The Time is Now For Lifestyle Medicine: Lesson From Lifestyle Medicine Leaders.

The time is NOW for Lifestyle Medicine. In this review based on a presentation at the American College of Lifestyle Medicine (ACLM) 2021 annual conference, ACLM Current President Cate Collings, MD, Immediate Past-President Dexter Shurney, MD, and President Elect Beth Frates, MD, share insights on the current state of lifestyle medicine (LM). Interest in LM has greatly advanced in the face of disruptions from the COVID-19 pandemic, expanded educational opportunities in the field, and a rapidly changing healthcare landscape. With growing access to virtual care, advancing technologies, growing emphasis on home-based chronic care, continuing corporate healthcare mergers and acquisitions, and widening adoption of personalized, patient-empowered treatments, the time is ripe for LM interventions to move to the mainstream. As health investments and costs skyrocket, and new players enter the scene, traditional models of payments, reimbursements, and incentives are slowly being upended. Companies and healthcare systems are finally recognizing the scientific evidence and powerful but undervalued potential of LM to accelerate healthy outcomes while controlling costs. Taken together, the lessons from the COVID-19 pandemic, the growth in LM educational opportunities, and the evolving "business of medicine landscape" signal that the time for lifestyle medicine is NOW.

Laying an Early Foundation: Lifestyle Medicine Pre-Professional Education (LMPP) Member Interest Group.

Just as lifestyle medicine is the necessary foundation for true health care reform, lifestyle medicine competencies should be the foundation for health education. Although lifestyle medicine education may benefit a health professional at any stage in their education or career, evidence-based undergraduate lifestyle medicine education for future health professionals shifts the perspective of health and health care delivery. Educating health preprofessionals in associate, bachelor's, master's, and other preprofessional healthcare training programs is of paramount importance due to the interdisciplinary nature of lifestyle medicine. To accomplish this, American College of Lifestyle Medicine (ACLM) members can work collaboratively through committees, projects, and working groups-becoming leadership champions of change. An ACLM Pre-Professional Member Interest Group (LMPP) was created in 2018. LMPP has been working to build a national collaborative effort to amass, create, and distribute resources for educators in this pre-professional arena. Educating college students planning to become professionals outside the medical sphere, for example, lawyers, business people, artists, and engineers, will also benefit the field by introducing the power of nutrition, exercise, sleep, social connection, and stress resiliency during this formative state of career development. Pre-professional educational programs provide learners the opportunity to personally experience the power of lifestyle medicine.

A Call to Action for Intermediate and Secondary School Lifestyle Medicine Education: Instating Healthy Teen Behaviors.

Chronic diseases, previously thought to require decades of risk factors, have become increasingly prevalent in America's youth. National Health Education Standards have been published since 1995, and yet nearly a fifth of schools fail to follow any state or national health education guidelines. Utilizing the phrase "lifestyle medicine" in childhood would elevate the importance and standardization of the core health guidelines. Several independent pilot programs taught by undergraduate and medical student volunteers have successfully demonstrated lifestyle medicine education models at intermediate and secondary schools. Preliminary feedback demonstrates that student interest in and consideration of behavioral change is possible within this age group. As with any life stage, significant behavior change in youth requires strategic planning of authentic learning practices and culturally competent lessons. We argue for the interdisciplinary development and implementation of community-engaged lifestyle medicine education for intermediate and secondary schools as a promising intervention to address and reverse the chronic disease trend in our youth.

Students Teaching Students: Bringing Lifestyle Medicine Education to Middle and High Schools Through Student-Led Community Outreach Programs.

Lifestyle medicine has the power to reverse the growing burden of chronic disease that now plagues our health care system. The World Health Organization, the Centers for Disease Control and Prevention, and the American College of Lifestyle Medicine have all independently recognized the need for community-centered lifestyle medicine education as a means of empowering individuals to take charge of their own health. Students in undergraduate, medical, and allied health schools may serve as mediators for these conversations. With guidance from faculty lifestyle medicine mentors, these students can operate as peer educators in primary and secondary schools to supplement current health teaching with the core tenants of lifestyle medicine: nutrition, exercise, sleep, mental and social well-being, and substance avoidance as strategies to prevent and treat chronic disease. We present models of two such student-led programs working with middle and high school students in Massachusetts and New Jersey. Both programs have found success by engaging middle and high school students in interactive workshops and by responding to their individual interests and community needs. We share our currently available resources and, moving forward, hope to publish a tested curriculum that students around the country can implement in their communities to promote lifestyle medicine.

