MODULE 1 - Introduction to Lifestyle Medicine |
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OBJECTIVES:
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lifestyle medicine definitions
Although recommended as the first line of prevention and management of chronic diseases, health care providers often do not provide lifestyle medicine counseling in their clinical care. This can be due to the lack of medical education in lifestyle medicine for health care providers to effectively and efficiently counsel their patients towards starting and sustaining healthy behaviors.
The practice of lifestyle medicine has been initially identified as a component of preventive medicine which eventually emerged as a stand-alone practice. The Physician Competencies for Prescribing Lifestyle Medicine was identified by the National Consensus Panel and was published in July 14, 2010 at the Journal of American Medical Association authored by Liana Lianov and Mark Johnson.
And from then on, Lifestyle medicine was defined in many different ways:
The practice of lifestyle medicine has been initially identified as a component of preventive medicine which eventually emerged as a stand-alone practice. The Physician Competencies for Prescribing Lifestyle Medicine was identified by the National Consensus Panel and was published in July 14, 2010 at the Journal of American Medical Association authored by Liana Lianov and Mark Johnson.
And from then on, Lifestyle medicine was defined in many different ways:
- Lifestyle medicine is the evidence-based practice of assisting individuals and their families to adopt and sustain behaviors that can improve health and quality of life (Journal of American Medical Association)
- Lifestyle medicine is a medical approach that uses evidence-based behavioral interventions to treat and manage chronic diseases related to lifestyle (American College of Preventive Medicine)
- The use of lifestyle interventions in the treatment and management of disease (American College of Lifestyle Medicine)
- Lifestyle medicine involves the use of evidence-based lifestyle therapeutic approaches, such as predominantly whole food, plant-based diet, regular physical activity, adequate sleep, stress management, avoidance of risky substance use, and other non-drug modalities, to prevent, treat, and often times, reverse the lifestyle-related, chronic disease. The use of lifestyle interventions in the treatment and management of disease (American College of Lifestyle Medicine)
- Comprehensive lifestyle medicine offers a unique approach that leverages a whole food, plant-based, physical activity, sleep, emotional well-being, and avoiding risky substances to not only prevent, but also treat and reverse lifestyle-related diseases (American College of Lifestyle Medicine)
- The application of medical, behavioral motivational, and environmental principles to the management of lifestyle related health problems in a clinical setting, including self-care and self-management (Egger G. Lifestyle Medicine 2011)
High yield board exam question: What is the definition of Lifestyle medicine as identified by the consensus panel? |
lifestyle medicine core competencies blue ribbon panel
The 15 core competencies in lifestyle medicine was identified by the Blue Ribbon Panel that was composed of representatives from:
- American Academy of Family Physicians
- American Medical Association
- American College of Physicians
- American College of Preventive Medicine
- American College of Lifestyle Medicine
- American Osteopathic Association
- American Academy of Pediatrics
- American College of Sports Medicine
Presently, the Lifestyle medicine core competencies is under initial review and updating process which was initiated by the following review team:
- Liana Lianov, American College of Lifestyle Medicine
- Karen Adamson, American Board of Lifestyle Medicine
- John Kelly, American College of Lifestyle Medicine
- Simon Matthews, Australasian Board of Lifestyle Medicine
- Mechelle Palma, Philippine College of Lifestyle Medicine
- Brenda Rae, American Board of Lifestyle Medicine
lifestyle medicine core competencies (jama 2010)
Leadership in Promoting:
- Healthy behaviors as foundational
- Practicing healthy behaviors and creating healthy environments
- Evidence that specific lifestyle changes can have positive health outcomes
- Physician engagement with patients can positively affect patients' health behaviors
- Predispositions of patients' behaviors and outcomes
- readiness, willingness, and ability to make healthy behavior changes
- history and physical examination, including lifestyle factors and "vital signs" such as physical activity level, body mass index, stress level, and sleep; and obtain and interpret appropriate tests.
- Use nationally recognized practice guidelines
- Establish effective relationships with patients and their families to sustain behavioral change
- Collaborate with patients and their families to develop written action plans
- Refer patients to appropriate health care professionals
- Practice in an interdisciplinary team
- Apply office systems to support lifestyle medical care
- Measure processes and outcomes to improve quality of lifestyle interventions
- Use of appropriate community referral resources.
