Abstract
It is clear that the messages of lifestyle medicine are beginning to take hold in very powerful ways.”
This issue marks the sixth year that the American Journal of Lifestyle Medicine (AJLM) has devoted an entire issue to the Proceedings of the National Conference of the American College of Lifestyle Medicine (ACLM) from the previous year. In a very challenging year, with enormous disruptions brought on by the COVID-19 pandemic, lifestyle medicine has emerged as an even stronger and more important approach for individuals to restore not only individual health but also national health, and the health and well-being of the people around the world, and even the planet itself!
The theme of the 2020 ACLM Conference “Health Restored” could not have been more appropriate given not only the challenges faced in 2020 but also the critically important efforts that we all must make to restore the health of people around the world.
It is clear that the messages of lifestyle medicine are beginning to take hold in very powerful ways. When many other disciplines in medicine experienced setbacks and declines in membership in 2020, the ACLM continued to rocket forward. In fact, in 2020 ACLM welcomed hundreds of new members. Since 2003, ACLM has increased its membership more than 1000% making it the most rapidly growing specialty within mainstream medicine!
Not only has the membership of ACLM grown, but the depth and breadth of materials being presented at the annual conference and recognized as components of lifestyle medicine has continued to also expand.
The current, wonderful issue of AJLM was skillfully assembled and edited by our Guest Editor, Dr Amanda McKinney. Dr McKinney solicited a wide range of articles covering multiple aspects of lifestyle medicine which has resulted in a diverse and exceptionally interesting group of manuscripts.
I have roughly divided the manuscripts in this issue into 5 groups. The first group of manuscripts focuses on the health-related impact of the COVID-19 pandemic. Articles in this group of manuscripts range from discussions of using lifestyle medicine and mindfulness techniques to help allay anxiety to strategies for reducing isolation, as well as the role of lifestyle medicine techniques in reducing underlying chronic diseases and health care disparities.
Despite the devastation caused from the COVID-19 pandemic, there may be a silver lining as we come to think about ways that lifestyle medicine can help restore health. A good example of this relates to the serious health disparities that were highlighted by this pandemic. We know that health disparities have played a role in the alarming racial and ethnic differences unmasked by COVID-19. Hospitalization rates for COVID-19 and deaths among Native Americans and Black Americans are between 4.5 and 5 times higher than that of White Americans. Hispanic Americans have also been disproportionately affected and are hospitalized at a rate approximately 4 times that of White Americans. 1 The mortality of Black Americans in a number of cities has been more than twice as high as the proportion of Black Americans in these geographic areas.
It should also be noted that obesity and poor nutritional habits have made a significant contribution to disparities in how COVID-19 has affected Americans. Both obesity and poor nutrition are more common in disadvantaged populations than they are in more affluent ones. Unfortunately, the isolation and anxiety cause by the pandemic has often made health problems even worse for some. In one recent survey, 42% of respondents reported weight gains averaging 29 pounds over the past year! Cigarette smoking and alcohol consumption have also increased.
Fortunately, a committed group of members of the ACLM has already met to examine some of these issues and are poised to generate a major state of the art review on this issue to be published in AJLM as well as a potential book in this area to be published as part of the Lifestyle Medicine Series that I am editing.
The second group of manuscripts emanating from the 2020 ACLM Conference focuses on planetary health. The article by Pathak and McKinney in this issue underscores how planetary health and climate change are inextricably linked to issues potentially ameliorated by lifestyle medicine. The global warming of our planet as well as the increased number of violent storms we are witnessing provide compelling examples that unless we take dramatic steps, our planet will become increasingly uninhabitable. Issues related to lifestyle medicine offer promising approaches to help to reverse the emerging pandemic of climate change and improve planetary health.
Lifestyle medicine practitioners have a unique set of skills to contribute in this area. This is all the more important since the World Health Organization (WHO) has launched a major initiative to combat noncommunicable diseases, many of which are related to issues of planetary health and climate change. I am delighted that the ACLM is playing a central role in this WHO initiative.
The third group of manuscripts in this issue relates to nutrition, Of course, the area of nutrition remains central to lifestyle medicine. The authoritative article by T. Colin Campbell on “Nutrition and Medicine: Are they Connected?” provides compelling evidence for how plant-based eating can contribute not only to individuals’ health but also to the health of the planet. One aspect of this is underscored by the authoritative review by Dr Michael Greger “Primary Pandemic Prevention,” which offers a compelling case for how animal production practices around the world have significantly increased the likelihood of viral spread—yet another reason for adopting a whole food plant-based diet.
The fourth group of articles in this issue relates to evolving practice models in lifestyle medicine. These articles emphasize the increasing sophistication of practice models that can contribute to the likelihood that more physicians will find economically viable ways of devoting either their entire practice or a portion of their practice to lifestyle medicine. These models include shared appointments, direct primary care, hybrid practice models, and lifestyle medicine prescriptions. The articles by Patel and also by Petersen et al show how some of these strategies can effectively be integrated into health systems for everyday practice.
