Great Progress,Enormous Challenges

This issue of the American Journal of Lifestyle Medicine (AJLM) represents the ninth year that we have published an issue largely focused on presentations made at the previous national convention of the American College of Lifestyle Medicine (ACLM).

As always, articles contained in this issue are diverse and thought-provoking. The Guest Editors for this issue, Drs. Cheryl True and Hugo Ortega did an outstanding job putting together a diverse and interesting issue. Together they curated 9 excellent articles based on presentations made at the 2023 national meeting of ACLM. They had to sort through over 75 excellent presentations and panel discussions where the expertise and passion for lifestyle medicine were shared by over 100 presenters to select the final 9 articles that they chose.

The articles selected by Drs. True and Ortega delve into important topics relevant to all practitioners of lifestyle medicine. While the topics show great diversity, the approach is uniform, blending a strong foundation of evidence with a vision and direct linkages to practical considerations for how the body of information presented is relevant to practitioners of lifestyle medicine.

The article by Amati and Brackbill ¹ offers important perspective and advice about how frontline providers who care for children who are obese, or at risk of obesity, can employ lifestyle medicine to make lifestyle changes easier. The focus of this article is family oriented and educational. The authors remind us that this is an enormous problem in our country and that obesity rates for children have more than doubled following the COVID-19 pandemic. They cite the startling statistic that by 2050, one in every two US children will experience obesity before the age of 35! We have an enormous challenge in front of us in the lifestyle medicine community to help ameliorate this rapidly emerging problem.

Bryant Webber and colleagues ² focus our attention on the enormous challenges faced by the military in our country given the unhealthy habits of the adult population, particularly those aged 17-40, who might otherwise qualify for military service. They quote the unfortunate statistic that only one-third of these individuals qualify for military service based on body mass and physical activity criteria. We need to do a better job on this since it reflects not only as a monumental health issue, but also carries a national security implications.

Mahima Gulati ³ extends our vision into how lifestyle medicine can help ameliorate common hormonal conditions. This is an area where we often don’t think about lifestyle medicine, but she makes a compelling case that typically hormonal conditions can be dramatically improved and, perhaps even reversed, by lifestyle medicine techniques.

The article by Sugden and Merlo ⁴ shows how lifestyle medicine modalities can play central roles in addiction recovery. This concept continues to build on the leadership position that Dr Merlo has built over the last decade in the bi-directional relationship between mental and physical health.

Landry and Ward ⁵ offer an important perspective on how plant-based dietary patterns can be implemented into healthcare and clinical practice. ACLM has been a leader in educating people on plant-based dietary patterns for good health. The next step must be the practical issue of how to implement these nutrition patterns into mainstream healthcare and clinical practice. Landry and Ward offer numerous, useful suggestions to accomplish this.

The article by Brown and Raisanen ⁶ explores how lifestyle medicine principles and practices can be blended into clinical settings for allied health professionals. They issue a call to action for lifestyle medicine clinicians to continue to expand the universe of lifestyle medicine into the education of diverse allied health professions.

The article by Lisa Mauch ⁷ provides a specific and practical template for how to introduce lifestyle medicine into mainstream medicine. A key consideration emphasized by Mauch is to tailor presentations for the benefit that the organizations who adopt lifestyle medicine can expect to achieve.

Wound management is critically important in all branches of medicine. It is particularly an issue in surgical care but also very important in diabetes care and other areas of family practice and primary care. Lai ⁸ offers advice and practical strategies for physicians to employ lifestyle medicine principles and practices to help control or lessen the likelihood of wound infection.

Systemic hypertension is the leading cause of outpatient visits to physicians through the United States and around the world. According to data from the Framingham Study, it is estimated that if an individual has a normal blood pressure at the age of 50, they are over 90% still likely to have high blood pressure by the time they reach the age of 80. Thus, the management of systemic hypertension is critically important to all medical professionals. The national, evidence-based guidelines to control blood pressure as articulated in the Joint National Committee on the Evaluation and Treatment of Hypertension (JNC VII) ⁹ recommend lifestyle treatments such as increased exercise, weight loss and healthy nutrition for 6 months before initiating pharmaceutical therapy in individuals with Stage 1 hypertension. Unfortunately, very few physicians follow this guidance. The Canadian randomized controlled trial published in this issue by Couture et al shows how lifestyle medicine principles and practices play a very significant role in managing individuals who have high blood pressure. ¹⁰

In addition to the articles that were selected from the 2023 national conference of ACLM, we have also added 2 additional articles which had already been accepted at AJLM but seemed particularly appropriate for this issue.

