Lifestyle medicine

Lifestyle medicine (LM) is a branch of medicine focused on preventive healthcare and self-care dealing with prevention, research, education, and treatment of disorders caused by lifestyle factors and preventable causes of death such as nutrition, physical inactivity, chronic stress, and self-destructive behaviors including the consumption of tobacco products and drug or alcohol abuse.[1] The goal of LM is to improve individuals' health and wellbeing by applying the 6 pillars of lifestyle medicine (nutrition, regular physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connection) to prevent chronic conditions such as cardiovascular diseases, diabetes, metabolic syndrome and obesity.[1][2] By focusing on these 6 areas to improve health, LM can prevent 80% of chronic illnesses and non-communicable diseases (NCD).[3]

Lifestyle Medicine
The focus of Lifestyle Medicine is on these 6 pillars.
Focusnutrition, sleep, physical activity, stress management, tobacco/alcohol cessation, and healthy relationships..
Significant diseases
SpecialistLifestyle medicine physician

Lifestyle medicine focuses on educating and motivating patients to improve the quality of their lives by changing personal habits and behaviors around the use of healthier diets which minimize ultra-processed foods such as a Mediterranean diet or whole food, plant-predominant dietary patterns. Poor lifestyle choices like dietary patterns, physical inactivity, tobacco use, alcohol addiction and dependence, drug addiction and dependence, as well as psychosocial factors, e.g. chronic stress and lack of social support and community, contribute to chronic disease.[1][4][5] In the clinic, major barriers to lifestyle counseling are that physicians feel ill-prepared and are skeptical about their patients' receptivity.[6] However, by encouraging healthy decisions, illnesses can be better managed, reversed, or prevented in the long term.

Characteristics

Lifestyle Medicine in Practice

The evidence that the body will heal itself when the factors that cause disease are removed is clear.[7][8] Diseases such as cardiovascular disease and type 2 diabetes that were once thought to be irreversible have been reversed by lifestyle interventions.[9][10][11] Lifestyle interventions require behavior changes that may be challenging for health professionals, communities, and patients. The task of the LM practitioner is to motivate and support healthy behavior changes through evidence-based holistic approaches to prevent and reverse chronic conditions. LM emphasizes personalized care and uses patient-centered approaches such as goal-setting, shared decision-making, and self-management. Coaching patients how to cook healthy food at home, for example, can be part of a lifestyle-oriented medical practice.[12] Focusing on the health needs of an individual includes looking at the person's social and economic needs, as well.

LM uses behavioral science to equip and encourage patients to make lifestyle changes. There are many theories of behavior change; the transtheoretical model is particularly suited to lifestyle medicine. It posits that individuals progress through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination.[13][14] Stage-matched interventions are most likely to result in successful behavior changes. LM practitioners are encouraged to adopt counseling methods such as motivational interviewing (MI) to identify patient readiness to change and provide stage appropriate lifestyle interventions.[15] These skills have shown to be more effective than giving advice like "Exercise more and eat healthy".[16] LM physicians provide the tools and resources necessary to empower people to manage their own healthcare and give them the confidence to live a healthy life.

LM is similar to preventive medicine in that it also bridges the gap between conventional medicine and public health. LM interventions such as behavioral change counseling are used in adjunct with pharmacotherapy.[17] Like all of medicine, LM promotes healthy lifestyle choices to prevent and treat diseases. Overall wellness and self-management are a crucial components of lifestyle medicine and enforce the idea of living healthier through behavioral change. Health promotion is the foundation of LM and encourages individuals to participate in their own care and well-being.[18]

Levels of Lifestyle Medicine

LM may be practiced on three levels. The first level involves recognition by all healthcare professionals that lifestyle choices determine health status and are important modifiers of the response to pharmaceutical and/or surgical treatments. All practitioners are encouraged to include lifestyle advice along with standard treatment protocols. The second level is specialty care (e.g., Exercise medicine and Physiatry) in which LM interventions are the focus of treatment and pharmaceutical and/or surgical treatments are an adjunct to be used as necessary.[19] The third level is population/community health programs and policies. Lifestyle intervention advice should be included in public health/preventive medicine guidance and policies for the prevention and treatment of chronic diseases.[20]

Interprofessional Education/Collaboration in Lifestyle Medicine Practice

Healthcare professionals and their future patients would benefit if the basics of LM were incorporated into all professional training programs. Formal training and personal experience of evidence-based lifestyle interventions such as plant-based nutrition, stress management, physical activity, sleep management, relationship skills, and substance abuse mitigation would transform the American healthcare system. LM is uniquely suited to interprofessional education in which students from two or more healthcare professions learn together during professional training with the objective of cultivating collaborative practice of patient-centered care.[21][22][23][24] Physicians and other healthcare providers should feel comfortable talking with their patient about behavioral lifestyle changes and assessing needs in determinants of health. Engaging patients in these conversations can better help them achieve their lifestyle and healthcare goals.

