Lifestyle Medicine and Multimorbidity in Viet Nam: Moving Beyond Single-Disease Care

Lifestyle Medicine and Multimorbidity in Viet Nam: Moving Beyond Single-Disease Care

Last reviewed: 24 September 2026

A person living with hypertension may also have type 2 diabetes. The same person may have obesity, chronic kidney disease, osteoarthritis, poor sleep, depression, or cardiovascular disease. Yet healthcare is still often organized around one diagnosis at a time: one guideline, one clinic, one prescription, one follow-up plan. For a growing number of people, particularly older adults, this no longer reflects the reality of their health.

Multimorbidity generally refers to the presence of two or more long-term health conditions in the same person. Unlike “comorbidity,” which usually considers additional conditions in relation to one main or index condition, multimorbidity does not prioritize a single disease. The distinction matters because the clinical question changes. Instead of asking only, “What should we do for this disease?”, clinicians also need to ask, “What combination of care makes sense for this person?”

That question is becoming increasingly relevant in Viet Nam. Noncommunicable diseases account for about 80% of deaths in the country. At the same time, the population is aging rapidly. The 2024 Population and Housing Mid-term Census recorded 14.2 million people aged 60 years or older, while 9.3% of the population was aged 65 years or older. By 2030, the number of people aged 60 and above is projected to approach 18 million.

Multimorbidity changes the clinical question

Living with several conditions creates challenges that do not appear when each disease is considered separately. A treatment that is appropriate for one condition may complicate another. Recommendations from several disease-specific guidelines may create an unrealistic daily workload. Multiple medicines increase the need to consider interactions, adverse effects, adherence, and treatment burden. Appointments with several specialists can result in overlapping tests or conflicting instructions. Meanwhile, the outcomes that matter most to the person may be less about reaching every disease-specific target and more about being able to walk, sleep well, remain independent, avoid hospitalization, or participate in family life.

Multimorbidity is therefore not simply a matter of counting diagnoses. It is also a challenge of coordination, prioritization, and integration of care. International guidance notes that recommendations for individual diseases are often based on evidence from people without multimorbidity and taking fewer regular medicines. Applying several guidelines independently can therefore produce a plan that is evidence-based for each disease in isolation but poorly suited to the person who has all of them at the same time.

Available studies from Viet Nam suggest that the burden is already substantial, although contemporary nationally representative prevalence data remain limited. A population-based study of 2,400 adults aged 60 years and older in Đồng Nai and Vĩnh Long found multimorbidity in 39.2% of participants. The data were collected in 2010, so this figure should not be interpreted as the current national prevalence. A more recent community study involving 317 older adults in Ho Chi Minh City reported multimorbidity in 53.0% of participants, polypharmacy in 24.9%, and impairment in instrumental activities of daily living in 13.9%. That study was cross-sectional and drawn from a single urban area, so its findings should not be generalized to the national population. Together, these studies highlight both the importance of multimorbidity and the need for better contemporary Vietnamese data on multimorbidity, frailty, function, treatment burden, and quality of life.

Where Lifestyle Medicine can contribute

Lifestyle Medicine may be particularly relevant to multimorbidity because many chronic conditions share modifiable risk factors and determinants. Nutrition, physical activity, tobacco exposure, harmful alcohol use, sleep, psychological well-being, and social circumstances can affect more than one condition at the same time. Addressing one of these areas may therefore contribute to several clinical goals, although the expected benefit and the appropriate intervention will differ from person to person.

Consider someone living with type 2 diabetes, hypertension, and osteoarthritis. They do not necessarily need three completely separate conversations about physical activity. A carefully adapted movement plan may contribute to glucose management, blood pressure control, mobility, muscle strength, physical function, and mental well-being. Smoking cessation can reduce risks across cardiovascular, respiratory, and cancer outcomes. Improving sleep may help some people with fatigue, mood, and metabolic health. Nutrition can influence several cardiometabolic conditions, but any dietary plan may also need to account for kidney function, frailty, unintended weight loss, medication use, food affordability, and personal preferences.

In this context, Lifestyle Medicine is best viewed not as another disease-specific pathway, but as a potential cross-cutting component of care. That does not mean every lifestyle intervention benefits every condition or that the same prescription is appropriate for everyone. Someone with frailty and unintentional weight loss has different nutritional priorities from someone seeking weight reduction. Exercise for a healthy middle-aged adult is different from exercise for a person with heart failure, severe osteoarthritis, or a high risk of falls. Sleep problems may reflect obstructive sleep apnea, chronic pain, depression, medication effects, or another condition requiring assessment and treatment rather than simply advice about sleep habits.