Lifestyle medicine training regulation (philippines)
- The Philippine College of Lifestyle Medicine (PCLM) is one of the leading lifestyle medicine societies in terms of education development. The PCLM developed the training regulation in lifestyle medicine involving a multidisciplinary competency levels.
Definition of Qualifications.
This refers to the group of competencies that describes the different functions of the qualification.
Lifestyle Medicine Fellow
- Family Medicine Track - 1 year Post-residency fellowship training.
- Lifestyle Medicine Track - 1 year Post-diplomate fellowship training.
- Residency Track - 2 year residency integration training.
- Lifestyle Medicine Track - 1 year innovative training.
- Masters Degree in Health / PhD / DrPH
- Allied Health Professionals
- Lifestyle Medicine Coaches
- Wellness Coaches
- Culinary Medicine Specialists
- Exercise Physiologist
Competency Standards
This gives specifications of competencies required for certain professional qualification.
Training Standards
Contains information and requirements in designed training program for certain qualification. It includes competencies, training delivery, entry requirements, training facilities, and trainer's qualification.
- Modular/self-paced learning
- Preceptorial training
- Immersion / Supervised training
- Project-based Instruction
- Research
Certification Standards
Describes the policies governing assessment and certification procedure.
the role of lifestyle medicine in healthcare practice
Lifestyle modification, lifestyle therapy, and intensive lifestyle therapy are the most common terms seen in the treatment algorithms for chronic disease such as diabetes, hypertension, hyperlipidemia, obesity, atherosclerotic cardiovascular disease and cancer. Unfortunately, despite being recommended as first line of prevention and management majority of health care practitioners do not provide lifestyle medicine counseling due to lack of education, skill, experience and confidence. Behavior change counseling is one of the most important part of clinical services that is not provided in most clinical practice.
Lifestyle Medicine Components
Lifestyle medicine intervention is prescribed to prevent, manage, and reverse chronic lifestyle-related diseases utilizing the following components:
Lifestyle medicine intervention is prescribed to prevent, manage, and reverse chronic lifestyle-related diseases utilizing the following components:
- Nutrition Science, Assessment and Prescription
- Physical Activity Science, Assessment and Prescription
- Emotional and Mental Health Assessment and Intervention
- Sleep Health Science and Intervention
- Managing Tobacco Cessations and other toxic exposures
- Connectedness and Positive Psychology
- Therapeutic Alliance
Unique Role of Lifestyle Medicine
Lifestyle medicine components are recommended to prevent, manage and reverse chronic conditions and therefore, it applies to every practice and every patient in the following fields:
Lifestyle medicine also emphasizes the use of a collaborative care and health care team model offering a spectrum of intervention in the following settings:
Lifestyle medicine components are recommended to prevent, manage and reverse chronic conditions and therefore, it applies to every practice and every patient in the following fields:
- General Practice
- Pediatrics
- Geriatrics
- Internal Medicine
- OB-Gyne
- Occupational medicine
- Surgery
- Family and community medicine
- Public health
- Wellness Coaching
Lifestyle medicine also emphasizes the use of a collaborative care and health care team model offering a spectrum of intervention in the following settings:
- Outpatient primary care
- Medical specialty setting
- Pallative care
- Hospital care for chronic disease
- Shared medical appointment (SMA) / Group visit
- Corporate lifestyle medicine practices
- Residential lifestyle medicine intervention
- Telemedicine
- Health coaching programs
- Medical fitness programs
- Physical and occupational therapy integration
conventional v.s. lifestyle medicine
There is a huge difference between the usual conventional medical practice that most physicians provide compared to trained lifestyle medicine health care providers.
Conventional Practice |
Lifestyle Medicine Practice |
Treats individual risk factors |
Treats lifestyle causes with the goal of primary, secondary and tertiary disease prevention |
Patient is often passive recipient of care |
Patient is active partner in care |
Patient is not required to make big changes |
Patient is required to make substantial transitions |
Treatment is often short term |
Treatment is always long term |
Responsibility falls mostly on the clinician |
Responsibility falls mostly on the patient; emphasis is on motivation and adherence |
Medication is often the "end" treatment; emphasis is on diagnosis, prescription and disease management |
Medication may be needed but as an adjunct to lifestyle change |
distinction of lifestyle medicine from other fields of practice
Lifestyle medicine components are widely recommended by a wide array of health practitioners, but it is a distinct field of medicine that is usually mistaken for other fields of practice.
