Lifestyle-related, non-communicable chronic diseases such as type 2 diabetes, heart disease, and hypertension factor in the death of nine out of 10 Canadians and affect the daily activities of millions more.² According to the Centre for Chronic Disease Prevention and Control, more than one third of adults, and more than half of seniors, suffer from one or more chronic conditions.³ Forty per cent of people have high blood cholesterol, a major cardiovascular disease risk factor and 20 per cent of people have high blood pressure. (Of those, nearly half are unaware of their condition, and fewer than one in five have it treated and under control.)⁴

The international picture is just as bleak. According to the World Health Organization (WHO), chronic diseases account for 60 per cent of deaths. By the year 2015, this number is expected to increase by 20 per cent; most notably, deaths from type 2 diabetes are projected to rise by nearly 40 per cent.⁵

The good news is, as a nation, Canada has been more progressive than most in recognizing lifestyle-related chronic diseases as a public health threat. In fact, public policies promoting both population-wide approaches and individual interventions are attributable in averting an estimated 1 million deaths from cardiovascular disease between 1970 and 2000.

More recently, in its 2003 Accord, the Health Council of Canada has committed to make chronic disease prevention a priority and accelerate work on a public health strategy for improving the nation’s health status by the year 2015. Three measurable targets—all aimed at healthy living—have been defined: better nutrition, increased physical fitness, and healthier weight.

Research suggests that even modest gains in this direction could significantly impact Canada’s chronic disease burden. For example, a Simon Fraser University team of researchers estimated that reducing salt intake by less than one teaspoon per day would reduce the incidence of high blood pressure by 30 per cent, and it would save up to $430 million per year due to a reduced need for physician visits, laboratory tests, and medications.⁶ And the WHO estimates that a mere 2 per cent annual reduction in Canada’s chronic disease death rates over the next 10 years would result in an economic gain of $1 billion.²
 

Certainly, the problem is enormous and public health officials will continue to grapple with these issues for years. But, the numbers of newly-diagnosed cases of lifestyle-related non-communicable chronic diseases continue to skyrocket. What can be done in the meantime?

Therapeutic Lifestyle Change (TLC) Programs

Widespread adoption of therapeutic lifestyle change, or TLC, programs may be a promising solution to this ever-growing problem. These professionally-supervised programs are focused on teaching healthy lifestyles, with the goal of delivering long-term health. Also referred to as lifestyle modification or lifestyle intervention programs, TLC programs have been proven effective in the prevention, management, and even reversal of some of the most common lifestyle-related chronic conditions, including high cholesterol, hypertension, type 2 diabetes, metabolic syndrome/insulin resistance, and overweight/obesity.

Ample scientific evidence suggests that TLC programs are effective in addressing chronic disease. A review of three recent, high-profile clinical trials—the Da Qing Study, the Finnish Diabetes Study, and the Diabetes Prevention Program—concluded that lifestyle intervention was more effective than conventional care in significantly reducing the progression from pre-diabetes to diabetes. Progression to diabetes was reduced by 40 per cent, 58 per cent, and 58 per cent, respectively.⁷

Not Weight Loss Programs

TLC programs should not be confused with diets or weight loss programs. Whereas these efforts typically fail, TLC programs have been remarkably successful in helping produce long-term benefits. However, the two programs do bear similarities. For instance, as in weight loss programs, TLC patients typically enroll for 12 weeks, meeting weekly with a healthcare practitioner during the first four to five weeks, then meeting bi-weekly for the remainder of the program.

Some of the key differences are as follows:

• Ongoing professional supervision. A physician or allied healthcare professional will assess the patient’s current health, establish goals, and develop a personalized step-by-step plan. Frequent follow-up visits are needed to track progress and make any necessary adjustments.
• A multi-disciplinary team approach. Although the supervising practitioner may conduct the entire program, certain services may be referred to others, such as a fitness trainer or nutritionist. Office staff members can help manage patient contacts, schedule follow-up visits, and prepare take home materials.
• Emphasis on body composition. The goal of a TLC program is to achieve a healthy body composition, not merely to shed pounds. In fact, while weight loss may occur, it is only secondary to achieving a healthy lean muscle-to-fat ratio.
• “24/7” lifestyle management. Program extras may include tips on shopping at the grocery store, meal planning, and time management.
  