The 2025 Lifestyle Medicine Core Competencies reflect this broader approach. The update increased the framework from 88 to 89 competencies and added a specific competency on applying Lifestyle Medicine interventions in the context of social determinants of health, while also updating competencies related to planetary health and food processing. This matters in multimorbidity because behavior does not occur independently of income, family circumstances, culture, housing, work, access to care, or the local environment.

The evidence requires restraint as well as enthusiasm

There is substantial evidence supporting specific lifestyle interventions for many individual chronic conditions. That should not, however, be confused with evidence that a comprehensive Lifestyle Medicine program has already been proven to improve every important outcome for people with multimorbidity.

A systematic review and meta-analysis published in Family Practice in 2025 identified 33 studies of interventions specifically designed for people with multimorbidity in primary or community care. Twenty-six studies involving 9,449 participants contributed to the meta-analysis. Overall, there was little significant evidence of benefit compared with usual care for most outcomes, although self-management support and models combining care coordination with self-management support showed benefits for selected outcomes. The authors also identified important gaps in evidence on health outcomes, healthcare use, and costs. Importantly, these were multimorbidity interventions broadly, not studies of Lifestyle Medicine as a defined model of care.

This distinction matters. Evidence that physical activity improves particular outcomes in hypertension, that smoking cessation reduces disease risk, or that specific nutrition interventions benefit people with diabetes does not automatically establish the effectiveness of “Lifestyle Medicine” as one package for multimorbidity. The appropriate position is neither to underestimate lifestyle interventions nor to oversell them. They should be used when the evidence, clinical circumstances, and patient's priorities support their use, while other necessary medical treatment continues and outcomes are monitored.

Research in older adults more broadly provides useful but indirect evidence. A 2026 systematic review and meta-analysis of 38 studies found that multidomain interventions involving physical, nutritional, cognitive, and other components improved selected motor-functional and psychological outcomes. Cognitive improvements were more limited, and some estimates weakened when studies at high risk of bias were removed. These findings are relevant to multimorbidity care, but they should not be interpreted as direct evidence that the same effects will occur in every person with multimorbidity.

Start with what matters to the person

In single-disease care, the starting point is often the diagnosis. With multimorbidity, the person may be the better starting point. What is interfering most with daily life? Which condition creates the greatest immediate risk? Which treatment is providing clear benefit? Which creates the greatest burden? What does the person most want to preserve or regain? What change feels realistic? What financial, family, occupational, or environmental barriers affect the plan?

A 72-year-old woman living with hypertension, diabetes, and knee osteoarthritis may tell her physician that her greatest concern is not her glycated hemoglobin value. It is that knee pain has stopped her from walking to the market, which has reduced her physical activity, social contact, and independence. Her care may therefore need to prioritize pain assessment, safe movement, and functional recovery while appropriate cardiometabolic treatment continues. This is not ignoring diabetes. It is recognizing that the person's conditions, treatments, function, and daily life interact.

International multimorbidity guidance takes a similar approach. It emphasizes quality of life, disease and treatment burden, personal goals and values, coordination across services, and an individualized management plan. It also recommends reviewing medicines and non-pharmacological treatments rather than assuming that every existing treatment should continue or that every disease-specific guideline recommendation should simply be added.

Lifestyle assessment should therefore not become six additional tasks added to an already overloaded consultation. A more useful approach is to identify the few factors most likely to influence several problems and that the person is willing and able to address. For one individual, smoking cessation may be the priority. For another, resistance exercise and adequate nutrition may matter more because of frailty. For someone with diabetes and severe insomnia, assessment and treatment of sleep may be more useful initially than introducing several new behavioral targets at the same time. A small number of coordinated priorities can be more realistic than a long list of advice.

Medication, treatment burden, and function need to be considered together

Multimorbidity frequently involves multiple medicines, but polypharmacy is not automatically inappropriate. A person may genuinely require several evidence-based treatments. The concern is inappropriate polypharmacy, unnecessary duplication, adverse effects, interactions, or a treatment regimen whose burden outweighs its likely benefit.

Lifestyle change adds another safety consideration. Blood glucose, blood pressure, body weight, and other clinical parameters can change significantly when a person makes substantial changes to nutrition, physical activity, alcohol use, or weight. Medication requirements may therefore need reassessment, particularly for people taking insulin, sulfonylureas, antihypertensive medicines, or other treatments where clinical improvement could increase the risk of hypoglycemia, hypotension, or overtreatment.

Reassessment does not necessarily mean deprescribing. Some medicines may still have important cardiovascular, kidney, or other indications even after a particular biomarker improves. The 2025 American College of Lifestyle Medicine clinical practice guideline for type 2 diabetes recommends adjusting pharmacological therapy according to changing medication needs and explicitly notes that medication decisions should take account of coexisting conditions. It also recognizes that some newer glucose-lowering medicines may continue to be indicated for cardiovascular or kidney protection even after diabetes remission or substantial improvement in glucose control. Medication adjustment should therefore be individualized, clinically supervised, and communicated across the care team.

