRQoL was constructed is such a way to enable health agencies to legitimately address broader areas of healthy public policy around a common theme in collaboration with a wider circle of health partners, including social service agencies, community planners and business groups.
HRQoL questions have become an important component of public health surveillance, anthropological field surveys and are generally considered valid indicators of unmet needs and intervention outcomes. Self-assessed health status is also a more powerful predictor of mortality and morbidity than many objective measures of health. HRQoL measures make it possible to demonstrate scientifically the impact of health on quality of life, going well beyond the old paradigm that was limited to what can be seen under a microscope or felt with a stethoscope.
Why is it important to track HRQoL?
Quality of life is important to everyone as it adds active years to the life of an individual. Although the World Health Organization (WHO) defined health in its broader sense in its 1948 constitution as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”, health has traditionally been measured narrowly and from a deficit perspective, often using measures of morbidity or mortality alone. But, health is a multidimensional construct that includes physical, mental and social domains.
As medical and public health advances have led to cures and better treatments of existing diseases and delayed mortality, it was logical that those who measure health outcomes would begin to assess the population’s health not only on the basis of saving lives, but also in terms of improving the quality of lives of people. It can also be used for policy makers, health planners to device strategies for prevention of many communicable as well a non-communicable diseases.
Focusing on HRQoL as an outcome can bridge boundaries between disciplines and between social, mental, and medical services. Several recent federal policy changes underscore the need for measuring HRQoL to supplement public health’s traditional measures of morbidity and mortality. Healthy People 2000, 2010, and 2020 identified quality of life improvement as a central public health goal. Some of the importance of measuring HRQoL are highlighted below:
- HRQoL is related to both self-reported chronic diseases (diabetes, breast cancer, arthritis, and hypertension) and their risk factors (body mass index, physical inactivity and smoking status). So, it provides data on overall health of an individual(s).
- Measuring HRQoL can help determine the burden of preventable disease, injuries, and disabilities, and can provide valuable new insights into the relationships between HRQoL and risk factors.
- Measuring HRQoL will help monitor progress in achieving the nation’s health objectives.
Analysis of HRQoL surveillance data can identify subgroups with relatively poor perceived health and help to guide interventions to improve their situations and avert more serious consequences. Interpretation and publication of these data can help identify needs for health policies and legislation, help to allocate resources based on unmet needs, guide the development of strategic plans, and monitor the effectiveness of broad community interventions.
Impact of Quality of Life on Lifestyle Diseases
Obesity to a great extent increases the risk for conditions such as type 2 diabetes, hypertension, dyslipidemia, gall bladder disease, sleep apnea, osteoarthritis, and lower back pain. Further, coronary artery disease and some cancers, which reduces life expectancy are found to be the outcome of obesity. The factors that increase blood pressure, such as obesity, high alcohol and salt intake are called “hypertensinogenic factors”; some of these factors have inherited, behavioural, and environmental components (Vikrant & Tiwari, 2001). Central obesity or abdominal obesity has been shown to be associated with metabolic syndrome. The key features of this condition are raised blood pressure, raised insulin and triglyceride levels, reduced high-density lipoprotein (HDL)-cholesterol levels, and insulin resistance.
The association between hypertension and obesity has been well documented in many countries. Worldwide, Indo-Asian people are among the populations at highest risk for cardiovascular disease (Jafar, 2005). In Zimbabwe, Mufunda et al. (2000) found this strong association, as did Rotimi et al. (1995) in populations of West African descent. Despite this clear association it has been suggested that the noxious effect of obesity in black people is less than in people of other ethnic groups. Most of the supporting evidence for this viewpoint is based on studies carried out with African Americans in the United States.
The increasing prevalence of overweight and obese population globally is associated with urbanization, changing dietary patterns and less physical activity and a rise in socioeconomic status. In 2014, more than 1.9 billion adults, 18 years and older, were overweight, of these over 600 million were obese. Kruger et al. (2002) studied the relationship of nutrition and physical activity patterns of a large sample of people from the North West Province of South Africa exposed to all levels of urbanization and found that there was positive correlation between total energy intake, fat intake and body mass index (BMI).
