Abstract
“My Lifestyle Medicine textbook has now been supplemented by a series of single topic books, which I also edit, called the Lifestyle Medicine Series.”
In this issue of the American Journal of Lifestyle Medicine, I am delighted that we are able to publish a Consensus Statement sponsored by the American College of Lifestyle Medicine (ACLM) entitled “Lifestyle Medicine Intensivist Competencies: 2022 Expert Consensus Update.” This is an important Statement and provides a solid framework for those who intend to practice intensive lifestyle medicine moving forward.
The current Consensus Statement is co-authored by a group of high level individuals who are skilled in the area of intensive lifestyle therapeutic change. The Panel is Chaired by Dr John Kelly, who has been a leading advocate for this area for over a decade. The Panel also contains a number of former Presidents of ACLM as well as numerous other individuals who bring a wealth of experience in intensive therapeutic lifestyle change (ITLC) from both a national and international perspective.
I was particularly delighted that in this update the decision was made to change the terminology for individuals who practice in this area from “specialist” to “intensivist.” I have been committed to the whole area of intensive medical treatment ever since the very beginning days of my academic medical career. I am now delighted to see that a framework for intensivists in lifestyle medicine has emerged!
This Statement updates the 2020 Consensus Statement by a similar group, also commissioned by ACLM. As already indicated, this distinguished Panel represents literally a “Who’s Who” both in lifestyle medicine and ITLC. John Kelly, who Chaired the Panel, not only coordinated this effort, but has built on the superb, evidence based chapters that he wrote on ITLC both for the 3rd and 4th Editions of my major academic textbook Lifestyle Medicine.1,2
Every significant branch of medicine has a major academic textbook. I hope and believe that my multi-authored Lifestyle Medicine textbook serves this need for practitioners of lifestyle medicine.1,2 This textbook, in collaboration with materials put out by the American College of Lifestyle Medicine and the American Board of Lifestyle Medicine, provides the foundation evidence base that lifestyle medicine rest on. These documents contain many thousands of studies supporting the role that daily habits and actions such as regular physical activity, proper nutrition, weight management, avoiding tobacco products, stress relief, and interpersonal connections play in both lowering the risk of chronic disease and, also, in treating chronic disease if it is already present. My Lifestyle Medicine textbook has now been supplemented by a series of single topic books, which I also edit, called the Lifestyle Medicine Series. This Series is designed to provide points of entry for individuals at the beginning of their careers or focused volumes for individuals who have a particular interest in a specific area of lifestyle medicine. I have challenged all of the editors of this Lifestyle Medicine Series to balance focusing on lifestyle medicine, with tight and overt links to various specialties that are recognized in mainstream medicine. These include cardiology, endocrinology, psychiatry, behavioral medicine, weight management women’s health, geriatric medicine, and family medicine, to name just a few of the areas where we have either published or will publish single topic, lifestyle related books.
As lifestyle medicine continues to grow and the number of individuals certified to practice lifestyle medicine expands, there is a clear need to define competencies for individuals at all levels, including ITLC. The current Consensus Statement is a logical next step and provides needed clarity in this area.
Intensive therapeutic lifestyle change is a particularly important topic, given that more and more lifestyle medicine practitioners are being imbedded in hospitals and large medical groups or receiving referrals from other clinicians either in primary care or various medical and surgical sub-specialties. This trend is likely to accelerate rapidly in the future, given the powerful database that supports how Iifestyle medicine, in general, and ITLC, in particular, can play powerful roles not only in the prevention of various chronic illnesses but, of equal importance, in the treatment of these conditions.
In short, the concept of intensive lifestyle medicine is a concept whose time has come!
I was particularly pleased that the Consensus Panel chose to follow the framework to organize their Statement according to 6 Accreditation Standards of Graduate Medical Education and American Board of Medical Sub-specialties (ACGME/ABMS) categories. This places the Consensus document as a guideline for the ongoing process for lifestyle medicine to be considered a mainstream medical specialty recognized in graduate medical education and eligible for lifestyle medicine practitioners to sit for Certification Boards from the American Board of Medical Specialties.
While lifestyle medicine has not yet achieved this status in mainstream medicine, it is a process which I believe will become increasingly inevitable. Once this happens, it will greatly expand the way physicians at all levels of training are taught and also the number of individuals who pursue careers in every level of lifestyle medicine practice.
The categories in the Consensus Statement were carefully selected and provide a strong framework and structure that every practitioner of ITLC should follow. The six categories are each listed in easy-to-use tables and include the following: Table 1 – Practice-Based Learning and Improvement Table 2 – Patient Care and Procedural Skills Table 3 – Systems-Based Practice Table 4 – Medical Knowledge Table 5 – Interpersonal and Communication Skills Table 6 – Professionalism
As already indicated, these categories are based on those listed for Board Certification in virtually every area of mainstream medicine. Individuals are required to have knowledge in all of these areas to pass Certification Exams from the American Board of Medical Specialties. Lifestyle medicine must and will follow this same rigorous process.
I have been personally interested in intensive medical care throughout my clinical career. As a House Officer at Massachusetts General Hospital, I was strongly attracted to the intensity of the Medical Intensive Care and Coronary Care Units not only because of the expertise required, but also the ability to make significant improvements in the outcome of desperately ill individuals.
The major problem that existed many years ago when I was a House Officer was that no standard textbook existed in the area of medical intensive care. During my second year of residency at MGH, I corralled other MGH Health Officers and, together, we wrote and published a book entitled the Manual of Intensive Care Medicine. 3
When I subsequently accepted a faculty position at UMass Medical School, this topic was expanded into the first, comprehensive, hardcover textbook in intensive care medicine.
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This book has now just published its 9th Edition as Irwin and Rippe’s Intensive Care Medicine.
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This book has become the leading textbook of intensive care medicine in the world. It is found in virtually every ICU and Coronary Care Unit as well as many Emergency Rooms throughout the United States and in many other countries. I believe there is a direct analogy to my early work in ICU medicine and the current emphasis on lifestyle medicine intensivists. While it may not be obvious, the medical conditions that could benefit from significant lifestyle medicine interventions are ultimately no less dangerous than conditions physicians treat in ICUs. The level of skill and commitment displayed by ICU physicians and ITCL clinicians are analogous. These practitioners are physicians who are literally “at the top of their game!” I will close this editorial by reiterating the concept that I have always emphasized as I have performed research, written papers and edited textbooks in the area of lifestyle medicine. In order for this field to grow it needs to welcome and embrace the highest levels of clinicians throughout mainstream medicine as well as those passionately committed to the area of lifestyle medicine. Thus, as the authors of the Consensus Statement point out as one of their criteria, ITLC clinicians should “advocate for LM as a solution to achieve a quintuple aim of health care by improving the care of individuals patients, promoting healthy populations, lowering health costs, including health equity, and maintaining their own wellbeing.” At the same time the Consensus Panel emphasizes that ITCL practitioners must clearly understand and promote health and lifestyle medicine as key components of basic medical science.
In the area of intensive care medicine, virtually every hospital in the United States has an ICU and now many of these units are stocked by fulltime intensivists. I can envision a time when every hospital in the United States and around the world has a division of lifestyle medicine headed by an individual with a high level of skills in intensive therapeutic lifestyle change. The current Consensus Statement provides an important roadmap that these individuals should follow. The future in this area is indeed bright!