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Noel L. Espallardo, MD, MSc, FPAFP ; Nicolas R. Gordo, Jr., MD, MHA, CFP ; Mechelle Acero Palma, MD, CFP

The Filipino Family Physician.2023;61(1):1-1.

There is now an epidemiologic shift in the burden of illness from infectious diseases in the last century to lifestyle diseases in the current. Mortality due to lifestyle diseases like diabetes, hypertension and heart disease is now ranked higher than infections. The medical community is now realizing the importance of lifestyle intervention to address the problem. We hope that this issue of our journal focused on lifestyle medicine will help inform our colleagues in family and community practice the necessity and available strategy of lifestyle intervention. Lifestyle Medicine is the use of evidence-based lifestyle therapeutic approaches, including a whole food, plant-based eating pattern, regular physical activity, restorative sleep, stress management, the avoidance of risky substances, and positive social connection as a primary modality delivered by trained and certified clinicians, to prevent, treat, and often reverse chronic disease.1 It is distinct from other disciplines, such as functional, integrative, complementary, and alternative medicine. Lifestyle medicine focuses on conditions that consume 80% of healthcare visits, hospitalizations, and costs. Hence, it is recommended as the first line and the foundational intervention for non-communicable diseases that address the modifiable lifestyle and behavioral risk factors impacting the disease trajectory, quality of life, and overall health outcomes.2 Despite the advances and increasing availability of medical care, these chronic lifestyle-borne diseases continued to increase exponentially, causing 74% of all deaths globally.2 However, healthcare providers do not receive adequate education, foundational skills, and personal experiential references to efficiently prescribe the recommended lifestyle therapy in primary and specialty care. Thus, lifestyle medicine initiatives align with the quadruple healthcare aims to deliver better patient experience, better outcomes, lower costs, and better clinician satisfaction.3 Through the lifestyle medicine lens and the empowerment of patients, healthcare providers often bring whole health management and disease remission into the scope of care at a lower cost. Lifestyle is an individual’s choice. The study by Longakit reveals an individual choice of lifestyle practice for wellness elements like physical, social and emotional state. While the study of Alimorong is a an individual’s choice when he or she has health risk like hypertension. Physicians should be able to influence this patient’s choice and there are several strategies available. The case studies of Solijon, Acero and Tan are different strategic methods to promote lifestyle change. The interventions given are usually structured and conducted face-to-face. On the other hand, the studies of Cristobal and Ngo uses digital health interventions to promote lifestyle change. While the studies on lifestyle interventions presented in this issue are not robust evidence like randomized trials, these are experiences by local physicians with their patients. These experience may be a good enough basis to increase awareness and provide training for family and community physicians on lifestyle medicine, as advocated by the study of Palma.

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Assessment on the body image and eating behaviors among senior high school students at Colegio De Santa Catalina De Alejandria, Dumaguete City

Roan Golez Longakit, MD

The Filipino Family Physician.2023;61(1):2-8.

Background: The increasing body image dissatisfaction and disordered eating attitudes among adolescents have become a public health concern globally. Detection and prompt intervention could save adolescents from physiological and psychological health problems. Objectives: The objective of this study was to determine the body image and eating behavior among senior high school students at Colegio de Santa Catalina de Alejandria enrolled in the school year 2020- 2021 and if there is any relationship between their eating behaviors and body image. Methods: This cross-sectional study was conducted on August 2020 to July 2021 at Colegio de Santa Catalina de Alejandria in Dumaguete City. The study utilized the questionnaires: Eating Attitude Test- 26 (EAT-26) in identifying the risk for eating disorders and the Stunkard Scale for the assessment of body image. The participants of the study were Grade 11 & 12 Senior high school students enrolled in the school year 2020-2021. Descriptive statistics including frequency, percentages, mean and standard deviation were calculated for each variable (age, sex, height and weight). The Spearman’s rank-order correlation was used to analyze the data in determining any relationship between the body image and eating behaviors of the participants. Result: Body dissatisfaction was noted in a portion of female respondents. EAT-26 was considered positive and confirmed the presence of eating attitudes that were associated with risks for the development of eating behavior disorders in 55% of the sample population. A positive correlation between EAT-26 scores and the body image was also observed among female respondents. Conclusion The results indicate that attention must be given to eating behavior risks within this group.
adolescent ; body image ; eating behavior

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Coping styles of Filipino hypertensive patients seen at the family and community medicine outpatient clinic of Region 1 Medical Center: A cross-sectional study

Carl Jones P. Alimorong, MD

The Filipino Family Physician.2023;61(1):9-14.

