Leading the Charge Forward Through Lifestyle Medicine Interest Groups

The 2021 Donald A. Pegg Student Leadership Award recipients share one important trait: a passion for innovation in medicine. However, it is not the type of innovation that comes to mind in today’s increasingly fast-moving world. We are surrounded by not just the talk but implementation of technologies such as virtual reality to enhance medical training, on demand 3-D printing to customize surgical care, gene-editing to personalize medicine and artificial intelligence to improve patient outcomes. While these are all noteworthy and remarkable achievements that add tools to the healthcare toolbox, the innovation this group of students seeks addresses patient care at its most foundational level. Alongside thousands of devout American College of Lifestyle Medicine (ACLM) members, this new generation of providers believes that while technological advancement is the way of the future, we cannot forget our roots and lose track of the evidence-base that continues to show the immense power of healthy lifestyle change. We therefore believe establishing lifestyle medicine as the first-line treatment for chronic disease management and prevention is fundamental for a sustainable health care system. Furthermore, we contend that an evidence-backed, global shift in the perception and management of chronic disease among patients and healthcare providers is the need of the hour.

“The realization that a remarkable spectrum of disease etiologies converge on suboptimal lifestyle behaviors motivated us to create initiatives to propel lifestyle medicine to the Vanguard of disease prevention” (Ramesh, Kirbach, Terrana).

The 2021 student winners were Caitlin Magee, Simal Ali, Brent Gawey, Gautam Ramesh, Kyleigh Kirbach, Alec Terrana, Gali Katznelson, and Leonie Dupuis. The American College of Lifestyle (ACLM) Medicine has a rigorous process by which these Pegg Award winners are selected. As this year marks the fifth year for granting this award, ACLM is honored and delighted to have such a talented and dedicated pool of applicants. Each year, the selection process is more and more difficult. This group of students for the 2021–2022-year cycle is remarkably gifted and passionate. Not only has this forward-thinking group of students recognized the crucial gaps within our country’s traditional medical curriculum, including education on nutrition, physical activity, restorative sleep, stress management, positive social connection, and avoidance of risky substances, they have decided to take action.

The recipients of this award come from institutions across the country. They have been inspired by diverse personal experiences to embark on separate yet united missions to fill these gaps at the student level through Lifestyle Medicine Interest Groups (LMIGs). Whether it was watching patient after patient being admitted for preventable diseases on rotations, witnessing the first-hand effects of a lifestyle change in a family member, or learning how to live a life centered around health and wellness for themselves, it’s these personal encounters with lifestyle medicine that continue to drive them forward. They feel fortunate to have Dr Elizabeth Pegg Frates as our accomplished mentor, who has spent the past 30 years researching, studying, teaching, and practicing lifestyle medicine. This award is in honor of Dr Frates’ father, Donald Anderson Pegg, who is her chief inspiration. After suffering a heart attack and stroke at age 52, the New York City businessman decided to take his health into his own hands by implementing a rigorous lifestyle medicine regimen, ultimately affording him an additional 27 years to enjoy with family and friends. The Pegg family serves as a refreshing reminder of how bright the future could be with lifestyle medicine at the core of healthcare. Dr Frates repeatedly shares that she feels humbled and honored to be part of this remarkable team. Learning the specific stories of each award winner and seeing how they have used their time and resources as LMIG leaders is one way to keep the Donald A Pegg inspiration alive and thriving.

Caitlin Magee, OMS II

Rocky Vista University College of Osteopathic Medicine

Discouraged by traditional medicine, I decided to shift my focus toward lifestyle medicine, ultimately leading me to establish the LMIG at RVU in March 2021. I believe lifestyle medicine is the future, and I am grateful for the opportunity to create change for my generation of future physicians.

Our LMIG is graced by 2 inspirational advisors who allow us to function independently while supporting us in all our endeavors. Dr Jean Bouquet, DO, and Air Force Maj. Regan A. Stiegmann, DO, have each given wonderful presentations for our LMIG on their specific area of expertise within lifestyle medicine. Dr Bouquet is an osteopathic family physician who specialized in Addiction and Chronic Pain medicine for many years and currently serves as a professor of clinical medicine at RVU and CEO of his nonprofit organization, Cure Cervical Cancer. Dr Stiegmann is a flight surgeon, preventive medicine physician, and RVU graduate who currently serves as the military’s Lead Expert in Lifestyle and Performance Medicine and director of the Digital Health Track at RVU.

