Furthering the Field of Lifestyle Medicine Through the Donald A. Pegg Student Leadership Award

Abstract

Lifestyle medicine focuses on six pillars: a predominantly whole food, plant-based dietary pattern, physical activity, stress management, avoidance of risky substances, sleep, and positive social connection. Lifestyle medicine has been shown to be effective in treating heart disease, type 2 diabetes, and hypertension, among others. Despite these data, lifestyle medicine education amongst medical schools continues to be inadequate. Lifestyle Medicine Interest Groups (LMIGs) are student-led organizations which work to fill the gap in lifestyle medicine education by holding a variety of programming for their student bodies, while concurrently advocating for designated lifestyle medicine education within formal curricula. The Donald A. Pegg Student Leadership Award was created by Dr. Beth Frates, current President of the American College of Lifestyle Medicine, to recognize outstanding student leaders in the field of lifestyle medicine, and specifically for the work related to their LMIG. The Donald A. Pegg Award provides recipients with LMIG funding for their respective institutions, complementary registration for the American College of Lifestyle Medicine national conference, and a stipend for conference travel. The funding provided by the Donald A. Pegg Award allows LMIGs to expand their reach to their greater student bodies, helping to further the field of lifestyle medicine. The purpose of this article is to highlight the 2022 Donald A. Pegg award recipients and how they are using its merit to advance the field of lifestyle medicine.

“Focused on beneficence and a culture of non-maleficence, forward thinking medical schools should strive to embrace lifestyle medicine as a key aspect of their curricula.”

Introduction

Lifestyle medicine focuses on six pillars: a predominantly whole food, plant-based dietary pattern, physical activity, stress management, avoidance of risky substances, sleep, and positive social connection. Lifestyle medicine has been shown to be effective in treating heart disease,^1-6 type 2 diabetes,^3,7-9 and hypertension.^3,10 In order to be adequately equipped to face the epidemic of chronic disease within the United States, it is important that physicians in training receive lifestyle medicine education within their medical school curriculum. Unfortunately, nutrition education amongst medical schools continues to be inadequate, and many medical schools do not meet the required average of 25 hours of nutrition education set forth by the National Academy of Sciences. ¹¹ Since the inception of the first Lifestyle Medicine Interest Group (LMIG) by Dr. Beth Frates at Harvard Medical School, medical students, health professional students, and graduate students alike have worked to establish over one hundred LMIGs across the U.S. ¹² LMIGs are student-led organizations which work to fill the gap in lifestyle medicine education by holding a variety of programming for their student bodies, while concurrently advocating for designated lifestyle medicine education within school curricula.

The Donald A. Pegg Student Leadership Award was created by Dr. Frates to recognize outstanding student leaders in the field of lifestyle medicine. Since 2016, the award has recognized medical and health professional students for their significant leadership in the field of lifestyle medicine. In 2022, five additional student leaders were recognized for their impact. The Donald A. Pegg Award provides recipients with LMIG funding for their respective institutions, complimentary registration for the national American College of Lifestyle Medicine conference, and a stipend for conference travel. The funding provided by the Donald A. Pegg Award allows LMIGs to expand their reach to their greater student bodies, helping to further the field of lifestyle medicine. Previous award winners have documented their specific experiences in previous articles published by the AJLM.^13,14 The purpose of this article is to highlight the 2022 Donald A. Pegg award recipients and how they are using its merit to advance the field of lifestyle medicine.

Abigail Joy Garcia—University of the Incarnate Word School of Osteopathic Medicine

Abigail Joy Garcia is a third-year osteopathic medical student at the University of the Incarnate Word School of Osteopathic Medicine (UIWSOM) in San Antonio, Texas. Her journey into the field of lifestyle medicine began in 2013 when her father experienced a near myocardial infarction and had three cardiac stents implanted. Unfortunately, the medication he was prescribed ultimately caused severe muscle wasting and weakness, prompting Abigail and her father to seek alternative approaches to prevent a repeat cardiac event without the use of medication. Through extensive research, trial, and error with nutrition and exercise, they discovered the transformative power of lifestyle medicine.

