Abstract
We launched the American Journal of Lifestyle Medicine (AJLM) slightly more than a decade ago. In our first editorial we wrote that our new journal was based on a “vision” with the goal of providing a “forum” with the “mandate” to embed the principles of lifestyle medicine into the mainstream of American medicine and health care. 1 Now that AJLM has just passed its 10th birthday, it seems like an appropriate time to look back and see how far we have come in our first decade and review the opportunities that lie ahead.
As articulated in our initial editorial, our “vision” was that the critical role of lifestyle practices and habits for both the short- and long-term health and quality of life for our patients deserved a much higher level of emphasis within American medicine. After all, it is clear that 75% to 80% of all chronic disease in the United States can be traced back to poor lifestyle habits and actions such as inadequate physical activity, poor nutrition, weight gain and obesity, and cigarette smoking.
Unfortunately, the academic literature supporting the critical role of positive lifestyle measures is scattered over a wide variety of disciplines including nutrition, psychology, exercise physiology, and various branches of medicine. For this reason, we felt it was important to establish a “forum” where health care practitioners could come and begin to understand the interconnection of all these disciplines.
Finally, the “mandate” of AJLM was to provide an academic home and evidence-based discussions of the power of daily habits and actions and why they are so important in modern health care.
‘Now, 10 years later, I am pleased and proud to state that the field of lifestyle medicine is continuing to thrive and move forward.’
Now, 10 years later, I am pleased and proud to state that the field of lifestyle medicine is continuing to thrive and move forward. There have certainly been great accomplishments in lifestyle medicine but enormous challenges also remain.
AJLM itself has grown dramatically over the past decade. We now have more than 10 000 subscribers representing virtually every country around the world. Last year there were more than 70 000 downloads of articles from AJLM. We have established new columns within the journal to emphasize education, communication, and the business of lifestyle medicine for those who wish to devote the majority of their medical practices specifically to this area. These columns have supplemented the state of the art reviews, original research, and case studies, which we continue to publish. We have devoted annual issues each year for the past 5 years to the proceedings of the national meeting of the American College of Lifestyle Medicine (ACLM), ensuring continued dialogue with leaders of the lifestyle medicine movement.2-6 The number of manuscripts submitted to AJLM has also grown dramatically. We now receive more than 10 times the annual number of manuscripts that we received in the early years of the journal. This makes for difficult editorial decisions but assures high-quality information to be published on our pages.
AJLM is proud to be the official journal of the American College of Lifestyle Medicine. This important organization has continued dramatic growth—more than doubling its membership in each of the past 5 years. ACLM offers a wide variety of resources for people who wish to emphasize lifestyle medicine and its principles as a cornerstone for their medical practice. ACLM also offers certification in lifestyle medicine as well as a variety of educational opportunities. Most recently, the development of a set of criteria for “lifestyle medicine specialists” represents an important new initiative.
The lifestyle medicine movement has truly become international with the establishment of the Lifestyle Medicine Global Alliance. 7 The robust growth of this organization demonstrates that the lifestyle medicine movement has become a significant presence around the world.
In the past decade we have also witnessed increasing recognition in mainstream American medicine of the central role that lifestyle measures play in the health and quality of life for our patients. As I have written in previous editorials, this fact is incorporated into the national recommendations for virtually every scientific guidelines related to metabolic disease including Guidelines from the American Heart Association, American Diabetes Association, Institute of Medicine, American Academy of Pediatrics, American Cancer Society, American Stroke Association, and so on.
In addition to these national guidelines, the American Heart Association (AHA) and American College of Cardiology (ACC) also issued in 2013 the AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk. 8
The Council of the AHA that I sit on also changed its name from the “Council on Nutrition, Physical Activity and Metabolism” to the “Council on Lifestyle and Cardiometabolic Health.” 9 The American Diabetes Association also issued a separate section on “Lifestyle Management: Standards of Medical Care in Diabetes—2018). 10 Other chapters of the Annual Clinical Guidelines from the American Diabetes Association also place a strong emphasis on lifestyle components.
The American Cancer Society has joined the American Heart Association and American Diabetes Association in issuing guidance for lifestyle measures to lower the risk of cancer as well as diabetes and heart disease. 11 The American Stroke Association and the AHA issued a presidential advisory titled “Brain Health,” which emphasizes lifestyle measures to lower the risk of both stroke and heart disease as well as improving overall brain health. 12
All of these recent documents and guidelines indicate that the concepts of “lifestyle medicine” are increasingly being incorporated into mainstream American medicine.
My team and I at Rippe Lifestyle Institute have also continued to play a role in advancing the evidence base of lifestyle medicine and further embed its principles into mainstream American medicine. In the previous issue of AJLM, I contributed a state of the art review titled “Lifestyle Medicine: The Health Promoting Power of Daily Habits and Practices.” 13 I realized that despite many years of editing AJLM we had never published a comprehensive state of the art review of lifestyle medicine. The intent of that article was to provide a wide-ranging overview of the disciplines involved in lifestyle medicine and the evidence base that supports the power of the principles related to lifestyle habits and practices and health.
This month I am also publishing a commentary in the American Journal of Medicine titled, “Are We Ready to Practice Lifestyle Medicine?” 14 American Journal of Medicine is a prestigious and widely read journal among physicians (more than 130 000 physician subscribers and many more online). Continuing to advance the field of lifestyle medicine is also the underlying principle behind the third edition of my eponymous, multi-authored textbook, which is due to be published later this spring. 15 This textbook brings together the expertise of more than 150 contributors spanning many of the fields related to lifestyle medicine. I am particularly pleased that this third edition also utilizes the talents and expertise of a number of members of ACLM to offer further practical advice and guidance for individuals wishing to make lifestyle medicine a cornerstone of their medical practices.
While the evidence base continues to grow concerning the clinical power of lifestyle medicine, I believe it is also essential to make the strongest possible economic case for lifestyle medicine principles. These principles and practices offer powerful tools to help not only improve patient outcomes but also control the runaway costs in American medicine. While many people have contributed to making the economic case for lifestyle medicine, I am particularly impressed by the work of Dr Mike Parkinson, who has demonstrated enormous financial benefits to a health care provider at the University of Pittsburgh Medical Center from individuals who improve their health by following the lifestyle medicine principles. 16
One other important opportunity for lifestyle medicine is to expand the triple aim of medicine (improving patient outcomes, controlling costs, and improving patient satisfaction) to include a fourth component of physician satisfaction and meaning, thus, creating a “quadruple aim.” This aspect of health care has become increasingly important and recognized since physician burnout is now endemic in the United States. One recent survey reported that over half of all physicians manifest at least some components of burnout. Many lifestyle medicine modalities such as increased physical activity and stress reduction hold great promise to help ameliorate burnout and bring more joy and satisfaction to the lives of physicians. Furthermore, by incorporating lifestyle medicine principles into the practice of medicine, we can underscore what Michael Porter has called the “Value Proposition” in medicine, namely, achieving superior outcomes while controlling costs. 17
So where do we stand on the 10th anniversary of AJLM? There is no question that we have achieved many important milestones and considerable success. Nonetheless, the challenges before us are immense. We need to continue to articulate the enormous power of daily habits and actions on both short- and long-term health and quality of life. Only by doing this can we live up to the reason why most of us entered into medicine in the first place, namely, to improve our patients’ lives by delivering optimum, evidence-based care.