Lifestyle Medicine is not:
Lifestyle Medicine is not:
- Complementary and Alternative Medicine (CAM)
- Integrative Medicine
- Functional Medicine
- Mind-body Medicine
- Preventive Medicine
Complementary and Alternative Medicine (CAM)
Many countries have their own traditional practices in treating ailments that are sometimes engraved in their culture and are passed from one generation to the next. Some of these practices have been existing even before the inception of modern medicine. Ayurvedic medicine and Traditional Chinese Medicine are best examples as it is still the existing treatment preference of the majority in India and China. CAM has no strong science historically but rather established through traditional knowledge and beliefs. But there is a recent increase in research in this field of practice.
CAM is practiced by many physician as complementary to their conventional practice however some practitioners use CAM as alternative treatment.
Many countries have their own traditional practices in treating ailments that are sometimes engraved in their culture and are passed from one generation to the next. Some of these practices have been existing even before the inception of modern medicine. Ayurvedic medicine and Traditional Chinese Medicine are best examples as it is still the existing treatment preference of the majority in India and China. CAM has no strong science historically but rather established through traditional knowledge and beliefs. But there is a recent increase in research in this field of practice.
CAM is practiced by many physician as complementary to their conventional practice however some practitioners use CAM as alternative treatment.
Integrative Medicine
This practice integrates conventional and CAM interventions with emphasis on patient-center care addressing physical, mental, emotional, social, spiritual and environmental influences on health. They also include lifestyle modification, medication and supplements.
This practice integrates conventional and CAM interventions with emphasis on patient-center care addressing physical, mental, emotional, social, spiritual and environmental influences on health. They also include lifestyle modification, medication and supplements.
Functional Medicine
This is a holistic model of practice that deals with the functional processes in the body including cellular metabolism, detoxification, and antioxidant-oxidative stress balance. The practice focuses on supplying the deficiency and enhancing cellular functions through nutraceuticals and botanicals. It also emphasize therapeutic nutrition as remedy to bodily dysfunctions. (The Institute for Functional Medicine)
Mind-Body Medicine
This is a practice with emphasis on power of the mind to positively impact body functions and personal behavior. It focuses on emotional, psychological, social, behavioral and spiritual factors that directly influence the person's overall health outcome. Modalities applied in this practice includes relaxation response, meditation, yoga, tai chi, spirituality, qi gong, cognitive-behavioral therapies and group support. Mind-body interventions constitute a huge portion of the overall use of CAM. In this practice, the health care providers serves as guides and catalysts in the process.
Preventive medicine
Preventive medicine is an established sub-specialty practice in medicine that focus on public health, population-based approach, community engagement, and interventional strategy. This practice is aimed at preventing disease in the community through screening and immunization as preventive interventions.
Task 1: Reflective Journal 1 |
To help you identify, recall and retain important learning points in the subjects you just read, an analytical practice through writing your personal reflection is required with the following components:
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Topics covered:
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lifestyle medicine evidence
Lifestyle medicine emphasizes the value of enhancing provision of lifestyle medicine services in health care facilities carried out by trained health care providers with a comprehensive collaboration and team approach. Lifestyle medicine recognizes the importance of lifestyle behaviors as modifiable risk factors that could largely change health outcome.
Lifestyle modification is the initial intervention for prevention and treatment of chronic diseases. And even when patients are already in need of taking medications, lifestyle modification is still included in the treatment plan. Sustainable lifestyle change deals with the "cause of the cause" of the disease, thereby addressing the root and not just the symptoms.
Lifestyle Medicine demonstrates knowledge of the evidence that specific lifestyle changes can have a positive impact on the prevention and management of chronic lifestyle-related diseases. Evidence of prevention, management, and even reversal of these chronic conditions has been already established yet its emphasis has long been neglected and was not given intentional emphasis nor effectively implemented in most clinical practice.
Below are pieces of evidences that is integral to lifestyle medicine practice for your article review that should be included in your reflective journal.
Lifestyle modification is the initial intervention for prevention and treatment of chronic diseases. And even when patients are already in need of taking medications, lifestyle modification is still included in the treatment plan. Sustainable lifestyle change deals with the "cause of the cause" of the disease, thereby addressing the root and not just the symptoms.