For the same reason, outcomes in multimorbidity should extend beyond biomarkers. Blood pressure, glycated hemoglobin, cholesterol, and body weight remain important, but clinicians may also need to ask whether the person can walk further, has fewer falls, sleeps better, experiences less pain, can prepare meals, participates more in family life, manages treatment more easily, or requires fewer unplanned healthcare visits.

Primary care is central to making this practical in Viet Nam

Multimorbidity is difficult to manage through a collection of episodic specialist visits alone. Specialist expertise remains essential, but someone needs to maintain the whole picture over time, reconcile recommendations, monitor treatments, recognize changing priorities, and coordinate referrals.

This is one reason current primary healthcare reform in Viet Nam is highly relevant. A 2025 World Health Organization review of the commune health system found that commune-level facilities were not consistently functioning as the coordinating center of the patient's care journey. Follow-up after referral or hospital discharge was limited, contributing to duplication of tests and services and risks including polypharmacy and medical errors. The review called for stronger continuity, coordination, and family medicine functions within primary care.

There has also been significant recent progress. In September 2026, the World Health Organization reported that a care model developed with the Government of Viet Nam had enabled around 10 million people to be screened for hypertension and diabetes and more than 2 million people to receive treatment. WHO also reported a 50% rise in effective blood pressure and glucose management. These figures do not demonstrate integrated multimorbidity care, but they show the scale that community-based chronic disease management can achieve when systems, protocols, training, and follow-up are put in place.

The next step should not simply be to reproduce separate disease programs at primary care level. Multimorbidity creates a stronger case for integrated chronic care: longitudinal records, coordinated referrals and back-referrals, medication reconciliation, risk-factor and lifestyle assessment, functional assessment when appropriate, shared decision-making, and clear responsibility for who coordinates the overall plan. Lifestyle Medicine can contribute to such a model, but it should be integrated into healthcare rather than constructed as a parallel system.

The Vietnamese context matters

Lifestyle recommendations only work when people can realistically act on them. Advice to eat differently, exercise more, or improve sleep may be scientifically reasonable but difficult to implement for someone working long hours, caring for dependent family members, living with financial constraints, or lacking safe and convenient opportunities for physical activity.

Food culture is particularly important. Evidence-based nutrition in Viet Nam should not mean replacing Vietnamese food with a foreign “Lifestyle Medicine diet.” It should mean applying sound nutritional principles within Vietnamese meals, ingredients, regional traditions, household budgets, and family eating patterns. The same applies to physical activity. Walking, cycling, resistance exercise, rehabilitation, tai chi, occupational activity, and structured exercise may all have different roles depending on age, disease, function, preference, and local circumstances.

Social relationships also have a distinct local context. Family can be a major source of support, but it can also influence food choices, caregiving burden, healthcare decisions, and the feasibility of behavior change. Effective Lifestyle Medicine therefore needs to work with the person's social environment rather than treating lifestyle as a series of isolated individual choices.

Policy creates opportunity, but professional boundaries remain

Viet Nam's policy environment is placing greater emphasis on prevention. The Law on Disease Prevention No. 114/2025/QH15 was adopted on 10 December 2025 and took effect on 1 July 2026. It provides a stronger statutory context for prevention, early detection, risk-factor management, and the prevention and management of noncommunicable diseases.

This does not create a separate legal category of clinical practice called “Lifestyle Medicine,” nor does it authorize a person or organization to diagnose or treat disease outside existing professional requirements. When Lifestyle Medicine interventions form part of medical examination or treatment in Viet Nam, practitioners and healthcare facilities remain subject to the Law on Medical Examination and Treatment and its implementing regulations.

The current consolidated Law on Medical Examination and Treatment is Consolidated Document No. 26/VBHN-VPQH dated 26 February 2026. Relevant implementation also includes Decree No. 96/2023/ND-CP and Circular No. 32/2023/TT-BYT, as amended and supplemented. Circular No. 25/2026/TT-BYT, issued on 30 June 2026 and effective from 15 August 2026, made further amendments to Circular No. 32/2023/TT-BYT and other health-sector regulations. Evidence-based Lifestyle Medicine should therefore strengthen appropriate medical care, not bypass professional scope, licensing, facility requirements, referral responsibilities, or clinical governance.

What could this look like in practice?

A multimorbidity-oriented Lifestyle Medicine approach does not necessarily require a new specialty clinic or a complicated new pathway. It can begin with a more integrated consultation. What conditions does the person have? Which carry the greatest risk or create the greatest burden? What medicines and supplements are they taking? What matters most to them? Which lifestyle factors influence several of their conditions? Are frailty, pain, sleep problems, mental health, nutritional vulnerability, or social needs being missed? Who is responsible for coordinating the overall plan?

