PRACTICE SPOTLIGHT:
David L. Katz, MD, MPH, FACPM, FACP
Leading authority on lifestyle and health, Dr. David Katz has practiced Lifestyle Medicine from the beginning. A prominent voice in medical media, Dr. Katz serves as an expert source for Health, Prevention, Men's Health, and O, The Oprah Magazine among other popular magazines and news sources. He’s published over 100 scientific papers, numerous textbook chapters, nearly a thousand newspaper columns, and twelve books to date. And these represent only a fraction of his many accomplishments.
Board certified in Internal Medicine and Preventive Medicine/Public Health, Dr. Katz is the Founding Director of Yale University's Prevention Research Center; Director and Founder of the Integrative Medicine Center at Griffin Hospital; Founder and President of the non-profit Turn the Tide Foundation; Editor-in-chief of Childhood Obesity; Principal Inventor of the Overall Nutritional Quality Index; Medical Director of Weigh Forward; Associate Professor (adjunct) in Public Health Practice, and former Director of Medical Studies in Public Health at the Yale University School of Medicine. Dr. Katz helped develop and found one of the nation's first combined residency training programs in Internal Medicine and Preventive Medicine, serving formerly as the program’s director. He's been nominated for the position of U.S. Surgeon General to the Obama Administration by the American College of Physicians, the American College of Preventive Medicine, and the Center for Science in the Public Interest, among other national and international health organizations. Well-known for his work in nutrition, weight management, lifestyle and chronic disease, he’s also a renowned authority on integrative medicine and patient-centered care.
His medical practice, designed to build patient engagement and foster healthy lifestyles, combines the best of internal medicine, evidence-based integrative medicine, and lifestyle medicine. “This is really about building health at its origin.” He maintains that "lifestyle is the most potent medicine we have", and says, “I have abiding respect for the general power and occasional marvels of modern medicine. But nothing we do with pills and procedures, syringes and scalpels is about the nurturing of health, however effective it may be at arresting the progression of disease. The path to vitality, does not begin and may not even run through the CCU, ICU, clinic, OR and ER where ‘health care’ is rendered. True vitality is pretty good at avoiding just such places.”
He asserts that health care would more accurately be referred to as disease care, and that prevention viewed through the lens of healthcare generally refers to clinical preventive services, such as cancer screenings. "As valuable as screening is, it does not prevent cancer outright- it finds it early. Finding cancer early is better than finding it late - and underutilization of services such as mammography and colonoscopy comes at a tragic cost in lives. But not getting cancer at all is far better than finding it early - and lifestyle change offers the power of that very outcome.”
Recognizing lifestyle as a powerful tool for prevention, he offers his short list of behaviors that influence health: feet, forks, fingers, sleep, stress, and love, referring to the first three as the ‘master levers’ of medical destiny. Decades of research implicate lack of exercise (feet), overeating and less than optimal food choices (forks), and tobacco use (fingers) as leading causes of premature death and chronic disease. Dr. Katz maintains that were we to fully apply what we know about lifestyle, "we could reduce heart disease rates by up to 80%; diabetes by 90%; and cancer by between 30% and 60%, with similarly stunning advances across a range of other conditions". But, he argues, we must first translate what we know into action. "We must move from our narrow vision of health care to a prevention-oriented system that is truly about the cultivation of health at its source.”
Ideally, he maintains, providers must be lifestyle advocates. “Even in a more conventional practice, my mission would still be to keep people as healthy as possible.” He offers his own approach to dealing with the reality of multiple and complex co-morbidities, describing as an example, a socially isolated patient who is overweight and experiencing weight-related joint problems that cause pain and subsequently lead to poor sleep. He argues that providers "cannot fix this cascade of problems in one fell swoop” offering an image of the spiral staircase that must be climbed one step at a time. “The top may hold the promise of perfect health and vitality, but we must still begin at the first step.” In his own practice, he asks, ‘What is the first thing we can do to help you feel better?’ And he offers advice to clinicians on the sequence of interventions, understanding that foundational steps might be needed for lifestyle change to occur. "It may be that managing pain is the most important step, allowing the patient to sleep better. This first step is critical because pain erodes the will needed to make changes in one’s lifestyle. As the physician, you can then take what you gain and invest it back into the patient; you can now work on both pain and sleep management. And you can begin to transition from more toxic to less toxic treatments for pain…and then perhaps to walking, or seated exercise, or exercising in a pool." He goes on to describe that patients can then begin to invest back into themselves with resources in place to begin working toward increased activity, improved diet, and weight loss. Dr. Katz is currently at work on a paper detailing the progression of treatment, combining conventional with integrative and lifestyle-based approaches.
Dr. Katz acknowledges the challenges of cultivating health within the confines of a three-minute medical visit. He points to the need for provider training and tools, viewing the ACLM (he himself is a member and self-described fan) as a key player in this arena: guiding and supporting providers in moving from knowledge to application. Recognizing the need for tools, Dr. Katz has developed a CME program entitled Online Weight Management Counseling for Healthcare Providers, or the O.W.C.H. program. The training modules focus on the essentials of lifestyle counseling in primary care and present a standardized approach to lifestyle counseling, including the rationale for lifestyle and weight management counseling, lifestyle practices for promoting health, behavior change models, and case studies that demonstrate the applicability of the program and its tools.
Yet even with the best of tools, Dr. Katz points out that, “Health is not exclusively, and perhaps not even preferentially, the province of the health care provider. Lifestyle Medicine needs to play out in settings other than health care. What we do with our feet and forks each day has much more to do with the origins of health than anything anyone does with a stethoscope. We as providers need to endorse the power of lifestyle but this is far too heavy a burden to see as a clinical job.”
Considering it essential to differentiate between the roles of provider, patient, and society, he states, “Ultimately, society must dispense this medicine. We as providers are not particularly well-suited to be the dispensary.” He describes that while the provider can point out the way, the individual patient must walk the walk, and society must "pave the way, enacting policies, programs, and practices that immerse individuals in healthy living”. He asserts that once the support of society is in place, individuals must then take responsibility for their own health. “No one is going to carry you there. We each must own our own health."
Dr. Katz urges Lifestyle Medicine practitioners to commit themselves to building a healthier society, maintaining that everyone is either part of the solution or part of the problem. “It’s imperative that clinicians be part of the solution. But we cannot be the entire solution because health at its source is not primarily a clinical issue. Minimally, we must be looking to society to encourage and identify solutions. Maximally, we need to be involved in development of programs and policies, to recognize that this is a medicine that society needs to be dispensing. Until society supports healthy behaviors, we need to give the message that our patients may find themselves disempowered by an unfriendly environment."
He urges providers to communicate the power of lifestyle. “We need to be expressing that lifestyle is medicine; a medicine that the patient is in charge of. We’re handing over the reins to the patient, which requires a certain level of humility.” He stresses that the patient’s convictions are what ultimately matter and challenges providers to ask of their patients, “What are your priorities? Do you cultivate your vitality with physical activity? What do you eat every day?" And to convey to patients, 'The power over your health is in YOUR hands, not mine. How are you using that power?"
Article by Kathleen Jones, MA
American College of Lifestyle Medicine
ACLM Disclaimer: Our Practice Spotlights are intended to provide examples of Lifestyle Medicine in practice.
We recognize that Lifestyle Medicine practices vary widely, and inclusion in Practice Spotlight is not intended
to imply official endorsement of individuals or practices.
