Healthy Communities

of chronic disease. The burden of chronic disease is growing in our society and is overwhelming our healthcare economy. Ninety percent of healthcare costs can be attributed to the treatment of chronic conditions. A western diet that is high in sodium, high in processed meats, and low in vegetables is the leading cause of chronic disease and disability in the United States.

Incorporating lifestyle medicine principles into practice can reduce the need for costly interventions and slow progression of disease — which will lead to a decreased reliance on prescription drugs and medical procedures. Since most modern diseases are caused by lifestyle factors, lifestyle changes can be part of the cure and serve as a fundamental philosophy to prevent disease.

pillars.

• A whole-food, plant-rich diet,

• Physical activity,

• Restorative sleep,

• Stress management,

• Avoidance of risky substances, and

• Positive social connections

Through a process that support the fundamentals of healthy behavior change, lifestyle medicine practitioners collaborate with their patients to identify ways to enhance these pillars of well-being in a way that is relevant and sustainable for the individual.

Research Supporting Lifestyle Medicine’s Benefits

The evidence for lifestyle medicine is growing as is our knowledge of the physiologic and genetic changes that can result with the adoption of a healthy lifestyle. The sentinel study that identified healthy lifestyle change as a viable treatment recommendation was the “Lifestyle Heart Trial.” That small study in 1998 of 48 participants concluded that comprehensive lifestyle change in individuals with moderate to severe heart disease lowered LDL, reduced angina episodes, and resulted in regression of coronary atherosclerosis. Published in 2004, a Percutaneous Coronary Angioplasty vs Exercise Training study demonstrated that 20 minutes of stationary bicycling per day increased event-free survival, reduced hospital readmissions, and improved exercise capacity in those with coronary artery disease. The 2002 landmark study conducted by the Diabetes Prevention Program research group demonstrated, through a randomized control trial including 3,234 participants with prediabetes, that lifestyle intervention was more effective than metformin in decreasing the progression to diabetes. A possible explanation for how lifestyle changes impact physiologic change was offered in the GEMINAL study in 2008, which demonstrated that intensive nutrition and lifestyle changes may modulate the gene expression in the prostate. Other studies are looking at how healthy diet, physical activity, and meditation affect telomere length, expression of GLP-1, ghrelin, BDNF, and other gut and neuro hormones. This is a fascinating area of research that will help us further understand how lifestyle factors affect our biochemistry, physiology, and gene expression and impact our physical health and mental well-being.

The Lifestyle Medicine Practitioner: Patient Engagement, Challenges, and Education

Lifestyle medicine practitioners are trained in the spirit of motivational interviewing, using positive psychology to support individuals in setting individualized health goals. Often health coaches, nutritionists, behaviorists, or exercises coaches are part of the team that helps to support healthy behavior change. This intervention can be delivered through individual encounters or through shared medical appointments during which providers see multiple patients simultaneously in a group setting. The advantages of the group setting for patients are many — lifestyle education, improved access to care, emotional support, more time with healthcare teams, and interpatient camaraderie. Shared medical appointments offer efficiency, increased patient capacity, and opportunities for lifestyle medicine interventions. Reimbursement models are emerging to allow for the coding and billing of group improvements. The American College of Lifestyle Medicine and the American Academy of Family Practice offer guidance for the development of group visits.

The challenges of instituting lifestyle changes are many which include not only individual factors (such as financial cost, time limitations, work stress, and lack of support) but also wider socioenvironmental factors (such as easy access to high-salt, high-sugar foods, limited insurance coverage for nutrition education, marketing of unhealthy products, technologies that increase sedentary behaviors, and social norms that make it difficult to sustain healthy behaviors). Systemic change is needed.

Huge health and economic benefits could be achieved through healthy lifestyle changes. There is abundant evidence that lifestyle interventions can lead to reductions in obesity, diabetes, and cardiovascular disease. These initiatives should be supported with a systems approach in a new ecosystem that truly supports lifestyle intervention as first line therapy. Sustainable behavioral change requires a healthy environment that includes availability of healthy foods, access to safe areas for physical activity, strategies to reduce stress, improved social connections, and avoidance of risky substances. Providers should integrate the use of technology and health coaches to personalize care.

The American College of Lifestyle Medicine, in conjunction with the White House Conference on Hunger, Nutrition, and Health, is offering free CME/CE to health care professionals, introducing them to lifestyle medicine, a powerful treatment tool for chronic disease. You are invited to access the training via the link below to learn more about Lifestyle Medicine, which encourages us to “eat plants, keep moving, sleep well, be present, stay calm, and love people.” portal.lifestylemedicine.org/ACLM/ Education/Campaigns/White-House/ WHconference-SignIn.aspx

The course bundle offers 5.5 hours of content: CME/CNE/CPE/CE/MOC

• Introduction to Lifestyle Medicine module (1 hr)

• Food as Medicine: Nutrition for Prevention and Longevity module (3 hrs)

• Food as Medicine: Nutrition for Treatment and Risk Reduction module (1.5 hrs)