President's Desk, February 2014
Liana Lianov, MD, MPH, FACPM
Hello Fellow ACLM Members! In late February I will be completing my term as ACLM president. It has been an honor and a privilege to serve in this capacity and to work with such a passionate group of colleagues. It is this dedication and passion that has boosted the organization’s success. Our membership continues to grow steadily and we are on track for another successful conference this fall. ACLM leadership is continuing to work with leaders at the American College of Preventive Medicine, the Institute of Lifestyle Medicine, and others to develop a comprehensive training program in lifestyle medicine. Together with our partners we are developing a strategic plan for promoting lifestyle medicine across the spectrum of health care and creating demand for lifestyle medicine by the public.
We can turn around our nation’s health, economy and security through successful implementation of lifestyle medicine at the clinical level and partnership with public health to ensure environments supportive of health living. I envision even more growth and exciting developments for ACLM’s future as Dr. David Katz steps up to the presidency.
I dedicate this President’s Desk to providing a summary of the lifestyle medicine standards. These standards were developed by a special ACLM task force which Dr. Jennifer Rooke chaired in 2011-12 and were adopted by the ACLM membership adopted in 2013. A special thank you goes to the our administrative team Grace Stillar and Lisa Gregory for this summary.
Wishing all of you happiness and health. Hold steadfastly to your vision of wellness. Live your professional and personal lives expecting to make extraordinary accomplishments!
DEFINITION OF LIFESTYLE MEDICINE
Lifestyle Medicine (LM) is the use of evidence-based lifestyle interventions to treat and prevent lifestyle-related diseases in a clinical setting. It empowers individuals with the knowledge and life skills to make effective behavior changes that address the underlying causes of disease.
LEVELS OF LIFESTYLE MEDICINE PRACTICE
LM brings medical practice closer to its ideals by treating the underlying lifestyle causes of disease. LM may be practiced on two levels.
1. One level involves the recognition by all health care providers that lifestyle is a significant determinant of health and an important modifier of patient outcomes and responses to pharmaceutical or surgical treatments. At this level all physicians should use lifestyle interventions as an adjunct to their standard treatment protocols.
2. The second level is specialty care practiced by LM experts in which lifestyle interventions are the main focus of treatment, and pharmaceutical or surgical treatments are used an adjunct to treatment when necessary.
LIFESTYLE MEDICINE INTERVENTION GUIDELINES
Lifestyle medicine is based on scientific evidence that the body will heal itself when the factors which cause disease are removed. Diseases such as cardiovascular disease, diabetes, and Crohn’s disease, that were once thought to be irreversible, have been reversed by comprehensive lifestyle changes. The goal of a lifestyle medicine intervention is to replace unhealthy behaviors with behaviors that promote health. A wide variety of health promoting behaviors have been successfully used in the treatment of lifestyle diseases; but most lifestyle-related diseases benefit from lifestyle behavior changes. These include, but are not limited to:
- Optimum nutrition
- Physical activity
- Stress management
- Tobacco cessation
- Improved interpersonal relationships
Nutrition is an essential element of LM practice; it the underlying cause of many lifestyle diseases, and changing eating habits alone can reverse these lifestyle diseases. Nutrition is the most confusing and controversial area of LM for both healthcare professionals and patients. Eating behaviors are formed in childhood and determined not by conscious thought but by unconscious sociocultural norms, beliefs, and taste preferences. When new scientific evidence regarding health and diet conflicts with accepted beliefs, cognitive dissonance can result, and scientifically based recommendations can be rejected in favor of established behaviors. Awareness of the unconscious influences that sustain unhealthy eating habits is crucial for successful eating behavior changes among both healthcare professionals and their patients.
All patients should be given accurate nutrition information that is based on the most current scientific evidence, regardless of their gender, ethnic group, income status, education level or perceived readiness to change. The most current scientific evidence available supports the use of whole, unprocessed or minimally processed plant foods as treatment for most of the lifestyle related illnesses in our population.
Physical Activity Guidelines
Regular physical activity results in short and long-term health benefits and reduces the risk of adverse health outcomes. The health benefits of exercise apply to all age and social groups and to patients with chronic diseases and disabilities. The importance of physical activity is generally accepted by most healthcare professionals and advice to be physically active is often the only lifestyle advice that patients receive. Any lifestyle improvement advice given by health care professionals is valuable, but physical activity alone without dietary changes can be ineffective in improving outcomes for many patients. Cardiac rehabilitation programs that focus only on physical activity may improve patient quality of life, but they do not prevent restenosis of stented coronary arteries or subsequent cardiac events. Physical activity is most effective when it is prescribed as part of a comprehensive LM treatment program.
Stress Management Guidelines
Stress can defined as “any demand for change.” The stress response is a cascade of physiological events that can lead to improved health and productivity or to anxiety, depression, obesity, immune dysfunction and poor health outcomes. Assisting patients to recognize maladaptive stress responses and to adjust those responses can improve health and well-being and is an essential part of lifestyle medicine practice.
Lifestyle medicine practitioners should be knowledgeable about basic evidence-based stress management techniques that they can share with patients. Common evidence-based stress-management techniques include autogenic training/guided imagery, cognitive behavioral therapy (CBT), diaphragmatic breathing, meditation, and progressive muscle relaxation.
Tobacco Use Cessation Guidelines
In a lifestyle medicine practice, the tobacco use cessation method should be individualized to suit patient needs and preferences. Tobacco use cessation medications are contraindicated in certain groups such as pregnant women, smokeless tobacco users, light smokers, and adolescents. Tobacco use cessation counseling may be conducted in one-on-one sessions, in groups, or on telephone quit lines. Practical problem-solving skills training and social support are important components of tobacco use cessation counseling.
Lifestyle medicine practitioners should know how to safely prescribe tobacco cessation medications. Currently two types of cessation aids are available: nicotine-replacement products and non-nicotine medications. Tobacco use cessation treatment is an important part of lifestyle medicine treatment and may be offered alone or as part of a comprehensive lifestyle intervention program.
Interpersonal RelationshipsHelping patients to develop these skills should be incorporated into every lifestyle medicine practice. The practice may offer or facilitate access to workshops that assist patients to improve health literacy, develop active listening skills, resolve internal and external conflicts to produce win-win solutions, improve intimacy, and improve workplace relationships. A key goal is to negotiate successful personal lifestyle changes in possibly resistant family and other social settings.
Lifestyle medicine prescriptions for developing or improving social relationships should be personalized to meet the needs of individual patients. Advice to prevent social isolation may include volunteering for a meaningful cause, involvement in spiritual/religious activities or participation in communication skills workshops such as compassionate (non-violent) communication. When an individual makes lifestyle changes to improve personal health, he/she may meet with resistance from friends, family, social groups, co-workers and even health care providers. This is especially true when the changes involve new ideas and behaviors that are different from accepted sociocultural norms. The ability to understand criticism and handle rejection and possible social isolation will determine whether the new healthy behaviors are sustained.