Dear Editor,
Lifestyle medicine involves modifying individual’s way of life for therapeutic purposes. They mean; with the knowledge of lifestyle changes and make some behavior changes, prevention and treatment of some lifestyle related diseases are possible.⁽¹⁾ These lifestyle interventions are about physical activity, nutrition, sleep health, alcohol and tobacco usage and stress management. The reason why we should apply them to our lives are mainly prevent ourselves from the non-communicable diseases. According to WHO, cardiovascular diseases, cancers, chronic respiratory diseases and diabetes are main noncommunicable diseases. 

They are responsible for 63% of all deaths worldwide. Even the mortality rate of these diseases is high, they are mostly preventable with some small but effective lifestyle changes such as prevention of tobacco usage, unhealthy diet, physical inactivity and harmful usage of alcohol.^(2,3) 

With lifestyle changes, we can prevent NCDs. According to American College of Preventive Medicine the general consensus of these recommendations include: 

• get about 30 minutes of moderately intense physical activity at least 5 days a week, preferably every day,
• quit smoking, if a smoker,
• use alcohol only in moderation, if at all
• limit to 2 servings/day for men, 1 for women,
• lose 5% to 10% of body weight, if overweight or obese, achieve weight loss by reducing kcal intake by about 500 kcal per day and gradually increase physical activity to 60 minutes per day,
• consume a diet rich in vegetables and fruits, at least 2 fruits, 3 vegetables per day,
• choose whole-grain, high-fiber foods (at least half of grains as whole grains),
• limit intake of saturated fat to <10% of energy, trans fat to <1% of energy, and cholesterol to <300 mg/day by choosing lean meats and vegetable alternatives, fat-free (skim) or low-fat (1% fat) dairy products and minimize intake of partially hydrogenated fats,
• consume fish, especially oily fish, at least twice a week, minimize intake of beverages and foods with added sugars.⁽⁴⁾

We can add some variations of these recommendations, there are a lot of things that we can do but they all depend on two key points. Which are healthy lifestyle practices are incorporated into almost every practice guideline for the prevention or management of chronic disease, and reasonably small lifestyle changes (e.g., 30 minutes of moderate exercise per day, 100 kcal less per day, a 5% weight loss) if sustained over time can lower the risk of developing chronic disease as well as the progression of it.⁽⁴⁾   

There are two challenges about lifestyle medicine. First one is, “How can we change our behavior and how can we maintain these changes?” And secondly “What is the role of physician?”   

Before the role of physician, there is a fact that patients health practices are strongly influenced by doctors’ health practice. Physicians have a critical role in adaptation of their patients to lifestyle changes to prevent chronic diseases. They should have healthy habits as a role model of their patients. Their role as a role model is important because they lend credibility to lifestyle medicine to guide their patients. Many physicians reported that they have difficulty counseling their patients about healthy behavior chances if they themselves do not make changes in their lives.⁽⁴⁾  

So, the first thing what physicians do is adapting lifestyle changes to their lives. And secondly it is their responsibility to teach lifestyle medicine to patients.

According to the AMA Council on Scientific Affairs, health professionals have a key responsibility to; promote preventive measures and encourage positive lifestyle behaviors relating to obesity, counsel patients about safe and effective weight loss and weight maintenance programs and identify and treat obesity-related co-morbidities.^(4,5) Several studies have demonstrated the enormous potential of physician recommendations to influence patients’ lifestyle behaviors, such as stopping smoking and improving diet.^(5,6) 

Advice from a physician has consistently been shown to lead to attempts to improve lifestyle. It is powerful motivator to increase physical activity or make a serious attempt to lose weight.^(1,6)

The other challenge is changing behavior. Making a lifestyle change is hard, especially when you want to transform many things at once. Lifestyle changes are a process that take time and require support. Once you’re ready to make a change, the difficult part is committing and following through. The changes you would do should be permanent.^(7-9)

According to American Psychological Association there are five tips to help make some positive lifestyle changes which are long lasting. 

