What Is Lifestyle Therapy. and Why Is It the New Blockbuster Medicine?

In a landmark trial, a lifestyle program cut new type 2 diabetes cases by 58%, nearly double metformin's 31%. Here's what lifestyle therapy is, and where the "blockbuster" label overreaches.

Blockbuster" is a drug-industry word, and no company sells lifestyle therapy. Yet one trial gave the idea real weight. The Diabetes Prevention Program randomly assigned 3,234 adults at high risk of type 2 diabetes to a placebo, metformin or an intensive lifestyle program. Over about three years, the lifestyle group cut new diabetes cases by 58%, compared with 31% for metformin. The result was published in the New England Journal of Medicine in 2002, and the paper concluded that the lifestyle intervention was significantly more effective than the drug. So what is lifestyle therapy, and does the blockbuster label hold up?

• 58% fewer new diabetes cases with the lifestyle program versus placebo, against 31% for metformin (Diabetes Prevention Program Research Group, 2002).
• 11.0, 7.8 and 4.8 new cases per 100 person-years in the placebo, metformin and lifestyle groups.
• 6.9 vs 13.9 people had to be treated for three years to prevent one case of diabetes with lifestyle versus metformin.
• 6 pillars define lifestyle medicine: nutrition, physical activity, sleep, stress management, connectedness and avoiding risky substances (American College of Lifestyle Medicine).

It's the treatment of disease with structured, evidence-based habit change. The American College of Lifestyle Medicine defines lifestyle medicine as a specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions such as cardiovascular disease, type 2 diabetes and obesity. Trained clinicians prescribe changes across six pillars, and when the changes are intensive they can sometimes reverse the conditions. Lifestyle therapy is not a wellness trend, and it isn't alternative medicine. It uses the same measured approach as any treatment: assess, prescribe, follow up. This is also why primary care physicians play a central role in lifestyle-based chronic disease management.

Clearly better for prevention, at least over three years. The table shows the numbers.

Because it was intensive, personal and sustained. The lifestyle group received intensive training in diet, exercise and behavior modification, not a leaflet. Participants aimed for at least 7% weight loss, a target that fits a medical approach to weight management, and at least 150 minutes of physical activity per week. The advantage over metformin was greater in older people and in those with a lower body mass index, according to the study's published analysis. In other words, the program worked because it drove behavior change through coaching and measurable targets, rather than relying on willpower alone.