During her tenure in medical school, Abigail established Food as Medicine (FAM), the Lifestyle Medicine Interest Group at UIWSOM, in 2021. FAM quickly gained popularity and became one of the largest student organizations, attracting over one hundred members in its inaugural year. The group organized various activities, including but not limited to visits to local plant-based restaurants to explore ingredients and foster positive social connections. A notable event organized by FAM was the plant-based Friendsgiving potluck, where students and faculty brought plant-based dishes, such as quinoa salad and sweet potatoes, to share. In another event, FAM organized a screening of the documentary “Code Blue,” which chronicles Dr. Saray Stancic’s experience with whole food, plant-based nutrition and its impact on multiple sclerosis. Dr. Stancic engaged in a discussion with the attendees following the screening. Finally, Abigail and her fellow FAM officers published a paper explaining the variety of nutrients based on the color of fruits and vegetables for pediatric nutrition awareness month. ¹⁵

Receiving the 2022 Donald A. Pegg Award has opened new opportunities for Abigail, FAM, and FAM’s faculty advisor, Robert Slater, MD, MPH. With the awarded funds, FAM launched a healthy food table on campus. While the university had an already established third-party vendor to sell snacks to students, these snacks primarily consisted of processed foods which were high in sodium and sugar. Committed to the mission of lifestyle medicine, FAM’s new officers initiated a petition to introduce healthier snack options, garnering over one hundred signatures. Deonte Jefferson, one of the officers, played a pivotal role in this endeavor. He presented the petition and FAM’s proposal for a separate healthy food table to UIWSOM’s Board of Resources and the Dean. Following approval from the school, FAM utilized the funding from the Donald A. Pegg Award to procure supplies and food for the healthy food table. The table now offers students a range of whole food, plant-based options, including bananas, apples, mixed nuts, and granola bars made with whole ingredients. FAM also recently helped in the planting and establishment of UIWSOM’s new community garden.

tWith the generous financial support from the Donald A. Pegg Award, Abigail had the opportunity to attend the 2022 American College of Lifestyle Medicine Conference held in Orlando. During the event, she engaged in inspiring conversations with her fellow Pegg Award recipients and had the privilege of discussing the future of lifestyle medicine with Dr. Frates. These interactions revitalized Abigail’s passion for medicine, and she found inspiration from the presenters and the numerous physicians and students she connected with. Currently, Abigail is serving her second term as the ACLM Trainee Executive Vice President of Lifestyle Medicine Interest Group Development, a role that allows her to contribute to the growth and development of interest groups focused on lifestyle medicine around the nation. In her future career, Abigail intends to specialize in Physical Medicine and Rehabilitation, integrating lifestyle medicine practices to empower her patients to lead more fulfilling, healthier, and active lives.

Ali Coffee—Rocky Vista University College of Osteopathic Medicine

Ali Coffee is a third-year medical student at Rocky Vista University College of Osteopathic Medicine—Southern Utah (RVUCOM-SU) in Ivins, UT. Ali first discovered lifestyle medicine through her mentor, Regan Stiegmann, DO, MPH, FACLM, DipABLM. Dr. Stiegmann is a pioneer in the field of lifestyle medicine and a former ACLM Trainee Executive Board member. As a pre-medical student shadowing in a pediatrician’s office, Ali quickly noticed that the epidemic of metabolic and cardiovascular diseases was affecting children, putting them at risk of leading lives riddled with life-altering diseases and medications. Lifestyle medicine was the missing piece in Ali’s passion for primary care and it provided her with a new-found passion to change the lives of her future patients. Following in the footsteps of the 2021 Donald A. Pegg Award winner and RVUCOM-Colorado’s Lifestyle Medicine Interest Group (LMIG) founder, Cait Magee, Ali founded RVUCOM-SU’s first LMIG. The success of this group allowed Ali to apply for and receive one of the 2022 Donald A. Pegg Student Leadership Awards for herself and her LMIG advised by Keith Bodrero, DO, PhD. The monetary award received from the Donald A. Pegg award served as an impetus for the RVUCOM-SU’s first year as an LMIG, gaining interest through healthy food and speakers in the field. Some of the guest speakers so far have included Steve Sugden MD, MPH, MSS sharing how he incorporates lifestyle medicine into his addiction medicine practice and Dr. Regan Stiegmann, discussing her work implementing lifestyle medicine as a Flight Surgeon in the U.S. Air Force.

