The Medicalization of Health: From Lifestyle Adjustments to Pharmaceuticals

In recent decades, the US healthcare system has shifted toward addressing various health conditions through clinical interventions rather than lifestyle changes. This is now a trend referred to as “medicalization”. Medicalization involves labeling natural processes and/or lifestyle-related conditions as medical conditions that require pharmaceutical or surgical treatments as the preferred solutions. Health issues such as childbirth, obesity, depression, ADHD, anxiety, insomnia, and others, were once managed with diet, exercise, and social support. In years past these issues were seen as part of the human experience. These ailments are now frequently treated with drugs or invasive procedures. Medicalization offers rapid solutions but also raises concerns about the rise in pharmaceutical dependence and how consumer influence is encouraging this shift.

Suppose Western allopathic medicine and medicalizing conditions are considered safe and effective treatments. Why are we seeing all-time highs in these areas?

Infant Mortality: The U.S. infant mortality rate rose to 5.6 deaths per 1,000 live births in 2022, marking the first increase in two decades, up by approximately 3% from 2021. This trend varies across racial and ethnic groups, with significant increases noted among infants of American Indian and Alaska Native mothers​ CDC​ CDC Blogs.

Obesity: Among U.S. adults, obesity prevalence was last recorded at 41.9% by the CDC. This figure has seen a steady increase over the years and reflects long-term trends rather than recent spikes​.

Depression: The National Institute of Mental Health (NIMH) reports that 8.4% of U.S. adults experienced at least one major depressive episode in 2022. This aligns closely with your figure and indicates an increase in mental health issues, especially post-pandemic​.

ADHD: For children ages 3–17, ADHD prevalence remains close to 10%, with recent surveys indicating about 9.8% are diagnosed with ADHD. Your figure of 11.4% is slightly higher than the current average but within a plausible range, considering increases in diagnosis rates over the past few years​.

Anxiety: Anxiety disorders affect around 31% of U.S. adults at some point, according to the NIMH. This remains one of the most common mental health conditions, with prevalence rising, particularly among younger adults​.

Insomnia: Roughly 14.5% of adults report experiencing chronic sleep issues, including difficulty falling asleep most nights, a condition that is increasingly recognized as widespread in the U.S. population​.

Treating symptoms without addressing the root causes of disease and illness, creates pharmaceutical customers for the long term, without effectively curing anything.

Direct-to-Consumer Pharmaceutical Advertising in the U.S. and New Zealand

The United States and New Zealand are the only countries allowing direct-to-consumer (DTC) pharmaceutical advertising, fueling the perception that medication is the primary route to wellness. With advertisements that are seen on television, in print, and online, drugs are marketed as quick and simple solutions to complex health issues, often emphasizing benefits while dismissing potential risks (Ventola, 2011). Such advertising encourages a culture where consumers may feel the need or desire for medications for issues that may otherwise be managed without drugs. This situation consequently drives demand for pharmaceutical solutions and potentially contributes to overdiagnosis and overtreatment (Ventola, 2011).

Role of Medical Professionals and Consumer Complacency

Medical professionals play a major part in driving medicalization. Pressured by patient demand for immediate solutions and limited consultation time, physicians may prioritize pharmaceutical treatments over lifestyle-based recommendations (Topol, 2015). Pharmaceutical companies knowingly promote their products to healthcare providers, offering the immediate solutions that medications may offer compared to lifestyle changes. Consumer demand favors this approach, where patients seek medications for conditions that could potentially be addressed through diet, exercise, or mental health practices (Moynihan et al., 2002). This dependency on pharmaceuticals creates a cycle of reliance, diminishing the desire for individuals to manage their own health through more sustainable means.

Medicalization of Childbirth

Throughout much of human history, childbirth was a natural process, often managed by midwives and family members (Simonds et al., 2007). Childbirth, especially in the US, has become highly medicalized, with many births taking place in hospitals with the usage of epidurals, Cesarean sections, and labor-inducing drugs. In the United States, the Cesarean section rate is nearly 32%, exceeding World Health Organization (WHO) recommendations of 10–15% (WHO, 2015). The routine use of medical interventions in low-risk pregnancies has led to concerns about unnecessary risks and a sense of reduced autonomy among women (MacDorman et al., 2016). These interventions may help to ensure safety in high-risk situations, but critics argue that their frequent overuse may add stress, complications, and an overemphasis on medical control (Simonds et al., 2007).

Obesity: The Turn to Medications and Surgery

Obesity is now seen as a medical condition, despite it being greatly influenced by lifestyle factors such as diet and exercise. Medications as well as surgeries, such as gastric bypass, have become common solutions despite the WHO’s emphasis on lifestyle interventions as first-line responses (WHO, 2021). Pharmaceutical options may provide rapid results and meet consumer demand for quick fixes. However, they often fail to tackle underlying factors like mental health, socioeconomic status, and environmental issues (Gaesser et al., 2021). The medicalization of obesity also reflects societal expectations for quick results, where lifestyle-based treatments are often seen as secondary (Gaesser et al., 2021).

Depression and Pharmaceutical Solutions

Depression was once regarded as a deeply personal struggle, has now been typically treated through antidepressants, making them one of the most prescribed medications in the world (McManus et al., 2016). Antidepressants provide critical support for those with severe depression, while the use of these pharmaceuticals can obscure the benefits of non-drug interventions, such as therapy, exercise, and lifestyle adjustments (Cuijpers et al., 2021). Medical experts typically advocate for a combined approach, but the demand for rapid relief often drives consumers toward pharmaceuticals as the primary solution. This trend highlights concerns about potential long-term dependency and other risks of addressing symptoms without fully understanding underlying causes (Cuijpers et al., 2021).

