A diabetologist noticed that his prescriptions for medications, where he would write two words in bold — DIET and EXERCISE — did not make much of a difference to his pre-diabetic and diabetic patients. They either forgot about these or just chose to ignore them.
Now, renowned diabetologist and physician, Dr KN Manohar, who is also the chairman of the Research Society for the Study of Diabetes (Karnataka Chapter) has started a new practice — providing “lifestyle prescriptions”.
Wondering what it is all about? Read this story.
Dr Manohar writes his lifestyle prescription on the usual prescription pad. This has detailed, tailor-made, specific actions that have been discussed during the assessment. “They have made a huge difference. These notes are very clear and extremely rewarding. It has worked from my youngest patient to the oldest,” says Dr Manohar.
The doctor further suggests that all endocrinologists and diabetologists switch to “lifestyle as a prescription” method. He also suggests employing a diabetic educator who can spend hours chalking out a proper prescription for patients with diabetes.
Why lifestyle prescription for diabetes is needed
Dr Manohar, who has been working on this method of lifestyle as prescription for almost two decades, says that in today’s fast-paced world, people often prioritise work over health, leading to a sedentary lifestyle, poor eating habits, and a lack of physical activity.
This unhealthy lifestyle can lead to various non-communicable diseases, such as diabetes, heart disease, and obesity, which are responsible for a significant number of deaths globally. In such a scenario, it is essential to emphasise healthy lifestyle habits as a prescription to prevent and manage such diseases, he says.
“India is very diverse in its culture, food habits, and lifestyle too. Every 30 km, our diet changes. A person who is a native of Chennai likes to eat dosa/idly/upma for dinner, while a person from Karnataka might prefer to eat these in the morning. An aged person of 60 years with obesity may not be able to even step out for a walk, or some may be working the night shift and sleeping six hours at night may not be in their daily routine. So in such situations, how does one prescription fit all?” the doctor asks.
However, “just calling for lifestyle changes won’t work. You need to do it methodically and there is a process to it”, says Dr Manohar, who motivates his patients by recording his own fitness videos on YouTube.
How to manage diabetes
Dr Manohar says that his prescription list consists of three major aspects: Wellness, lifestyle, and exercise.
He first categorises patients who come to him into four groups — those who do not have any intention to change their lifestyle and get better, then those who have an intention but there is no action, next comes those who have intention and action, but no direction, and lastly, those who have all the three but need tips to sustain their activity.
After categorising these patients, Dr Manohar says that doctors need to either hire diabetes educators or they themselves should spend time with the patients to motivate them, according to their category.
Following this, he suggests prescribing them a detailed diet and exercise plan. He stresses that the concept of six meals a day, one hour of exercise may not work for everyone. Also, it may be counterproductive.
Patients’ sleep cycles, stress levels, and so on, should also be considered. It has to be a holistic change in their lifestyle to beat a lifestyle disease like diabetes, adds the doctor.
“The way we prescribe medicines and explain to the patient, the same way, a prescription for diet and exercise should be explained and followed up too,” he points out.
Bring importance of lifestyle changes into school textbooks
Dr Manohar says that school textbooks have so much science in them, so he wonders, “Why not include the basic parameters for a good lifestyle?”
Children need to learn not just about how a heart functions, or how glucose gets produced in the body, but they should also know what are the normal blood sugar, BP, body mass index (BMI) levels, etc, he says.
They should also be taught the kind of yearly tests one needs to do and lifestyle to follow to prevent lifestyle diseases, explains Dr Manohar.
He adds that this knowledge will go a long way as children will follow-up with their parents, relatives, friends on the tests and their normal markers. They will also put lifestyle prescription into action, he adds.
In conclusion Dr Manohar says, “Food as medicine can make you metabolically fit. Adding exercise as medicine can make you physically fit. Adding lifestyle as medicine can make you medically fit.”
What to do for a healthy lifestyle?
Here are the five commandments for a healthy lifestyle that Dr Manohar swears can serve as a prescription for preventing and managing non-communicable diseases.
Love Yourself: Reserve an hour a day for “self”. Self-love is the foundation of good health.
Nutrition: What, when, and how much to eat is most important. Nutrition plays a crucial role in maintaining good health. It is essential to follow a balanced diet that includes all the essential nutrients in the right proportion. Additionally, it is crucial to pay attention to when and how much one eats.
Fitness = Exercise + Physical Activity + Keep Moving: Physical activity is crucial for maintaining good health. It is essential to indulge in physical activity for at least 30 minutes every day.
Mindfulness: Sleep, stress, reality, family! Mindfulness refers to being present in the moment and paying attention to one’s thoughts and feelings. It is essential to practice mindfulness to manage stress, which is a significant contributor to various diseases. Additionally, getting adequate sleep is crucial for maintaining good health. It is also crucial to stay connected with family and friends to maintain a healthy social support system.
Habit: It begins with motivation. Building healthy habits takes time and effort. It is crucial to start with motivation, which can come from within or through external factors such as a health scare. Motivation must then be translated into self-discipline to follow through on healthy lifestyle habits consistently. Over time, these habits can become ingrained and sustained.