Cardiovascular diseases (CVD) are a major cause of morbidity and mortality worldwide, hypertension is one of their most prevalent risk factors. Globally, they account for approximately 17 million deaths a year. CVD is the leading cause of no communicable morbidity and mortality among low- and middle-income countries, accounting for almost 25% of total deaths and, by the year 2030, is projected to be the leading cause of death worldwide (Murray & Lopez, 1997, Lopez et al., 2006).
High blood pressure is a major risk factor for heart attacks and strokes (Kannel, 1996). It also contributes to renal disease and blindness. The main risk factors for hypertension include: heredity, age, ethnicity, obesity, stress, sedentary lifestyle, alcohol consumption, gender, use of contraceptives and high sodium intake (Simonetti et al., 2002). Thus, because of its close association with lifestyle, hypertension can be prevented, attenuated or treated by adopting healthy habits.
Earlier surveys showed that the lowest prevalence of hypertension occurred in the poorest African countries, and as affluence increased, the prevalence increased. The surveys also revealed that hypertension was more common in urban than in rural settings in the region (Nissinen et al., 1988). The Kenyan Luo migration study of Poulter et al. (1990) was the first to show that migration of people from traditional rural villages on the northern shores of Lake Victoria to the urban settings of Nairobi was associated with an increase in blood pressure. This suggests a marked change in the diet of the new arrivals in Nairobi.
Some dietary factors are related to hypertension, including increased salt (sodium) intake and a decrease in fruit and vegetables (potassium); a higher intake of alcohol products, particularly by men, also plays a pivotal role. The data on the association between high salt (sodium chloride) intake and hypertension in black people from Africa has been summarized by Seedat (1996) and suggests that black people have a transport mechanism of high sodium retention and a low renin activity. Higher pulse rates in the Nairobi participants suggest that mechanisms related to increased autonomic nervous system activity could contribute to the higher levels of blood pressure observed (Poulter et al., 1990).
Since the past few years, stress has been postulated to be an important factor in the pathogenesis and development of lifestyle diseases which further leads to the development and acceleration of atherosclerosis. Stress may be caused due to many factors like family pressure, work pressure, health, etc. Many studies have reported that urban settlers have higher stress levels and lower social integration scores than their rural counterparts. These indicators of increased stress in the urban setting were associated with higher blood pressures (Kaufman et al., 1999).
Dyslipidemia is defined as a clinically significant alteration of the naturally occurring blood lipids and lipoproteins predisposing to cardiovascular diseases and other chronic diseases (Berger and Marais, 2000). A particularly atherosclerotic combination of lipid and other risk factors is referred to as the metabolic syndrome and leads to premature coronary heart disease. This syndrome consists of high levels of blood triglyceride, low levels of HDL cholesterol, and small dense LDL particles. It is also associated with type 2 diabetes, hypertension, abdominal obesity, insulin resistance, and physical inactivity. Dyslipedemia aggravates the quality of life of people with hypertension.
Impact of Lifestyle Diseases on Quality of Life (QoL)
Several studies have shown that living with a chronic condition significantly reduces Quality of Life (QoL) and having multiple chronic conditions reduces QoL even further. People living unhealthy lifestyle are at risk of suffering from different types of chronic diseases which may occur in the early part or in the last period of human life. The most common degenerative diseases leading to reduced quality of life (QoL) are cancer, hypertension, osteoporosis, and diabetes mellitus (Fortin et al., 2006). Regardless of the condition type, patients’ QoL is adversely affected by chronic illness (Stewart et al., 1989); this is an important consideration in the management of asymptomatic conditions such as hypertension (Plaisted et al., 1999).
The quality of life in chronic illnesses can vary with age, especially for senior adults. Though Chronic conditions affects patients of all ages and sex, seniors’ mobility and consequently their physical and functional status, emotional balance, and self-esteem decline because of their dependence on others. which, in turn, contribute to the reduction in the quality of life for seniors suffering from lifestyle diseases. Many studies have shown consistently negative relationship between multiple chronic diseases and quality of life. The presence of chronic illness is related to unhappiness and psychological distress, resulting in low quality of life for both men and women.
Ozturk et al. (2011) found no association between chronic diseases and physical mobility, functional independent activities, and type of chronic conditions in either gender. Despite these inconsistent findings, degenerative diseases still have a significant influence on quality of life. Carvalho et al. (2013) evaluated HRQoL in hypertensive patients and compared it to that of normotensive individuals and concluded that those with high BP had worse HRQoL.
