Life, Style, and Hard Times

I was privileged Friday morning to address the virtually assembled multitudes for the 2020 Harvard Lifestyle Medicine conference. 

Hundreds were gathered from throughout the US, and countries all over the world.

As ever, the enthusiasm of this group ran high- albeit expressed on this occasion via texts on Zoom, rather than the smiles, hugs, high-fives, and back-pats of life as we knew it before COVID. We’ll get back to all of that some time, but for now- a chorus of “amens” via the Zoom chat function conveyed much the same.

Reflecting on this conference, at this time, I feel compelled to borrow from Dickens: these are both the worst and best of times for lifestyle medicine. 

These are the worst of times for reasons all but self-evident. We advocate for relaxation, stress management, and good mental health- and people are dealing with extreme stress, radical anxiety, and an unprecedented confluence of worries.

We advocate for exercise, and people have been confined, constrained, shut in, and locked out of the gyms and fitness classes they customarily frequent.

We advocate for optimal diet, and people have been turning to junk food for comfort through the hours, days, weeks, and now months of sequestration and disquiet.                                                                                                            

We advocate for ample quantities of restorative sleep, and people have been lying awake worrying about a horrible infection, or how to make ends meet and put food on the table, or make hopeful plans for the future- in lieu of sleeping.

We advocate the importance of social connections, as we all navigate a pernicious loneliness born of social distancing and sheltering in place.

We advocate for happiness and optimism- at a time of much sadness and abundant reason for it, and seemingly, for pessimism too.

But, as for Dickens, there is more to all this than a diagnosis in one direction. These are the best of times, too.

The true importance of lifestyle as medicine has been revealed in the uneven burdens of the pandemic.  The opportunity to deliver clinical care virtually has been much accelerated. The need for innovation related to care delivery models, and their reimbursement, is a matter of dedicated attention, and enormous opportunity.

The best of lessons tend to issue from the worst of times. Perhaps that’s why the best and worst of times commingle- in tales of people, as of cities. Adversity is never fun, but it is often indelible, and the deep impression of it can change us for good.

Lifestyle medicine is much about the choices we make to populate our daily patterns of eating and sleeping, exercising and relaxing, caring for ourselves and interacting with others. Pandemic policies of sheltering, isolating, and distancing are a vivid illustration of how dependent are the choices we each make, on the choices we all have. 

The protests for racial equality and justice evince massive disparities in those choices, in the opportunities and expectations we encounter on any given day. They remind us that the appendage of “style” to just “life” is itself a privilege. Too many are working too hard on simply living to give a care for any related elements of “style.” Our field, to them, is a field of distant dreams. We must be honest with ourselves about that, if we are to help fix it.

The status quo is too costly a state to tolerate- and here, too, the confluent crises of this time are the best of teachers. The very disparities of opportunity attendant upon color and race that cause lifestyle practices to diverge result in a disproportionate burden of chronic diseases- diabetes, hypertension, heart disease- in communities of color. These are the very factors that greatly compound the risks of bad outcomes with COVID infection, and so inevitably- that burden, too, has been falling hardest on those same communities. And, in a perfect storm of prejudicial fate, the same communities are most prone to the most dire consequences of unemployment, too.

These worst of times teach us we cannot best face the acute threat of pandemic contagion unless we attend well to the chronic state of our health. These worst of times teach us that lives and livelihoods are ineluctably linked through the medium of opportunity and social determinants of health that come before the personal choices of “style.” These worst of times teach us how indifferent are threats to us all, like SARS-CoV-2, to trivial variations in skin pigment we contrive into bias and divisions. These worst of times teach us the futility of recommending good choices to those who can mostly only access bad ones.

Our field of lifestyle medicine, made up of diverse health professionals, is imbued with exceptional passion for the cause of adding years to lives and life to years. We must embrace a special humility as well. For, to the best of my knowledge, nowhere in the world, and at no time in history, was an entire population particularly vital because of extraordinary efforts, fabulous skill, or exceptional coaching by clinicians. The clinical domain of lifestyle medicine practitioners can be in the vanguard of change; we can be at the tip of the spear. But where lifestyle confers the greatest return in vitality and longevity, it does so via culture, not clinics. People live well and thrive where it is normal to do so; where healthy living is communal.

These worst of times that have separated us in unprecedented ways do, indeed, reveal how much we are all “in it” together. These worst of times are the best of teachers about much that matters most to human potential, and hides in plain sight. We have cause to hope they are ushers to far better, if not the best, of times; all we need do is heed their lessons.

Dr. David L. Katz is a board-certified specialist in Preventive Medicine/Public Health and Past President of the American College of Lifestyle Medicine