At RVU, our LMIG is known for our weekly TL;DR series (Too Long, Didn’t Read), where we write summaries of evidence-based lifestyle medicine research in a digestible format to share with our peers. In fall 2021, we hosted a six-week Healthy Living Challenge to introduce the fundamental pillars of lifestyle medicine. After the challenge, 2 winners were each awarded Hello Fresh gift cards equivalent to 6 weeks of healthy, unprocessed meals, generously funded by the Pegg Award.

This semester, we moved the application of lifestyle medicine beyond the classroom walls by giving RVU students the opportunity to get their vitamin D and socialize while simultaneously contributing to our community through a local trail maintenance initiative. Students were rewarded for their hard work with a flavorful plant-based meal funded by the Taste of Lifestyle Medicine Grant which generously provides up to $500 to encourage whole-food, plant-based meals at LMIG events. We also partnered with our Mental Health and Wellness Committee to host a registered dietitian on intuitive eating, followed by an event focused on meal prepping hosted by a clinical dietician and nutritionist.

Additionally, we have had the unique and exciting opportunity to collaborate with the Metropolitan State University of Denver’s LMIG (the only university in the country currently offering a bachelor’s degree in Lifestyle Medicine). Together, we established our newest discussion-based series: “Lifestyle Medicine Cafés.” Our first café was hosted and led by Jonathan Aluzas, president of MSU Denver LMIG. We had a lively discussion between 30 participants regarding the explosion of chronic disease over the last 100 years, the role lifestyle medicine plays in addressing this crucial issue, and how wellness coaching can facilitate behavior change between clinic visits.

Lifestyle medicine aligns with osteopathic medicine in our belief that all of the body’s systems are interconnected and, if we can bring the body back into alignment, it has the capability to heal itself. Therefore, we found it particularly important to host an event focusing on integrating osteopathy and lifestyle medicine, with a deeper look into the relationship between cranial manipulation and sleep.

Most recently, I worked with Student Doctor Ali Koehler from our sister campus in Utah to launch the RVUCOM-Southern Utah branch of the LMIG, which was officially inaugurated in March 2022. Ali and I are currently working on an exciting project with Dr Stiegmann to build an elective for students in their clinical years utilizing the LM Foundations Course, which will prepare students to sit for the American Board of Lifestyle Medicine exam. We plan to launch this pilot program next semester and will also be conducting a research study to evaluate student perception regarding the effectiveness of this course in Integrating Lifestyle Medicine Foundational Curriculum in Undergraduate Medical Education. Our goal is to build this into a pipeline using Rocky Vista University as a pilot for osteopathic medical schools, eventually adapting allopathic milestones to expand this wonderful educational opportunity to all medical students.

Simal Ali, OMS II

Touro College of Osteopathic Medicine—New York

The philosophy of lifestyle medicine naturally complements the values and Osteopathic principles emphasized in our medical curriculum at TouroCOM. To help our students fulfill their goals of becoming competent, comprehensive providers, we have focused on five major areas through our subcommittees: education, nutrition, physical activity, creative health, and social media. Through these committees, we serve a three-fold mission: to equip students with the knowledge to educate patients on lifestyle modifications, encourage students to utilize lifestyle as a form of self-care, and empower the community of the Greater Hudson Valley region to take charge of their health using the principles of lifestyle medicine. With over 100 members in our group, it is evident that we have articulated a vision for our institution that anyone can get behind.

At the start of our inaugural year, the nutrition committee created grocery guides with recommendations in each key food group to encourage a whole-food, diverse diet even on a student budget. We also researched the benefits of superfoods to highlight on our social media pages each month, followed by an event where we prepared and served dishes utilizing those superfoods. The committee also used Pegg funding to host a registered dietitian to speak on multiple topics, including the role of nutrition in the management and mitigation of diabetes and selecting therapeutic diet orders for hospitalized patients.

The physical activity committee launched a 2-week Step Challenge to encourage students and faculty to incorporate daily movement regardless of our busy schedules in the name of friendly competition.

