Lifestyle medicine in Nigeria – interview with Dr Ore Makinde

This week, I had the pleasure of interviewing Dr Moyosore Makinde a.k.a Ore from Nigeria about the fantastic work she does promoting lifestyle changes to improve health and wellbeing. Lifestyle medicine is the concept of using evidence-based principles to treat lifestyle-related diseases rather than relying on pills or medical interventions. It is underpinned by six key pillars of physical activity, nutrition, sleep, stress reduction, mental health, harmful substance reduction and healthy relationships. It’s certainly gaining popularity in the UK where I live and I was interested to hear about the movement, 3100 miles away, in Nigeria.

Ore is a family physician in a teaching hospital in Lagos, the second-largest city in Africa. Being a financial hub and one of the fastest-growing cities in the world, I can imagine the fast-paced lifestyle not being conducive to good health. Her interest in lifestyle medicine was spawned during her five-year family medicine residency during an update course that she took in preparation for her exam. For her compulsory dissertation to complete her residency, she took what she had learnt and followed two groups of hypertensives – one with the standard hypertensive treatment and education programme offered at her clinic and the other with an additional structured lifestyle intervention. She found that, although the reduction in blood pressure was similar in both groups, the one with the structured lifestyle interventions had better mental dimensions in their health-related quality of life assessment as well as a reduction in Body Mass Index (BMI). Having decided that she wanted to explore this sub-speciality further, she wrote to the director of the British Society of Lifestyle Medicine who introduced her to Dr Ify Monye, the President of the new Society of Lifestyle Medicine of Nigeria. Ore is now their Education Committee Lead.

She now runs a lifestyle medicine clinic in her public hospital after petitioning the Chief Medical Director and receives referrals from other doctors for patients who would benefit from her interventions. She usually has 30 minutes for each of her patients to deep-dive into their lifestyle and use motivational interviewing to change their mindset and their behaviour. She also has a website with its own blog and runs monthly meetings called BYC (boost your confidence) where patients can share their successful experiences. There are several things I like about this initiative including how it bypasses the moralising nature of medicine. For example, when we tell someone that obesity is bad for their health and that they need to lose weight, there is a real risk of implying negative judgement on that person, especially when it comes from a doctor – a voice of authority. When we tell someone that they have high cholesterol, we are implying that they eat too many “bad fats.” Ore’s peer-to-peer learning takes away the power imbalance between patient and doctor and focuses on the positive and the changes can feel realistic, not aspirational. Furthermore, she has Lifestyle Champions who are non-medical members of the community who learn about healthy changes so that they can teach others. This reminds me of work that has been done in the Nagano prefecture in Japan. One of the initiatives was the training of housewives on three-year non-repeatable tenures where they would learn the importance of a healthy low-salt diet and exercise to reduce the incidence of stroke and heart attacks. In the space of 50 years, alongside other incredible work, the local health authority had improved the life expectancy in the Nagano prefecture from one of the worst to one of the best in Japan. I really believe in community ambassadors and feel that this is one way to have these conversations outside of our consultation room and out in society and I love seeing it work successfully in Nigeria. Furthermore, Ore recently also organised a panel with an exercise physiologist/ physiotherapist and an etiquette consultant (a teacher of positioning, mannerisms and attitudes) to talk about the importance of posture and exercise in wellbeing. I love how she thinks outside the box by bringing in experts in different fields to create these holistic spaces for the general population to ask questions. This would certainly be helpful for my patients who come to see me with their neck pain and back pain due to desk work or smartphone use.

During our conversation, I reflected on my own consultations in the UK. I feel that some of my patients are receptive to my advice on healthier lifestyles, especially the younger generations, but some of my patients are really resistant. Ore says that she observes that her patients find changing their diet most challenging. The Nigerian diet has a lot of processed rice, deep fat frying and sugary drinks which is a challenge when talking about cholesterol, weight and diabetes. She teaches the concept of improvement, not perfection which centres around “what can I do today which is better than yesterday?” – perhaps having one less sugary drink, changing the type of rice you eat. Making small sustainable changes will allow the patient to feel empowered to tackle the bigger problems. This is especially important in countries like Nigeria with a rapidly increasing economy where the number of deaths caused by infectious diseases is shrinking but is being replaced by deaths due to non-communicable diseases. The WHO very much focuses on four main areas when tackling NCDs which is the reduction in tobacco use, the reduction in harmful use of alcohol, increase of physical activity and encouragement of healthy diets so the work that Ore and her colleagues do comes at a really timely intersection. I also think about my Nigerian diaspora population in London where sometimes I feel that my advice doesn’t get absorbed. I’m thinking that I might ask a few of them to check out Ore’s resources because it might resonate better. 

Finally, we talk about how to become a lifestyle medicine doctor. Ore recommends the International Board of Lifestyle Medicine which is affiliated with the British Society where you can get certified. After that, it depends on which country you are in as to how you want to take it forward. Ore petitioned her Chief Medical Officer at her hospital and was able to open her clinic. In the UK, with all the British bureaucracy and funding red-tape, this will probably be quite difficult in the public system so most open private clinics although this means that you have to establish yourself as a private doctor (this is unusual for GPs in the UK which is a predominantly public system). Without a doubt, we have both seen an increase in the popularity of lifestyle medicine in both our countries. There were 400 people who attended a recent webinar held by the Society of Lifestyle Medicine of Nigeria and I feel that it can only be a positive for patients to focus on prevention rather than cure.

I would like to thank Dr Ore Makinde for her time to give this interview. She will also be appearing in the WONCA Young Doctors Movement webinar next weekend, organised by AfriWon and the Spice Route, on Lifestyle Medicine. 

Mar 28, 2021 01:00 PM
Universal Time UTC

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