Introduction: Hypertension is still prevalent globally, especially in low- and middle-income countries such as the Philippines. Despite its great burden, its psychosocial aspect including the coping strategies is still understudied. Upon literature search, there seems to be no local studies available, hence this study aimed to explore the coping strategies used by Filipino hypertensive patients. Objective: This study aimed to identify the coping styles utilized by Filipino hypertensive patients seen in Region 1 Medical Center Family and Community Medicine Out-Patient Clinic (R1MC FCM OPC). Methods: This is a cross-sectional descriptive study with a descriptive-cross-sectional research design. Purposive sampling was used to select 280 hypertensive patients from the R1MC FCM OPC between April 1, 2021 and April 1, 2022 to answer a modified version of the Filipino Coping Strategies Scale (FCSS). The following statistical tests were utilized: frequency count and percentages for qualitative data; mean, median and standard deviation for continuous variables. All analyses were performed using SPSS version 26. Results: The study enrolled 280 respondents who met the eligibility criteria. The majority were 51 to 60 years old (27.14%, mean age 51.23 ± 13.12), female (60%), and high school graduates (41.79%). Furthermore, most were unemployed (63.57%) and belonging to the low-income class (75%). Among the coping strategies, the highest scores were the problem-solving domain, religiosity and relaxation/recreation domains (Mdn=3). The lowest were in emotional release and substance use domains (Mdn=1). Conclusion The coping strategies of Filipino hypertensive patients seen at R1MC FCM OPC were problem-oriented domain, religiosity and relaxation/recreation; emotional release and substance use was the least used. Further research into the psychosocial aspects of hypertension using FCSS should be conducted in other institutions or locations.
Hypertension

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Alcohol, coronary artery disease with myocardial infraction, lifestyle medicine: A case study

Vigilanda M. Solijon, MD, MHM-MBA, DPCLM

The Filipino Family Physician.2023;61(1):15-20.

This 63 year old, heavy drinker, previous smoker man, was physically active, a community leader and with good sleeping habits. His diet: processed foods and drinks, meat, poultry products; minimal fruits and vegetables added about a year earlier. Two weeks prior, after drinking alcohol, he experienced progressive difficulty of breathing on physical exertion, relieved by rest. The night before the incident he had a drinking spree. Early morning, he had severe shortness of breath, difficulty of breathing and chest heaviness. He was rushed to the nearby hospital, was admitted at the ICU with the diagnosis of Ischemic Heart Disease with Myocardial Infarction, and, Type 2 Diabetes. The diagnosis was sustained and the management continued upon transfer to a better-equipped hospital. Strict nutritional prescription was introduced and early ambulation started while still in the hospital. His medications were steeply tapered off while lifestyle modification intensified. His progress was extraordinary. This case exemplified the havoc of heavy alcohol drinking, and, its uneventful cold turkey abstinence; favored early ambulation post myocardial infarction, and showed the independence of each CVD risk factor. Is intensive Lifestyle Modification safe and beneficial even in morbid situations?
Coronary artery disease ; myocardial infarction ; alcohol consumption

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“Lifestyle Redo” managing dyslipidemia as risk factor for cardiovascular disease in adults through lifestyle intervention

Harris E. Acero, RMT, MMHA ; Mary Jane Botabara Yap, RN, MPH, DrPH ; Mechelle A. Palma, MD, MMHA, CFP, DPCLM, DipIBLM, FPCLM, FACLM

The Filipino Family Physician.2023;61(1):21-26.

Background: Cardiovascular disease (CVD) is a leading cause of death around the world including the Philippines. Dyslipidemia and lifestyle have been considered as important modifiable risk factors. Experts in the Philippines have recommended that among individuals with dyslipidemia, lifestyle modification should be advised regardless of their present condition or risk profile. However, a key limitation of the most recent guidelines is the lack of studies on lifestyle interventions involving Filipinos. Objective: This study aimed to provide preliminary evidence for the use of a lifestyle medicine intervention program in the management of dyslipidemia as risk factor for cardiovascular disease. Methods: This study employed a mixed method of quantitative and qualitative research designs. The tools used were selfadministered questionnaires, collecting and examining documents. Measures to improve validity in qualitative studies have also been employed such as respondent validation and rival explanation. Triangulation with the findings from the other qualitative methodologies was also employed. Ethical approval was granted. Results: The first part of the study has a total of 66 participants who underwent a lifestyle intervention program in a single clinic, comprising of 26 male and 40 female subjects were selected through convenient sampling method. Around 50% of the participants were 40-59 years old, 42.4% were 30-39 years old, and only 7.6% were 60-89 years old. The knowledge of the respondents had an overall mean of 7.73 (SD=1.16) which is interpreted as high knowledge. The attitude of the respondents had a mean of 3.58 (SD=0.50) which is interpreted as very positive. The respondents also had a good lifestyle practice with overall mean of 2.76 (SD=0.49). The second part of the study consisted of eight participants with 3 males and 5 females who were chosen through purposive sampling. All participants experienced reduction of their LDL-C and total cholesterol levels after the 12-week lifestyle intervention. Two participants had increased triglyceride levels. The select group also showed reduction in the blood glucose levels and body mass index. Conclusion This study revealed that participants had good knowledge and attitude regarding cardiovascular diseases and its risk factors. Yet, there is still a high number of those who do not efficiently practice healthy lifestyle and diet. Additional information should be extracted to establish the dietary intake of participants which contributed to the increase in triglyceride levels of some select participants.
lifestyle ; ischemic heart disease ; dyslipidemia