The fifth group of articles relates to the important and evolving area of education in lifestyle medicine. The article by Rea et al on “Medical Education Transformation: Lifestyle Medicine in Undergraduate and Graduate Medical Education Fellowship and Continuing Medical Education” shows how at every level of medical education lifestyle medicine principles and practices are being demonstrated to be effective. The article by Trilk et al offers a lifestyle medicine curriculum that can potentially be implemented in medical schools around the country.
It is gratifying to see how the evidence of benefit from lifestyle medicine principles and practices continues to permeate other subspecialties of medicine. As I cardiologist, I have been delighted over the past few years to see both the practice guidelines as well as the guidelines for treatment of cholesterol 2 and hypertension 3 from the American Heart Association (AHA) and the American College of Cardiology (ACC) increasingly emphasize the vital role of lifestyle medicine in the practice of cardiology with the goal of reducing the risk of heart disease. In fact, the 2013 AHA/ACC overall practice guidelines are entitled “Guidelines on Lifestyle Management Reduce Cardiovascular Risk.” 4 . The Strategic Plan for the AHA for 2030 also emphasizes the importance of reducing health disparities and articulates the goal of increasing wellness throughout the life span. 5 These initiatives could have come directly from lifestyle medicine!
As we continue to work in the area of linking lifestyle medicine to restoring health, I believe it is important to recognize an important issue related to many people’s perspective on health. Some years ago, I wrote a book entitled High Performance Health, 6 which emphasized using health as a platform for achieving improved life. In the course of doing research for this book, I discovered a fact that still amazes me. We know that only 25% of adults achieve enough exercise to achieve cardiovascular benefits. Over 73% of the adult population is overweight or obese and less than 15% of adults consume the recommended amounts of fruits and vegetables.
Despite these grim statistics, when the Department of Health and Human Services asks people how they rate their health an astounding 80% to 90% reliably rate their health as “good” or “excellent.” How can individuals have such high personal ratings of their health yet such poor habits? I believe the answer lies in that most people confuse “good” or “excellent” health with simply the lack of disease.
We need to focus on how lifestyle medicine not only lowers the risk of disease but also helps people achieve optimal health or as I have called it “high performance health.” This places the value of health as fundamental to achieving the kind of lives that we all want and deserve. We still have long way to go in our country to helping people understand that they can utilize the platform of good health and achieve more joy and fulfillment if they adopt more positive practices in their daily lives. That should be a goal for us in the area of lifestyle medicine!
As part of my commitment to lifestyle medicine, my research organization has continued to play a role in empowering its central pillars. One initiative that we have undertaken is to launch a series of single topic books in the area of lifestyle medicine. I am delighted to serve as the Series Editor for this Lifestyle Medicine Series. I was also pleased to author the first book in this Series Increasing Physical Activity: A Practical Guide. 7 This book relates to my passion for the role of physical activity in good health. I am delighted that the current President of ACLM, Dr Cate Collings, came to lifestyle medicine through her initial work in the area of exercise physiology. This is the same initial interest that brought me into the area of lifestyle medicine. Under Dr Collings’ leadership, ACLM is also participating in the Physical Activity Alliance, which I hope and believe will bring a greater emphasis on physical activity into ACLM. There are currently seven other single topic books in progress in the Lifestyle Medicine Series many of which are being edited by members of ACLM.
I know that most people who came into lifestyle medicine came through the area of plant-based eating, but increasing physical activity is also vitally important to improving overall health and, of course, serves as one of the pillars of lifestyle medicine. The Physical Activity Guidelines for Americans 2018 8 provides an overwhelming body of information showing that regular physical activity substantially not only lowers the risk but also serves of an important component of the treatment of virtually every chronic disease.
If we in the lifestyle medicine community are going to truly play a leadership role in restoring health, we should embrace the silver lining that for many individuals the pain and suffering caused by the COVID-19 pandemic may have brought a formal reconning of what really matters in life. I believe the pandemic reminded people of how precious life is, and all that we must do to preserve or enhance it. The year that we have suffered through in 2020 also reminds me of the profound message of Viktor Frankl writing during the madness of the Holocaust when he wrote that “We do not get to choose our difficulties but we have the freedom to select our responses.” 9 He argued that “Meaning comes from three things: the work we offer in times of crisis, the love we give, and our ability to display courage in the face of suffering.”
There is no question that people in the United States are suffering not only from the COVID-19 virus but perhaps even more profoundly, from adverse life choices that are robbing thousands of individuals the kind of healthy life that we all hope for and deserve.
We in the lifestyle medicine community have the tools and obligation to truly help restore health through our hard work and commitment.