Abstract
“…lifestyle medicine represents a very significant approach for individuals to preserve and enhance their health…”
This issue marks the 7th year that the American Journal of Lifestyle Medicine (AJLM) has focused the majority of an issue on the proceedings of the previous year’s national conference of the American College of Lifestyle Medicine (ACLM).
2021 was another year marked by extreme the challenges brought on by the COVID-19 pandemic. It is inspiring to see how ACLM, as an organization, and the members of ACLM have risen to multiple challenges and continue to move the field of lifestyle medicine forward in a vigorous and thoughtful way.
There is no question that lifestyle medicine represents a very significant approach for individuals to preserve and enhance their health. The theme of the 2021 conference “Patient Centered, Value-based, Outcome Driven” clearly underscores what lifestyle medicine is already beginning to accomplish and represents a very powerful vision for the future.
The current, excellent issue of AJLM was skillfully assembled and edited by our Guest Editors, Drs Neha Pathak and Melissa Mondala. They curated a wide range of articles covering multiple aspects of lifestyle medicine from the ACLM conference. The resultant issue of AJLM is diverse and exceptionally interesting.
As I read through the manuscripts that Drs Pathak and Mondala selected, I am struck by the passion that every member of the ACLM, who wrote for this issue, brought to their subject. The articles show a wide range of areas where lifestyle medicine can play a critically important role and underscore the urgency of the moment.
These articles also contain a broad range of information in areas where lifestyle medicine has clearly begun to expand and have an impact. For example, the article by 3 former or current or future Presidents of ACLM, Drs Collings, Frates, and Shurney outline why the “Time is Now” for lifestyle medicine to play an even more central role in American medicine. The article by Dalal et al underscores that lifestyle interventions should begin in early childhood and perhaps even in utero. This article is chock full of helpful, practical advice for parents about how to introduce children to important health habits and practices that are central to lifestyle medicine.
The article by Abascal et al provides a compelling case for why there is a bidirectional relationship between mental health and lifestyle medicine. A leader in this area has been Dr Gia Merlo, who serves as a Psychiatry Editor for AJLM, and who I have recently appointed as an Associate Editor.
The article by McHugh et al focuses on lifestyle medicine for women and covers a wide range of important topics that physicians need to know and understand. There is no question that women are already paying enormous attention to aspects of their life and health, often however, with inaccurate information. One astounding fact that struck me from this article was that the average woman spends over $225,000 on skincare items over the course of her life…More than the average retirement account! The interest is certainly there, we just need to focus it now on issues that really matter in terms of both short and long-term health.
Pathak, Pollard, and McKinney continue an important theme that they introduced last year on the linkage between personal and planetary health. While it may seem daunting for individual physicians to try to have an impact on planetary health, making this linkage is important. Physicians are trusted resources and can play leadership roles in protecting not only individual health but also planetary health.
The article by Carmona and Shurney is important for a variety of reasons. First of all, it demonstrates that issues of lifestyle and health have now reached into the thoughts and framework presented by multiple Surgeon Generals of the United States. These physicians are truly providing leadership in this area. I also was struck by how the Surgeon Generals uniformly emphasize the importance of health equity. This is an area where lifestyle medicine can play an extremely important role.
In addition to the articles based on the ACLM conference, I have added several articles that were scheduled to be published in future issues of AJLM that I thought were particularly appropriate for some of the themes raised in the current issue.
The article by Thomas et al describes how proper nutrition can play an important role in affecting the gut microbiome and managing symptoms of irritable bowel syndrome. The article by Barton and Pugliese provides a practical approach to injury prevention. This is a topic that I have been interested in for many years. As this article states, injuries are the leading cause of mortality for individuals under the age of 44. My thinking in the area has been very much influenced by Dr David Sleet, who is the former Associate Director for Science in the Division of Unintentional Injury Prevention at the CDC.
Dr Sleet edits the section on Injury Prevention for both the third edition of my Lifestyle Medicine textbook as well as the upcoming 4th edition.
The article by Xu et al on the interrelationship between cancer risk factors and adolescent dietary behaviors underscores a topic that is emerging throughout medicine and particularly in oncology. In both the 3rd and 4th of my Lifestyle Medicine textbook, there are significant descriptions of not only nutrition but also physical activity and weight management and their powerful role in both reducing the risk of cancer and also assisting in its treatment.
