Abstract
The Global Alliance Lifestyle Medicine
Leadership Forum, 2024
February 16, 2024
We Envision
We, the Lifestyle Medicine leaders of countries, global organizations, and educational institutions, in pursuit of reversing the chronic disease epidemic, make the following declarations: • We recognize that the global burden of non-communicable diseases (NCDs) continues to increase despite the best efforts of current health care approaches and systems. Clinical outcomes are unsatisfactory, costs continue to rise, and patients are frustrated with the services received. We find this inappropriate considering how far medical care has advanced. We call for the urgent institution of Lifestyle Medicine. Lifestyle Medicine (LM) is a clinical, medical, and health discipline providing evidence-based care to promote wellness, prevent disease, reverse chronic disease, and care for individuals suffering from chronic conditions by employing LM therapeutic interventions through modifying behaviors to enhance overall health and well-being.
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It encompasses six foundational pillars: a healthy, whole-food predominant plant-based eating pattern; regular physical activity; stress management; restorative sleep; social connectedness; and avoidance of risky substances.
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LM is an interdisciplinary approach that places the patient at the center, acknowledging the significance of social, economic, cultural, and other factors that influence the patient. • We have assimilated the science and experienced the results of NCD prevention and reversal in individual patients, groups and communities using LM therapeutic interventions. We know that, when fully applied using the scientific evidence from multidisciplinary fields currently available, a whole health LM approach can improve patient satisfaction, decrease health care costs, and maximize health outcomes.
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LM has the potential to offer cost-effective, efficient, sustainable, and equitable health care to individuals worldwide, irrespective of their socioeconomic status. We find this inspiring, energizing, and rational. It has become why we do what we do. It is the new, transformational approach we urge all to adopt for our world.
• We have discovered that LM often requires less change to existing infrastructure but requires a shift in paradigm to well care in all stages. It simply involves training health professionals and physicians in the science of LM, practice, and community engagement. This approach empowers health care policymakers, leaders, providers, and patients to recover well-being, prevent NCDs, maintain quality of life, and enhance longevity. It is relevant in all care settings, across various communities, and in countries of all income levels. • LM has been reversing chronic disease for 5 decades. Competencies for health care providers in LM have been defined for 14 years. LM Certification for physicians and doctorate & master’s level health professionals has been available since 2017. Systems for applying LM skills that achieve chronic disease reversal continue to be refined and improved. The research behind what works best continues to expand. A global cadre of qualified and board-certified LM providers, currently standing at 6650 diplomates of the International Board of Lifestyle Medicine (IBLM),
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continues to grow exponentially. The foundation for transformation is solidly set. • To fully achieve NCD epidemic reversal, LM competencies need to become universal. Health care education must honor LM in its training endeavors to produce effective, competent LM providers. Health care systems must be redesigned to incorporate LM strategies. Future health care research must recognize the need for understanding LM care for whole health, not just biomedical reductionist solutions. • As leaders in the Lifestyle Medicine Global Alliance (LMGA), we recognize that in our individual patient care, educational, research and community improvement activities we can achieve much. But together, partnered with governments, health care and educational institutions, corporate and religious organizations, and other private and public local and global entities, we can truly transform approaches to health care, and can reverse the global NCD epidemic. We are committed to applying current science, the LM competencies, our shared experiences, and our collaborative energies to achieving this outcome.
We Agree
There are various levels of LM competencies that need to be recognized. These include (1) a foundational understanding and application of LM by all health professionals; (2) a core set of LM competencies that can be achieved by all primary care providers; and (3) a more advanced set of LM competencies that may only be attained by a specialized cadre of LM intensivists.
The scope of the Doha Declaration focuses on the foundational LM understanding for all health professionals. Other resources have and will continue to address additional core LM competencies for primary care providers, 1 and the competencies needed for LM intensivists.
Lifestyle Medicine competencies for all professionals fall into 3 general categories: 1. Understanding the foundations of LM, including attitudes, knowledge, and skills: • • • • LM 2. Understanding our patients’ stories, and their role in lifestyle choice and interventions: • The role of • The role of • The significance of • The significance of 3. Clinical skills and application of them in individual, group and team-based patient care settings: • • • •
Achieving the promise of whole health, the LM approach does not require major disruptions to current clinical, educational and research approaches. It simply asks that we start with a new foundation. This new foundation must include the core competency areas we have listed.
We Recognize
• We can only teach what we ourselves know, we ask that ALL health professional training programs address the core LM competencies. • We can only help and improve what we deeply understand, we ask that ALL health professionals are trained to become experts in fully knowing their patient’s needs. • Medical care contributes only 10%–20%—of the modifiable contributors—to population health outcomes, with the remaining 80%–90% attributed to non-medical factors, particularly lifestyles,
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we ask that ALL health care approaches thoroughly incorporate LM competencies and clinical strategies prior to the utilization of costlier pharmaceuticals and procedures, which inherently carry associated risks. • We manage what we measure, we ask that ALL health care systems measure using LM competencies as guidelines. • We can only achieve improved outcomes with meaningful doctor–patient relationship-based care in an aligned payment system, we ask that payers recognize the significant cost savings and commit to co-designing financial systems that are proactive and support time for health.
