‘Implementation of a lifestyle change implies that a routine is followed and habits are formed.’
An apple a day keeps the doctor away. This popular expression indicates that apples are good for one’s health, and highlights the importance of routinely eating them. Often the message individuals take away from the apple-a-day health advice is to eat more apples. However, perhaps the more important take away message is to eat nutritious foods regularly. The term lifestyle change inherently means that changes are made such that they can be followed for the lifetime of an individual. Implementation of a lifestyle change implies that a routine is followed and habits are formed. A healthy lifestyle includes habitual consumption of nutritious foods, regular physical activity, and consistent sleep. In this issue, Weaver and colleagues1 discuss the structured day hypothesis as an explanation for the trend in children gaining weight over the summer. When days are less structured, such as the summer months when school is out of session, children are more prone to engage in obesogenic behaviors.2 As a result, most children—irrespective of their weight status—gain weight over the summer.3
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Routine is consistently found to be important for children. A bedtime routine is associated with increased family functioning and improved sleep habits.4,5 Family routines have been linked to the development of social skills and academic success,6 and adherence to family routines has been identified as important for family resilience during times of crisis.7 However, the importance of routine is not unique to children. Observational research indicates that individuals in good health engage in highly routine health behaviors. For example, those successful at maintaining weight loss often eat the same foods, engage in consistent exercise, and do not skip meals.8-10 While the preponderance of observational-level research points to the importance of routine, little attention has been paid to the role routine may have in lifestyle medicine. Instead, health behavior research often focuses on patient adherence.
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According to the World Health Organization, adherence refers to “the extent to which a person’s behavior—taking medication, following a diet, and/or executing lifestyle changes—corresponds with agreed recommendations from a health care provider.”11 Patient adherence is one of the greatest challenges in lifestyle medicine. In the short term, many patients are able to adhere to recommendations. However, it has been estimated that only about 50% of patients adhere to their long-term treatment plan.11 Nonadherence to medication, for example, can lead to poor management of chronic disease and a higher health care burden.12 This is a critical issue for lifestyle medicine as chronic disease is, by definition, long term.
It is evident from low adherence rates that adherence does not always lead to routine. A routine can be defined as a repeated behavior involving a momentary time commitment task that requires little conscious thought.7,13 If health recommendations were to become routine, adherence would likely occur. A novel way to approach the issue of patient adherence is to assist patients in creating a routine around the health recommendation. However, there are many challenges to the creation of routine.
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