Lifestyle Medicine demonstrates knowledge of the evidence that specific lifestyle changes can have a positive impact on the prevention and management of chronic lifestyle-related diseases. Evidence of prevention, management, and even reversal of these chronic conditions has been already established yet its emphasis has long been neglected and was not given intentional emphasis nor effectively implemented in most clinical practice.
Below are pieces of evidences that is integral to lifestyle medicine practice for your article review that should be included in your reflective journal.
High yield board exam question: According to the Nurses' Health Study what is the strongest risk factor identified for developing Type 2 diabetes? |
lifestyle medicine in treatment algothithms
Lifestyle therapy has been the initial recommendation for chronic diseases shown in many published clinical practice guidelines. In 2019, lifestyle therapy was given much intentional emphasis for comprehensive clinical practice implementation. The American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (ACCE) developed the algorithm for comprehensive management of type 2 diabetes (T2D). The guideline provides clinicians evidence-based approaches of treating the whole patient including the spectrum of risks and complications. In the 2020 Executive Summary of AACE and ACE Consensus Statement, they emphasized that the algorithm has been updated as new therapies, management approaches and important clinical data have emerged.
The founding principles of the AACE/ACE algorithm includes up-to-date sections on lifestyle therapy applied in the management of prediabetes, glycemic control, obesity, hypertension, and dyslipidemia. It was emphasized that lifestyle optimization is multifaceted that needs the collaborative implementation of a multidisciplinary team. In cases when pharmacotherapy is indicted specifically for higher risk individuals, it should not be interpreted as a failure of lifestyle management but as an adjunctive intervention that should be adjusted based on patient response to lifestyle efforts.
Health care providers in the Philippines felt that they have been providing advices on lifestyle modification to patients with chronic diseases. Some chronic disease specialists believe they already have efficient skill and are even skeptical about the need for specific training on lifestyle medicine. It is therefore important to analyze the difference between physician's conventional clinical practice delivery and the lifestyle medicine emphasis correlated to evidence of overall health outcome.
As the Western clinical practice guidelines proactively adapt to the changing demand of emerging management approaches to chronic diseases, health care providers in the Philippines needs to develop intentional awareness of the relevance, evidence, and effective implementation of lifestyle therapy recommended in the treatment guidelines. It is however challenging to encourage patients to start and sustain a healthy behavior when the health care providers are not doing it themselves. Studies show that physicians who are eating a healthy diet and engaging in active lifestyles are more likely to advise and counsel patients to the same as they are better examples to them.
The founding principles of the AACE/ACE algorithm includes up-to-date sections on lifestyle therapy applied in the management of prediabetes, glycemic control, obesity, hypertension, and dyslipidemia. It was emphasized that lifestyle optimization is multifaceted that needs the collaborative implementation of a multidisciplinary team. In cases when pharmacotherapy is indicted specifically for higher risk individuals, it should not be interpreted as a failure of lifestyle management but as an adjunctive intervention that should be adjusted based on patient response to lifestyle efforts.
Health care providers in the Philippines felt that they have been providing advices on lifestyle modification to patients with chronic diseases. Some chronic disease specialists believe they already have efficient skill and are even skeptical about the need for specific training on lifestyle medicine. It is therefore important to analyze the difference between physician's conventional clinical practice delivery and the lifestyle medicine emphasis correlated to evidence of overall health outcome.
As the Western clinical practice guidelines proactively adapt to the changing demand of emerging management approaches to chronic diseases, health care providers in the Philippines needs to develop intentional awareness of the relevance, evidence, and effective implementation of lifestyle therapy recommended in the treatment guidelines. It is however challenging to encourage patients to start and sustain a healthy behavior when the health care providers are not doing it themselves. Studies show that physicians who are eating a healthy diet and engaging in active lifestyles are more likely to advise and counsel patients to the same as they are better examples to them.
Video Review
Liana Lianov, MD, MPH
Michael Greger, MD, DIBLM, FACLM
David Katz, MD, MPH, FACPM, FACP, FACLM
Michael Greger, MD, DIBLM, FACLM
David Katz, MD, MPH, FACPM, FACP, FACLM
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Task : Reflective Journal |
Topics covered:
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