โปรแกรมปฏิวัติพฤติกรรมเพื่อต้านโรคเรื้อรัง  Total Lifestyle Modification (TLM)

<h2><span style="color: #00826a;">What are the health problems of Thai people today?</span></h2>
<p>The main problem is the increase in chronic non-communicable diseases, which are related to atherosclerosis, such as ischemic heart disease, stroke, hypertension, chronic kidney disease, diabetes, etc. The latest statistics from Thailand tell us that Thai people die from chronic non-communicable diseases at a rate of 32.4%, which is the leading cause of death, surpassing death from old age, which has decreased to only 23.5%. Besides the current statistics indicating that these diseases, which were very rare in the past, have increased significantly today, we can also predict quite accurately that these diseases will become the main health problem of our nation, multiplying over the next 20 years.</p>
<h2><span style="color: #00826a;">But medical technology is improving every day, so can’t it handle these problems?</span></h2>
<p>At first glance, it seems so, but looking deeper, it is not the case. There is a very large research study that tells us what will happen in the future if we stick to the current high-tech treatment model. This research is called Euroaspire. They followed 13,935 cardiovascular patients who were treated in 76 top hospitals in 22 European countries, using risk factors as indicators. These patients were compliant, attending appointments and taking medications as prescribed. After following them for 12 years, it was found that the situation worsened. For example, the percentage of obese people increased from 25% to 33%, hypertension increased from 32% to 43%, and diabetes increased from 17% to 20%. Remember, these people took medications and used good technology for treatment, but their health structure deteriorated. This research is evidence that the current chronic disease care model focused on medication is ineffective.</p>
<h2><span style="color: #00826a;">So what method is effective?</span></h2>
<p>The answer lies in health behavior change research. For example, the diabetes prevention study in people at risk of diabetes, abbreviated as DPPRG. They took 3,234 people with blood sugar levels over 100 mg/dL, divided them randomly into three groups. The first group completely changed their lifestyle by exercising to standard levels, increasing fruits and vegetables, and reducing calories. The second group took diabetes medication. The third group did nothing. After 5 years, it was found that the group with complete lifestyle changes had the lowest diabetes incidence at 4.8%, the medication group had 7.8%, and the no-action group had the highest at 11.0%. This research tells us that complete lifestyle modification prevents diabetes almost twice as well as medication.</p>
<p>Regarding hypertension, a compilation of research presented at the international conference (JNC7) concluded that there are many ways to reduce blood pressure without medication. For example, losing 10 kg if obese can reduce blood pressure by 20 mmHg. Changing diet to more fruits and vegetables and low fat can reduce it by 14 mmHg. Reducing salt intake can reduce it by 8 mmHg. Regular exercise can reduce it by 9 mmHg. Reducing alcohol intake can reduce it by 4 mmHg. All of these indicate the potential of complete lifestyle modification in solving chronic disease problems.</p>
<h2><span style="color: #00826a;">What exactly does “complete lifestyle modification” mean?</span></h2>
<p>It means our current way of life, whether it is high-calorie food, daily life with no opportunity or even avoidance of exercise, insufficient rest, or behaviors that increase the risk of illness such as smoking and alcohol, all lead us down the road to chronic non-communicable diseases, which will unfortunately undermine our quality of life in the end, even if we are currently healthy. To get off this road, we must change ourselves—not just a little, but completely, turning over a new leaf.</p>
<h2><span style="color: #00826a;">The key points of lifestyle modification are</span></h2>
<ol>
<li>Change from being inactive to exercising regularly.</li>
<li>Change from high-calorie food to low-calorie food with high fruits and vegetables.</li>
<li>Allocate time for sufficient sleep and rest and manage stress well.</li>
<li>Know your specific health risk factors and have special activities to address them, such as focusing on weight loss if obese, quitting smoking if a smoker, etc. All of these are the main points of complete lifestyle modification or Total Lifestyle Modification (TLM).</li>
</ol>
<h2><span style="color: #00826a;">But if someone already has a chronic disease, can it still be prevented?</span></h2>
<p>Many studies indicate that complete lifestyle modification can reverse existing diseases. This has led to the concept of “Secondary Prevention,” meaning that people with chronic diseases such as heart disease, stroke, diabetes, hypertension, kidney disease, or even cancer, besides medication treatment as usual, should seriously focus on complete lifestyle modification as a mainstream approach alongside medication or other medical technologies. At Phyathai Hospital, we are currently implementing the secondary prevention concept systematically for chronic disease patients.</p>
<h2><span style="color: #00826a;">What does that mean? If someone already has severe heart disease, do they still need to exercise?</span></h2>
<p>It means we will not just manage patients by scheduling medication refills repeatedly. We will not stop there but discuss complete lifestyle modification. Patients must take an active role in changing their health behaviors, with doctors acting as helpers or guides.</p>
<h2><span style="color: #00826a;">Will people dare to do it? They are already sick and feeling bad.</span></h2>
<p>There are two major obstacles to behavior change: lack of knowledge and inability to change despite knowing. To solve the lack of knowledge, doctors and nurses will add educational activities into the standard care for each disease. At Phyathai 2 Hospital, a Health Promotion Hall is under construction on the 7th floor of Building 2. It will be like a museum providing knowledge on lifestyle modification for good health, such as nutrition displays on what to eat and what not to eat, cooking classes to practice making low-calorie and tasty food, exercise classes for patients with different diseases and ages who need guidance and skill training in exercise. All of these help change from ignorance to knowledge and from inability to ability.</p>
<h2><span style="color: #00826a;">What about those who know but can’t do it, doctor?</span></h2>
<p>Once there is intention, successful behavior change requires self-discipline, group discipline, and good friends. At Phyathai 2 Hospital, we try to form patient groups for various diseases to change behaviors together, such as muscle training groups for diabetic patients. Doing things in groups benefits from group discipline. We also try to be good friends to patients. For chronic patients, we are adjusting disease-specific care standards to include follow-up and support for successful behavior change alongside usual medication treatment. For those not yet sick, we have a health care program with a personal doctor called PMP (Personalized Medical Program). This is an annual health check program that assesses personal health risk factors and creates an annual health plan, similar to other annual check programs at Phyathai. In PMP, everyone has a personal doctor who is a good friend to guide, motivate, and follow up on successful lifestyle changes.</p>
<h2><span style="color: #00826a;">Does having a doctor as a good friend really work?</span></h2>
<p>According to statistics since we started the PMP project, it definitely works. The rate of health behavior change is higher than in cases without a personal doctor. Some results are very good. For example, in this program, out of 8 smokers, 6 have quit for over a year, which is a very good rate. The rate of stopping chronic disease medications such as antihypertensives and lipid-lowering drugs is also satisfactory, with dozens quitting. Having a doctor as a good friend is definitely beneficial. Phyathai Hospital has learned from this that inducing health behavior change cannot rely solely on the doctor-patient relationship but must also be a human-to-human relationship. This means that the more doctors and nurses know and befriend patients, the more successful they will be in guiding patients to change health behaviors.</p>
<h2><span style="color: #00826a;">The more doctors know and befriend patients, the more successful the guidance for health behavior change will be</span></h2>
<p>The key point is that the good friendship between doctors and patients is not limited to the PMP program only. Chronic patients usually have long-standing relationships with their doctors. The good friendship naturally exists. Phyathai’s systematic use of the secondary prevention concept is just a reminder of the health promotion content that doctors and nurses need to communicate to each chronic patient, relying on the pre-existing good friendship as a foundation.</p>


The main issue is the increase in non-communicable chronic diseases, which are a group of diseases related to atherosclerosis.

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