Lifestyle Is the Medicine, Culture Is the Spoon

Abstract

We have known now for a span of decades that the leading causes of premature death and chronic disease in the United States and increasingly around the world are behavioral factors under our potential control. We have as well consistent evidence from diverse sources indicating that amelioration of a short list of such factors, with an emphasis on dietary pattern, physical activity, and tobacco use, can slash rates of chronic disease and premature death alike. But choices people make are governed ultimately by choices people have. In an obesigenic and morbidigenic environment that conspires mightily against healthful living, salutary behavior change is all too often forestalled. Constructive and compassionate guidance from clinicians can help confront this challenge, and the case is made that lifestyle in medicine is of real value. But the case is also made that lifestyle is not fundamentally a clinical issue but a cultural one. For the full promise of lifestyle medicine to be realized, it must be lifestyle as medicine—and spoons full of cultural change will be required to make that medicine go down.