Dr. Sohaila Cheema

“In the IPH, we believe all current and future health professionals must be trained so that they can incorporate lifestyle medicine in their medical practice.”

The Institute for Population Health (IPH) at Weill Cornell Medicine-Qatar (WCM-Q) helps to build a healthier community in Qatar through a wide and diverse range of programs, initiatives and activities grouped under the broad themes of education, research, and community outreach. “Hospitals” magazine spoke with Dr. Sohaila Cheema, Assistant Dean for the Institute for Population Health and Associate Professor of Clinical Population Health Sciences at WCM-Q, to find out more about the work of the IPH, which recently celebrated its 10^th anniversary of promoting population health. Dr. Cheema, a medical doctor by training, completed a fellowship in Integrative Medicine at the Arizona Center for Integrative Medicine, University of Arizona. She received her Master of Public Health degree from Johns Hopkins Bloomberg School of Public Health and is certified in public health by the National Board of Public Health Examiners, USA. Additionally, she is a diplomate of the International Board of Lifestyle Medicine. Dr. Cheema’s research interests include integrative medicine, lifestyle health, population health and emerging aspects of healthcare.

There is a lot of discussion about lifestyles and their role in several chronic diseases like diabetes, obesity, cancer, heart disease and other serious conditions. But life expectancy is increasing in most parts of the world. Can you explain what is happening? 

First, let’s review the context of today’s world and the way modernity and its trappings impact health. The good news is that we have advanced medically and technologically, and along with this we see an increase in life expectancy in several countries. However, at the same time, and in general, an increase in lifestyle-related diseases has been observed. We now understand that the root causes of these diseases are unhealthy behaviors like sedentary habits, unhealthy eating (increased intake of fast food and processed food), poor sleep habits, substance misuse, and an increase in stress. There has also been a tremendous uptake of social media usage, which appears to be linked to sedentary behavior and a global increase in mental health issues. 

We also see an interplay of psychosocial factors, with more competition, time pressure, social isolation, and less intimate engagement with the family unit.

Living longer is of course good, but aging does impact healthcare delivery, family structure, and social infrastructure, and we can see that many older people have health conditions that impact their quality of life. The challenge is to remain healthy while living longer. For us to prosper and thrive, the focus should be on a healthy lifespan, and that is where lifestyle medicine can play an important role. 

Can you give us a definition of lifestyle medicine and discuss which specific lifestyle-related factors we need to think about? 

Evidence suggests that 80 percent of chronic diseases can be prevented, treated, and often reversed by adopting healthy lifestyle measures like physical activity, healthy diet, stress management, restorative sleep, maintaining healthy relationships and social connectedness, tobacco cessation, and avoiding the use of other risky substances. These practices/behaviors form the core pillars of lifestyle medicine (LM) – an emerging healthcare discipline gaining acceptance worldwide. The definition of lifestyle medicine used by the American College of Lifestyle Medicine (ACLM) states: “Lifestyle Medicine is the use of a whole food, plant-predominant dietary lifestyle, regular physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connection as a primary therapeutic modality for treatment and reversal of chronic disease.”

Can you elaborate on the evidence base for lifestyle medicine approaches to nutrition and how can this be used to address chronic diseases?

The nutrition promoted by the ACLM is a dietary pattern centered on whole plant foods, such as vegetables, fruits, whole grains, legumes, nuts, and seeds. Processed foods and animal foods are limited or excluded. 

Research shows that diets high in whole plant foods have numerous health benefits. These include weight loss, favorable change in lipid profile, decreased risk of diabetes, improved glycemic control or normalized blood glucose levels for those with diabetes, and decreased risk (and even reversal) of cardiovascular disease. Plant-based diets are associated with decreased risk of some cancers, improved migraine symptoms, and a decrease in all-cause mortality. New studies are coming out all the time showing numerous other benefits of predominantly plant-based diets.  

There also appear to be benefits for mental health disorders; research studies have shown an association between Western or highly processed diets and increased risk of developing psychiatric symptoms such as depression and anxiety. And not only does shifting to a whole-food, plant-predominant dietary lifestyle protect human health, it can also reduce commercial agriculture’s carbon footprint, enabling the preservation of natural resources while decreasing greenhouse gas emissions.

What is the role of physical activity in lifestyle medicine?

Physical inactivity has been described as the biggest problem of the 21^st century. Our lifestyles are now increasingly sedentary, with the resultant side effect of obesity currently recognized as a major health problem worldwide. 

It is important that adults engage in general, incidental, and purposeful physical activity.  General physical activity can burn calories and is important in combating the negative effects of sedentary behavior. Purposeful exercise meanwhile improves cardiorespiratory fitness and strength and leads to substantial health benefits.

In children and adolescents, physical activity improves cardiorespiratory and muscular fitness, cardiometabolic health (blood pressure, dyslipidemia, glucose, and insulin resistance), bone health, cognitive outcomes (academic performance, executive function), mental health (reduced symptoms of depression), and reduced adiposity (excess fatty tissue).

All adults should undertake regular physical activity and limit the amount of time spent being sedentary. The evidence shows that physical activity improves sleep quality, reduces anxiety, and lowers blood pressure. 