From there, the care team can agree on a limited number of priorities, define outcomes that matter to the patient as well as clinical outcomes, and review the plan over time. A physician may coordinate medical treatment. A dietitian may address nutrition. A physiotherapist, rehabilitation professional, or appropriately qualified exercise professional may support safe movement and function. A pharmacist may contribute to medication review. Mental health professionals may be needed for depression, anxiety, substance use, or other concerns. Family members and community resources may also play important roles. What matters is not how many professionals are involved, but whether the person receives one coherent plan rather than several disconnected plans.

Moving from diseases to people

Multimorbidity exposes an important limitation of modern healthcare. Medicine has become very good at organizing knowledge around diseases, while patients experience all of their conditions, treatments, symptoms, relationships, and daily responsibilities at the same time.

Lifestyle Medicine will not solve multimorbidity on its own. Evidence-based medicines, procedures, rehabilitation, and specialist care should not be replaced simply because an intervention is described as “lifestyle.” Current evidence for multimorbidity-specific interventions remains incomplete, and Viet Nam needs substantially more research on multimorbidity, treatment burden, function, implementation, and outcomes.

But Lifestyle Medicine can make a useful contribution. It can help identify common modifiable factors across conditions, bring behavior and everyday life more fully into clinical care, support shared decision-making, and encourage healthcare teams to consider health and function across the whole person rather than treating each diagnosis as an isolated problem.

For Viet Nam, where population aging, noncommunicable disease, primary care reform, and a stronger national focus on prevention are converging, that shift is becoming increasingly relevant. The question is no longer only, “How should we treat each disease?” It is also, “How can we help this person live better with everything they have?”

Selected references

1. World Health Organization. Viet Nam unites to tackle top causes of disease and death. 15 December 2025.

2. General Statistics Office of Viet Nam. Results of the 2024 Population and Housing Mid-term Census. 2025.

3. Ha NT, Le NH, Khanal V, Moorin R. Multimorbidity and its social determinants among older people in southern provinces, Vietnam. International Journal for Equity in Health. 2015;14:50. doi:10.1186/s12939-015-0177-8.

4. Pham Duy Quang. Prevalence and factors associated with frailty using the Clinical Frailty Scale among community-dwelling older adults in Ho Chi Minh City. Vietnam Journal of Community Medicine. 2026;66(English Version No. 2):307-312. doi:10.52163/yhc.v66i8.4079.

5. National Institute for Health and Care Excellence. Multimorbidity: Clinical Assessment and Management. NICE Guideline NG56.

6. Rea BL, Cheema S, Lanza S, et al. Lifestyle Medicine Core Competencies: 2025 Update. American Journal of Lifestyle Medicine. 2026;20(3):443-451. doi:10.1177/15598276251379821.

7. Lim YW, Al-Busaidi IS, Caya R, et al. Effectiveness of interventions for the management of multimorbidity in primary care and community settings: systematic review and meta-analysis. Family Practice. 2025;42(6):cmaf085. doi:10.1093/fampra/cmaf085.

8. Pagan E, Okoye C, Cuffaro L, et al. Effects of multidomain interventions on health outcomes in older adults: a systematic review and meta-analysis. The Journal of Nutrition, Health and Aging. 2026;30(6):100865. doi:10.1016/j.jnha.2026.100865.

9. Rosenfeld RM, Grega ML, Karlsen MC, et al. Lifestyle Interventions for Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults: A Clinical Practice Guideline From the American College of Lifestyle Medicine. American Journal of Lifestyle Medicine. 2025;19(2 Suppl):10S-131S. doi:10.1177/15598276251325488.

10. World Health Organization Regional Office for the Western Pacific. Primary Health Care in Viet Nam: A Review of the Commune Health System. 2025.

11. World Health Organization. Strengthened grassroots health care brings NCD services to 10 million in Viet Nam. 8 September 2026; and Donors Making a Difference. 10 September 2026.

12. National Assembly of Viet Nam. Law on Disease Prevention No. 114/2025/QH15. Adopted 10 December 2025; effective 1 July 2026.

13. Office of the National Assembly of Viet Nam. Consolidated Document No. 26/VBHN-VPQH: Law on Medical Examination and Treatment. 26 February 2026.

14. Government of Viet Nam. Decree No. 96/2023/ND-CP detailing a number of provisions of the Law on Medical Examination and Treatment. Effective 1 January 2024.

15. Ministry of Health of Viet Nam. Circular No. 32/2023/TT-BYT, as amended and supplemented, including by Circular No. 25/2026/TT-BYT dated 30 June 2026, effective 15 August 2026.

This article is intended for professional education and general information. It does not replace individualized clinical assessment, applicable clinical practice guidelines, professional scope-of-practice requirements, institutional requirements, or Vietnamese law.

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