We had excellent participation, and our highest achieving steppers earned gift cards sponsored by the Pegg Award to a local smoothie shop after each taking over 260,000 steps in just 2 weeks!

Our education committee worked with our high school mentorship program, MedAchieve, to host interactive workshops on the implications of lifestyle choices and utilizing lifestyle modifications as a form of medical treatment. After presenting to 180 high school students and their medical student mentors, we gave them an opportunity to brainstorm ways to prescribe lifestyle medicine to their patients struggling with sleep, substance use, nutrition, exercise, and social connection. The committee also launched a biweekly webinar series to utilize the existing content available through ACLM. The webinars were offered both in-person and over Zoom, covering various topics, including the role of lifestyle medicine in optimizing pregnancy, reversing memory loss in Alzheimer’s disease, musculoskeletal disorders, and clinician self-care.

The creative health committee utilized Pegg funding to host a candle-making workshop to encourage aromatherapy as an outlet for stress relief and relaxation. The proceeds from this project were donated to Sullivan180, an organization focused on improving health outcomes in Sullivan County, NY.

The remainder of our Pegg Funding went toward an initiative led by our club advisor, Dr Mary Ellen Dean, to revive a community garden right behind our school. The long-term goal of the initiative is to educate future physicians and our community members about the sustainability of healthy and affordable foods through gardening. Under Dr Dean’s guidance, we are excited to make fresh, organic produce more readily accessible to our students and neighbors and share the experience of gardening to inspire conscious living among us for generations to come.

Brent Gawey, MS IV

Emory School of Medicine

Up to 40% of the causes of premature death can be attributed to behavioral patterns. ¹ During my medical education, I came to experience this as accurate, seeing the root of many diseases starting with unhealthy behaviors. However, despite my understanding of this fact, I felt limited in what I could offer patients to address these habits, as I had no previous training in techniques for behavioral change. Determined not to be limited in my capacity as a future medical provider, I began seeking ways to become better equipped to address the totality of the individual, offering not only medications but effective, evidence-based, health-promoting behaviors to prevent and reverse disease. This quest led me to Dr Sharon Bergquist, MD, Associate Professor at Emory School of Medicine and Medical Director of Emory Lifestyle Medicine and Wellness. She introduced me to the American College of Lifestyle Medicine (ACLM) during our meeting. I quickly became involved with the Emory Lifestyle Medicine Interest Group (LMIG), directed by previous Pegg Award winner Krystyna Rastorguieva. I was inspired by the group’s mission and the pillars espoused by the ACLM. As I became more involved with the group’s activity on campus, I knew medical students needed exposure to these empowering conversations and resources. After being elected as President of the LMIG in spring 2021, I was determined to grow the awareness of lifestyle medicine and the ACLM in my medical school.

Encouraged by the outstanding leadership at the ACLM to apply for the Donald A. Pegg Award, I was fortunate enough to receive the esteemed award. With the financial backing of the award, my mission was to firmly establish the presence of the LMIG and grow exposure to the educational opportunities available through the ACLM at the Emory University School of Medicine. Ultimately, I hoped to further empower students as advocates for their patients by helping them become equipped with strategies to approach the behavioral component of disease and inspire the next generation of medical providers to recognize the importance of lifestyle medicine.

With the backing of the Donald A. Pegg Award, we have hosted numerous events to give students a broad range of exposure to the various ways lifestyle medicine can be implemented in patient care. In Fall 2021, our lectures included “What is Lifestyle Medicine” with Jon Bonnet, MD; “Full Plate Living: Fiber Focus Diet” with Amy Hanus; “Mindfulness and Self-Compassion” with Jennifer Mascaro, PhD; “The Science of Plant-based Nutrition” with Sharon Bergquist, MD and Jenny Bilko, RD; and “Exercise and Movement” with Peter Sprague, PhD. In the Spring (2022), we hosted Dr Will Hsu, MD, to present “The Science of Fasting” and also had talks focused on “Lifestyle Medicine Integration in Acute Stroke Patients Care” with Karima Benameur, MD; “The Science of Sleep” with Nancy Collop, MD; and a Careers in Lifestyle Medicine Panel. We also used funding from the Pegg Award to host a Culinary Demo which focused on creating a healthy, plant-based, nourishing soup. Participants were able to practice chopping skills and discuss fiber, grains, beans, spices, and creating cost-effective meals great for batch cooking and sharing.

