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

Abstract

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.

Background

Lifestyle medicine (LM) is an evidence-based medical practice that focuses on helping people make changes in everyday behaviors in order to prevent and treat disease. As a clinical discipline, LM-based interventions are considered first-line treatment for many diseases.^1-3 Despite this understanding, a majority of physicians report a lack of training and low self-efficacy in the practice of LM.^4,5 Medical students and allied health students alike perceive competencies in physical activity, nutrition, and stress management to be valuable and important professional skills. However, the opportunity for students to learn how to perform assessments and provide recommendations in these areas are generally limited, and subsequent interest in LM tends to wane during undergraduate medical education. ⁶ The majority of medical and allied health institutions overlook the importance of educating students about the essentials and fundamentals of LM. As a result, young professionals remain largely unaware of medical intervention outside of pharmaceutical and surgical disease management. To combat this trend, the American College of Lifestyle Medicine (ACLM) Professionals in Training Committee (PiT), and the board of directors of ACLM are actively nurturing interest in LM by encouraging the organization of Lifestyle Medicine Interest Groups (LMIGs) at medical schools as well as allied health universities and institutions across the nation. These LMIGs, patterned after the original LMIG at Harvard Medical School, offer a parallel curriculum in LM, which focuses on physical activity, nutrition, behavior change, and self-care. ⁷

In 2016, the Donald A. Pegg scholarship award was founded through private funds, offering 4 students in various allied health fields the opportunity to receive supportive funds for establishing or augmenting their institution’s LMIG. The Donald A. Pegg award was introduced as a means to supplement the foundation and growth of student-led LMIGs, which increase the visibility of LM while also inspiring young professionals to become the next generation of LM leaders. The distributed funds facilitate students’ work with peers, faculty members, curriculum committees, and local communities to host LM-focused events. In addition, the ACLM is further supporting Pegg award winners by providing assistance for awardees to attend the annual ACLM conference.

This article showcases how each of the 4 inaugural Pegg award winners have changed the face of LM at their institutions and how future scholarships will continue to help shape the strong trajectory of LM as a fundamental foundation for health care education.

Introduction

Student-led medical interest groups have existed for many decades in the standard fields of traditional medical training: family medicine, psychology, surgery, OB/GYN, pathology, and nearly every other specialty. However, LMIGs serve as a compelling method for promoting a new area of medicine that is less well recognized in conventional medical practices and educational training. Changing medical school curricula and educational schedules can be a daunting task that takes years to complete; many medical school deans as well as faculty and administrators are in the precontemplative stage of change for adding lifestyle medicine to their core curriculum. In combining a medical field that is not yet mainstream with formal traditional educational curricula, LMIGs serve as an effective conduit to broaden the reach of LM to students while also allowing for immediate implementation in the academic setting without disruptions of the current core curriculum.

Pegg Award Winner Reports

• James E. Gardner—Medical Student, University of Utah School of Medicine

• LMIG Faculty Adviser: Dr Amy Locke, MD, FAAFP

When I began studying medicine at the University of Utah in 2015, I quickly realized that the curricular offerings and student groups focused on LM were limited. Occasional activities were provided by the school of medicine’s wellness program, which focused on stress management, exercise, and diet; however, these activities were sporadic and limited to principles of self-care. I became aware that several faculty members had taken it upon themselves to increase the amount of nutritional education being taught in the preclinical curriculum. However, this knowledge was not translating to application in either curricular or clinical settings. Once I realized the dearth of curricular content within the LM competencies, I joined forces with one of my classmates to form a LMIG. Our group activities were few during that first year, with only a handful of students and faculty members participating in lunch lectures. However, some of our members laid the foundation for the future by joining the school of medicine’s curriculum committee to learn how to facilitate change in student curriculum. Other members began working with patients on lifestyle modification at the Midvale CBC clinic, a multidisciplinary student-run clinic.

Receiving the Donald A. Pegg award has been an incredible boon to our LMIG. Thanks to the funding, we have improved both the quality and quantity of LMIG-based student activities. One of our biggest successes was the expansion of a culinary medicine course, which we co-taught with a dietetics student at the Midvale CBC clinic. The culinary medicine course teaches patients how to approach, prepare, and taste new foods while simultaneously educating patients about the concept of mindful eating. The LMIG has also been afforded the opportunity to host interactive didactic lunch sessions on various aspects of LM, including speaking to patients openly about diet and nutrition, using mindfulness to manage student and patient stress, and teaching exercise as medicine. These events, compared to those of the first year of the LMIG, have certainly been the largest events the LMIG has hosted, attracting over 75 attendees each.