The Rise of ADHD Diagnoses and Stimulant Use

Another mental ailment that has increased greatly in recent decades is ADHD. Stimulant medications have become the primary treatment (Visser et al., 2014). Medications that improve focus and relieve symptoms such as Ritalin and Adderall can also lead to dependency and behavioral side effects. Non-pharmaceutical interventions, such as behavioral therapy and parental training, are often underutilized, despite their effectiveness in managing ADHD (Molina et al., 2009). The great increase in ADHD diagnoses has led some researchers to question whether typical childhood behaviors are increasingly pathologized, leading to increased unnecessary use of medication (Visser et al., 2014).

Medicalization of Other Common Conditions

Other medical conditions reflect the trend toward medicalization such as:

1. Anxiety and Anti-Anxiety Medications: The increased prescription of anti-anxiety medications, such as benzodiazepines, often occurs without deeper inquiry into alternatives of several agents such as ashwagandha, passionflower, galphimia, echinacea, ginkgo, chamomile, lemon balm, valerian, and lavender, which can often manage symptoms without the potential risks of dependency (Garakani et al., 2020).
2. Sleep Disorders and Sleeping Pills: Insomnia is frequently treated with sleeping pills, even though non-drug approaches, such as sleep hygiene and lifestyle adjustments, often produce more sustainable results (Smith & Perlis, 2020).
3. Menopause and Hormone Replacement Therapy (HRT): Menopause is a natural process, where hormone replacement therapy (HRT) is frequently prescribed to address symptoms. While HRT can be beneficial, its risks and potential side effects bring light to the discussion for balanced approaches that implement lifestyle adjustments (Manson et al., 2016).

Conclusion

The medicalization of various health issues, ranging from childbirth to obesity, depression, anxiety, insomnia ADHD, and perhaps others, reflects a broader societal trend toward pharmaceutical dependency and reliance. Medical interventions are invaluable in many cases, however, the increased reliance on medications and clinical treatments for conditions historically managed through lifestyle adjustments raises many ethical and practical concerns. The influence of pharmaceutical companies and the current advertising permissiveness in the United States and New Zealand further highlight the much-needed balanced approach that encourages sustainable, lifestyle-based strategies along with clinical treatment options. Increased emphasis on non-pharmaceutical approaches can help empower individuals to take a more proactive role in their own health and cultivate more realistic long-term wellness.

References

Cuijpers, P., Stringaris, A., & Wolpert, M. (2020). Treatment outcomes for depression: challenges and opportunities. The Lancet Psychiatry, 7(11), 925–927. https://doi.org/10.1016/s2215-0366(20)30036-5

Gaesser, G. A., & Angadi, S. S. (2021). Obesity treatment: Weight loss versus increasing fitness and physical activity for reducing health risks. iScience, 24(10), 102995. https://doi.org/10.1016/j.isci.2021.102995

Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of Anxiety Disorders: Current and emerging treatment options. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.595584

MacDorman, M. F., Declercq, E., Cabral, H., & Morton, C. (2016). Recent increases in the U.S. maternal mortality rate: Disentangling trends from measurement issues. Obstetrics & Gynecology, 128(3), 447-455. https://doi.org/10.1097/AOG.0000000000001556

Manson, J. E., Chlebowski, R. T., Stefanick, M. L., Aragaki, A. K., Rossouw, J. E., Prentice, R. L., … & Anderson, G. (2013). Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. JAMA, 310(13), 1353-1368. https://doi.org/10.1001/jama.2013.278040

McManus, S., Bebbington, P., Jenkins, R., & Brugha, T. (2016). Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. A survey carried out for NHS Digital by NatCen Social Research and the Department of Health Sciences, University of Leicester-UCL Discovery. https://discovery.ucl.ac.uk/id/eprint/1518055/

Molina, B. S., Hinshaw, S. P., Swanson, J. M., Arnold, L. E., Vitiello, B., Jensen, P. S., … & MTA Cooperative Group. (2009). The MTA at 8 years: Prospective follow-up of children treated for combined-type ADHD in a multisite study. Journal of the American Academy of Child & Adolescent Psychiatry, 48(5), 484-500. https://doi.org/10.1097/CHI.0b013e31819c23d0

Moynihan, R., Heath, I., & Henry, D. (2002). Selling sickness: The pharmaceutical industry and disease mongering. BMJ, 324(7342), 886-891. https://doi.org/10.1136/bmj.324.7342.886

Simonds, W., & Rothman, B. K. (2007). Laboring on: Birth in transition in the United States. Routledge.

Perlis, M. L., Pigeon, W. R., Grandner, M. A., Bishop, T. M., Riemann, D., Ellis, J. G., Teel, J. R., & Posner, D. A. (2021). Why treat insomnia? Journal of Primary Care & Community Health, 12, 215013272110140. https://doi.org/10.1177/21501327211014084

Topol, E. J. (2015). The patient will see you now: The future of medicine is in your hands. Basic Books.

Ventola C. L. (2011). Direct-to-Consumer Pharmaceutical Advertising: Therapeutic or Toxic?. P & T : a peer-reviewed journal for formulary management, 36(10), 669–684.

Visser, S. N., Danielson, M. L., Bitsko, R. H., Perou, R., & Blumberg, S. J. (2014). Trends in the parent-report of health care provider-diagnosed and medicated ADHD: United States, 2003–2011. Journal of the American Academy of Child & Adolescent Psychiatry, 53(1), 34-46. https://doi.org/10.1016/j.jaac.2013.09.001

World Health Organization (WHO). (2021). Obesity and overweight. Retrieved from https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

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