17 views on whether NHS medical professionals should (and can) make the public change their lifestyle behaviours

In response to a previous article written by our Clinical Content Editor Dr Hayley Willacy, this month we asked subscribers to our newsletter for healthcare professionals the following question: 'Should (and can) we make people change their lifestyle behaviours?' Here are 17 responses we received. 

Yes, the NHS should try. I'm thinking especially with relation to diabetes (others may focus on obesity). Mike Cannon

I used to work as a Community Health Trainer in areas of deprivation. In my limited experience, I found that core self-esteem and confidence were factors that influenced whether an individual was able to make lifestyle changes. I would like to see more weight management programmes addressing this connection in the future to include this important psychological element to change. Frances Thomas (Health Improvement Practitioner)

Lifestyle: the NHS picks up the health problems resulting from poor lifestyle. But advertising, the food and drinks industry, long working hours (or even lack of work), poor skills in preparing food so that fast food and prepared food high in salt and fat are used, and an attitude resulting in lack of exercise and activity - all are much more important factors in lifestyle. This is where the intervention is needed. However, politicians ignore effective interventions such as minimum pricing of alcohol, schools no longer having playing fields and the food and drinks industry opposing better food labelling and promoting sugary 'sports' drinks. It is not about telling people what to do but about looking at the advertising and attitudes that create poor choices. This is not the job of the NHS - over to the politicians. Judith

Sadly we live in an age of self, self and self. Human rights have now become so downgraded as to have lost their true meaning. No professional person seems allowed to give smokers or fat people a diagnosis which includes a change of lifestyle even though we all know the difference these changes would make. Somehow society has to change. Each and every one of us has to become far more responsible about our own actions. We have to stop blaming others. Bad habits are very hard to stop. Help is out there so I believe as long as a person is trying to change then treatment for medical troubles should be given. Barbara Heape

I lived in Australia for a number of years (where, insurance-wise, healthcare and having to make up any 'insurance shortfall' payments for treatment can be expensive). This is perhaps the reason that the 'average' Australian is far healthier than their UK counterpart (aware of the high cost involved). It is the 'norm' for many Australians to jog, swim, etc (weather helps!). We in the UK have for too long taken our NHS and our health for granted. Lazily, we assume whatever our 'lifestyle', there is an instant 'free fix'. On a personal note, hypertension and high cholesterol led me to take control of my dietary habits and exercise. Constant monitoring by myself - everyone should learn basic physiology - has meant that now both my markers are low. Now I'm 73 years old, I have never felt so well before! The recommendation that everyone should appreciate the harm that an unhealthy lifestyle makes to general health and wellbeing is fully endorsed by me. Brian Cox

A balance needs to be struck between what is seen as an influence rather than a demand in respect of lifestyles. People have choices and this needs to be maintained and not denied. Accurate objective information needs to be given to patients and they need to be allowed to make the decisions affecting their health and lifestyle. Josie Duffy

I am amazed that the NHS hasn't had a preventative strategy from its conception. I believe that a lot of ill health stems from ignorance and lack of training, but also from peer pressure (smoking, drinking, sex). Cookery lessons at school were always enjoyable, informative and generally delicious, and they have been scrapped. What does PSE teach? Lifestyle if not already, could be incorporated into this.

Sports at school is also a great way to keep fit and provides many different types of sport especially for the traditionally non-sporty. It's also competitive which means you have to be reasonably fit. For adults there are clubs relating to specific sports, dance classes and so on for social mixing and keeping fitness going into old age. Anne Fish

For years now, people have been advised to have healthy lifestyles. One problem is education; things most people know, others do not. I think it is taken for granted everyone has that knowledge. As a nurse I find people are so different that sometimes I'm shocked. It isn't necessarily lower or working class people (the stereotypes) that lack knowledge; it could be anybody. Over the years I've found, non-smoking campaigns are not working. Smoking is an addiction and is not easily broken. Mixed messages are given as to healthy foods and all this does is confuse people. I don't know what the answer is to these problems. I don't believe it's been found. Susan Wood

This is something I feel strongly about as I believe people must take responsibility for their own health. I think doctors need to be tougher with people but offer assistance to help them change their unhealthy lifestyles. Instead of prescriptions of tablets, how about prescriptions for them to go to the gym? Perhaps people who are recently diagnosed with type 2 diabetes should be shown a film about how poor management can lead to blindness, amputations, etc. Let them see a film of people having gangrene and limbs being cut off. I am not I favour of a nanny state but do firmly believe that people need to take responsibility for their actions and that includes the rubbish some of them put into their bodies. Jordan Hilary

In mental health our patients will smoke in bed and will not stop even to sleep. They lie in bed during the day and are up all night. We have them too long, sometimes for months, years and more. I see very little difference in those long-term patients than I do if they had been with us weeks. They can walk about with long faces, be depressed and do it on their own time! Those who wish to work on their programme of care could stay until progress is sufficient to live independently. Carol Bulmer

Patients who compromise their health due to poor lifestyle need services to improve their health. For example, Weight Watchers and exercise programmes with trainers, just as smokers are offered stop smoking clinics and medication to help them stop. These services need to be free of charge as smoking cessation services are. Following compliance with these services, then patients' health issues can be tackled.