With the growing interest in lifestyle medicine across both the Southern Utah and Colorado campuses, Ali worked as one of the leaders on a project to launch a lifestyle medicine elective course to be offered to all fourth year osteopathic medical students starting in the 2023-2024 academic year. This course utilizes the existing and high quality ACLM Foundation of Lifestyle Medicine Board Review Course, the primary learning material, and capitalizes on scheduled free time during their fourth year of school to broaden their lifestyle medicine knowledge for graduation credit. Ali and the rest of her team are working on building a framework for both osteopathic and allopathic medical schools across the country for easy implementation of similar lifestyle medicine electives at their respective schools. In addition, Ali co-founded a lifestyle medicine mentorship group in 2023. This group meets bi-monthly and provides other like-minded individuals the opportunity to network, brainstorm project ideas, and gain valuable advice on anything and everything lifestyle medicine.

Annika Lintvedt—Michigan State University College of Human Medicine

Annika Lintvedt is a third-year medical student at Michigan State University’s College of Human Medicine (MSU CHM) in Grand Rapids, MI. After the death of her father in 2018, she became passionate about preventive healthcare and was looking for a way to integrate its principles into her career in medicine. She ultimately discovered lifestyle medicine and took the lead in forming the first Lifestyle Medicine Interest Group at her medical school with the help of faculty advisor Carolyn Vollmer, MD. This allowed her to apply for and receive one of the 2022 Donald A. Pegg Awards. MSU CHM is affiliated with Corewell Health West (previously Spectrum Health), and is home to the innovative lifestyle medicine practice with medical director Dr. Kristi Artz at the helm. This allowed their interest group to work closely with an established cohort of lifestyle medicine physicians. The Donald A. Pegg Award allowed the LMIG at MSU CHM to expand their reach to a larger audience of medical students through increased opportunities to hold sophisticated events within the Corewell Health Lifestyle Medicine practice. These events included lectures on the power of plants in cancer prevention and the role of nutrition in mental health, both followed by a professional chef demonstration of a plant-based meal. The monetary stipend provided by the Donald A. Pegg Award allowed the group to hold multiple Culinary Medicine events hosted by a professional, plant-based chef along with lectures regarding the importance of lifestyle medicine in mental health and cancer prevention. Later on, the group shifted their sights to two key aspects of lifestyle medicine advancement and widespread integration: medical education and community engagement.

Medical Education

MSU CHM’s LMIG started to focus on implementing lifestyle medicine into the curriculum at CHM. Annika and the Vice President of the LMIG, Michael Knox, took the lead in creating the first-ever pre-clinical lifestyle medicine elective at their school which will launch in the Fall of 2023. This elective will start as a longitudinal, 6-week course (approximately 12 total hours), and each week will cover a different pillar of lifestyle medicine. The elective will closely follow the lifestyle medicine course syllabus as authored by Dr. Frates. Additionally, they were able to successfully implement a University-recognized clinical elective in lifestyle medicine at the Corewell Health Lifestyle Medicine practice for third and fourth year students. The group plans to conduct a curriculum-wide audit to identify specific lifestyle medicine-related educational gaps and subsequently provide resources and material to address them. The success that the MSU CHM LMIG had with implementing curriculum-wide changes owes in part to the resources, connections, and guidance that came along with receiving the 2022 Donald A. Pegg Award.

Community Engagement

An important aspect of integrating a novel field of medicine into the mainstream is through community outreach. The students at MSU started the first Shop with a Doc series in the Greater Grand Rapids area which aims to educate patients on the healthiest ways to navigate a grocery store, with emphasis on plant-based proteins, produce, and non-dairy substitutes. They plan to expand their reach to grocery stores in surrounding underserved and rural communities. The initial event had fifteen patients and ten medical students and faculty of the Corewell Health lifestyle medicine practice. In the future, they plan to expand to larger grocery stores who can compensate for a larger group of individuals. Additionally, they worked to establish a relationship with Baxter Community Center, which is a non-profit organization that functions as a resource for families who struggle financially to receive healthcare (including mental health), dental care, fitness classes, nutrition information, and more. Students are beginning to regularly volunteer with Baxter by providing lectures and workshops regarding lifestyle medicine, such as lifestyle-focused diabetes education.