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Implementing lifestyle changes and diet- tracking APP in an obese male: A case report

Karlo Adrian Y. Nemenzo, MD ; Bysshe M. Fernan, MD, DPCLM, DipIBLM

The Filipino Family Physician.2023;61(1):27-35.

Obesity is an epidemic and a major public health concern, with 800 million obese people worldwide and 27 million in the Philippines. Several guidelines have recommended that all adults be screened for obesity and that obese patients be offered intensive, multi-component behavioral interventions. Barriers to addressing obesity include insufficient time during visits, a lack of available referral services, the perception that patients will not be willing or able to make lifestyle changes, poor reimbursement for nutrition and weight-management counseling, a reluctance to discuss weight among physicians, and uncertainty about whether interventions will have a positive impact. Lifestyle medicine interventions and smartphone diet-tracking apps may help individuals lose weight, manage chronic conditions, and understand dietary patterns. This is a case report of a 31-year-old obese Filipino male who sought consultation at the Health and Lifestyle Institute with a complaint of 11 kg of weight gain over the past 4 years. He had previously been diagnosed with Hodgkin’s lymphoma and had previously undergone chemotherapy and radiation therapy. He was currently working as a resident physician at a private institution. He considered himself physically active and was thus concerned with his gradual weight gain and the resultant decrease in body image, as well as his overall health. A detailed history and physical examination were done, as were the examinations of the six pillars of lifestyle medicine, namely, diet, exercise, sleep, stress, relationships, and substance use. The GAD 7 and PHQ 9 screening questionnaires were given. Lifestyle prescription and setting of goals were then done, and the patient was followed up at a 4-month interval. On all visits, body fat analysis using a Karada scan was done, and the results were discussed with the patient. On the second follow-up consult, the patient reported the usefulness of a diet-tracking application he found called Lifesum. The patient lost a total of 13 kg and improved his overall sense of well-being.
Obesity ; case report ; Asian ; male

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A case report on SMART-EST action plan with lifestyle medicine approach in the non-pharmacologic management of the metabolic syndrome

Andres Kim L. Tan III, MD, DFM

The Filipino Family Physician.2023;61(1):36-40.

Obesity and overweight are considered health risks for non-communicable diseases. Most clinical practice guidelines suggest lifestyle modification as the primary management and as an adjunct to pharmacologic treatment. Using the SMART-EST goaloriented action plan and lifestyle medicine may improve weight reduction outcomes. The case presented had clinical criteria (3/5) for metabolic syndrome, diagnosed previously as obese stage II, asthma moderately uncontrolled, prediabetes, and mild dyslipidemia. Baseline weight and waist-to-hip ratio were taken and interpreted as obese stage II with a very severe risk for comorbidity. The diagnostics used were fasting plasma glucose, lipid profile, HbA1c, and 2-D echocardiography on the eight months of intervention only. Using the SMART-EST action plan plus Lifestyle medicine approaches as non-pharmacologic management for metabolic syndrome. There was an 11.4 % reduction in weight, improved fasting glucose, lipid profile, and 2-D echocardiography within the eight months of intervention.
Metabolic syndrome

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A case report of non-alcoholic fatty liver disease in a 10 year old boy: Challenge in the approach and management

Pauline Tan Ngo, MD, FPPS, FPSPC

The Filipino Family Physician.2023;61(1):41-46.