There are many educational pathways to becoming an expert in LM. Physicians can become certified or accredited from the International Board of Lifestyle Medicine (IBLM), American Board of Lifestyle Medicine (ABLM), and British Society of Lifestyle Medicine (BSLM).[25][26][27][28][29] The Lifestyle Medicine Global Alliance (LMGA) is an organization that connects LM professionals from nations around the world to collaborate, share resources, and create solutions to preventing and reversing non-communicable and chronic diseases.[30]

See also

References
  1. Mechanick, Jeffrey I.; Kushner, Robert F., eds. (2016). "The Importance of Healthy Living and Defining Lifestyle Medicine". Lifestyle Medicine: A Manual for Clinical Practice. Cham, Switzerland: Springer Nature. pp. 9–15. doi:10.1007/978-3-319-24687-1. ISBN 978-3-319-24685-7. S2CID 29205050.
  2. Lifestyle Medicine. Wiley. doi:10.1002/(issn)2688-3740.
  3. Katz, David L.; Frates, Elizabeth P.; Bonnet, Jonathan P.; Gupta, Sanjay K.; Vartiainen, Erkki; Carmona, Richard H. (July 2018). "Lifestyle as Medicine: The Case for a True Health Initiative". American Journal of Health Promotion. 32 (6): 1452–1458. doi:10.1177/0890117117705949. ISSN 0890-1171.
  4. Kvaavik, Elisabeth (April 2010). "Influence of Individual and Combined Health Behaviors on Total and Cause-Specific Mortality in Men and Women: The United Kingdom Health and Lifestyle Survey". JAMA Internal Medicine. 170 (8): 711–8. doi:10.1001/archinternmed.2010.76. hdl:10536/DRO/DU:30131641. PMID 20421558. Retrieved 7 July 2015.
  5. Sagner, Michael (October 2014). "Lifestyle medicine potential for reversing a world of chronic disease epidemics: from cell to community". International Journal of Clinical Practice. 68 (11): 1289–1292. doi:10.1111/ijcp.12509. PMID 25348380.
  6. Hivert, Marie-France; Arena, Ross; Forman, Daniel E.; Kris-Etherton, Penny M.; McBride, Patrick E.; Pate, Russell R.; Spring, Bonnie; Trilk, Jennifer; Horn, Linda V. Van; Kraus, William E.; Health, On behalf of the American Heart Association Physical Activity Committee of the Council on Lifestyle and Cardiometabolic; the Behavior Change Committee, a joint committee of the Council on Lifestyle and Cardiometabolic Health and the Council on Epidemiology and Prevention; the Exercise, Cardiac Rehabilitation; Nursing, and the Council on Cardiovascular and Stroke (1 January 2016). "Medical Training to Achieve Competency in Lifestyle Counseling: An Essential Foundation for Prevention and Treatment of Cardiovascular Diseases and Other Chronic Medical Conditions: A Scientific Statement From the American Heart Association". Circulation. 134 (15): e308–e327. doi:10.1161/CIR.0000000000000442. ISSN 0009-7322. PMID 27601568. S2CID 7847964.
  7. Esselstyn, Caldwell B. (2017-05-28). "A plant-based diet and coronary artery disease: a mandate for effective therapy". Journal of Geriatric Cardiology. 14 (5): 317–320. doi:10.11909/j.issn.1671-5411.2017.05.004. PMC 5466936. PMID 28630609.
  8. Ornish, D.; Brown, S.E.; Billings, J.H.; Scherwitz, L.W.; Armstrong, W.T.; Ports, T.A.; McLanahan, S.M.; Kirkeeide, R.L.; Gould, K.L.; Brand, R.J. (July 1990). "Can lifestyle changes reverse coronary heart disease?". The Lancet. 336 (8708): 129–133. doi:10.1016/0140-6736(90)91656-U. PMID 1973470. S2CID 4513736.
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  10. Davis, Brenda C.; Jamshed, Humaira; Peterson, Courtney M.; Sabaté, Joan; Harris, Ralph D.; Koratkar, Rohit; Spence, Jamie W.; Kelly, John H. (2019-06-05). "An Intensive Lifestyle Intervention to Treat Type 2 Diabetes in the Republic of the Marshall Islands: Protocol for a Randomized Controlled Trial". Frontiers in Nutrition. 6: 79. doi:10.3389/fnut.2019.00079. ISSN 2296-861X. PMC 6560078. PMID 31231656.
