Study highlights lifestyle medicine as potential solution to soaring health care costs for patients and payers

The reversal of chronic disease through intensive, therapeutic lifestyle medicine intervention changes could result in significant health care cost savings and deserves further research to determine its full potential economic benefits, according to a case series published Oct. 29 in the International Journal of Environmental and Public Health.

The study, conducted by the American College of Lifestyle Medicine, examined four individual patient cases of disease reversal achieved through intensive lifestyle changes and the associated changes in health care costs. A substantial potential cost savings for both the patients and their insurance providers was identified in each case. For an adult male who lost 150 to 200 pounds after committing to a lifestyle change for six months, this included potential savings of $92,000 in avoided discrete medical costs.

"Our findings are important because accumulated chronic and mental health conditions are responsible for 90 percent of the $3.8 trillion spent each year on health care in the U.S.," said ACLM Senior Director of Research Micaela Karlsen, Ph.D., MSPH. "Lifestyle medicine addresses the root causes of chronic disease to restore health with evidence-based treatment rather than the more common disease management approach of our health care system, under which costs have soared."

"This case series is a promising foundation for further research into how lifestyle medicine not only benefits a patient's overall health but makes a positive economic impact on patients and our heavily burdened health care system," she said.

Data for the case studies were self-reported by participants and histories were collected through online surveys. Participants were asked to share their previous diagnosis, lifestyle changes, and cost details for their diet, lifestyle, and health care, both pre- and post-lifestyle change, as well as to participate in follow-up interviews if necessary.

Examples of cost savings included $18,000 to $35,000 for a potential gastric bypass surgery and a decrease in the annual pharmaceutical costs paid by a participant's insurer from $19,000 in 2009 to $122.24 in 2015 and 2016 combined. Another formerly obese participant avoided bilateral knee replacements at a cost of $58,000 to $68,000. Participants also reported saving money on grocery bills and heath appointment copays.

The study noted that the case outcomes were superior to the typical prognoses of the chronic conditions involved, consistent with research demonstrating that intensive lifestyle medicine interventions are effective at delivering significant health benefits. The authors outlined six key research priorities needed to further characterize the field's health and economic benefits:

• Conduct rigorously designed studies, including randomized controlled trials (RCTs) to adequately measure the effects of intensive, therapeutic lifestyle medicine intervention changes on chronic disease health outcomes.
• Estimate cost and value of altered lifestyle expenses outside of medical care and in comparison to medical care, including grocery costs or educational programs, as well as decreased workplace absenteeism and increased productivity, and better quality of life.
• Measure the effects of lifestyle medicine practice on providers' burnout levels.
• Model the potential economic cost savings enabled by health improvements following lifestyle interventions as compared to usual disease progression and management.
• Measure actual health care expenditures, such as those per member per month in a larger cohort of insured individuals, comparing those exposed to lifestyle medicine to those who are not.
• Examine the effects of lifestyle medicine implementation upon different payment models.

"We know that chronic disease places an enormous burden on both individuals and our health care system," said Padmaja Patel, MD, DipABLM, a study co-author and Medical Director of the Lifestyle Medicine Center at Midland Health in Midland, Texas. "The current health care quality measures, performance measures and incentive models are tied to a disease management model. They do not serve well for lifestyle medicine providers who focus on disease reversal and remission.

"We believe this case study provides the justification for these research priorities and hope it will lead to other study designs that further explore the full benefits and value of lifestyle medicine."