Behavioral risk factors, such as smoking and alcohol abuse, are another important modifiable risk factors which decrease the quality of life. Empirical studies clearly show that alcohol and smoking habits have negative consequences for health-related quality of life by reducing life expectancy and resulting in psychological problems (Vogl et al., 2012).
Most of the available studies related to chronic diseases and lifestyle behaviors have been conducted in developed countries and very less is known about the influence of lifestyle factors, including smoking and alcohol drinking, and chronic illnesses on the quality of life in developing nations. Much more research is required to be directed in this field to understand the pathogenesis of the lifestyle diseases. Chronic life-threatening and disabling conditions introduce significant psychosocial stressors which reduces the quality of life of patients suffering from lifestyle diseases.
Awareness is also an important factor in reducing the effect of lifestyle diseases. Hypertension and diabetes are two common conditions which in recent times have had new extended definitions to include so-called pre-hypertension and pre-diabetes states wherein this gives an individual a warning period before the onset of the disease for intervention in terms of physical activity or lifestyle modification. But, sometimes awareness may play a negative role, at least for hypertension, those aware of their hypertension have been found to have a lower HRQoL than those who were unaware i.e. there is a ‘labeling effect’ (Mena-Martin et al., 2003).
Prevention and control of Lifestyle diseases
Lifestyle disease rates are already higher than expected in many countries. Consequently, these patients are making significant demands on the health services. Appropriate planning to manage Lifestyle diseases and their risk factors is of paramount importance. Most of the risk factors emerge as a result of an unhealthy lifestyle that is followed for several decades. The risk factors have a synergistic effect on the total chronic disease risk. Health services planned for prevention and care must therefore take cognizance of the burden of multiple chronic disease risk factors in the same patient.
Although a wide range of cost-effective primary and secondary prevention strategies are available, their coverage is generally low, especially in poor and rural populations. Much of the care for chronic diseases is provided in the private sector and can be very expensive. Sufficient evidence exists to warrant immediate action to scale up interventions for chronic diseases through private and public sectors; improved public health and primary health-care systems are essential for the implementation of cost-effective interventions.
Another important way to control lifestyle diseases is to focus on reducing the risk factors associated with these diseases. To lessen the impact of NCDs on individuals and society, a comprehensive approach is needed requiring all sectors, including health, finance, transport, education, agriculture, planning and others, to collaborate to reduce the risks associated with NCDs, and promote interventions to prevent and control them.
Investing in better management of NCDs is critical. Management of NCDs includes detecting, screening and treating these diseases, and providing access to palliative care for people in need. High impact essential NCD interventions can be delivered through a primary health care approach to strengthen early detection and timely treatment. Evidence shows such interventions are excellent economic investments because, if provided early to patients, they can reduce the need for more expensive treatment.
Countries with inadequate health insurance coverage are unlikely to provide universal access to essential NCD interventions. NCD management interventions are essential for achieving the global target of a 25% relative reduction in the risk of premature mortality from NCDs by 2025, and the Sustainable Development Goals (SDG) target of a one-third reduction in premature deaths from NCDs by 2030. The WHO report focuses on the need to move away from the acute model of care to efficiently coordinated and patient-centered care.
Such a move needs to facilitate an ongoing relationship between providers and patients and help patients to make full use of their own and their community’s resources (Holman and Lorig, 2000; Wagner, 2000). The partnership between the patient and the health care provider is not just a resource for understanding ill health, it is the basis for the prevention and management of chronic diseases and their risk factors (Swartz and Dick 2002). Therefore, the approach of healthcare prevention and management should focus on the patient’s own social settings and context ,cultural beliefs and practices.
Above all, physical activity and dietary modifications are purportedly identified as the cornerstones of management of overweight and obesity. Overall, encouragement of healthy lifestyles in the population should help to reduce the high burden of lifestyle diseases and metabolic syndrome (MS) in India. Governmental and non-governmental agencies of the country should work together to achieve this goal. Lifestyle interventions have shown definite benefit in the management and prevention of lifestyle diseases in large scale studies.
