Book Review

Lifestyle Medicine

N Engl J Med 2000; 342:1927-1928June 22, 2000

Article

Lifestyle Medicine
Edited by James M. Rippe. 1388 pp., illustrated. Malden, Mass., Blackwell Science, 1999. $125. ISBN: 0-86542-249-X

There has been considerable scientific interest in the contribution of lifestyle to health since recorded history began. However, the idea that the study of lifestyle's contribution to health is a discipline in itself seems to be relatively new. The editor of this book, a cardiologist, hopes that the publication of this book “will open an entire new branch of medicine emphasizing the important linkages between clinical practice and the recommendation of positive lifestyle behaviors for patients.” Whether this book will indeed have this effect is difficult to judge, so I have elected to review it as a resource for someone engaged in primary care practice.

The editor defines lifestyle medicine as the integration of lifestyle practices into medical practice for both therapy and prevention. Less well defined are “lifestyle practices,” but a review of the chapter titles helps to clarify the difficult choices that had to be made. Diet and exercise habits are clearly lifestyle practices, as is the use of tobacco. As a group, these topics make up about 85 percent of the chapters concerning specific lifestyle issues. There is relatively little on the use of alcohol or illicit drugs and almost nothing on the use of nutritional supplements, herbal remedies, or nontraditional exercises such as yoga.

Because of its broad scope, the book must handle these lifestyle issues at a number of levels. It is not surprising that the chapters dealing with exercise discuss the benefits of exercise for the prevention of osteoporosis, cardiovascular disease, and chronic lung disease for persons 5 to 85 years of age, as well as approaches to changing the behavior of the well and the sick and young and old. I was somewhat surprised to see chapters on the evaluation of acute sports injuries, the effect of exercise on immune function in adults (those who are healthy and those with various diseases), and the evaluation of student athletes before their participation in competitive sports. Given this breadth, I was disappointed that no chapter had more than a very brief discussion of the importance of race, ethnicity, and culture as determinants of lifestyle and strategies for lifestyle modification.

The book has 116 chapters and 21 sections. Rippe has recruited 20 section editors to help him tie the book together. The text and figures are easy to read. Liberal use of subheadings within chapters allows one to skip around to areas of interest, an important advantage, since this book is clearly not meant to be digested at a single sitting, but rather to serve as a reference. The multiauthored and multieditored nature of the production leads to some inevitable inconsistency in style, given the mixing of discussions of the wealth of empirical data on the links between diet, exercise, obesity, and type 2 diabetes mellitus with discussions of the use of the Internet by patients for preventive health care. Overall, however, most readers will find the chapters that interest them to be clearly written, if occasionally a bit dated. The Heart and Estrogen/Progestin Replacement Study (a negative randomized trial of estrogens for secondary prevention in women with coronary heart disease), for example, is mentioned only in passing as a counterpoint to the generally enthusiastic assessment of the value of estrogen therapy in reducing the risk of cardiovascular disease.

The text often does not specify who is responsible for establishing the background of a problem and who should discuss the specific approach to a problem. Thus, many authors recommend “stages of change” models (sometimes specifying the transtheoretical model, a stage-based model of behavior change introduced by Prochaska and DiClemente) as an appropriate framework for changing the lifestyle of interest. Unfortunately, a discussion of the transtheoretical model that would allow one actually to apply it does not occur until chapter 45, and even there it is truncated to just over a page. Similarly, the perceived exertion scale is not described in the chapter where it is recommended for use in prescribing exercise for patients with chronic diseases, but rather in a table in the next chapter. Also, the scale is referred to differently in different chapters.

How well does the book achieve its goal of opening a new branch of clinical medicine? I believe that the enormous breadth of material that is included, coupled with attempts to be very detailed in the coverage of some areas, makes this work too patchy to be considered a standard reference for all the material that is included in the field of lifestyle medicine. However, by presenting a range of material and labeling it “lifestyle medicine,” the editors may have succeeded in opening the discussion of what this discipline actually is and is not.

Should the average primary care provider own this book? I would note that it did fill some holes for me. The sections on nutrition and the application of behavioral psychology to changes in lifestyle are not included in textbooks that I currently use. The discussions of workplace and community interventions, as well as public policy related to healthy lifestyles, are not germane to everyday practice but do provide background that would be of use when a physician takes on the role of community leader. At the same time, many and perhaps most segments, including those on women's health, sports medicine, and cardiac rehabilitation, are at least as well covered in textbooks that more clearly focus on these topics. Similarly, epidemiologic reviews of the evidence linking lifestyle to disease overlap discussions in textbooks on the various diseases. I suspect that the need for this book will vary depending on how “lifestyle savvy” the potential reader is. However, those who are as mired in the biomedical model as I am will probably find a lot of the material new and interesting.

Jeff Whittle, M.D., M.P.H.
Veterans Affairs Health Care System, Pittsburgh, PA 15240