: According to the World Health Organization, in 2019, an estimated 38.2 million children under the age of 5 years were overweight or obese. With this increased prevalence along came the rise of its comorbidities such as non-alcoholic fatty liver disease (NAFLD) at early ages. The general objective of this case study is to bring awareness of NAFLD in the young. The specific objective is to present a case of a ten year old boy with non alcoholic liver disease and the challenge in the management. The case study is a 10 year old boy diagnosed to be overweight, hypertriglyceridemia and non-alcoholic fatty liver disease. Baseline weight and body mass index were taken on his first visit and follow up. CBC, Na+, K+, Creatinine, SGPT, FBS, Uric Acid, Total cholesterol, triglycerides, high density lipoprotein, Low density lipoprotein, HBsAg, Anti-HBs, ultrasound of the abdomen and fibroscan of the liver were done. Nutritional counselling was given but not followed. Physical activity prescription of at least 30 minutes/day moderate intensity exercise five times/week. This was done for 1 hour/day five times/week. He was also prescribed N acetylcysteine, Fish oil and Vitamin D. After six and a half months, triglycerides became normal however weight and BMI remain the same. Non-alcoholic liver disease was still present on repeat abdominal ultrasound. Conclusion 1. By engaging in exercise for 6 1/2 months, patient NP was able to normalize the elevated triglyceride level. 2. Without dietary modification, patient wasn’t able to improve his body mass index. His ultrasound still showed the presence of fatty liver. 3. Physicians have the power to influence patients on developing healthy behaviors. They need to take time to engage and listen and help patient discover by themselves lifestyle behaviors that can impact their health. 4. There is a great challenge in instituting this therapeutic intervention for a teenager especially when he is asymptomatic and do not see the need for it. To elicit a better outcome of this patient, it will entail the adoption of the lifestyle modification by the entire family. To set clear and achievable goals and a collaborative management to include a dietician, a health coach and a behavioral therapist may aid compliance.
Pediatric ; non-alcoholic fatty liver disease (NAFLD) ; hypertriglyceridemia ; lifestyle

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Effects of tele-education on adherence to healthy lifestyle among hypertensive healthcare workers in a tertiary government hospital

Eunice F. Cristobal, MD, MPM

The Filipino Family Physician.2023;61(1):47-54.

Background: Hypertension remains the leading risk factor for mortality due to cardiovascular diseases worldwide. In the Philippines, this is the second most common cause of morbidity, with a rate of 602.4/100,000. Contributory to this burden is low adherence to lifestyle modifications in the general population and among healthcare workers (HCWs). This is observed despite HCWs’ knowledge and access to health services. Key to addressing this problem is patient education regarding healthy lifestyle, which has proven benefits on blood pressure control. Supportive methods, such as text messages and phone calls, can improve adherence. However, there is a gap in local data regarding tele-education, content, and healthcare workers. Objectives: The study aimed to determine adherence to a healthy lifestyle among hypertensive healthcare workers, specifically 1) adherence score to diet, physical activity, smoking cessation, and alcohol intake after 8 weeks of tele- education; 2) change in adherence from baseline to week 8; 3) change in adherence of those who underwent standard versus intensified tele-education. Methods: A randomized, controlled intervention study with 40 participants was conducted. Baseline adherence was recorded at the beginning, standard and intensified tele-education at week 4, and final adherence measurement at week 8. Results Baseline data revealed low total adherence to healthy lifestyle, with the lowest scores for diet (0%) and physical activity (20%). Highest change after week 4 of tele-education was seen in the intervention group diet (50%) and physical activity (70%). Total adherence increased in control (10%) and intervention (45%) groups. However, only the intervention group showed statistical significance (p-value < 0.001). Conclusions. Thus, intensified tele-education given one month after standard face-to-face education is an effective way of increasing adherence of hypertensive HCWs to a healthy lifestyle.
Hypertension ; telemedicine ; patient education

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Physician’s lifestyle counseling knowledge, attitude, and practice: A basis for lifestyle medicine continuing medical education (CME)

Mechelle A. Palma, MD, MMHA, CFP, DPCLM, DipIBLM, FPCLM, FACLM

The Filipino Family Physician.2023;61(1):55-60.

Background: The close association of lifestyle with the pathogenesis of chronic diseases has been established since early times. Lifestyle medicine provides an evidence-based solution to the Non-communicable disease epidemic. However, physicians do not receive adequate training on lifestyle counseling and intervention in both undergraduate education and graduate medical training. Objective: The aim of this study was to examine whether knowledge and attitude regarding lifestyle medicine and the Physicians’ personal lifestyle practices will determine the presence or absence of lifestyle counseling in their medical practice. Methods: An online survey questionnaire was formed and spread through the internet. The questionnaire consisted of four parts- demographics, physicians’ personal lifestyle practices, their attitudes, and knowledge about Lifestyle Medicine. Ethical approval was granted. Results: Out of 188 respondents, 81.4% were females with mean age ranging between 40-49 years. 49 (26.1%) were residents, 84 (44.7%) were Fellows and the remaining participants were Diplomates. 71.3% and 48.4% of respondents said that they include animal and plant food in their diet. The results regarding attitude and knowledge of the doctors of Lifestyle Medicine were mostly insignificant. Conclusion The study doesn’t only provide information about the knowledge gap and lack of counseling skills but also highlights the urgent need for lifestyle medicine education programs for the new trainees as well as practicing physicians.
lifestyle ; continuing education ; nutrition ; medical education

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