PREVENTION IS EASIER THAN CURE….OR IS IT? SEPTEMBER BLOCK 2018 DR A SULAKSHANA TPD LUTON VTS

TRUE OR FALSE A GPs role is more preventative than curative A GP prevents more illnesses in their career than manages them A lot of preventative medical advice is hyped up in the medical world to scare patients into improving their lifestyles Brief interventions and motivational interviewing techniques take up a lot of time and make little difference in GP consultations

What are the commonest types of preventative medicine consultations in General Practice?

An Introduction to Lifestyle Medicine What is it? Who can do it? Why is it important?

What is it? ‘Lifestyle Medicine is a branch of Medicine dealing with research, treatment and prevention of diseases caused by lifestyle factors like nutrition, physical inactivity and stress’

Who can do it? Clinician Public Health Professional Health Practitioner

Why is it important? Some interesting evidence based facts:

Obesity BMJ ‘meta review’ 2017 concluded that there was strong evidence that adiposity was associated with 11 cancers, with a linear rise in rates of these cancers seen with increasing BMI. This potentially makes body fat the second most important modifiable cancer risk factor after tobacco use!

Does it matter if you are overweight but fit?

Evidence Epic cohort study, 7000 patients found that fit patients (No HT, DM, dyslipidaemia) but high BMI or obese had an increased CVD risk of 26% and 28% compared to healthy individuals with normal BMI… Brief Interventions for Obesity in Primary Care, Lancet 2016 1882 patients, 137 GPs, 18+, BMI 30+ (or 25 + if Asian), raised body fat Pt presenting for other reason GP gave 30 second brief intervention about BMI Active arm: 12 week wt mngt programme and offered fup Advice arm: Simply advised that losing weight would benefit their health. Pt were weighed at 0, 3 and 12 m. Results: Active arm mean wt change at 12 months=2.43 kg Advice arm mean weight change at 12 months=1.04 kg Cost to GP time: 1.45 pounds….

Smoking ‘Very Brief Advice’ approach (Ask, Advise, Assist) Assessment of Nicotine dependance (Mins after waking to 1st cigarette, no per day, cravings or withdrawals on previous quit attempts) Smoke cessation programmes, NRT types What about vaping???

Alcohol Recent change to 14 units/pw for men due to dose dependant increase risk of cancer BMJ 2017: Advices as people live longer affects of alcohol on the heart needs to change to effects of alcohol on our minds from 60s- 80s(dose dependant association between alcohol consumption over 30 years and hippocampal atrophy)

Evidence Brief intervention in consultations about drinking habits and limits changes patterns of drinking… Audit score and simple feedback on drinking levels is sufficient

Now for a little bit of … TED TALK….

What now? 3 groups: Obesity, Smoking, Alcohol Work together, research resources (Ipads) and prepare a 3 minute role play with SMART advice on how to make these changes The consultations will start with: While you are here can we talk about your….. Assume patient is willing to change or interested in talking about it The patient will be ME! For all three groups