Nurturing the Seeds of Change: Strengthening the Lifestyle Medicine Movement With the Donald A. Pegg Student Leadership Award.

Student-led Lifestyle Medicine Interest Groups (LMIGs) empower the next generation of healthcare professionals to tackle the pandemic of lifestyle-related chronic diseases and provide important pathways to increasing the visibility of Lifestyle Medicine (LM) in health professions schools. Each year, the Donald A. Pegg Student Leadership Award offers four allied health students a seed grant to start or support LMIGs at their schools as well as financial assistance to attend the annual American College of Lifestyle Medicine (ACLM) conference. The 2017 student winners were Paresh Jaini, Albert Barrera, Alyssa Greenwell, and Alicja Baska. With the support of the Pegg Award, the awardees and their faculty advisors have made great strides in LM at their institutions in the areas of research, community outreach, student education, and global networking. Their LMIG activities have included students presenting research at national conferences, initiating a chapter of the national organization Walk with a Doc, hosting educational lectures on LM principles, sponsoring plant-based cooking sessions, facilitating stress management workshops, and hosting a national-level LM congress in Europe. Through the ACLM, the Pegg Award generates an atmosphere of growth for LMIGs, fostering the expansion, vision, and integration of LM into the education of health professions students worldwide.

A Web-Based Lifestyle Medicine Curriculum: Facilitating Education About Lifestyle Medicine, Behavioral Change, and Health Care Outcomes.

BACKGROUND: Lifestyle medicine is the science and application of healthy lifestyles as interventions for the prevention and treatment of disease, and has gained significant momentum as a specialty in recent years. College is a critical time for maintenance and acquisition of healthy habits. Longer-term, more intensive web-based and in-person lifestyle medicine interventions can have a positive effect. Students who are exposed to components of lifestyle medicine in their education have improvements in their health behaviors. A semester-long undergraduate course focused on lifestyle medicine can be a useful intervention to help adopt and sustain healthy habits. OBJECTIVE: To describe a novel, evidence based curriculum for a course teaching the concepts of Lifestyle Medicine based on a web-based course offered at the Harvard Extension School. METHODS: The course was delivered in a web-based format. The Lifestyle Medicine course used evidence based principles to guide students toward a "coach approach" to behavior change, increasing their self-efficacy regarding various lifestyle-related preventive behaviors. Students are made to understand the cultural trends and national guidelines that have shaped lifestyle medicine recommendations relating to behaviors. They are encouraged to engage in behavior change. Course topics include physical activity, nutrition, addiction, sleep, stress, and lifestyle coaching and counseling. The course addressed all of the American College of Preventive Medicine/American College of Lifestyle Medicine competencies save for the competency of office systems and technologies to support lifestyle medicine counseling. RESULTS: The course was well-received, earning a ranking of 4.9/5 at the school. CONCLUSIONS: A novel, semester-long course on Lifestyle Medicine at the Harvard Extension School is described. Student evaluations suggest the course was well-received. Further research is needed to evaluate whether such a course empowers students to adopt behavior changes.

The Art and Science of Group Visits in Lifestyle Medicine.

Lifestyle medicine group sessions present a promising approach to clinical care. Based on decades of work in shared medical appointments and group visits for diabetes and other chronic conditions, a lifestyle medicine group session has the potential to provide a fresh and rewarding way of interacting with patients that fuels the practitioner and feeds patients' needs to spend time with the lifestyle medicine practitioner, connect with him or her, connect with others, learn the latest recommendations regarding healthy habits, practice these behaviors, and discuss their obstacles, motivations, and strategies for healthy living. The lifestyle medicine group session discussed in this article is a combination of group coaching, education, and group support.

