Abstract
‘The article itself provides an extensive and evidence-based list of competencies for individuals who wish to specialize in the practice of lifestyle medicine.’
In this issue of the American Journal of Lifestyle Medicine we are delighted to publish an important article by Kelly, Karlsen, and Lianov titled “Establishing Competencies for Physicians Who Specialize in the Practice of Lifestyle Medicine.” 1
This article is a result of a year of arduous debate and evidence gathering on the part of not only the authors but also a select group of 13 leaders in lifestyle medicine who constituted the “expert lifestyle panel” which helped develop this article. The article itself provides an extensive and evidence-based list of competencies for individuals who wish to specialize in the practice of lifestyle medicine. In particular, these individuals are focused on intensive therapeutic lifestyle change.
The article is divided into 6 categories based on the 6 Accreditation Council for Graduate Medical Education and American Board of Medical Specialties (ACGME/ABMS) categories. The competencies are further divided into 34 specific areas. The intent of the article is to provide guidance for the education, certification, and practice of lifestyle medicine by physicians and other health care providers who wish to specialize in the practice of intensive lifestyle medicine treatment.
This article follows up on an article published in 2010 in the Journal of the American Medical Association coauthored by one of the current authors (Lianov), which represented the combined wisdom of multiple professional organizations, including the American College of Physicians, American Academy of Family Practice, American College of Sports Medicine, American College of Lifestyle Medicine and the American College of Preventative Medicine.
The current article extends the findings of the 2010 article and is specifically focused on individuals who wish to practice intensive therapeutic lifestyle medicine. The current article takes the next step forward in the field of lifestyle medicine by offering guidance to specialists in this discipline. This is very similar to other branches of medicine where specialists exist as well as general practitioners. For example, in the field of internal medicine there are specialists in cardiology, pulmonology, nephrology, infectious disease, and many others.
This article is based on a detailed introduction and summary of high-intensity lifestyle change written by Dr Kelly, published in the third edition of my textbook (Lifestyle Medicine, CRC Press, 2019). 2 The interested reader is referred to that chapter to find detailed examples of high-intensity and therapeutic lifestyle change and the multiple studies which support its efficacy.
In this chapter in my textbook, Dr Kelly provides a definition of intensive therapeutic lifestyle change (ITLC) as the following: ITLC utilizes an intensive whole emergent approach to change rather than the more gradual incremental changes commonly recommended by physicians. This “full court press” includes a comprehensive multi-factorial lifestyle change approach. As the treatment begins in a residential facility, therapeutic meals are typically prepared and served. Exercise is scheduled multiple times per day, educational activities are conducted and plenty of sleep is included. The patient has 4 to 8 hours of contact with intervention staff on most week days for a few weeks with intensity decreasing until the patient returns home.
ITLC is contrasted to TLC particularly by the induction stage and the high level of contact with providers. In the current article, it is important to note that the intent is not to exclude primary care physicians or other specialists. Rather it is intended to provide an alternative for physicians who feel that their patients could benefit from more intensive therapeutic lifestyle change who can then be referred to individuals who are skilled and certified in the area of ITLC.
This article represents an important step forward in the development of the field of lifestyle medicine. It provides a framework for individuals who wish to specialize in lifestyle medicine. It is also consistent and will be used with multiple other educational materials that have been developed by the American College of Lifestyle Medicine. 3 This article also represents the next step in the progression toward what I hope will be ultimate recognition by the American Board of Internal Medicine for a subspecialty of lifestyle medicine.
This work represents an important milestone in the development of lifestyle medicine as the field continues to advance and mature. We are delighted to share the framework provided in this article with the readers of the American Journal of Lifestyle Medicine.