Initiatives taken by WHO to prevent lifestyle diseases (WHO, 2017)
Walk the Talk: WHO Healthy Work Place Initiative
The ‘Walk the Talk: a WHO Healthy Work Place Initiative’ was launched at WHO headquarters at Geneva and regional offices on the 19 January 2016. The initiative aims to promote healthy lifestyles in the workplace and reflects the commitment of WHO staff to set an example by following the recommendations set forward to Member States. A comprehensive strategy for a healthy workplace addresses a broad range of health issues, including physical activity, occupational health and safety and nutrition. The initiative is taken forward by the ‘Staff Health Safety and Wellbeing’ (SHSW) committee.
Step-up! Campaign
The main stairways of WHO headquarters, as well as various regional offices, were decorated with a series of motivational messages. This colourful and exciting campaign promotes the use of stairs as part of the sustained commitment by staff to increase physical activity at work. This campaign was followed up with 3 surveys assessing stairway usage. The results from the latest survey showed that stairway usage has increased from the period before the campaign had launched, while use of elevators has decreased. An example of the stairway message campaign is shown below.
Global Corporate Challenge 2016 (GCC)
The ‘Global Corporate Challenge’ began on 25 May 2016. WHO had 1295 participants, amounting to 185 teams globally. Staff participants at WHO managed to walk a daily average of 13000 steps which totalled to 1.5 billion steps or 960000 km. Staff participants also managed a total combined weight loss of greater than 1000 kg. At the conclusion of this successful challenge, participants described increased productivity, improved sleep and greater adherence to healthier nutritional choices.
Walk the Talk monthly runs and guided walks
WHO headquarters and regional offices have also committed to undertaking a series of monthly runs and guided walks. This initiative provides a productive break from the office, an opportunity to strengthen social ties amongst colleagues and promote community wellbeing.
Promoting healthy diet choices at the workplace
WHO has published sugar guidelines and provides technical assistance to Member States in the design of policies to promote healthy diet choices. In accordance with its guidelines, WHO has replaced sugar-sweetened beverages (including fruit juices) in their restaurants and vending machines with healthier alternatives. There are plans in the future to label the nutritional value of snacks and meals available for purchase across the workplace.
Summary
Poor lifestyle choices, such as smoking, overuse of alcohol, poor diet, lack of physical activity and inadequate relief of chronic stress are key contributors in the development and progression of preventable lifestyle diseases, including obesity, type 2 diabetes mellitus, hypertension, cardiovascular disease and several types of cancer. Even though doctors encourage healthy behaviors to help prevent or manage many chronic medical conditions, many patients are inadequately prepared to either start or maintain these appropriate, healthy changes. Most patients understand the reasoning behind a healthy lifestyle even if they do not understand the disease processes that can occur when they do not maintain healthy habits. Despite an understanding of what constitutes a healthy lifestyle, many patients lack the behavioral skills they need to apply everyday to sustain these good habits.
Healthy lifestyle modifications intervention include nutritional counseling, exercise training, and stress management techniques to improve outcomes for patients at risk and those who already have common chronic diseases.
Anthropological studies show that adults with common chronic conditions who participate in comprehensive lifestyle modification programs experience rapid, significant, clinically meaningful and sustainable improvements in the overall health outcomes.
It may be recommended that, in addition to the preventive actions required to reduce the risk factors of lifestyle diseases, health services should diagnose and control hypertension and diabetes and should ensure access to knowledge about healthy living and the development of affordable clinical care. It may also be emphasized that there is a need to build a niche to conduct research and development activities and to develop institutional frameworks. This would facilitate the development of lifestyle disease prevention activities by advocating healthy lifestyle for healthy quality of life and the transformation of the health care services to adequately cope with the enormous, mostly unacknowledged burden of lifestyle diseases. Regular physical activity reduces the risk and symptoms of many lifestyle diseases. Therefore, modification of lifestyle for a healthy living increases quality of life.
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Suggested Readings
- Quality of Life: Concept, Policy and Practice By David Phillips, Taylor & Francis e-Library, 2005.
- Guide to Prevention of Lifestyle Diseases By M. Kumar R. Kumar. Deep & Deep Publications, Rajouri garden, Delhi.
- Health and Wellness By Gordon Edlin, Eric Golanty. Jones & Bartlett Learning Publications, USA.