07 May 2021 BANT welcomes the BJGP article on the ‘lifestyle medicine movement’ and opens the door to further discussions.
BANT welcomes the British Journal of General Practice (BJGP) May 4th article on lifestyle medicine (1) and is encouraged by the acknowledgement of well-informed drivers validating this movement.
“There are numerous drivers for lifestyle medicine. Our analysis does not aim to argue against the importance of these drivers as many of them are well informed”.
Since its foundation in 1997, BANT, as a professional association, has been at the forefront of nutritional therapy (NT) and personalised nutrition in support of its nearly 3,500 members. This individualised approach to health and well-being is founded on principals of lifestyle medicine, where diet and lifestyle are recognised as modifiable factors for therapeutic consideration. A newly published pilot study by Harris and Benbow, in April 2021 (2), highlights the effectiveness of NT as an evidence-based therapy for health and lifestyle improvements using the Working Alliance Inventory-Short Revised (WAI-SR) and a symptom-specific outcome measure, Measure Yourself Medical Outcome Profile 2 (MYMOP2) as validated measures. Results from 55 subjects suggest NT practice is effective in reducing client symptoms and improving health and activity, and that this may be further facilitated by a strong therapist and client working relationship. Whilst larger scale studies are necessary, these preliminary results are testament to the satisfactory outcomes that can be achieved with a personalised NT and lifestyle medicine approach.
The drivers identified by the BJGP are the precise reasons for the rise in lifestyle medicine. This ‘movement’ is part of a wider paradigm change that has been evolving over the past few decades, partly in response to the rise of non-communicable diseases, but most notably in recognition of the individual factors that determine how these diseases express themselves. The emergence of lifestyle medicine has been fuelled by the public response to public health measures. Measures which are purposely aimed at the general population and are, therefore, unable to serve at an individual level, resulting in too many individuals with long-term chronic conditions seeking more individualised support elsewhere.
Lifestyle medicine places the patient at the centre of their care and provides individualised protocols designed to offer optimum, rather than generic, support to patients. It is precisely this personalised approach that drives patients to seek NT and lifestyle medicine. The American Nutrition Association highlight this most eloquently in their 2020 paper ‘Toward the Definition of Personalized Nutrition’ (3) in which they argue that “a disease-centered, acute care approach is ill suited to chronic conditions that develop over time and have multiple causes”. Non-communicable diseases differ by person and typically impact multiple biological systems. As such, there is no one single intervention and one-size-fits-all solution, hence the demand for personalised nutrition and lifestyle medicine. This skew towards an acute-care model is evolving and integrated approaches to patient care are increasing. Registered Nutritional Therapy Practitioners seek to work in collaboration with medical practitioners to provide individualised nutrition and lifestyle recommendations for their clients as a support to their prescribed medical protocols, if any.
With every paradigm shift there are inevitably questions. The BJGP raise valid considerations regarding standards and evidence-based practice of lifestyle medicine.
‘Lifestyle medicine’ needs a clear consensus on what constitutes evidence-based practice, with organisational standards and leadership commitment to the removal of bad science, and of financial and ideological conflicts. Movement towards this is welcome.’
BANT is especially happy to address this and share its own mission statement.
The BANT Mission Statement (4): The primary function of BANT is to assist its members in attaining high standards of education and professional practice, in order to protect the client’s interest, and the professional reputation of nutrition and lifestyle medicine.
As the leading professional organisation for practitioners of nutrition and lifestyle medicine BANT requires all members to have met training and qualification standards including:
- to meet full BANT membership criteria members must achieve BSc (Hons) degree or higher from a recognised university and qualifications from a Nutritional Therapy Education Commission (NTEC) accredited Nutritional Therapy course.
- to meet the National Occupations Standards (NOS) for nutritional therapy. NOS remain the basis for assessing the competency and skills of Registered Nutritional Therapy Practitioner in one-to-one clinical practice and form the foundation of clinical training. Furthermore, the Core Curriculum sets out the underpinning evidence-based knowledge require by Registered Nutritional Therapy Practitioner, and the broader skills required to work in the wider field of nutrition, including industry academia and in non-clinical setting.
- to be registered either with Complementary and Natural Healthcare Council (CNHC) or be statutorily regulated. CNHC holds a register accredited by the Professional Standards Authority for Health and Social Care (PSA).
- to continue to meet annual Continuing Professional Development (CPD) standards, BANT Professional Practice standards for safe, ethical and professional conduct and CNHC Code of Conduct, Ethics and Performance.
All efforts to recognise and ensure the safe practice of nutrition and lifestyle medicine are supported by BANT. As are efforts to reduce the health inequalities highlighted by the BJGM.
‘The concept of individual ‘choices’ and ‘changes’, and by proxy ‘control’, plays a central role in many working definitions of lifestyle medicine. We are concerned about the potential for widening health inequalities when conceptualised and delivered in this way’.
BANT accepts the current inequalities in accessing nutrition and lifestyle medicine services. However, the concepts of ‘individual choice’ and ‘change’ are critical to the success of services, irrespective of whether they are delivered through public health channels or dedicated nutrition and lifestyle medicine channels. Adherence to any intervention is first preceded by an individual’s desire to make healthier choices and changes. That these should be facilitated to address socioeconomic, ethnic, religious and social challenges is a broader issue and one that BANT is committed to championing through its communications with government and primary care providers. BANT has launched two important initiatives in 2021 to formally address such inequalities, beginning with a new Food for your Health campaign (5), launched 22nd February, providing open access to a range of tools and resources to introduce the public to nutrition and lifestyle medicine, and secondly recruiting a dedicated diversity panel to signpost BANT Members to ways of working with community groups and people less able or willing to access services through traditional means.
BANT is fully invested in achieving the shared objectives of making nutrition and lifestyle medicine part of an integrated healthcare system that recognises the role of individual health alongside that of community and population health. BANT welcomes all discussion that furthers this paradigm shift and makes meaningful strides to improving healthcare for all.
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- David Nunan, David N Blane and Margaret McCartney. Exemplary medical care or Trojan horse? An analysis of the ‘lifestyle medicine’ movement. British Journal of General Practice 2021; 71 (706): 229-232. DOI: https://doi.org/10.3399/bjgp21X715721
- Miranda D Harris, Alison Benbow. Evaluating the Effectiveness of Nutritional Therapy in the McClelland Teaching Clinic at the University of Worcester. On J Complement & Alt Med. 6(3): 2021. OJCAM.MS.ID.000637. DOI: 10.33552/OJCAM.2021.06.000637
- Corinne L. Bush, Jeffrey B. Blumberg, Ahmed El-Sohemy, Deanna M. Minich, Jóse M. Ordovás, Dana G. Reed & Victoria A. Yunez Behm (2020) Toward the Definition of Personalized Nutrition: A Proposal by The American Nutrition Association, Journal of the American College of Nutrition, 39:1, 5-15, DOI: 10.1080/07315724.2019.1685332
- BANT Mission https://bant.org.uk/our-story/
- BANT Food for your Health campaign https://bant.org.uk/food-for-your-health/