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GPs need to start prescribing lifestyle medicine



I am writing this whilst visiting my mother in Malta. On this island, my mother’s generation is cruising into their ninth decades whilst the generation behind them is suffering from the modern day afflictions of diabetes, heart disease and obesity related problems and barely reaching their eighth decade.

What has changed? The new film The Big Fat Fix, a documentary fronted by leading cardiologist Dr Aseem Malhotra, gives a clue. The documentary is all about the health benefits of the Mediterranean diet and Malta is a case study for the dangers of leaving it behind.

GPs need to start ‘prescribing’ lifestyle medicine 

Malta is a tiny island with an enormous problem with obesity – and despite being slap bang in the middle of the Mediterranean the new generation’s diet no longer consists of pasta with olive oil or rabbit cooked slowly with salad. Now, you are more likely to eat sugary sweets (though I have to admit, my father would serve us fried pastry dipped in honey and sprinkled with sugar as a Feast day treat). Fast foods and ready-made dishes are sold by the increasingly numerous supermarkets which are sadly drowning out the local greengrocers and mobile fish and meat vans.

Watching The Big Fat Fix filled me with nostalgia for my youth – southern Italy where the documentary is largely filmed and Malta are not far away and the diets are/were very similar. As the film highlights though, it is not so much the ‘diet’ that concerns us – in fact the word diet derives from the Greek word, ‘diaita’ which literally means ‘lifestyle’ – the true meaning of the Mediterranean diet must include not just what is taken in but how one also lives. It should therefore come as no surprise that Malta also has more cars per head of population than most places in the world, driving is a way of life.

The film takes us ‘beyond food’ to define and explore the components of this traditional lifestyle and their potential benefits.

The main finds of this research include the importance of habitual movement and the most effective exercise protocols; Vitamin D; sleep; quality olive oil, fatty acids and the quality of the local produce enjoyed; the absence of sugar in the traditional diet; the re-engineering of wheat since the research took place; social connections and stress. Dr Malhotra takes us through what we can all do to live healthily and how we can be significantly more ‘heart healthy’ in just 21 days. 

This film provides many answers, it rightly concludes that a high fat, low carb diet may not only be best for weight loss, but also for reducing several markers of chronic diseases.

But what can we do about it in the UK? 18 million patients in the UK have a chronic condition, most of them diet- and lifestyle-related. If you look at the global burden of diseases, poor diet contributes to more disease and death than physical inactivity, smoking and alcohol combined. With the rising problems of obesity, diabetes and cardiac disease it is essential that we empower the public to take control of their own health. Dietary control and lifestyle intervention is essential.

We have to change the mindset. GPs need to start ‘prescribing’ lifestyle medicine as so powerfully advocated in this rigorously research and scientifically-referenced film. If you do one thing, tell your patients: next time you are in the supermarket and are tempted to pick up a pack of low-fat spread, buy a pack of butter instead or, better still, a bottle of extra virgin olive oil. Your heart will thank you for it. The father of modern medicine Hippocrates once said, ‘let food be thy medicine and medicine be thy food’.

Dr Malhotra believes, and I suspect all GPs would agree, that lifestyle ‘pills’ taken daily are the solution to our obesity problem.

The Big Fat Fix is now available to download and watch by visiting thebigfatfix.com.

Professor Clare Gerada is a GP in south London and former chair of the RCGP