Another exciting opportunity made possible through the Pegg award was an LMIG plant-based cooking night. More than 25 medical students were invited to the home of my classmate and LMIG cofounder to prepare a selection of plant-based appetizers, entrees, and dessert. Throughout the evening, the LMIG leadership discussed the research behind the whole food plant-based diet while offering the opportunity for participants to enjoy homemade plant-based food creations. The participants came for the food, but they stayed for the incredible information. The plant-based cooking event was a game-changer for our LMIG. The excitement around LM immediately after this event was incredible. As a result of the newly established interest generated around LM and the LMIG, we have committed to mentoring our younger medical student colleagues to lead LMIG events in the future.

As with many medical schools across the country, the University of Utah School of Medicine constantly strives to make improvements to its undergraduate medical curriculum. A new and exciting option within this curriculum will include an offering of elective courses centered on the science of health and wellness for the incoming medical students beginning in 2017. Although these courses are still in the developmental stage, they will focus on providing knowledge and clinical competency in the prevention and treatment of chronic disease through the fundamentals of LM.

• P. Elainee Poling—Medical Student, Oakland University William Beaumont School of Medicine

• LMIG Faculty Advisors: Victoria Lucia, PhD, and Jaime Hope, MD

Upon starting medical school at Oakland University William Beaumont School of Medicine, I was newly exposed to the concept of LM. Eager to learn more, I discovered I would have a longitudinal course with a preventive medicine focus titled Promotion and Maintenance of Health (PMH). However, because this course had such a broad scope of topics to cover, including health disparities, biostatistics, and nutrition, I felt students were only able to scratch the surface in learning about LM and its application to clinical practice. After talking with Dr Victoria Lucia (our PMH course director) and Dr Jaime Hope (a clinical faculty member with a passion for LM), they agreed to support me in creating an LMIG to supplement the existing curriculum, and their role as advisors has been critical to the development of our LMIG. One year before I received the Pegg award, our LMIG formed with a 3-pronged mission in mind: student education, student role-modeling of wellness, and community service engagement. During our first year, our LMIG was able to host a few very successful events to address these 3 components. These events included a “Lifestyle Medicine Week” in which we held various presentations (Exercise is Medicine), social events (Forks over Knives viewing), wellness events (Tai Chi session), and several health fair demonstrations to provide opportunities for experiential service learning and to garner student interest. However, once the week’s events were over, our LMIG found it difficult to sustain the momentum throughout the year, with limited resources and no existing infrastructure from which to work.

After our LMIG was founded, I entered my clinical years of medical school, and leadership roles were passed on successfully with the help of our faculty advisors. However, I became involved with the ACLM PiT group, which connected me to other trainees and LMIG leaders who are passionate about LM. Discovering these kinds of connections prompted me to apply for the Donald A. Pegg award.

Since receiving this award, our LMIG has received more recognition and visibility within the school, as well as increased student and faculty involvement. With this additional funding, our LMIG has worked to expand the scope of our events to include not only medical students interested in LM but also the community of patients whom we serve. Other specialty interest groups are enthusiastic about partnering with our LMIG to host events, such as a combined event with the Internal Medicine interest group titled “Nutrition and the Elderly.” Collaboration like this has allowed LM concepts to gain more visibility among students and faculty in the various specialties. Current LMIG leadership have connected with community organizations that already partner with our school to organize events that allow students to provide lifestyle education and counseling through cooking demonstrations and the provision of healthy recipes, meal planning guides, salt-free spices, and even pedometers. Such events help students apply their knowledge of LM and provide a foundation to carry the LM mentality forward into their future careers. Our LMIG has also been keeping with tradition in organizing a month-long version of our “Lifestyle Medicine Week” to implement in the fall semester so that incoming first year students are exposed to LM right away. The month will include a picnic social event titled “Maintaining a Healthy Lifestyle in Medical School,” featuring a panel of senior students who can share LM tips and offer insight on clinical LM opportunities, as well as an introduction to multiple wellness challenges, educational LM presentations, and organized opportunities for community engagement. One exciting possibility in the works is the potential for our LMIG to participate in a hospital-based food pantry (an idea currently in development) that would offer healthy foods, along with educational LM-based classes focusing on smart grocery shopping, nutrition, and cooking.