Funding from the Donald A. Pegg award has also allowed our LMIG to offer educational scholarships to medical students interested in growing their knowledge about lifestyle medicine by providing stipends for courses offered through the education hub on the ACLM’s website. We were excited to see high levels of student interest and chose seven winners to take a course of their choosing.

We recently used Pegg Award funds to sponsor a Heart Health Month for all of Emory University. Participants were given seven challenges; each focused on one of the seven pillars of lifestyle medicine. The students demonstrating the most engagement were awarded a gift card to a local health food store to support further their desire to live out the seven pillars. This was a tremendous educational opportunity that increased student enrollment in our LMIG.

These collective efforts have grown our student engagement significantly, with our group now consisting of over 60 active members. Additionally, due to our increased membership, we have elected the first full executive board for our LMIG and received a charter in the medical school to guarantee future funding and recognition by the Emory Medical School Senate.

Our ongoing goal is to incorporate an interactive lifestyle medicine presentation for first-year medical students. Conversations are well developed at this point, and we are currently working out the details of the talk. This will allow all entering medical students to learn what lifestyle medicine is and will hopefully drive continued interest in the transformative power of lifestyle medicine for patients and the provider.

Our group is indebted to the generosity of the ACLM and Dr Beth Frates for offering this award and giving us a platform to share the message of the ACLM. Further, we have benefitted tremendously from our faculty advisors, Dr Jonathan Bonnet, MD, MPH, and Dr Jennifer Mascaro, PhD. It has been a fulfilling experience seeing the power of the collective in spreading awareness of lifestyle medicine. We excitedly look forward to the future with the momentum our LMIG has gained from the backing of the Donald A. Pegg Award.

Gautam Ramesh, Kyleigh Kirbach, and Alec Terrana—MS III

University of California, San Diego, School of Medicine

The vast majority of the patients in our healthcare system suffer from chronic diseases closely linked to lifestyle factors. To make the most significant impact on our patients, we would prevent these diseases from arising in the first place. Yet, the U.S. continues to be plagued by an epidemic of cardiovascular disease, diabetes, obesity, and metabolic syndrome. We believe that lifestyle medicine training should be an integral part of medical training. Our interest group is supported in our passion for lifestyle medicine by faculty advisor Dr Deepa Sannidhi.

To supplement our medical education, we began an Integrative and lifestyle medicine seminar series in autumn 2020 to present our colleagues with clinically oriented foundations and current research data supporting the prescription of evidence-based non-pharmaceutical therapies for managing and reversing chronic disease. This included specific pathologies, such as polycystic ovarian syndrome and dementia, as well as broader topics including pharmacologic and nonpharmacologic management of hypertension, and dietary management of atherosclerotic cardiovascular disease, mainstays of primary care, relevant to our students’ USMLE exams, while also being critical to their development as clinicians.

We are also driven to revamp our core medical curriculum to incorporate lifestyle medicine topics, including diet, exercise, and lifestyle counseling, proven remarkably efficacious in observational and interventional studies. We combed through the entire Practice of Medicine, Problem Based Learning, and Cardiology curricula and provided detailed recommendations on augmenting existing lectures and clinical cases to illustrate the efficacy of lifestyle interventions on a myriad of disease processes. Finally, we are dedicated to creating opportunities for our students to explore facets of lifestyle medicine within the community by fostering community partnerships to improve access to lifestyle medicine resources in San Diego. Recent efforts include teaming up with local public health organizations to increase access to fresh fruits and vegetables through building a community garden and teaching kitchen. We are also developing trauma-informed nutrition education for a local organization that houses survivors of sex trafficking.

Since the 1970s, decades after discovering the link between smoking and lung cancer, physicians have actively counseled their patients on smoking cessation. By 2011, the per capita cigarette consumption had decreased by 70%. This massive paradigm shift was achieved by numerous initiatives, with proper physician training being a crucial component. Modern physicians are not well equipped to counsel patients on their lifestyle practices, even though it arguably has the most significant impact on their health and wellbeing. We believe that initiatives to improve the training provided to medical students are the first step toward better patient counseling and, subsequently, better patient outcomes. We hope to impress the indelible mark of lifestyle medicine onto medical academia to appropriately equip future physicians to battle our national epidemic of preventable disease.

