Lifestyle Impact On Non-Communicable Chronic Disease

Watch this video to understand the impact of Lifestyle on Non-Communicable Chronic Disease such as High Blood Pressure, Obesity and Type 2 Diabetes.

Which is the optimal approach? And or which approach is recommended by medical guidelines? Should medication be used first and then use lifestyle to reduce the medication? Or should one use lifestyle to improve the condition and then add a medication as necessary?

The optimal approach for managing many chronic conditions, such as hypertension, type 2 diabetes, and hyperlipidemia (high cholesterol), depends on the severity of the condition and individual patient factors. Both lifestyle changes and medications are important components of treatment, but the order in which they are introduced can vary.

Optimal Approach:

For many conditions, especially in mild to moderate cases, lifestyle changes are often considered the first-line approach to improve the condition, as they address the root causes, such as poor diet, lack of physical activity, and stress. Lifestyle modifications, such as dietary changes, increased physical activity, weight management, and smoking cessation, have been shown to significantly reduce the need for medications over time.

However, in more severe or acute cases, medications may need to be started early or immediately to quickly control the condition and reduce the risk of complications, with lifestyle modifications implemented in parallel to reduce or even eliminate the need for medication over time. For example:

• In the case of severely high blood pressure (hypertension), medication is often required immediately to prevent heart attacks or strokes while lifestyle changes take effect.

• In type 2 diabetes with high blood sugar, medications like metformin or insulin may be needed early to control blood sugar levels, but lifestyle changes are still crucial.

Medical Guidelines Recommendations:

1. Hypertension (High Blood Pressure):

• Guidelines (for example, the American Heart Association): Recommends starting with lifestyle changes (like reducing salt intake, exercising, losing weight, etc.) in cases of elevated or stage 1 hypertension, (when the risk of cardiovascular disease is lower). Medications are recommended if lifestyle changes alone are insufficient or if blood pressure is severely high from the outset - this is stage 2 or higher. 

2. Type 2 Diabetes:

• Guidelines (for example,the American Diabetes Association): recommends Lifestyle changes, especially dietary adjustments, weight loss, and physical activity, are the cornerstone of treatment. Medication (like metformin) is usually added if lifestyle changes alone do not adequately control blood sugar levels or if the initial blood glucose levels are high enough to require immediate medication.

3. Hyperlipidemia (High Cholesterol):

• Guidelines (for example, American College of Cardiology): recommend Focusing first on lifestyle changes, particularly in diet (reducing saturated fats), exercise, and weight loss. Statin medications are recommended if lifestyle changes are insufficient or if there is a high risk of cardiovascular events based on other factors (such as atherosclerosis or family history).

Summary:

• Optimal Approach: In mild to moderate cases, start with lifestyle modifications first. If the condition is severe or doesn’t respond adequately, introduce medications while continuing to improve lifestyle factors to potentially reduce medication over time.

• Medical Guidelines: Generally recommend lifestyle changes as the first step for managing chronic conditions, with medications added based on severity, risk factors, and the patient’s response to lifestyle interventions.

In practice, both approaches are often used together, and the treatment plan is tailored to the individual’s specific health status and risk profile.

Next, are the ranges and their relevant metrics for no-risk, low-risk, medium-risk, and high-risk? Then at those stages, we indicate where lifestyle is the main contributor, only contributor, on up to a contributor along with medication.

Here’s a breakdown of common chronic diseases (such as hypertension, type 2 diabetes, and hyperlipidemia), along with their risk categories, relevant metrics, and corresponding treatment approaches (such as lifestyle modifications vs. medication use).

(summary tables)

(downloadable PDF file of chronic conditions, risk categories, relevant metrics, and corresponding treatment approaches)

1. Hypertension (High Blood Pressure)

Metrics: Blood pressure (measured in mmHg)

Risk Category is Systolic BP and Diastolic BP (in millimeter of mercury). The Treatment Approach is:

Normal for systolic BP <120 and diastolic BP <80; the recommendation is Lifestyle to maintain normal levels (diet, exercise)

Elevated for systolic BP 120 to 129 and diastolic BP <80; the recommendation is Lifestyle modification only (main contributor)

Stage 1 Hypertension for systolic BP 130 to 139 and diastolic BP 80

to 89; the recommendation is Lifestyle as first line; medication if other risk factors are present

Stage 2 Hypertension for systolic BP ≥140 and diastolic BP ≥90; the recommendation is Lifestyle and Medication (both required)

Hypertensive Crisis for systolic BP >180 and diastolic BP >120; the recommendation is  Immediate medication; lifestyle changes long-term

The summary for Hypertension (High Blood Pressure):

• Lifestyle-only stages: is recommended for Elevated BP;

• Lifestyle as main contributor: is recommended for Stage 1 Hypertension (may still need medication if other risk factors are present);

• Lifestyle + medication: is recommended for Stage 2 Hypertension and Hypertensive Crisis