The article by Liana Lianov ¹¹ continues to buttress her leadership position in the area of positive psychology by demonstrating how behavior change relies on positive psychology. She links the application of positive psychology to all six of the pillars of lifestyle medicine.

The article by Morton, Renfrew, and Matthews describes the important initiative that ACLM undertook by offering its members a multi-component mental health and well-being program (the LIFT Project). ¹² It is critically important that as we offer lifestyle medicine principles around the world we not forget the enormous challenges faced by our own members as they continue to face the daunting challenges of introducing lifestyle medicine to the practice of clinical medicine, in general, and in their own lives. These challenges were, of course, exacerbated by the COVID-19 pandemic.

I was struck that the annual ACLM conference continues to underscore the passion and commitment that members of ACLM bring to the field of lifestyle medicine. It was also noteworthy to observe the dramatic increase in companies and organizations displaying innovative business models linking plant-based nutrition and other lifestyle medicine modalities to an array of medical conditions. Persistent themes presented in these booths included not only practical applications but were also underscored by a heavy emphasis on education.

The national conference also afforded me an opportunity to meet with those members of the American Journal of Lifestyle Medicine Editorial Board who were in attendance and also talk to several ACLM members who have agreed to edit books in the Lifestyle Medicine Series where I serve as Editor in Chief. We have currently published 9 volumes in this Series and in the next 12-18 months we anticipate publishing 3 more volumes in the areas of gerontology, family practice, and health equity. Clearly, there is an enormous pool of talent and interest in people within ACLM who are willing to rise to the challenge of editing books in the Lifestyle Medicine Series.

On a personal note, I was honored to receive the Trail Blazer Award at the 2023 ACLM conference for academic contributions that I have made over many years to the field of lifestyle medicine. I was also touched to witness the presentation of the Lifetime Achievement Award posthumously to my friend Hans Diehl who made enormous contributions throughout his life in educating people not only in the United States, but around the world on the health benefits of plant-based nutrition.

The ongoing success of the lifestyle medicine movement which was so prominently displayed at the 2023 annual meeting is deeply gratifying to me, but this achievement does not happen by accident. ACLM has had 10 years of phenomenal leadership, growth, and vision from its Executive Director, Susan Benigas. It has also been benefited from an array of talented and committed volunteer Presidents of ACLM. Dr Beth Frates, the most recent ACLM President, has continued the legacy of past ACLM presidents with great energy and vision advancing all aspects of lifestyle medicine.

The conference also reminded me of the enormous challenges that lie ahead. Chief among these is to drive lifestyle medicine into the heart of mainstream academic medicine. We have made some inroads in education, but the challenges remain. It always saddens me to hear that only 17% of medical schools have a nutrition offering and only 9% have formal offerings in physical activity. It is not surprising then that only 40% of physicians ever discuss these issues with their patients. This represents wasted opportunity given that 70% of adults in the United States visit their primary care physician on at least an annual basis.

As I said in my acceptance speech for the Trail Blazer award, the true trail blazers are those individuals who are either able to participate in the ACLM conference or in other ways contribute in their own clinical careers and practices to advancing the field of lifestyle medicine. In addition, the dedicated staff of ACLM continues to provide expert guidance, support, and hard work to manage this ever-growing organization.

I left the conference deeply impressed by the passion and commitment that members of ACLM bring to the entire field of lifestyle medicine. While enormous challenges remain, with this type of commitment, I am confident that we will rise to meet them. Afterall, the truth is on our side! As the World Health Organization stated in their non-communicable diseases initiative, over 71% of all mortality each year is caused through largely self-inflicted wounds by how people are living their day to day existence. ¹³ Many of the ameliorations proposed by WHO to address this modern pandemic clearly have lifestyle medicine components.

Thus, while enormous challenges remain, I am confident that we will meet them. Together we will change the world!

James M. Rippe, MD

Editor in Chief, AJLM

Founder and Director, Rippe Lifestyle Institute,Shrewsbury, Professor of Medicine

UMass Chan Medical School,

Worcester, MA