Annika served as President of the MSU CHM LMIG until 2023, when she transitioned leadership to a new executive board of seven inspired and brilliant students who plan to take the group to new heights. Annika capitalized on the momentum she gained from receiving the Donald A. Pegg award by applying for and accepting the role of Trainee Vice President of Communications for the 2023-2024 ACLM Trainee Executive Board, allowing her to work with talented minds both nationally and internationally and deepen her passion for lifestyle medicine. She is planning a career in Internal Medicine and Pediatrics.

Stephen Manga—Eastern Virginia Medical School

Stephen Manga, a medical student at Eastern Virginia Medical School (EVMS), collaborated with student leaders and faculty advisor, Dr. Gunadhar Panigrahi, to grow EVMS’ LMIG into the fourth largest student organization on campus. Before medical school in 2020, Manga was a masters student at EVMS and joined an LMIG during its first year as an official student organization. Unfortunately, due to restrictions imposed by the COVID-19 pandemic, the LMIG was unable to offer in-person events when he first joined. This motivated Stephen to expand the LMIG’s reach as restrictions began to lift in 2021. With the help of the rest of the executive board, the LMIG was able to put on near-monthly events and integrate two student presentations about lifestyle medicine into the curriculum. The efforts were recognized by the ACLM at the 2021 Lifestyle Medicine Conference and earned EVMS’ LMIG the LMIG Excellence Award for their all-around efforts to promote lifestyle medicine on campus, and within the community. Stephen was subsequently elected as co-president of the LMIG, pending acceptance to EVMS’ medical school.

With the student organization’s popularity on campus increasing, attendance for guest speaker events started increasing as well. In order to accommodate the increased number of attendees and maximize the $500 offered per grant from the Taste of Lifestyle Medicine (ToLM) grant, LMIG at EVMS restricted ToLM grant use for speaker events. While the ToLM grant is incredibly beneficial for expanding the reach of their speaker events, many club members expressed a desire to attend other types of events. The funding provided by the Donald A. Pegg award allowed the LMIG to expand the variety and number of near-monthly events held. In order to promote events, the group started by hosting a raffle for free personal training sessions at the on-campus wellness center, along with spice-rack starter kits. The starter kits contained garlic, onion, paprika, oregano, chili, and cinnamon which were purchased from a local Harris Teeter and were also offered as a prize to the winners of a lifestyle-medicine themed jeopardy session that was attended by eighteen students. Most recently, they collaborated with the campus’ American Medical Women’s Association to host a “Ladies Lifting Session” and provided post-workout smoothies. This event was hosted at the on-campus wellness center, led by the center’s personal trainers, and was attended by thirteen students. It provided a safe space where female-identifying students could learn the fundamentals of building strength and endurance, how to use gym machines, and create workout routines. Lastly, in order to accommodate the increased attendance at catered guest lectures, the award funding bolstered the aforementioned grants for plant-based catering. The topics covered in the lectures were timed with the EVMS curriculum with intent to boost faculty engagement and to ensure that the information provided was relevant to the material students were currently learning. For example, the first event of the year was a Heart Disease Reversal Patient Panel in partnership with the local Ornish clinic during EVMS’ Heart, Lung, and Kidney Module, which Stephen moderated.

In addition to the financial support, national recognition by the ACLM increased awareness of the EVMS LMIG’s initiatives inside and outside the school. First, school faculty began to see the group’s efforts as fundamental in the advancement of the field of lifestyle medicine. This allowed Stephen to work with the course director of the Multisystem Disorder module, Dr. Anca Dobrian, to create and implement a presentation about diet and weight loss as part of the class. The presentation focused on how processed foods utilize the bliss point to overcome sensory-specific satiety, how calorie density plays a fundamental role in weight loss, and how the National Institute of Health’s Body Weight Planner can be used instead of outdated methods such as the 3,500 kcal rule to estimate weight loss. The presentation was also accompanied by questions students answered as part of a mandatory research review session on weight loss.

