The Doha Declaration and Lifestyle Medicine: Have We Reached a Tipping Point?

In this issue of AJLM, we are pleased to publish a document that emerged from Doha, Qatar written by a grouping of lifestyle medicine leaders from around the world, global organizations and educational institutions. We are also delighted to publish an Editorial by Dr. Sohaila Cheema and colleagues who played key roles in organizing this initiative and formulating the Declaration.

The Doha Declaration essentially represents a “stake in the ground.” These lifestyle medicine leaders from around the world have now clearly articulated the essence of lifestyle medicine and committed, in writing to each other, and to the world, that they are prepared to lead the process of adopting lifestyle medicine-first principles throughout healthcare around the globe!

This is an important statement and, if I may indulge with a bit of grandiosity, in a sense, it represents for lifestyle medicine a similar statement that the founders of the United States made in the “Declaration of Independence.” The reason I make this bold statement is that the Doha Declaration now commits the signers in writing to lead the transformation of American medicine. This is analogous to what the Founding Fathers of the United States intended when they signed the Declaration of Independence when they focused on freedom and human rights. In both instances, the writers put their position in writing and committed to principles with each other and the world.

Thus, the Doha Declaration marks a significant milestone in the evolution of lifestyle medicine. But does it really represent a tipping point?

In his best-selling book, Malcolm Gladwell ¹ makes the salient point about tipping points when he states “It may seem like an immovable, implacable place. It is not. With the slightest push-in just the right place-it can be tipped.” He applies this concept to ideas and products, but can it equally be applied to lifestyle medicine?

Gladwell goes on to define the tipping point as that “magic moment when an idea, trend or social behavior crosses a threshold, tips and spreads like wildfire.”

Is that what we are experiencing in lifestyle medicine?

Let’s explore this issue in more detail. It is important not to forget that the subtitle of Gladwell’s tipping point book was “how little things can make a big difference.” So, are we seeing a number of “little things” that will lead to lifestyle medicine sparking a tipping point? I believe we are. Let’s look at some of the evidence over the past two decades.

• The Evidence Base for Lifestyle Medicine

As Cheema et al. underscore in their Editorial, it is essential to emphasize that lifestyle medicine is based on hardcore evidence. I couldn’t agree more! In fact, when I edited the first major academic textbook in lifestyle medicine back in 1999 ² which actually named the field “lifestyle medicine” in the academic literature, I emphasized the fact that even then enormous evidence existed in multiple fields including physical activity, nutrition, weight management, and avoidance of addictive substances that their benefits for health was readily available. The problem for most physicians was that this evidence was spread out over a variety of diverse disciplines and often inaccessible to members of the medical community.

The core idea in lifestyle medicine was to bring these disparate sources of evidence together under one umbrella that would be understandable and usable in the medical community. Even in that first edition of my Lifestyle Medicine textbook, I provided extensive examples that virtually every expert panel in the area of metabolic conditions which developed evidence-based guidelines for how to prevent or treat these conditions started with lifestyle medicine principles. Now, in the fourth edition of this textbook, which has just been published, ³ the number of expert panels in metabolic disease which have adopted lifestyle medicine principles has expanded even further. Thus, while we may view lifestyle medicine as the umbrella under which this evidence resides, the fundamental evidence is overwhelming and has been the cornerstone of almost virtually every metabolic disease treatment protocol issued in the last 25 years.

• International Applicability

There is no question that the impact of lifestyle habits and practices on health is highly relevant around the world. For example, the non-communicable disease (NCD) initiative from the World Health Organization states that 74% of all annual global mortality comes from basically lifestyle related conditions. ⁴

• Will the Field be Called “Lifestyle Medicine”?

There is no longer any question that this entire field is going to be called “lifestyle medicine.” The World Health Organization convened its “Traditional Medicine Global Summit in 2023” ⁵ and defined numerous approaches to health including traditional medicine, integrative medicine, complementary/alternative medicine, and functional medicine which all contain approximately 80% of the scientifically based evidence subsumed in lifestyle medicine. Along these lines, I should emphasize that the Editorial by Cheema et al. is appropriately cautious by calling the field “lifestyle medicine-like” to incorporate all of these disparate but largely compatible approaches which ultimately depend on encouraging individuals to take more positive actions in their daily lives.

• Is the Field of Lifestyle Medicine Growing?

The answer to this is a resounding “yes!” The Lifestyle Medicine Global Alliance whose leaders participated in the Doha Declaration has now certified over 6650 diplomates through the International Board of Lifestyle Medicine which continues its rapid growth! The Lifestyle Medicine Global Alliance now represents organizations in 21 countries around the world. ⁶

In the United States, the American College of Lifestyle Medicine has experienced explosive growth in the past decade and now numbers almost 12,000 members! ⁷ In addition, I had the personal experience of seeing how rapidly the growth of lifestyle medicine is occurring around the world when I delivered a keynote address at a major lifestyle medicine conference in China in November 2023. ⁸ This conference which marked the unveiling of the Chinese translation of the third edition of my Lifestyle Medicine textbook, showed the power that lifestyle medicine has already achieved in China. My speech was attended virtually by over 2.5 million people! Lifestyle medicine has become the centerpiece for the “Healthy China Campaign” and now over 100 hospitals in China have already signed up to support this effort.

Thus, with the two most powerful countries in the world, namely, the United States and China, firmly backing the concept of lifestyle medicine, momentum is building and there are enormous opportunities ahead.

• Is Lifestyle Medicine beginning to Penetrate Mainstream Medicine?

While many challenges remain, we can see the beginnings of lifestyle medicine as a centerpiece for many branches of the mainstream practice of medicine. Indeed, in my own field of cardiology, the Academic Council at the AHA which had been previously called the “Nutrition, Physical Activity and Metabolic Council” in 2013 changed its name to the “Council on Lifestyle and Cardiometabolic Health.” ⁹ In addition, the American Heart Association and the American College of Cardiology issued their evidence-based “Guideline on Lifestyle Management to Reduce Cardiovascular Risk” ¹⁰ and subsequent scientific statements from ACC/AHA both for treatment of dyslipidemia ¹¹ and hypertension ¹² both focused on lifestyle as the first and most important modality.

• How important is lifestyle medicine?

Not only is lifestyle medicine critically important to the health of people around the world, it is also critically important to the health of our very planet! The Lancet EAT Commission clearly issued the warning that unless food consumption patterns around the world are dramatically changed to emphasize a plant-first basis, irreparable harm will continue to occur to our environment and ultimately make the planet virtually unlivable. ¹³ Lifestyle medicine strongly supports a plant-first nutrition pattern as one of its key precepts.

While I could mention other initiatives, I believe these examples illustrate the point that the field of lifestyle medicine meets the criteria of the subtext of Malcomb Gladwell’s book that “Little things can make a big difference” in achieving the tipping point.

While the Doha Declaration is an important step there are many other factors which need to fall into place in order to truly change the way medicine and healthcare are practiced around the world. Thus, while I strongly support the impetus to call this field “lifestyle medicine” we must never forget that enormous evidence exists in other areas of medicine which must be recognized and supported as components of lifestyle medicine. We need to adopt a “big tent!”

Having said that, I strongly applaud the Lifestyle Medicine Global Alliance leadership and their strong statement in the Doha Declaration. The signers of this Declaration may currently be a small number of people, but they can help lead the process that will ultimately change health care and health around the world. This reminds me of the famous quote from cultural anthropologist Margaret Mead, who wrote: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” ¹⁴

The current leaders in lifestyle medicine are thoughtful and committed and ultimately can change the world both for the benefit of the health of individuals throughout the planet and, indeed, the health of planet itself.