Gali Katznelson, MS IV

Schulich School of Medicine and Dentistry—Western University

After seeing countless patients admitted to the hospital with preventable illnesses on my rotations, I was motivated to start a lifestyle medicine interest group at the Schulich School of Medicine and Dentistry at Western University. I was first introduced to the field through my mentor, Dr Ronit Lavi, a passionate lifestyle medicine physician. Speaking to her encouraged me to make several positive changes in my own life surrounding exercise and nutrition. I realized that I wanted to have the tools to help my patients make such changes too. I was fortunate to bring together a talented executive team, and with Dr Lavi as our faculty advisor, we successfully became an official LMIG.

To supplement our medical school curriculum, we kicked off the year with a walk for breast cancer awareness and an introductory talk by Dr Ronit Lavi about the incredible field of lifestyle medicine. Other lectures included “Exercise in Pregnancy” by Dr Michelle Mottola, “Weight Stigma in Health” by Dr Eva Pila, and “A Healthy Prescription: A Whole-Food Plant-Based Nutrition Plan and Shared Medical Appointments” by lifestyle medicine physician Dr Larry Schmidt. We had terrific turnouts to these lectures. Simultaneously, we continue to make strides with our institute’s leadership to determine ways to incorporate more lifestyle medicine into our core curriculum.

Our team also attended the ACLM annual conference, where we presented a poster highlighting the value and application of lifestyle interventions for surgical patients. We are also engaging with our medical school leadership about incorporating more lifestyle medicine into our medical school curriculum. We are incredibly grateful for the Pegg Award, which enables us to organize a nutritional cooking event for medical students. We hope to show students how to cook healthy food on a budget in the hopes that this could empower them to make nutritional recommendations for their patients. We are incredibly grateful to the ACLM and to Dr Frates for the opportunity to bring lifestyle medicine to our school.

Leonie Dupuis, MS III

University of Central Florida College of Medicine

Over the past year, our LMIG has placed a heavy emphasis on enhancing its community relations. First, a connection was built with Montverde Academy high school students to create the first-ever high school Lifestyle Medicine Club. The UCF LMIG has provided mentorship and guidance to the high school students so that they can share the six pillars of lifestyle medicine with their peers. They are now working on an article together to document the process of starting a Lifestyle Medicine Interest Group and sharing their experiences with a broader audience.

As for the Pegg award, it is being utilized to plan and host UCF’s participation in Lifestyle Medicine Week. From events at the university to events in the community, we hope to engage many community members in conversations based on ways to improve health through lifestyle modifications. The biggest event will be the second edition of an online plant-based cooking class.

Conclusions

This year’s Donald A. Pegg Student Leadership Award recipients come from various backgrounds, each with their own unique stories of how they found lifestyle medicine and what ignited them to become the leaders they are today. Through Lifestyle Medicine Interest Groups, generous funding from the Pegg family, and insurmountable support from ACLM, they report feeling fortunate to be provided with all the tools necessary to turn their ideas and dreams into reality. Their work has gone above and beyond expectations. The intent of the Pegg Award is to inspire future leaders in lifestyle medicine and provide them with the support and tools to empower them to be change agents who inspire health professional students and practicing physicians alike. This type of inspiration encourages others to step out of their comfort zones and create novel lifestyle medicine programs and opportunities that help people add years to their lives and life to their years.

Together, the 2021 Pegg Award winners have made substantial strides in making the knowledge of lifestyle medicine more accessible to thousands of students across the nation. Their greatest collective successes include presenting evidence-based research in digestible formats, inter-institution LMIG collaboration, hosting countless expert speakers, and showcasing the ease of application of lifestyle medicine through grocery guides and friendly physical challenges. They have taken lifestyle medicine beyond the walls of the clinical and classroom setting by hosting plant-based culinary demonstrations, developing community gardens, maintaining nature trails, and planting the seed for inspiration in the next generation of lifestyle medicine enthusiasts through high school mentorship programs. As they continue to learn from and contribute to the field, this group of students will inevitably be at the forefront of the charge forward in establishing lifestyle medicine as the first-line treatment for chronic disease management and prevention. One of these leaders may be the President of the American College of Lifestyle Medicine one day.