The group’s recognition was also noticed by students on campus, and the club’s membership grew from thirty to over 150 students over the course of two years, with over 90% of the membership being medical students. Additionally, the executive board was expanded from six to ten students to help accommodate the student body’s increased interest for a variety of events. For reference, each class in the EVMS MD program is around 150 students. The national recognition also attracted the attention of additional speakers. Most notably, President of the Physicians Committee for Responsible Medicine, Dr. Neal Barnard, came in-person to an audience of over seventy students and faculty to lecture about the effect of diet on hormonal health during EVMS’ Hormones and Reproductive Health module.

Stephen served as co-president for two academic years and recently passed on the leadership to a well-staffed and motivated executive board. He will soon start his third-year clinical rotations and currently plans to become a primary care physician, dual board-certified in Internal and lifestyle medicine.

Timothy Voehl—Arizona State University

Timothy Voehl is a masters student in the Global Health program at Arizona State University School of Human Evolution and Social Change (ASU SHESC) in Phoenix, AZ. In 2006, Timothy was diagnosed with a debilitating and terminal neuromuscular disease called Ataxia, caused by a genetic mutation, which left him feeling helpless and searching for meaning. In 2014, he returned to school in search of a better life. Eight years, three degrees, multiple awards later, and with many intense, holistic therapies centered around healthy lifestyles, Timothy realized that earlier lifestyle medicine interventions would have positively altered the course of his diagnosis.

In 2018, Timothy co-founded the Healthy Lifestyles Student Organization (HLO). In parallel, he was working to earn his second undergraduate degree in Healthy Lifestyles Coaching through ASU’s College of Health Solutions (CHS). At that time, ASU did not have an online student organization and he acted as a pioneer in its development. HLO became a Lifestyle Medicine Interest Group in March of 2022 and he was encouraged by the LMIG faculty advisor, program director and professor, Karen Gregory-Mercado Ph.D, MPH, MCHES, NBC-HWC, to apply for and ultimately be awarded the 2022 Donald A. Pegg Student Leadership award.

The Pegg award has created a steady breeze for Timothy’s sails. As president of the HLO, the group has substantially benefited from his renewed source of energy, team building skills, professional monthly presentations, steady organizational growth and the awards financial contribution being added to the NBC-HWC certification scholarship fund. All of this led to receiving an ASU Pitchfork Award for Outstanding Student Organization. Timothy has established many professional connections and contributes to a Pegg team initiative to advance Lifestyle Medicine among medical schools (outlined below). He also is pursuing an internship with ACLM’s past president and 2022 Trailblazer award recipient, Liana Lianov, and has a firm foundation for a global “launch-pad.” Timothy was recently awarded ASU’s highest student honor: 2023 Outstanding Graduate Student Leader Award. Timothy owes much of his confidence and success to receiving the Donald A. Pegg Award at the 2022 ACLM national conference.

The Healthy Lifestyles Student Organization at Arizona State University accepted the ACLM Virtual Victor Award at the LM2022 conference for outstanding achievement in maintaining a largely virtual LMIG that serves over 550 members and is ACLM’s largest student LMIG. As one of the nation’s largest universities, with over 142,000 students worldwide, there is ample room for further growth. The potential to integrate the pillars of lifestyle medicine amongst its students, faculty, affiliated health systems, alumni, and within post-graduate careers is vast, and HLO is poised for the challenge. With a firm foundation, a dynamic team, dedicated leadership, eternal energy, and a righteous path, Timothy is eager to see HLO blossom. Largely, this is due to the resources and motivation provided by the Donald A. Pegg Student Leadership Award.