2. Type 2 Diabetes (Blood Sugar Control)

Metrics: Fasting blood glucose (FBG) or A1C (as glycated hemoglobin)

Risk Category is Fasting Glucose (miligrams per decileter) A1C (%); The Treatment Approach:

Normal fasting glucose <100 and A1c <5.7%; recommendation is Lifestyle to maintain normal glucose (diet, exercise)

Prediabetes fasting glucose 100 to 125 and A1c 5.7% - 6.4%; Lifestyle is the main contributor (weight loss, diet)

Diabetes (Early Diagnosis) fasting glucose ≥126 and A1c ≥6.5%; Lifestyle as first line, medication may be needed (metformin)

Diabetes (Poor Control) fasting glucose ≥126 and A1c ≥7%; Lifestyle and Medication (insulin, metformin, others)

Severe Diabetes  fasting glucose >200 and A1c >8% Medication is necessary, lifestyle for long-term management

Summary for type 2 diabetes:

• Lifestyle-only stages: Prediabetes;

• Lifestyle as main contributor: Early diagnosed diabetes;

• Lifestyle + medication: Diabetes with poor control or high initial A1C;

3. Hyperlipidemia (High Cholesterol)

Metrics: Total cholesterol, LDL (“bad” cholesterol), HDL (“good” cholesterol), and triglycerides

Risk Category Total Cholesterol, LDL HDL and Triglycerides in miligrams per deciliter; Treatment Approach

Desirable Total cholesterol <200, LDL <100, HDL >60, triglycerides <150; Lifestyle to maintain optimal levels (diet, exercise);

Borderline High Total cholesterol 200 to 239, LDL 100 to 159, HDL 40 to 59, triglycerides 150-199; Lifestyle modification only (main contributor);

High Total cholesterol ≥240, LDL ≥160, HDL <40,  triglycerides ≥200; Lifestyle + Medication (statins for LDL, fibrates for triglycerides);

Very High/Severe Total cholesterol ≥300, LDL ≥190, HDL <40, triglycerides >500; Medication necessary, lifestyle supports long-term control

Summary for Total Cholesterol:

• Lifestyle-only stages: Borderline high cholesterol;

• Lifestyle as main contributor: Borderline high cholesterol, depending on risk factors;

• Lifestyle + medication: High or very high cholesterol, especially when other cardiovascular risk factors are present;

4. Obesity and Weight Management

Metrics: Body Mass Index (BMI)

Risk Category BMI, in kilogram per meeter squared. The Treatment Approach is:

Normal weight,BMI 18.5-24.9; recommendation is to Maintain lifestyle (diet, physical activity);

Overweight, BMI 25-29.9, recommendation is for Lifestyle modification (diet, exercise) is the main focus;

Obesity (Class 1), BMI 30-34.9, recommendation is Lifestyle is essential; medication may be used (orlistat, etc.);

Obesity (Class 2), BMI 35-39.9, recommendation is Lifestyle + Medication (both required for weight loss);

Severe Obesity (Class 3), BMI  ≥40, recommendation is Medication or surgery (bariatric) needed; lifestyle for maintenance

Summary for Obesity and Weight Management:

• Lifestyle-only stages: Overweight;

• Lifestyle as main contributor: Class 1 obesity;

• Lifestyle + medication: Class 2 and Class 3 obesity, especially if there are comorbidities like diabetes or hypertension.

5. Coronary Artery Disease (CAD)

Metrics: Based on lipid levels, blood pressure, and presence of atherosclerosis or ischemia (lack of blood supply to the heart)

Risk Category Indicators and :Treatment Approach:

No Risk/Healthy: Normal cholesterol, no plaques Maintain lifestyle (healthy diet, regular exercise);

Low Risk: Elevated cholesterol, no major blockage Lifestyle modification (diet, exercise) is primary;

Medium Risk: Elevated cholesterol, mild plaque buildup Lifestyle + possible medication (statins);

High Risk: High cholesterol, significant atherosclerosis Medication + lifestyle to prevent complications

Summary of Coronary Artery Disease:

• Lifestyle-only stages: No risk and low risk;

• Lifestyle as main contributor: Low to medium risk;

• Lifestyle + medication: Medium to high risk, especially in the presence of cardiovascular disease

Summary of Risk Stages and Interventions:

1. No Risk/Normal: Maintain lifestyle (healthy diet, regular exercise).;

2. Low Risk/Elevated: Lifestyle changes are the main focus (diet, exercise, weight loss);

3. Medium Risk: Lifestyle modification is essential, but medication may be needed depending on the condition’s severity and other risk factors;

4. High Risk: Lifestyle + medication together are necessary for management;

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5. Severe Risk: Immediate medication is necessary, with lifestyle changes supporting long-term management.

In all cases, lifestyle modification is recommended across all stages, but the severity of the condition determines whether medication is introduced early and used alongside lifestyle changes.