Our LMIG has also been advocating for curricular shifts and an increased emphasis on classroom and clinical LM opportunities. There have also been discussions of adding an LM elective that would allow students to lead LM education-based group appointments for patients or offer extended individual appointments to allow more time for lifestyle counseling.

Thanks to the generosity of the Pegg award, I was also able to connect with other professionals involved in the LM movement by attending the 2016 ACLM national conference, which was extremely valuable in stimulating ideas for future events and opportunities. I look forward to attending the ACLM conference again in 2017 to be further inspired by leaders in LM and to share the stories of success from my own LMIG, while learning about the successes of other LMIGs throughout the country.

• Alyssa Abreu—Master Student in Kinesiology, Stephen F. Austin State University

• LMIG Faculty Advisor: Mark Faries, PhD

As a student studying Kinesiology with a specialization in Behavior and Preventive Medicine, I am passionate about how to prevent and treat chronic disease with lifestyle changes. However, up until I began my master’s program, I was unaware there was an actual LM specialty. I have a strong desire for community outreach and facilitating behavior changes, but until learning about the Donald A. Pegg award and ACLM, I had not thought about starting an interest group. At my institution, there were kinesiology programs promoting activity, but no organization combining the aspects of LM for disease prevention and education. Our institution was fortunate enough to have a graduate class taught by Dr Mark Faries on Behavioral Medicine. Because of this class experience, there were many graduate students who gained awareness of LM and its health effects. Therefore, Stephen F. Austin’s (SFA) LMIG is focused on educating and encouraging students including prehealth professionals, nutrition, kinesiology, and nursing students with the help of the graduate students already aware of LM. Since receiving the Pegg award, the LMIG at our institution has truly been able to thrive.

The goal of SFA’s LMIG is increasing LM awareness, which consists of 2 subgoals: student education and community outreach. For student education, our LMIG hosts a biweekly workshop covering a specific LM topic in an open-discussion format. This semester, we are hosting 5 workshops consisting of an introduction to LM, exercise prescription for diseased populations, nutrition recommendations, motivational interviewing, and career options and opportunities.

Thanks to the Pegg award, our LMIG will also be facilitating free cooking and exercise classes in an effort to expand our community outreach. The cooking class consists of a 4-week program with one 90-minute course taught each week. These courses include short lesson plans such as how to read food labels, smart grocery shopping, plant-based myths, and meal preparation demonstrations. These classes are open to the first 10 participants who apply. We then have a follow-up support group style meal at the end of the 4 weeks where we all share our experiences to spark motivation and consistency for our participants’ future maintenance of practice. We also host weekly exercise classes that are open to the community which alternate between circuit-style bodyweight training and yoga. There is minimal equipment, if any, so we can educate our participants about the ease of exercising at home.

Our LMIG members are also involved in making biweekly brochures for public use. They include a healthy plant-based recipe, a “tip” for healthy eating (food substitutions, cravings) while also providing an example at-home workout, and a “tip” to reduce stress. These “tips” are displayed in buildings across our campus for students, faculty, and staff, and the pamphlets are also available for students to hand out to friends and family members.

Beyond my local efforts at SFA, my faculty advisor, Dr Mark Faries, and I have also founded a statewide student interest group, Lonestar Lifestyle Medicine (www.lonestarlm.org). This fledgling large-scale LMIG will consist of webinar series from inspiring speakers in the LM field such as exercise physiology, nutrition science, obesity medicine, and behavioral medicine. The webinars are available to be accessed by over 30 schools in Texas, including different allied-health programs. This group will serve as a catalyst to bring together students, faculty, and professionals from across the state who are interested in LM and hopefully result in a yearly conference for participants in the state of Texas starting in 2018.

Without the Pegg award, our LMIG would not have been able to host the free cooking and exercise classes. These classes are what make the interest group fun and entertaining, while satisfying our goals of student education and community outreach. The students are able to learn how to make a workout plan as well as put together nutrition education packets and plant-based recipes, while the community is offered free workouts and cooking ideas. This is providing students a chance to think about LM in a practical way, while simultaneously allowing for community involvement in LM.