Planting the Seeds of Change: Growing Lifestyle Medicine Interest Groups With the Donald A. Pegg Award.

The practice of Lifestyle medicine (LM) focuses on helping patients make healthy choices to prevent and treat disease. While such interventions are considered first-line treatment for many diseases, many medical schools have not yet been able to include lifestyle medicine classes in the core curriculum but most are able to offer a parallel curriculum that does not interfere with the schedule of core classes. Lifestyle Medicine Interest Groups (LMIGs) are being created around the country and around the globe. Many students and faculty members are interested in starting and sustaining a LMIG at their schools, but some do not have enough funding or they lack the framework that provides structure to their efforts. To address this situation, the American College of Lifestyle Medicine (ACLM) has encouraged the development of LMIGs, which are student-run organizations that provide a parallel curriculum in LM. To support and strengthen this effort, the ACLM initiated the Donald A. Pegg award to fund four allied health students in founding and augmenting their institution's LMIGs. The 2016 inaugural winners were James Gardner, P. Elainee Poling, Alyssa Abreu, and Jessie M. Hipple. Their LMIG activities have included events such as nutrition and cooking classes, exercise prescription seminars, group fitness sessions, and patient lifestyle counseling in various clinical settings. Pearls of wisdom for building successful LMIGs include cultivating strong faculty mentorship, marketing the personal benefits to students who attend activities, and collaborating with other student groups.

The Connection Prescription: Using the Power of Social Interactions and the Deep Desire for Connectedness to Empower Health and Wellness.

Social connection is a pillar of lifestyle medicine. Humans are wired to connect, and this connection affects our health. From psychological theories to recent research, there is significant evidence that social support and feeling connected can help people maintain a healthy body mass index, control blood sugars, improve cancer survival, decrease cardiovascular mortality, decrease depressive symptoms, mitigate posttraumatic stress disorder symptoms, and improve overall mental health. The opposite of connection, social isolation, has a negative effect on health and can increase depressive symptoms as well as mortality. Counseling patients on increasing social connections, prescribing connection, and inquiring about quantity and quality of social interactions at routine visits are ways that lifestyle medicine specialists can use connection to help patients to add not only years to their life but also health and well-being to those years.

Lifestyle medicine consulting walking meetings for sustained weight loss.

With rates of obesity and diabetes rising worldwide, effective ways of managing weight are becoming more important. We present the case study of a middle-aged Caucasian-American woman (body mass index (BMI) 27.8, overweight category) who wanted to lose weight. The patient participated in a behaviour modification programme with a physician trained in lifestyle medicine as well as health and wellness coaching. After the 14-week programme, which included 9, 1 h long walking sessions with the clinician, the patient lost 11 Ibs (BMI 24.7, normal category). The programme included a combination of increasing physical activity, eating appropriate quantities of healthy foods, goal setting and a positive attitude. The patient has kept her BMI at or below 24.1 for over 2 years. This case demonstrates a novel approach to weight loss management--walking therapeutic sessions--and also outlines critical components of lifestyle medicine counselling that facilitate the process of sustainable weight loss and lasting change.

Collaboration and Negotiation: The Key to Therapeutic Lifestyle Change.

Counseling patients on behavior change is an important skill that traditional medical training does not emphasize. Most practitioners are trained in the expert approach to handle problems, which is useful in the acute care setting. However, in the case of chronic disease, a coach approach is more effective. This approach allows the patient to reflect on his or her own motivators for change as well as obstacles hindering the change. Changing from the expert approach to the coach approach is contingent on the lifestyle medicine practitioner sharing information when the patient is ready to receive it, listening mindfully, asking open-ended questions, treating problems as opportunities to learn and grow, and encouraging patients to take responsibility for their actions. By collaborating with the patient, the practitioner can guide patients to find solutions to the problems they are facing and foster an environment that leads patients to self-discovery, accepting responsibility for their behaviors, and ultimately, achieving goals that result in healthier daily habits. As a framework and a guide, lifestyle medicine practitioners can use a 5-step cycle of collaboration and a ladder of behavior change when working with patients on behavior change.

Case Series in Lifestyle Medicine: A Team Approach to Behavior Changes.