The article by de Fatima Guimaraes et al documents an innovative Canadian program for girls called FitSpirit which was delivered in schools. While it demonstrated some benefit, it is clear that girls had to stick with the program for at least 3 years in order to firmly establish lifelong habits.
Finally, the article by Dissen et al shows that undergraduate students are currently not able to clearly able to distinguish good information on websites related to lifestyle habits and practices as opposed to inaccurate information on these websites. ACLM has played an important role in beginning to educate individuals of all ages. This is an important initiative.
The theme of the 2021 ACLM conference, namely, “Patient Centered, Value-based, Outcome Driven” underscores some key issues in lifestyle medicine that deserve further thought and discussion. First of all, all of the key modalities of lifestyle medicine are indeed “patient centered.” Changing habits is hard and requires the full understanding and commitment of patients to accomplish these things. There is probably no field of medicine more patient centered than lifestyle medicine.
“Value-based” is also an important concept. When we think of value-based, we often think about dollars and cents; however, I view value-based as the underlying proposition that physicians should bring personal values to every clinical encounter. My thinking in this area was greatly influenced by Michael Porter who wrote in the Harvard Business Review 1 that medicine could only move forward if it can reconnect with underlying human values. So, it is not just dollars and cents that determine value, but it is also the humanity, love, and caring that we bring to lifestyle medicine.
The final issue of “outcome driven” is also critically important. There are enormous data already available about how such key concepts as regular physical activity, proper nutrition, weight management, stress reduction, and sleep all significantly impact on the likelihood of developing chronic disease.
A treasure chest of information on the multiple linkages between physical activity and improved health outcomes across the lifespan can be found in the Physical Activity Guidelines for Americans 2018. 2 This document should be part of the tool chest for every lifestyle medicine practitioner. Nutrition also plays a critically important role in lowering the risk of a variety of chronic diseases. We tend to focus on metabolic diseases such as heart disease and diabetes when it comes to nutrition, but recent data have clearly demonstrated the links between proper nutrition and reducing the risk of dementia. An article in the February 2022 issue of the American Journal of Clinical Nutrition, based on analyses from the Women’s Health Study at the Harvard School of Public Health, demonstrated that individuals who followed a plant-based diet were less likely to experience subjective cognitive decline than individuals who followed the typical American diet. 3
As the field of lifestyle medicine has continued to grow and expand, I am personally committed to provide the sound academic underpinnings which are essential for lifestyle medicine to influence mainstream medicine. One initiative in this area is a series of single topic lifestyle medicine books for which I serve as Series Editor. In the past 2 years, we have published small volumes in physical activity, 4 weight management, 5 and women’s health. 6 In the next 12 months, we will publish additional volumes in diabetes and the metabolic syndrome, 7 nursing, 8 behavioral medicine and counseling, 9 and cardiovascular disease. 10 I would love to encourage members of ACLM to edit a volume on lifestyle medicine and health equity. So, if anyone who reads this Editorial is ready to take leadership in this area, I would welcome future discussions.
Recent events including the COVID-19 pandemic and the horrific and unprovoked war Russia brought to Ukraine serves as a stark reminder to cherish the values that we hold most dear. In lifestyle medicine, the core value is that of caring. I regard caring and love as very similar concepts. Back in my undergraduate college days, I focused on American history and literature. My favorite poet at that time was TS Eliot who wrote the classic series of poems called the Four Quartets. 11 When I think about the core values of lifestyle medicine, I often remember the quote from Elliot in one of the Four Quartets called East Coker where he wrote:
Love is most nearly itself
When here and now cease to matter.
Old men ought to be explorers
Here or there does not matter
We must be still and still moving
Into another intensity
For a further union, a deeper communion…
In my end is my beginning
TS Eliot, East Coker
Back in 1999, when I edited the first academic lifestyle medicine textbook,12 I certainly did not regard it as my end, but I am inspired by the growth of lifestyle medicine and the passion of individuals who are leading the movement. It gives me courage to think that it was “just the beginning.” I am convinced that in the next decade in lifestyle medicine, we will move forward “Into another intensity.” The current status is only “the beginning.”