Lost Opportunities in Primary Care
In the peer-reviewed journal, The Internist, a team of prominent German researchers opined that preventive medicine is “the stepchild of internal medicine,” and argued that “pharmacotherapy can only be an adjunct” in the prevention of arteriosclerotic cardiovascular disease.⁸ To the chagrin of many in the public health arena, despite being knowledgeable about the benefits of lifestyle intervention and an ever-increasing demand for these services, most physicians still fail to provide them. Certainly, time constraints, financial pressures, lack of appropriate tools and training, and low patient compliance make it difficult to address lifestyle issues in everyday clinical practice. These attitudes were borne out recently in a large recent survey of more than 13,000 primary care physicians which found that few provided written prescriptions, performed fitness assessments, or referred patients for lifestyle counseling.⁹

An Opportunity for Chiropractic Professionals
In its November 2006 Call to Action, the Chronic Disease Prevention Alliance of Canada implored individual communities and public health officials to undertake health-promoting policies, stating that “Canada’s health care system cannot cope now, and is not prepared for the next decade when a tidal wave of chronic diseases will become overwhelming.”¹⁰ Given the need for lifestyle counseling and the limited availability of these services from the current medical system, a considerable opportunity exists for allied healthcare professionals to fill the void.

As one of the country’s largest primary-contact healthcare professions, and with their knowledge of diet and nutrition, chiropractors are especially suited for this task. Indeed, becoming established as the community TLC specialist can potentially generate increased physician referrals and word-of-mouth advertising, in turn creating new and sustainable revenue streams. More importantly, chiropractors who seize the moment have the opportunity to secure their place as key partners in resolving Canada’s chronic disease dilemma.

References:

1.       World Health Organization. WHO Statistical Info System (WHOSIS). Life expectancy at birth (years), both sexes. Available at http://www.who.int/whosis/database/country/compare.cfm?strISO3_select=VCT&strIndicator_select=LEX0Male,LEX0Female&language=english&order_by=FirstValue%20DESC. Retrieved 08/19/08.

2.       World Health Organization. Facing the facts: the impact of chronic disease in Canada. Available at http://www.who.int/chp/chronic_disease_report/media/CANADA.pdf. Retrieved 08/22/08.

3.       Broemeling AM, Watson DE, Prebtani F. Populations patters of chronic health conditions, co-morbidity and healthcare use in Canada: implications for policy and practice. Healthc Q. 2008;11(3):70-76.

4.       Heart and Stroke Foundation of Canada. Available at http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3483991/k.34A8/Statistics.htm. Retrieved 08/19/08.

5.       World Health Organization. The impact of chronic disease in low income countries. Available at www.who.int/chp/chronic_disease_report/en. Retrieved 08/20/08.

6.       Joffres MR, Campbell NR, Manns B, Tu K. Estimate of the benefits of a population-based reduction in dietary sodium additives on hypertension and its related health care costs in Canada. Can J Cardiol. 2007;23(6):437-443.

7.       Rasmussen SR, Thomsen JL, Kilsmark J, et al. Preventive health screenings and health consultations in primary care increase life expectancy without increasing costs. Scan J Public Health. 2007;35(4):365-372.

8.       Windler E, Zyriax BC, Beil FU, Greten H. Primary prevention of cardiovascular diseases. Stepchild of internal medicine. Internist (Berl). 2004;45(2):173-181.

9.       Petrella RJ, Lattanzio CN, Overend TJ. Physical activity counseling and prescription among Canadian primary care physicians. Arch Intern Med. 2007;167(16):1774-1781.

10.   Chronic Disease Prevention Alliance of Canada. Canada cannot cope now with chronic disease and is not ready for the tidal wave in the next decade: call to action says help the worst, first. Issued November 8, 2006.

Jeffrey S. Bland, PhD, FACN, CNS, is a nutritional biochemist and author of several books on nutritional medicine for healthcare professionals and the general public. Dr. Bland is Chief Science Officer for Metagenics, Inc., a life sciences company and leading developer and manufacturer of science-based nutraceuticals and medical foods sold to healthcare practitioners worldwide