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for the heritability of obesity have also been proposed (typically >70%). However, the exposure to an obesogenic environment is necessary for the development of T2DM and obesity, suggesting that the genetic background is important, but several other environmental/lifestyle factors may also exert a cumulative effect on human health.

       Key Point

      The genetic background is important, but several other environmental/lifestyle factors may also exert a cumulative effect on human health.

      Lifestyle choices and the way the individuals conduct their lives have recently received great attention, since these factors are modifiable and, therefore, may be subject to intervention and improvement. Lifestyle factors that may affect health include habits, attitudes, tastes, moral standards, economic level, activities, interests, opinions, and values. It is a constellation of motivations, needs, and wants, influenced by factors such as culture, family, reference groups, and social class. Many unhealthy lifestyle choices, such as poor diet, physical inactivity, tobacco use, excessive alcohol intake, and excessive stress have been associated with the development of many chronic diseases. Therefore, scientific research on the lifestyle factors that may have negative (unhealthy lifestyle) or positive (healthy lifestyle) effects on health has intensified over the last decades.

       Key Point

      Even small changes toward healthy lifestyle choices can translate to significant benefits in the prevention and treatment of chronic diseases.

       Key Point

      “Lifestyle Medicine is the use of a wholefood, 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.” ACLM

      Soon after the ACLM was formed, many similar organizations were formed (e.g., Lifestyle Medicine Global Alliance, European Lifestyle Medicine Council, European Lifestyle Medicine Organization, British Society of Lifestyle Medicine, Australasian Society of Lifestyle Medicine), demonstrating the global realization of the benefits of lifestyle medicine.

      Take‐Home Messages

       Wellness is the holistic integration of an individual's physical, mental, and spiritual health.

       The “Six Dimensions of Wellness” are physical, occupational, social, intellectual, spiritual, and emotional wellness.

       Healthy thinking and positive outlook are essential features to ensure overall wellness.

       Several parameters such as the genetic background and environmental and lifestyle factors affect human health.

       Lifestyle choices, as modifiable factors, may have negative (unhealthy lifestyle) and positive (healthy lifestyle) impact on health.

      Self‐Assessment Questions

      1 How has the definition of health evolved through the years?

      2 Give the definition of wellness according to the NWI.

      3 What are the Six Dimensions of Wellness according to the NWI?

      4 Physical wellness can be achieved through:regular physical activityhealthy dietary habitsadequate sleepthe rejection of detrimental habits (e.g., undue stress, excessive alcohol intake, and use of tobacco or other substances)all of the above

      5 Emotional wellness refers to:the satisfaction gained in the workplace, in balance with personal lifethe trait of self‐consciousness and the state of being in harmony with oneself as well as coping with life’s adversities and expressing one's feelings in a constructive waybeing harmoniously related to other people and efficiently sustaining positive intimate bondsthe adeptness of being receptive to different views and perspectives, and constructively encompassing them in future decision‐makingthe sense of satisfaction when someone manages to live within his or her means

      6 Which components of the unhealthy lifestyle have been associated with the development of chronic diseases?

      7 Give the definition of lifestyle medicine.

      1 Birrell, F.N., Pinder, R.J., and Lawson, R.J. (2021). Lifestyle medicine is no Trojan horse: it is an inclusive, evidence‐based, and patient‐focused movement. Br. J. Gen. Pract. 71 (708): 300. doi: 10.3399/bjgp21X716201.

      2 Frates, E.P. and Bonnet, J. (2016). Collaboration and negotiation: the key to therapeutic lifestyle change. Am. J. Lifestyle Med. 10 (5): 302–312. doi: 10.1177/1559827616638013.

      3 Frates, E.P., Morris, E.C., Sannidhi, D. et al. (2017). The Art and science of group visits in lifestyle medicine. Am. J. Lifestyle Med. 11 (5): 408–413. doi: 10.1177/1559827617698091.

      4 Kent, K., Johnson, J.D., Simeon, K. et al. (2016). Case series in lifestyle medicine: a team approach to behavior changes. Am. J. Lifestyle Med. 10 (6): 388–397. doi: 10.1177/1559827616638288.

      5 Lalley, N.A., Manger, S.H., Jacka, F. et al. (2021). The Mind‐Body Well‐being Initiative: a better lifestyle for people with severe mental illness. Australas Psychiatry, 1039856220978864. doi: 10.1177/1039856220978864.

      6 Lawson, R. (2020). British Society of Lifestyle Medicine: founding principles and current achievements. Am. J. Lifestyle Med. 14 (3): 286–288. doi: 10.1177/1559827619867627.

      7 Masic, I. (2015). Determinants of health and health concepts according to WHO targets. Int. J. Biomed. Health 3: 16–21.

      8 National Wellness Institute (NWI). (2020). The Six Dimensions of Wellness. www.nationalwellness.org.

      9 Phillips, E.M., Frates, E.P., and Park, D.J. (2020). Lifestyle medicine. Phys. Med. Rehabil. Clin. N. Am. 31 (4): 515–526. doi: 10.1016/j.pmr.2020.07.006.

      10 Saper, R.B. (2017). Integrative medicine and health. Med. Clin. N. Am. 101 (5): xvii‐xviii. doi: 10.1016/j.mcna.2017.07.002.

      11 Smith, B.J., Tang, K.C., and Nutbeam, D. (2006). WHO health promotion glossary: new terms. Health Promot. Int. 21 (4): 340–345.

      12 Stoewen, D.L. (2017). Dimensions of wellness: change your habits, change your life. Can. Vet. J. 58 (8): 861–862.

      13 Travis, J.W. (1977). Wellness Workbook: A Guide to Attaining High Level Wellness. Wellness Resource Center.

      14 Travis, J.W. and Ryan, R.S. (2004). The Wellness Workbook: How to Achieve Enduring Health and Vitality, 3e. Random House Digital.

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