Discussion

In 2004, the American College of Lifestyle Medicine (ACLM) formed to fan the flame of lifestyle medicine’s research and integration into modern medicine. Promoting six broadly accepted pillars of a healthy lifestyle, the ACLM now has over 10,000 members—including physicians, health professionals, and trainees, who share the common interest of treating patients through use of lifestyle modifications. Lifestyle medicine has gained attention with help of many pioneers in the field, and the opportunity to meet many of them at the ACLM conference was inspiring and motivating.

As future torchbearers of lifestyle medicine, Donald A. Pegg student leaders were charged with helping mold its direction for tomorrow. Long overdue, integration of lifestyle approaches to prevent, treat, and reverse chronic diseases is the future of medicine. If one of modern medicine’s primary goals is to act in the best interest of patients, and lifestyle modification has been proven to be beneficial for a variety of illnesses, then healthcare must sustain its duty of non-maleficence by adding lifestyle medicine to its tool box.

Focused on beneficence and a culture of non-maleficence, forward thinking medical schools should strive to embrace lifestyle medicine as a key aspect of their curricula. Positive lifestyle behaviors have been pivotal to human health throughout history, but yet modern healthcare is becoming overrun by largely preventable lifestyle-related diseases, such as hypertension, diabetes, and stroke. According to the CDC, our healthcare system spends approximately $216 billion per year on these chronic diseases, leading to $147 billion in lost productivity on the job. The onerous costs associated with the reactive treatment of these diseases are staggering and may soon become crippling, and lifestyle medicine has proven to be a more cost-effective approach to chronic disease management.

The Donald A. Pegg award will continue to inspire student leaders for years to come, and has room for vast adaptation to the dynamic landscape of modern medicine. Lifestyle Medicine Interest Groups continue to rise at an exponential pace, and this is in part due to the fierce leadership that has been cultivated through the mentorship provided by the Donald A. Pegg support network.

Medical schools and students who wish to be on “the right side of history” will continue their evolution of medical education. There are different doses of lifestyle medicine and different prescriptions for individual patients, allowing for intensive patient-centered care. Intensive lifestyle medicine interventions often involve deprescribing medicine, for example, in the setting of diabetes remission. The ability of lifestyle medicine to enable physicians to de-prescribe certain medications in cases of disease remission speaks to the physiological power of lifestyle modifications. Patient’s lives are on the line, and it is our turn to help save them.

Future Directions

In addition to individual benefits at each award winner’s institution, bringing the student leaders together at the 2022 American College of Lifestyle Medicine conference prompted a new project: an open letter to the NBME/NBOME petitioning for the inclusion of lifestyle medicine questions into the USMLE/COMLEX exams. Throughout extensive networking opportunities, back-to-back expert lectures, and delicious plant-based meals, the 2022 Donald A. Pegg leaders discovered a common obstacle regarding lifestyle medicine integration into medical school curricula: limited space for additional educational programming. While the change of USMLE Step 1 to pass/fail grading has provided an opportunity for some schools to add lifestyle medicine to their curriculum, many schools have also begun shortening their pre-clinical curriculum to increase clinical training for students. To date, only ten schools (University of South Carolina School of Medicine Greenville, Loma Linda University School of Medicine, Harvard Medical School, Warren Alpert Medical School at Brown University, University of Central Florida School of Medicine, University of California Irvine School of Medicine, Wake Forest School of Medicine, Keck School of Medicine of the University of Southern California, A.T. Still University of Osteopathic Medicine, and University of Oklahoma College of Medicine) have integrated lifestyle medicine as part of their curriculum, the majority of which have lifestyle medicine as part of elective courses. ¹⁶ Given the potential of lifestyle medicine to empower the medical field to respond to the epidemic of chronic disease, this is a far cry from the extent of widespread adoption needed. Therefore, the Donald A. Pegg student leaders realized that if more rapid, sweeping changes were to happen, an appeal would need to be made directly to the NBME/NBOME to prompt the addition of lifestyle medicine-related questions to board examinations. This draft was initially brought forward by Stephen Manga and with the help and key insights of the other award winners, is currently being refined. The group is working closely with ACLM President Dr. Beth Frates, lifestyle medicine curriculum trailblazer Dr. Jennifer Trilk, and other ACLM leadership to decide how the ACLM can best support the NBME/NBOME in this endeavor.