Additionally, physical activity reduces the risk of dementia, depression, heart disease, stroke, and type 2 diabetes. It lowers risks of cancers of the bladder, breast, colon, endometrium, esophagus, kidney, lung, and stomach, reduces the risk of weight gain, improves bone strength and reduces risks of falls, enhances the immune system, and reduces the incidence
of osteoarthritis.

Why is social connectedness considered important in lifestyle medicine?

Social connection is a well-established determinant of mental and emotional well-being, physical health outcomes, and longevity. Humans appear to be “wired” for social connection, which is why the social isolation and associated loneliness due to COVID-19 lockdowns have been such a concern. Social support can also buffer the negative effects of stress on mental and physical health. Low-quality and low-quantity social ties are linked to heart attacks, atherosclerosis, high blood pressure, delayed cancer recovery, slower wound healing and development, and progression of cardiovascular disease. 

Enhanced social connection can improve prevention and help in the treatment of leading chronic diseases and lead to increased life expectancy.

What are the other important elements of lifestyle medicine?

The other key points are optimizing restorative sleep, management of stress, and avoidance of tobacco products and other unhealthy, habit-forming substances.

Sleep is now known to be essential for health and optimal functioning. In fact, sleep deprivation can be used as a form of torture. Yet many of us continue to get inadequate sleep, either because we deliberately deprive ourselves of sleep or because we seem unable to get a good night’s rest. Getting good restorative 7-8 hours of sleep as an adult is extremely important for our body to function optimally. Over time, sleep deprivation increases the risk for a number of chronic health problems, including obesity, diabetes, high blood pressure, depression and anxiety, and heart disease. 

Stress is ubiquitous in modern society, and it has been further exacerbated by the COVID-19 pandemic. Chronic stress is linked to many illnesses, including coronary artery disease, heart failure, asthma, rheumatoid arthritis, and psoriasis. Stress is also intimately related to mental illness—especially anxiety. In addition to the physiologic changes that accompany the stress response, stress can adversely affect health behaviors resulting in poorer dietary choices, inactivity, disordered sleep, and substance use. Stress is unequivocally linked to poor health outcomes and evidence-based stress management should be considered foundational for the management of chronic health conditions.

Regarding smoking and the use of other substances, there is a very large body of evidence that demonstrates the negative effects of these habits. As an example, if an individual quits smoking, benefits include a decrease in blood pressure within one hour, decreased heart attack risk within 24 hours, and a 50 percent lower risk of myocardial infarction after nine months.

Are hospitals and educational institutions considering lifestyle medicine when providing care for patients and educating healthcare professionals?

Healthcare professions education is traditionally disease-focused with a predominant emphasis on pharmacotherapy and interventional and surgical approaches to treatment. This focus continues to dominate the healthcare sector and education of healthcare professions. 

However, health practitioners who utilize lifestyle medicine in their practice report benefit both for their patients and themselves. And several published studies report high patient satisfaction with lifestyle medicine and support the benefits of lifestyle medicine for the treatment and prevention of chronic diseases. Nevertheless, many healthcare providers remain unfamiliar and/or skeptical about its usefulness. 

I believe the evidence shows that lifestyle health approaches are indeed effective and that education should therefore be incorporated into health professions curricula globally to allow for better acceptance and familiarity among healthcare providers. Lifestyle medicine competencies should also be integrated into the current healthcare environment to become a routine aspect of healthcare practice.  

Healthcare professionals must take the lead in creating a culture change within communities so that they embrace the importance of living a healthy lifestyle as opposed to being solely dependent on medication for health and longevity.

In the IPH, we believe all current and future health professionals must be trained so that they can incorporate lifestyle medicine in their medical practice. The time is now to prioritize and optimize lifestyle health learning to curb the tide of chronic disease and shift the care model from one based on treating disease to a truly holistic healthcare model.

What is the role of the Institute for Population Health in building the lifestyle medicine movement? 

In April 2016, we launched our hugely successful Certificate in Clinical Nutrition program for healthcare professionals. Four offerings of the course were successfully delivered and a total of 200 healthcare professionals were awarded the certificate.  However, we realized that nutrition was only one piece of the puzzle. To promote the spirit of lifestyle medicine, the Lifestyle Medicine Interest Group-Qatar was initiated. To date, approximately 800 healthcare professionals are members of the Group to help us in the journey to reduce the burden of disease and improve the health of future generations. In tandem, the IPH leadership forged relationships with the American College of Lifestyle Medicine and the International Board of Lifestyle Medicine leadership. The IPH hosted a two-day symposium on lifestyle medicine with local and international speakers in 2019. The journey led to the development and implementation of the 60-hour Certificate in Lifestyle Medicine in January 2020. 

To date, four successful offerings of the course have taken place with 164 healthcare professionals awarded the certificate. The evaluations show the course is successful and beneficial to improve healthcare professionals’ knowledge, competency, and skills to practice lifestyle medicine. Additionally, to date 51 healthcare professionals – who registered on our IPH platform- have been board certified in lifestyle medicine. We continue on this enthusiastic journey to support health professionals, patients, and communities.