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Independents' Day

Why the RCGP was wrong to describe Covid-19 as a ‘lifestyle disease’

Dr Tehseen Khan

An RCGP virtual conference titled ‘Covid-19: A lifestyle disease and the vital role GPs have in beating it’ set medical Twitter ablaze over the weekend. The agenda included useful talks to help GPs with video consultations and how best to utilise community assets.

I have no doubt that the day was useful for the doctors attending, as well as for their patients. However, the controversy that arose was specifically around terming Covid-19 a ‘lifestyle disease’.

According to the PHE report from earlier this month, living in a deprived area doubled your chances of dying from the virus. Working as a security guard, taxi driver or being a ‘lower skilled worker’ (many of whom have been clapped and celebrated along with NHS workers during this pandemic) was also bad news. Belonging to an ethnic minority increased your risk of death between 10% and 50%.

These statistics might suggest why people took offence to the conference title, as most of the risk factors are non-modifiable. Ethnicity, sex and being poor are not lifestyle choices, and to suggest otherwise is offensive and disrespectful to those who have died from the disease.

The report also revealed that having diabetes or hypertension also increased your risk of dying. Most people don’t actively choose to be unhealthy - we know it’s a mix of environmental and genetic factors.

Of course, individual behaviour and lifestyle are important, and it would be irresponsible to deny their role in illness. However, by terming Covid-19 a ‘lifestyle disease’, we run the risk of shifting the locus of blame to lie within the patient, rather than seeing it as a complex interplay between constitutional, social, political, and economic factors.

We run the risk of shifting the locus of blame to lie within the patient

My point extends to a wider critique of lifestyle medicine, an emerging specialty which is generating an ever-increasing number of Instagram doctors who proselytise multi-pillar plans and dietary guides to keep you healthy and glowing through self-care. According to the British Society of Lifestyle Medicine, the specialty promotes ‘physical, emotional, environmental and social determinants of disease operat[ing] within a boundary of evidence-informed medicine’. This sounds a lot like holistic general practice to me.

I have no doubt that the speakers and chairs planned this event with the aim of helping patients. I know they’re as passionate about social determinants as they are about exercise and lifestyle. However, semantics matter and sometimes you don’t see the issue until it’s pointed out.

Tellingly, a college rep who was on the event’s steering committee wasn’t aware it was happening until the day itself, and said he would like an audit, endeavouring to find answers.

With over 43,500 dead in the UK already and counting, this was a poorly-titled event delivered to the profession, many of whom are at risk due to non-modifiable factors and not lifestyle choices.

Going forward, I do hope that event organisers take the time to consider marketing and the power of language, so the potency of their aims are not lost.

Dr Tehseen Khan is a GP in Hackney, east London

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Readers' comments (5)

  • Very well said

    Of course we should look into all factors which may be contributing towards ill health.

    But the name lifestyle disease is not a good one as it implies guilt and blame.

    Of course, GPs were always the ones practising holistic medicine, until we got shackled with the trappings of performance related targets and QOF

    But the title of this conference was very upsetting to anyone (like me) who has lost a family member to covid

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  • Vinci Ho

    The problem is the arguably discriminatory message it sent out :
    One can only say poor lifestyles are associated with higher risk of severe complications and fatality of COVID 19 .
    Not labelling Covid 19 as a lifestyle disease !
    My concern is the philosophy, mentality and questionable prejudice propagating within the hierarchy of the college .
    Nobody has any second thought about how serious our problems of obesity , type 2 diabetes etc are in this country. But to single these patients out and call Covid 19 categorically as a lifestyle disease is beyond professional and ethical codes . No wonder this ‘unconscious bias’ ,correctly used by the judge in the controversy of CSA examination , still rings a bell in our ears .

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  • You are right. I advised one of my rather rotund patients to lose some weight last week. She told me off. "You are not allowed to say I'm overweight anymore--I am living with obesity"

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  • This was just another example of the systemic racism within the RCGP- please just call it what it is! The person who wrote the article is so apologetic, this of all times is when we should use our voices to speak out decisively.

    And you don't have to pay them, just pass the exam and never part with a penny again. Until they address their horrific record on racial issues, they dont derserve anyone's money.

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