Its A New Day In Health Care:  Doctors To Be Competent In Lifestyle Medicine

For the first time doctors have outlined defined areas for competency in the new field of "Lifestyle Medicine", using nutrition, counseling, exercise, and addressing other causative factors as the basis of treatment.  For the first time the Journal of the American Medical Association (JAMA) has published an article on “Lifestyle Medicine.” And for the first time, top level representatives from all the primary care specialties, the AMA, and other professional medical organizations have collaborated to produce consensus in recommended physician skills to address the causes of most medical problems in America today.

The July 14, 2010 issue of JAMA carried the result of a two year project initiated by the American College of Lifestyle Medicine (ACLM), a national professional membership association, to begin establishing standards in the newly defined field of Lifestyle Medicine.  The American College of Preventive Medicine (ACPM) led out in the organization and management of the project.  The publication, entitled “Physician Competencies for Prescribing Lifestyle Medicine,” is a set of recommended competencies for all physicians in addressing the lifestyle causes and treatments for most medical problems in modern society. These recommended competencies are the consensus product of a blue ribbon panel composed of top level representatives from the American Medical Association (AMA), the American Osteopathic Association (AOA), the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), the American Academy of Pediatrics (AAP), ACPM, ACLM, and individual national experts in nutrition, exercise, and Lifestyle Medicine that convened in Washington DC, July 2009.

This list is intended to provide a minimum guideline for all physicians, and especially primary care physicians. Guidelines for Lifestyle Medicine Specialists are under development.

Mark Johnson, MD, MPH, FACPM, current President of the American College of Preventive Medicine (ACPM) and co-author of the published recommendations had the following to say: "This is a landmark event. The principles of lifestyle medicine are foundational to health promotion, disease prevention and chronic disease management. Yet we believe this is the first time that a comprehensive group of physician stakeholders has met to determine what it is that physicians in primary care practice should know about this vital aspect of modern medicine."

"The JAMA article marks a turning point toward a more proactive, health promoting health care system. Lifestyle medicine is in alignment with the Affordable Care Act and directly addresses the predominant causes of death, disease and health care costs," says Edward Phillips, MD, Director of the Harvard-affiliated Institute of Lifestyle Medicine, member of ACLM’s Advisory Board, and member of the Blue Ribbon Panel producing the recommendations.  Phillips has also been a key player in the American College of Sports Medicine’s (ACSM) “Exercise is Medicine” initiative, which promotes treating physical activity as a vital sign and prescribing exercise as treatment.  He is co-author of ACSM’s book by the same title.

Physicians have known for years that they should recommend things like cutting down on salt for patients with high blood pressure, or making dietary changes for high cholesterol.  However, doctors typically receive little to no training in nutrition, exercise, stress management, sleep issues, and other lifestyle factors that modern science increasingly demonstrates to be the cause of most medical problems.  They also have no training in how to engage patients for positive change.  This problem is compounded by the fact that they are forced to see ever increasing numbers of patients, leaving them no time to effectively engage patients for lifestyle changes even if they did know how.  They only have time to write more prescriptions to try to slow down the problems caused by the disease-causing lifestyle factors.

“Our current system doesn’t have health care providers dealing effectively with the causes of most disease,” says Marc Braman, MD, MPH, current Executive Director and Immediate Past President of ACLM.  “The only way we will ever make any sense out of health care in America is if we actually reform the kind of care we provide at the most fundamental level by treating the cause instead of just the symptoms and consequences.  This is not rocket science.  Any 3rd grader gets this.  It’s just not what we are doing in our current collapsing system.”

And he and other physicians and health care professionals are doing something about it.  They are developing this new field through the national professional association known as the American College of Lifestyle Medicine.  ACLM exists to define this field and this approach, and represent its members to advance the practice of Lifestyle Medicine.  Many of the leaders and pioneers in Lifestyle Medicine related fields of science are on their advisory board, and they have big plans to be a positive force in healthcare going forward.

"While a core base foundation for the future is set, this is just the beginning,” said Liana Lianov, MD, MPH, FACPM, co-author of the publication and ACLM’s President-Elect.  Lianov should know.  She has been pursuing Lifestyle Medicine for many years, including time as Director of the Healthy Lifestyle Division at the AMA, and as Chair of the ACPM Lifestyle Medicine Task Force.  She is very clear that there is a lot of work ahead to make health care what it should be.

While there remains much to be done, none of those involved in the new field of Lifestyle Medicine are discouraged.  On the contrary, they are quite energized and excited.  They feel that the time has come for Lifestyle Medicine. ACLM is increasingly receiving requests for  books from major medical publishers, endorsements for scientific journals, and even requests from medical schools in other parts of the world to help them teach and practice Lifestyle Medicine.  Health care is changing - in this case definitely for the better.

It is indeed a new day in health care.  And the future is looking very bright.

Special thanks to competencies publication author LIana Lianov, whose interview served as the basis for this article. Funding for the development of the competencies was provided by The Lifestyle Center of America and Proctor & Gamble.  For further information about Lifestyle Medicine, contact ACLM (www.lifestylemedicine.org ).