As an international medical graduate starting a residency in the U.S., one of my earliest observations was patients’ fixation on finding a “clinical” explanation for nearly every aspect of their health. Be it physical symptoms, mental state, or emotional maladies, they were certain there had to be a clear, measurable, and distinct cause for what ailed them. That contrasted with my experience during medical school when patients would go to a health care professional to get any sinister explanations for their symptoms ruled out. In the U.S., patients seem to want to get a diagnosis “ruled in” to put them at ease.
At the beginning of my career, I rationalized such behavior by attributing it to a resource-rich system. I assumed that patients felt the condition should be managed or cured even if there was a low likelihood of any medical disorder causing their symptoms.
After almost 15 years in practice, I’ve re-examined my observations and come to a different conclusion.
Lifestyle in the U.S. has been medicalized. It has become this way slowly, over many decades, by different players and for various reasons. It isn’t about using treatments that effectively prevent, manage, or cure well-studied diseases like diabetes, cancer, or heart conditions. Instead, it’s about applying a clinical framework to problems that stem from lifestyle.
There are physical symptoms borne out of lifestyle. In my specialty of endocrinology, one of the common complaints is fatigue. Many patients present to our practice who are convinced that abnormal lab results or hormonal imbalances can explain their tiredness or brain fog. During these encounters, I listen closely and almost always find something in their daily routine that explains their symptoms: lack of sleep, a stressful work environment, caring for young ones, high caffeine intake, or lack of family/broader social support. Few patients have underlying hormonal disorders requiring medications.
The biopsychosocial model of health care is based on the idea that taking care of social determinants of health such as stable housing, literacy, access to nutritious food, and supportive communities, among others, will sustain one’s mental and biological health, ultimately improving overall well-being. But in practice, its application has been turned upside down. In the current health care landscape, psychosocial factors have been overlooked and patients have come to expect a biological explanation for their social behaviors.
A young woman was referred to our practice for the evaluation of fatigue. Her PCP had ruled out a broad range of differential diagnoses. In the first five minutes of our meeting, I discovered that she was nursing a 4-month-old and caring for her 6-year-old while she and her husband worked full time. After reviewing her extensive laboratory work and offering my usual “it’s-not-your-hormones” script, I inquired about her social support system. She had none. Her work didn’t offer any compensated maternity leave of absence, she and her husband had no local familial support, and they were struggling to find quality child care. The root cause of her exhaustion was glaringly clear: an overburdened lifestyle with no safety net. Yet she was convinced something must be biologically wrong.
This disconnect between societal expectations and the realities of its structures is striking. While economic demands often force both parents to work, society lacks adequate infrastructure to support them. The U.S. is the only OECD country without compensated maternity leave or an array of childcare options and workplace accommodations for parents. According to the U.S. Surgeon General, 1 in 3 parents experience high levels of stress and almost half of them report feeling completely overwhelmed in their parental role. It’s an alarming statistic — one that cannot be “cured” in a doctor's office.
Another example of the medicalization of lifestyle frequently encountered in endocrinology is the obsession with nutrition supplements. When my patients inquire about my preferred brand of multivitamins for their “lifestyle symptoms,” my response is usually, “the fresh fruits and vegetables section of your nearest grocery store.”
The over-the-counter nutrition supplement industry was estimated to be around $152 billion in 2021 and is expected to be around $300 billion in 2028. Most micronutrients in those supplements can be obtained by consuming a balanced diet. However, the industry’s marketing wizards have people believing otherwise. Despite lacking sound scientific evidence, these supplements are promoted for numerous conditions, as either prevention or cure. Worse, some patients prioritize these supplements over proven, lifesaving medications. The nutrition supplements industry and its economic cost to society is the manifestation of nutrition illiteracy at a population level — an issue that leads to misguided lifestyle choices.
And perhaps the most fervent case of the medicalization of lifestyle in my specialty is the obesity epidemic. According to the CDC, 40% of adults and 20% of children in the U.S. are obese. Weight management is a lifestyle issue, not only of willpower but also of social determinants of health. On top of that, the food industry manipulates consumers by establishing a “bliss point” — an ideal combination of salt, sugar, and fat at which their food products are most irresistible and will enhance cravings. Human biology hasn’t changed, but our environment certainly has.
Our societal response to such maneuvering should have been to regulate and redesign our institutions. Instead, we have medicalized the issue. Now semaglutide and tirzepatide are the talk of the town. Wegovy (semaglutide) and Zepbound (tirzepatide) projected sales in 2024 are $1.82 billion and $1.7 billion, respectively.
We have the tools to change our relationship with food and, thus, our health. A combination of preparing plant- and protein-based food at home with time-restricted eating (or reducing snacks) has been shown to help with maintaining a healthy weight. But considering the structure and demands of our society, most patients have no choice but to seek an effective solution through a prescription.
Why does all of this matter?
The medicalization of lifestyle has consequences. It increases the cost of health care through unnecessary evaluations and prescriptions. I believe it creates a significant barrier for patients with genuine medical needs to access health care promptly and contributes to physician burnout since physicians can only provide a Band-Aid solution without addressing the root cause, which is beyond their control.
The physician community has a vantage point from which we see issues like the patient above. We can offer personalized solutions tailored to individual needs whenever possible. Thankfully, her husband was able to change his work hours, and some friends were able to support their childcare needs. She improved her sleep, which improved her symptoms to some extent. A social solution for her psychosocial needs. But these solutions are not readily available to every patient, and it can not be incumbent upon health care professionals to fix the misalignment of societal expectations and their setup.
Addressing these issues requires a long-term, consistent, and multi-tiered strategy. At the micro level, patients’ education, at the meso level, improving societal infrastructure (childcare, maternity leave); promoting work-life balance; offering nutrition education in schools and workplaces; strengthening and supporting families, neighborhoods, and communities, and at the macro level, changes in policy, regulations, and legislative initiatives that improve social support and are economically efficient. And to uphold our Hippocratic oath, physicians must be an integral part of that process at all levels.
What issues do you see in your practice with medicalization of lifestyle? Share in the comments!
Dr. Ameer Khowaja is an Endocrinologist based in San Antonio, TX. In addition to his clinical practice, he enjoys participating in population research, teaching internal medicine residents, community volunteer work, reading, writing, and spending time with his family. Dr. Khowaja is a 2024–2025 Doximity Op-Med Fellow.
Image by ajijchan / Getty Images
