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THE TOPLINE
- A 21-year study of adults with prediabetes just published in JAMA found that participants who received intensive lifestyle support had a significantly lower risk of developing multiple chronic conditions compared with placebo, while metformin did not show a statistically significant benefit.
- The findings suggest that structured lifestyle programs can help reduce multimorbidity—the accumulation of multiple chronic diseases—which is a major driver of healthcare costs, disability, and loss of independence among older adults.
- Healthcare systems often reimburse medications more readily than prevention programs, despite growing evidence that nutrition counseling, exercise, weight-loss coaching, and other lifestyle interventions can improve long-term health outcomes and should be treated as core components of healthcare.
A new long-term study just published in JAMA gives prevention advocates a rare and important data point. Among adults with prediabetes followed for more than two decades, those originally assigned to an intensive lifestyle intervention had a significantly lower risk of developing multiple chronic conditions than those assigned to placebo. Metformin, by contrast, was not associated with a statistically significant reduction in multimorbidity risk compared with placebo.
This is not an argument against medication. It’s an argument against a health system that often pays more readily for a pill than for the intensive, supported prevention that helps people avoid disease in the first place. Better understanding how to curb the rise of prediabetes and diabetes should be a crucial public health concern given that over 60% of all adults are affected, with prediabetes affecting roughly one-third of adults.
What the JAMA Study Found
The study examined 1,173 Medicare-linked participants from the Diabetes Prevention Program and its long-term follow-up, the Diabetes Prevention Program Outcomes Study. Participants were originally randomized to one of three groups: intensive lifestyle intervention, metformin, or placebo.
The lifestyle program included 16 individual sessions followed by monthly sessions for roughly two years, with goals of reducing calories and fat, achieving at least 150 minutes of physical activity per week, and losing at least 7 percent of baseline body weight. During the follow-up period, all participants were offered lifestyle sessions, and the original lifestyle group also received booster sessions.
After 21 years, multimorbidity, defined as having two or more of 15 chronic conditions tracked in Medicare data, occurred in 82 percent of the original lifestyle group, 85 percent of the metformin group, and 87 percent of the placebo group. After adjustment for relevant factors, the lifestyle group had a lower risk of multimorbidity than placebo. The metformin group did not show a statistically significant reduction versus placebo.
NIH summarized the finding bluntly: the long-term trial found no difference between metformin and placebo for multimorbidity risk, while lifestyle intervention lowered the risk of developing multiple chronic conditions.
Why This Matters
Multimorbidity may sound like an abstraction, but it is the lived reality of millions of older Americans: diabetes plus hypertension, heart disease plus kidney disease, arthritis plus depression, dementia plus frailty. Once chronic conditions start stacking up, people often face more specialists, more prescriptions, more side effects, more medical bills, and less independence.
That is why this finding is so timely and important. It suggests that intensive lifestyle support may do more than delay diabetes. It may help reduce the long-term burden of chronic disease itself.
This should be a wake-up call for policymakers and insurers. If nutrition counseling, physical activity support, weight-loss coaching, and structured prevention programs can reduce downstream disease burden, they should not be treated as optional extras. They should be treated as core healthcare.
The Bigger Picture: Prevention Is Medicine
This JAMA finding fits with a larger body of evidence showing that movement and lifestyle interventions can have serious health effects. A 2018 study, for example, found that 80 percent of chronic disease and premature death “could be prevented by not smoking, being physically active, and adhering to a healthful dietary pattern.”
A British Journal of Sports Medicine study published online in earlier this month followed 147,374 participants for up to 30 years and found that 90 to 119 minutes per week of resistance training was associated with a 13 percent lower risk of death from any cause, a 19 percent lower risk of cardiovascular death, and a 27 percent lower risk of neurological disease death. The lowest mortality risk was seen among people combining aerobic activity with resistance training.
That study was observational, so it cannot prove cause and effect. But taken alongside the randomized Diabetes Prevention Program evidence, the message is hard to ignore: lifestyle is foundational medicine.
The policy problem is that our system still privileges interventions that can be packaged, billed, and patented. A person can sit on the couch and take metformin. Sometimes that may be appropriate. But if the system makes that path easy while making prevention hard to access, poorly reimbursed, or unavailable, it is steering people toward disease management instead of health creation.
Conclusion
The JAMA study does not mean lifestyle eliminates chronic disease. In fact, multimorbidity remained common in all three groups, underscoring the scale of America’s chronic disease crisis.
But it does show something important: intensive, supported prevention can move the needle over decades.
That should be enough to demand serious attention from policymakers. Prevention cannot remain a slogan while reimbursement systems reward late-stage disease management. If Washington is serious about lowering healthcare costs and improving health, it must stop treating lifestyle medicine as a nice add-on to drugs and surgery and start treating it as a central pillar of care.
Consumers deserve more than a prescription pad. They deserve access to the tools that help keep them well.
Our Arizona Statement—the emerged from a meetings earlier this year in Arizona but applies to all Americans—provides a litany of reforms that could help center natural health and prevention in the fight against chronic disease. Read the statement, add your name to it, and help us demonstrate that Americans are tired of business as usual.