The cost of weight-reduction surgery is extremely high but management by a team, such as is offered in Newcastle, is one example of good practice for those who are morbidly obese. The governments of the past have a lot to answer for. Employers were in many places offering free lunch. The government of the day taxed these, so they fizzled out. Free school milk was targeted; many parents could not pay. School meals and hospital food are appallingly poor quality but are not subject to scrutiny. Therefore teachers bring in food for children who are hungry; relatives bring food for inpatients in hospital. We cannot forget the advertisers of nutritionally poor food and the supermarkets for offering deals on unhealthy foods, rather than fruit and veg. It's a complex problem, which needs a multifaceted approach to stem the tide of diabetes heart disease. Ann Marie Friend

Yes, we can change lifestyle. We can prevent and reverse diabetes and heart disease. We not only we can; we should. This is the most important thing we can do for our patients' health. It is also the most important thing we can do for the NHS. It is the only way to move forward. We spend so much on drugs and surgery. If we put the resources into promoting health we would make a much more significant difference - and it would last, not only for people now, but also for generations to come. Helen Angel

Lifestyle choice is the primary driver of most common chronic conditions being treated by the NHS at this time. The focus of current healthcare policy cannot ignore the influence appropriate individualised lifestyle adaption can have upon patients as part of their treatment programme. The time is fast approaching where it will no longer be financially tenable to treat ailments simply by medicating symptoms as this has driven all Western-based medical systems to the point of bankruptcy due to its inability to act in a truly preventative nature.

It will be necessary to re-educate medical staff in the importance of nutrition and exercise as this knowledge has largely been excluded from medical training in preference of pharmacological interventions. Although the policy of pharmacological intervention appears to be successful on the basis of numbers of patients treated and longevity, the true picture fails to recognise health and vitality as a quotient in its appraisal of success. Current practices fail to address underlying drivers of health conditions and medical practitioners lack both time and training in order to educate and enthuse their patients with scientifically validated dietary and lifestyle approaches that are often equally, if not more, therapeutic than many classes of modern medications.

Should lifestyle behaviours form part of a therapy protocol - yes without doubt, but it requires a new class of medical professional with time and expertise to work one to one or in groups of individuals with similar conditions to educate and support patients and I fear that it will be seen by many stalwarts that the current system is the only way forward, albeit in a bigger form but essentially doing the same that came before. Ultimately this model will fail unless the UK is prepared either to privatise the health system or allow the NHS to continue to absorb more and more of our resources as a nation. Simon W Bradley

I am afraid I will be damned for my views. So many people do not take any responsibility for their own health or indeed their ill health. They seem to believe that they can eat what they like, sit around all day, drink to excess, smoke and when the inevitable illness hits they expect to hand their illness over to the medical profession to make it all go away. They make noises about it all being unfair, crying 'Why me'? Through ignorance or blindness they do not see they have at least partly been to blame.

We need to get tougher. Free prescriptions for all need to go. Those in financial need get them free anyway. It causes so much waste and encourages unnecessary doctors' visits. A friend who is a GP tried to get her patients who were overweight and unfit to take up the offer of a free gym membership and a personalised exercise programme. She could not give them away. All they wanted was medication, a sick line and to be left in peace to continue their journey to an early death, costing the NHS a fortune along the way.

Incentives to discourage obesity, along with targeting the processed food industry and supermarket policies about where they place their products, need serious think-tank time. The food and drink industry must be made to take responsibility for their input into ill health. If the awful food was not on the shelves and fresh food was cheaper than processed food, it would be a start. It is not an easy task, but much of the general population have proved incapable of making sensible decisions - not only about their own lives - but about the cost to the country. M Pettigrew

It's too easy for individuals to abuse their bodies, knowing the NHS will pick up the cost. However this does not seem to deter Americans! Derek Coffman

You can't legislate to stop bad behaviour of any sort; education is the only way. The NHS can only be sustainable with major changes. It's completely dysfunctional - every function it provides works as a separate entity. There is no joined-up thinking. When it doesn't work it's always easier to blame lack of money. Graham Randall

It is a very difficult issue. There must be incentives for people to take responsibility for their own health and fitness. The public costs of not encouraging good habits are a disaster for the individual and the cost of healthcare and drugs will not be sustainable long-term. One of the themes of countries where health and fitness are positive, seems to flow from common free time where people can do sport, get together socially and have good healthcare.

There is no excuse really now for people to be ignorant about the bad effects of smoking and excessive eating of high-sugar and fatty food. The availability of such foods, cigarettes and alcohol has been liberalised. People naturally lack self-discipline. These things must be controlled as they were historically. It's not difficult to see a causal relationship between a lack of cooking skills and bad diet either. Despite endless cooking programmes! I have lost two stones since August last year by eating slightly less and exercising two to three times a week. If I can do it ... Jo Dore