We Commit
A foundation grounded in LM provides profound healing, engendering a sense of joy and tranquility that our patients and the world at large both desire and merit. It is essential to empower patients to not only request but indeed insist on more comprehensive care. This necessitates: • The full incorporation and integration of LM’s core competencies by health professionals and health systems. • Guaranteeing that the voices of patients and communities are fully acknowledged, and prioritizing the provision of all low-risk, cost-effective, evidence-based LM interventions as the primary option, and when indicated, supplementing with additional interventions provided as required.
We Pledge
We, the representatives of the Lifestyle Medicine Global Alliance Leadership Forum, pledge on this day, February 16, 2024, to:
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Act in strict accordance with the principles and guidelines outlined in this Declaration. We commit to fostering an environment of solidarity and coordination among patients, health care providers, and all relevant stakeholders. Our efforts will be guided by the common objective of improving health outcomes and promoting well-being.
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Advocate tirelessly for the widespread support of this transformative movement. We invite people from all backgrounds, countries regardless of their economic standing, and organizations, whether public or private, to unite with us in this important mission. We believe that collective action is the key to effecting meaningful change in the field of health care.
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Support nations and health care systems in conducting regular and comprehensive assessments of the implementation of this Declaration. We will collaborate closely with stakeholders at various levels to ensure effective integration of LM principles into health care policies and practices.
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United in our mission, we are confident in our capacity and unwavering in our determination to attain health and well-being for all. We firmly believe in the principle of inclusivity, and we pledge to leave no individual behind in our pursuit of a healthier world. Our commitment is not just to the health of individuals, but to the health of communities and the world at large. We envision a future where LM is at the forefront of health care, driving the transformation towards a more sustainable and equitable health system.
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Work together tirelessly to achieve health and well-being for everyone. Our dedication extends beyond individual well-being to the wellness of communities and the entire global population. We imagine a future where LM leads the way in health care, facilitating the shift towards a more sustainable and fair health system.
Signed by
• Wayne Stephen Dysinger, MD, Chair of Advisory Board, Lifestyle Medicine Global Alliance. • Ravinder Mamtani, MD, Vice-Chair of Advisory Board, Lifestyle Medicine Global Alliance, Institute for Population Health, Weill Cornell Medicine-Qatar. • Agnese Lapsa-Lešinske, Executive Director, Lifestyle Medicine Global Alliance. • Amit Abraham, MD, Assistant Professor, Institute for Population Health, Weill Cornell Medicine-Qatar. • Amy Reinhold Mechley, MD, Chair, International Board of Lifestyle Medicine. • Anera Lazić, MD, President, Croatian Lifestyle Medicine Association. • Daniel Ireneusz Śliż, MD, President, Polish Society of Lifestyle Medicine. • Emanuela Mercore Huțanu, MD, President, Romanian Society of Lifestyle Medicine. • Jenny Seunghyun Lee, PhD, Founding Chair, Korean College of Lifestyle Medicine. • Klára Koncz, MD, Member of the Board, Hungarian Society of Preventive and Lifestyle Medicine. • Lydia Altini, MD, Member of the Board, South African Lifestyle Medicine Association. • Mechelle Acero Palma, MD, President, Philippine College of Lifestyle Medicine. • Moyosore Taiwo Makinde, MD, President, Society of Lifestyle Medicine of Nigeria. • Mufeedha Fausz, MD, Member of the Board, Sri Lankan Society of Lifestyle Medicine. • Padmaja Patel, MD, President-Elect, American College of Lifestyle Medicine. • Rabbanie Tariq Wani, MD, President, Indian Society of Lifestyle Medicine. • Saleh M Alrajhi, DO, President, Saudi Arabia Lifestyle Medicine Group. • Sandra Daniela Lanza Sagardia, MD, President, Chilean Society of Lifestyle Medicine. • Sara Alexandra Gamboa Madeira, MD, PhD, Vice-President, Portuguese Society of Lifestyle Medicine. • Shagufta Feroz, MD, President, Pakistan Association of Lifestyle Medicine. • Silvia Merhy Lagrotta, MD, President, Brazilian College of Lifestyle Medicine. • Sivaneswaran Poobalasingam, MD, President, Malaysian Society of Lifestyle Medicine. • Sohaila Cheema, MBBS, Assistant Dean, Institute for Population Health, Weill Cornell Medicine-Qatar. • Stephan Herzog, Executive Director, International Board of Lifestyle Medicine. • Victor Saadia, Executive Director, Mexican Association of Lifestyle Medicine.