• Explore some reasons why patient adherence to lifestyle advice is low.
• Emphasize the importance of lifestyle, or behavior, modifications and the physiological benefits that can be achieved as a result of these modifications.
• Outline some effective, realistic, and easily implemented strategies for successful behavior change.

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Patient adherence, especially to recommended behavioral interventions and lifestyle changes, is notoriously difficult to achieve, but essential to the success of managing chronic disease. Lifestyle changes, often involving a combination of losing weight, adopting a healthier diet, stopping smoking, and decreasing alcohol consumption, are hard for patients to initiate and even harder to maintain. Adherence becomes a more complex issue when the cognitive, psychological, and social elements of living with a chronic disease come into play.[1] Rates of “nonadherent” patients have hovered around 40 to 50% for decades. Some experts estimate that nonadherence to lifestyle changes is even higher.[2]

In recent years, health care experts have proposed that the term “adherence” replace “compliance”, suggesting that the underlying meaning of “adherence” more appropriately describes the complexities involved in patient behavior, in the interactions between physician and patient, and in the decision-making processes of patients. Experts have postured that a paradigm shift from “compliance,” implying a submissive gesture on the part of the patient, to “adherence,” stressing an individual’s autonomy, might affect health care professionals’ entire approach to the issue.[2,3] After decades of research on this topic, it has become apparent that “noncompliant” patients may not have “defiant” personalities; rather, most “nonadherent” patients may simply be experiencing some sort of barrier to adhering to the recommended therapy. It is the physician’s discovery of these barriers that can potentially make a big difference in a patient’s life!

Motivating a patient to change one’s lifestyle seems a daunting task that requires Herculean effort and a considerable sacrifice of time. Perhaps that is why, in one recent study, physicians recommended lifestyle changes to patients with uncontrolled hypertension in only 47% of office visits.[4] However, if a physician can isolate a barrier that is preventing a patient from making or adhering to a specific behavior change, small modifications can begin. When even minimal behavior changes are successfully initiated and maintained, the benefits are significant. Consider the case study below.

“Shawn” is a 33-year-old white male with a BMI of 36 and a waist circumference of 42, who is new to your practice. He is Stage 1 hypertensive and currently takes hydrochlorothiazide 25 mg. His SBP at this office visit is 152 mmHg, and his DBP is 91 mmHg. His most recent laboratory tests reveal that his lipid levels are near normal; however, a confirmatory oral glucose tolerance test revealed that his 2-hour plasma glucose level was 148mg/dL, supporting a diagnosis of impaired glucose regulation, or “prediabetes”. Shawn is very motivated to change his lifestyle and adopt healthier habits.