As the number of people living with chronic diseases climbs upward, novel methods to address the root causes of these disease are necessary to transform the state of our nation's health and our health care system. Interventions directed at making lasting lifestyle changes can have a major impact on the overall health of patients. In this pilot study, 4 obese patients, with unhealthy habits and abnormal blood profiles and biometrics, were able to significantly improve their lifestyles and their lab values with the 3-month intervention of a lifestyle medicine team, including a physician trained in lifestyle medicine, a certified wellness coach, a licensed nutrition specialist, a physical therapist, and a licensed mental health professional. Two patients had type 2 diabetes, and all 4 were hypertensive (blood pressure > 120/80 mm Hg). After the intervention, all improved their nutrition and increased their physical activity. In addition, all experienced improvements in lipid counts, blood pressure, weight loss, and cholesterol. The diabetic patients' levels of hemoglobin A1C dropped to normal. These successes show the benefits of a lifestyle medicine team approach.

Group health coaching: strengths, challenges, and next steps.

There is great need for cost effective approaches to increase patient engagement and improve health and well-being. Health and wellness coaching has recently demonstrated great promise, but the majority of studies to date have focused on individual coaching (ie, one coach with one client). Newer initiatives are bringing a group coaching model from corporate leadership development and educational settings into the healthcare arena. A group approach potentially increases cost-effective access to a larger number of clients and brings the possible additional benefit of group support. This article highlights some of the group coaching approaches currently being conducted across the United States. The group coaching interventions included in this overview are offered by a variety of academic and private sector institutions, use both telephonic and in-person coaching, and are facilitated by professionally trained health and wellness coaches as well as trained peer coaches. Strengths and challenges experienced in these efforts are summarized, as are recommendations to address those challenges. A working definition of "Group Health and Wellness Coaching" is proposed, and important next steps for research and for the training of group coaches are presented.

Existe una gran necesidad de planteamientos económicamente rentables que incrementen el compromiso de los pacientes, y mejoren su salud y su bienestar. La formación de salud y bienestar ha demostrado recientemente ser muy prometedora, pero la mayoría de los estudios realizados hasta la fecha se han centrado en la formación individual (es decir, de un entrenador con un cliente). Existen iniciativas más recientes, procedentes del área de desarrollo del liderazgo empresarial y de entornos académicos, para trasladar modelos de formación en grupo al ámbito de la atención sanitaria. El abordaje en grupo podría proporcionar un acceso rentable a un mayor número de clientes, además de contar con la posible ventaja adicional del apoyo del grupo. En este artículo destacamos algunos de los planteamientos de formación en grupo que se están llevando a cabo en Estados Unidos. Las intervenciones de formación en grupo que incluimos en este resumen provienen de diversas instituciones académicas y privadas, utilizan la formación telefónica y presencial, y cuentan con el apoyo de monitores de salud y bienestar con formación profesional, así como de colegas entrenadores cualificados. Resumiremos los puntos fuertes y los retos a los que se enfrentan estas iniciativas, y se ofrecerán recomendaciones para abordar dichos desafíos. Se propondrá una definición operativa de "formación de grupos de salud y bienestar" y se mostrarán los próximos pasos importantes que deben seguir la investigación y la formación de monitores de grupos.

Coaching for behavior change in physiatry.

Behavior modification is vital to the prevention or amelioration of lifestyle-related disease. Health and wellness coaching is emerging as a powerful intervention to help patients initiate and maintain sustainable change that can be critical to physiatry practice. The coach approach delivers a patient-centered collaborative partnership to create an engaging and realistic individualized plan. The coaching process builds the psychologic skills needed to support lasting change, including mindfulness, self-awareness, self-motivation, resilience, optimism, and self-efficacy. Preliminary studies indicate that health and wellness coaching is a useful and potentially important adjunct to usual care for managing hyperlipidemia, diabetes, cancer pain, cancer survival, asthma, weight loss, and increasing physical activity. Physiatrists can benefit from the insights of coaching to promote effective collaboration, negotiation, and motivation to encourage patients to take responsibility for their recovery and their future wellness by adopting healthy lifestyles.