• First you make a plan that will stick. Your plan will guide you and it should be specific. 
• Secondly start small and thirdly change one behavior at a time. Baby steps are important for not to lose motivation. Unhealthy behaviors develop over the time, so replacing unhealthy behaviors with healthy ones requires time and it requires patience. To improve your success, just focus on one goal at a time.
• Forth tip is start making these changes with somebody. Whether it be a friend, co-worker or family member. The important thing here is to stay motivated.
• And lastly you can ask for support. Accepting help from those who care about you can comfort you during the process of behavior change.^(10,11)

As a conclusion, lifestyle medicine is a topic of especially our times. Because of sedentary life and fast foods, inactivity and obesity are increased. Because of increased stress level, people tending to use more alcohol and tobacco also sleep balances are bad. If we adapt lifestyle medicine to our lives within small changes, we can protect ourselves from NCDs. 

During the last decade, lifestyle medicine has evolved and developed in tandem with the dramatic rise in the prevalence of chronic diseases that can be avoided or managed by adopting a healthy lifestyle. Even though lifestyle changes are challenging, with sustainable motivation and support, anything is possible. Support of physicians are crucial at this point not only for their paints but also for the community. Their recommendations on patients’ lifestyle changes are very effective.

1. Gökdemir Ö. Aile Hekimliği ve Yaşam Biçimi Tıbbı. In: “Aile Sağlığı Merkezi Yönetimine Güncel Yaklaşım-2”. (ed) Yılmazer TT. 1st ed. Ankara, Akademisyen Yayınevi. 2021:161–5.
2. The TTF for the management of arterial hypertension of, Of ES of C (ESC) and the ES, (ESH) H. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Journal of Hypertension. 2018: 3021–3104 .
3. Gökdemir Ö, Özçakar N. Healthy aging and exercise. J Turkish Fam Physician 2022;13(3):104–15.
4. American College of Preventive Medicine. Definitions and differentiation of LM and related disciplines, Reimbursement trends, The Current Status of Lifestyle Medicine, Evidence for Lifestyle Interventions – Treating Chronic Disease, Practice Patterns Related to L. LIFESTYLE MEDICINE – EVIDENCE REVIEW 2009: 2 – 43.
5. Malatskey L, Hekselman I, Afek S. Lifestyle Medicine Around the World: Lifestyle Medicine in Israel. Am J Lifestyle Med 2020;14(4):377–81. 
6. Gokdemir O, Ersil Soysal D. Brittle Diabetes Needs Patient Centered Treatment and Lifestyle Modification in the Rural. Gazi Med J 2022;33(3):270–2. 
7. Polak R, Shani M, Dacey M, Tzuk-Onn A, Dagan I, Malatskey L. Family physicians prescribing lifestyle medicine: Feasibility of a national training programme. Postgrad Med J 2016;92(1088):312–7. 
8. Phillips EM, Frates EP, Park DJ. Lifestyle Medicine. Phys Med Rehabil Clin N Am 2020;31(4):515–26. 
9. Baska A, Kurpas D, Kenkre J, Vidal-Alaball J, Petrazzuoli F, Dolan M, et al. Social prescribing and lifestyle medicine—a remedy to chronic health problems? Int J Environ Res Public Health 2021;18(19):1–9. 
10. Weir K. The Key to Making Lasting Lifestyle and Behavioral Changes: Is it Skill or Will? Am Psychol Assoc [Internet]. 2015;1. Accessed from: https://www.apa.org/helpcenter/lifestyle-behavior, adress on 08/11/2022.
11. Malatskey L, Bar Zeev Y, Polak R, Tzuk-Onn A, Frank E. A nationwide assessment of lifestyle medicine counseling: Knowledge, attitudes, and confidence of Israeli senior family medicine residents. BMC Fam Pract 2020;21(1):1–9.