Developments in 'lifestyle medicine' and implications for tropical conditions

The discovery, over a decade ago, of a form of low grade, systemic inflammation (metaflammation) associated with obesity, proffered a possible causal explanation of the well known link between obesity and chronic disease. However accumulating evidence has shown that obesity may not be necessary for such a „metaflammatory‟ response to occur. Lifestyle and environmental factors, some, but not all of which lead to obesity, can be directly associated with a range of chronic diseases (vascular disease, myocardial infarction, stroke, micro-vascular disease, renal dysfunction, erectile dysfunction etc.). A physiological link appears to be through a cascade of inflammatory events in a range of target organs, typified, and perhaps initiated by inflammatory dysfunction at the endothelial intima. It has been proposed that such a cascade occurs as a result of an immune reaction to predominantly lifestyle and environmental „inducers‟ with which the body has not evolved. This suggests that while metaflammation may be widespread, and cause disease in a number of end organs (pancreas, heart, kidney etc.), the endothelium is where the „rubber meets the road‟ in lifestyle-related disease. Attempts to manage this through standard treatments, such as pharmacotherapy, or even weight loss, are likely to be only palliative as these leave the cause of the problem untouched. A new approach, broadly called „Lifestyle Medicine‟ within the broader field of health promotion, should involve an acknowledgement of economic and environmental, as well as individual behavioural causes in modern chronic disease. The current article considers the broader determinants of such disease with particular emphasis on the influence of tropical climates.