• Jessie M. Hipple—Pharmacy Student, Lipscomb University College of Pharmacy

• LMIG Faculty Adviser: Marni Hillinger, MD

During my first year of pharmacy school, I started interning at the Osher Center for Integrative Medicine at Vanderbilt, which resulted in continuous exposure to the benefits of LM. This early exposure offered me a different perspective compared to my fellow classmates, most of whom did not understand the importance of the LM field. Although Lipscomb has a required course titled Natural Medicines, which has a section focused on LM, I noticed there was a general lack of visibility and information about the foundations of LM. In receiving the Pegg award and starting an LMIG, I have been able to slowly and steadily increase student interest in learning more about LM.

Our kick-off event was a mindful eating class that consisted of a locally sourced plant-based chef-prepared meal. Our hope is that with increased exposure to the practices of LM, students will see the benefits and the ease of integrating LM practices into their own lives. We hope this LM inspiration will transfer into how students practice on rotations and ultimately, how they practice in their future careers as health care providers. Our LMIG is also in the planning process of hosting events that focus on mindfulness practice such as Tai Chi and yoga. One of the main selling points for attracting more students to join the LMIG is by focusing on how events that we host can benefit the student through teaching beneficial coping mechanisms to balancing stress and promoting self-care while in graduate school. In an effort to recruit new students to join the LMIG, I have worked on partnering with the student government association to increase funding and exposure for the LMIG, while also facilitating pre- and post-block exam LM events.

There are many pharmacy students who are interested in learning more about LM, especially once they realize they will experience the benefits of smart eating, mindfulness, and therapeutic yoga. LM is often referred to as only an abstract idea of medical practice; however, the ability to actually experience the benefits of LM cannot be overstated. Thanks to funding provided by the Pegg award, our LMIG has been able to translate the conceptual aspects of LM into a variety of healthy and life-changing experiences.

LMIG Pearls of Wisdom

Maintaining strong LMIG student leadership and finding dedicated faculty mentorship are key. Faculty advisors play a critical role in helping LMIGs grow and thrive by securing institutional resources and support, identifying future LM leaders, and providing consistency as leadership changes to ensure important projects and traditions are carried on. One of the most important ways to be successful as an LMIG is to market how events will be beneficial to the student on a personal level. Also, it is crucial to encourage young LM leaders to seek alternative funding sources from academic outlets, professional medical colleges, or other student funding sources, while being creative in how LMIG events are planned and executed. It is important to realize that facilitating smaller scale activities, such as getting people outdoors for mini-meditation sessions, or getting together with small groups of student-colleagues to prepare a healthy meal can be educational without the need for significant monetary support. LMIGs create opportunities for students to get involved with curriculum creation, development, and revision at academic institutions, which are imperative for LM to become a core element of allied health and medical education. A smart way to build LMIGs is to partner with existing specialty interest groups, such as Preventive Medicine or Family Medicine, as a way to further reinforce the concept that LM intersects with all areas of medicine. This co-collaboration with preexisting interest groups also provides a greater variety of potential events, improved attendance for events, and opportunities to save money by sharing costs for setting up events.

Conclusions

Without question, the Donald A. Pegg award has generated an atmosphere of growth for LMIGs, fostering the expansion, vision, and integration of LM into the education of allied health students nationwide. In summary, Pegg award winners found that even modest award funds served as an effective springboard for promoting local LM functions. These functions include hiring local chefs to demonstrate unique healthy recipes, hosting LMIG sponsored plant-based cooking sessions, facilitating body weight–based exercise programs, and teaching mindfulness methodologies through presentations and hands-on exercises. Future winners of the Donald A. Pegg award will serve to plant and nurture the seeds of LM growth in schools and communities throughout the country. This relatively small scholarship for students in medical schools and allied health institutions has ended up creating a much larger set of impactful LM outcomes. These 4 inaugural Pegg award winner reports have also shown how schools can serve to positively influence health practitioners in training, seasoned medical providers, local communities, and potentially hundreds and thousands of future patients. LMIGs help promote a physical presence at academic institutions, advocating for the discussion and action of smart nutritional choices, the simplification of physical activity, and the promotion of effective stress management and mindfulness. Imagine if every medical student or student in allied health care programs knew the tenets of LM and how to effectively discuss, assess, and prescribe LM to the patients with whom they interact. Health care could be very different.