  11. Sandefur, Kelsea; Kahleova, Hana; Desmond, Alan N.; Elfrink, Eden; Barnard, Neal D. (2019-06-20). "Crohn's Disease Remission with a Plant-Based Diet: A Case Report". Nutrients. 11 (6): 1385. doi:10.3390/nu11061385. ISSN 2072-6643. PMC 6628285. PMID 31226766.
  12. Polak, R; Phillips, EM; Nordgren, J; La Puma, J; La Barba, J; Cucuzzella, M; Graham, R; Harlan, TS; Burg, T; Eisenberg, D (January 2016). "Health-related Culinary Education: A Summary of Representative Emerging Programs for Health Professionals and Patients". Global Advances in Health and Medicine. 5 (1): 61–8. doi:10.7453/gahmj.2015.128. PMC 4756781. PMID 26937315.
  13. Prochaska, James O.; Velicer, Wayne F. (September 1997). "The Transtheoretical Model of Health Behavior Change". American Journal of Health Promotion. 12 (1): 38–48. doi:10.4278/0890-1171-12.1.38. ISSN 0890-1171. PMID 10170434. S2CID 46879746.
  14. Norcross, John C.; Krebs, Paul M.; Prochaska, James O. (February 2011). "Stages of change". Journal of Clinical Psychology. 67 (2): 143–154. doi:10.1002/jclp.20758. PMID 21157930.
  15. Resnicow, Ken; McMaster, Fiona (2012). "Motivational Interviewing: moving from why to how with autonomy support". International Journal of Behavioral Nutrition and Physical Activity. 9 (1): 19. doi:10.1186/1479-5868-9-19. ISSN 1479-5868. PMC 3330017. PMID 22385702.
  16. "What is Lifestyle Medicine? - Find Out From British Society of Lifestyle Medicine". British Society of Lifestyle Medicine. Retrieved 2023-03-13.
  17. "What is Lifestyle Medicine? - The European Lifestyle Medicine Organization". www.eulm.org (in Greek). Retrieved 2023-03-22.
  18. Yeh, Byung-Il; Kong, In Deok (March 2013). "The Advent of Lifestyle Medicine". Journal of Lifestyle Medicine. 3 (1): 1–8. ISSN 2234-8549. PMC 4390753. PMID 26064831.
  19. Phillips, Edward M.; Frates, Elizabeth P.; Park, David J. (2020-11-01). "Lifestyle Medicine". Physical Medicine and Rehabilitation Clinics of North America. Integrative Medicine and Rehabilitation. 31 (4): 515–526. doi:10.1016/j.pmr.2020.07.006. ISSN 1047-9651.
  20. Lianov, Liana (2010-07-14). "Physician Competencies for Prescribing Lifestyle Medicine". JAMA. 304 (2): 202–3. doi:10.1001/jama.2010.903. ISSN 0098-7484. PMID 20628134.
  21. Urkin, Jacob; Merrick, Joav (March 2008). "The Principles and Framework for Interdisciplinary Collaboration in Primary Health Care". Journal of Policy and Practice in Intellectual Disabilities. 5 (1): 75. doi:10.1111/j.1741-1130.2007.00144.x. ISSN 1741-1122.
  22. Dow, Alan W.; DiazGranados, Deborah; Mazmanian, Paul E.; Retchin, Sheldon M. (July 2013). "Applying Organizational Science to Health Care: A Framework for Collaborative Practice". Academic Medicine. 88 (7): 952–957. doi:10.1097/ACM.0b013e31829523d1. ISSN 1040-2446. PMC 3695060. PMID 23702530.
  23. Meleis, Afaf I. (January 2016). "Interprofessional Education: A Summary of Reports and Barriers to Recommendations: Interprofessional Education". Journal of Nursing Scholarship. 48 (1): 106–112. doi:10.1111/jnu.12184. PMID 26642299.
  24. Godin, Isabelle; Kittel, France; Coppieters, Yves; Siegrist, Johannes (December 2005). "A prospective study of cumulative job stress in relation to mental health". BMC Public Health. 5 (1): 67. doi:10.1186/1471-2458-5-67. ISSN 1471-2458. PMC 1177967. PMID 15958170.
  25. "Home". American Board of Lifestyle Medicine. Retrieved 2023-03-15.
  26. "Core Accreditation". British Society of Lifestyle Medicine. Retrieved 2023-03-15.
  27. "Certification". American College of Lifestyle Medicine. Retrieved 2023-03-15.
  28. "Board Certification". Australasian Society of Lifestyle Medicine. Retrieved 2023-03-15.
  29. "Lifestyle Medicine Certification". International Board of Lifestyle Medicine. Retrieved 2023-03-15.
  30. "Lifestyle Medicine Global Alliance - About the Global Alliance". Lifestyle Medicine Global Alliance. 2016-04-19. Retrieved 2023-03-15.

Further reading
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