"Everyone is a Candidate for Some Positive Lifestyle Change," Guideline Author Suggests

"...we don’t yet know with certainty who is not a good candidate for lifestyle change."

In a recent interview, Patient Care© asked Richard Rosenfeld, MD, MPH, MBA, to describe the "ideal candidate" for the recommendations in the new guideline Lifestyle Interventions for Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults: A Clinical Practice Guideline from the American College of Lifestyle Medicine.

Although the guideline is focused on ameliorating or even reversing the hyperglycemia that characterizes prediabetes and type 2 diabetes (T2D), Rosenfeld, lead author of the guideline, opened with the observation that, given the poor state of nutrition and physical activity in the US, "I think everyone's a candidate for some positive lifestyle change."

In terms of individuals with or at risk for T2D, he explained, the profile for those best suited will depend more on the duration of their disease than on the specific hemoglobin A1c level at the start of a lifestyle change regimen. In the short video excerpt above, Rosenfeld discusses the topic in more depth as well as how dietary intensity can be tailored to clinical goals.

The following transcript has been edited for style and flow.

Patient Care: Is there a profile of an individual with prediabetes or type 2 diabetes who would be an “ideal candidate” for adopting these lifestyle measures?

Richard Rosenfeld, MD, MPH, MBA: I think everyone’s a candidate for some positive lifestyle change. We know that, in general, lifestyle habits in the U.S. are not great—especially when it comes to nutrition and physical activity. We’ve made a lot of progress with smoking, but there’s still room for improvement for everyone.

What’s interesting is that it’s not necessarily the degree of hemoglobin A1c that predicts remission, but really the duration of diabetes. If someone has had type 2 diabetes for ten years and has a very high hemoglobin A1c, it’s probably going to be difficult to achieve full remission through lifestyle changes. But if it’s only been a few years—even with a very high hemoglobin A1c—if you can get that person properly engaged, there’s a real opportunity.

If the goal is remission, you have to start off a bit more intensively. We make that distinction in our guideline: depending on your goal, there are ways to tailor the plant-forward nutritional approach. For remission, you often need to begin with a very low-calorie diet. That might include liquid diets or other strategies, typically for a short period—maybe just a few weeks. That approach really kickstarts things. Then, you transition into something more sustainable, like a plant-predominant, whole-foods diet.

That said, we don’t yet know with certainty who is not a good candidate for lifestyle change. And even setting diabetes aside, lifestyle improvements benefit your life, your vitality, your longevity, your cardiovascular health, your brain health. You may not achieve full remission, but you can absolutely give it the best shot.

Richard Rosenfeld, MD, MPH, MBA, is the distinguished professor of otolaryngology, SUNY Downstate Health Sciences University and senior advisor for quality and guidelines for the American Academy of Otolaryngology – Head and Neck Surgery. Rosenfeld is board certified in otolaryngology – head and neck surgery and in lifestyle medicine.