Lifestyle Medicine: Prevention, Treatment, and Reversal of Disease.

Lifestyle medicine (LM) expands the scope of preventive medicine by focusing on the promotion of healthy lifestyles while preventing, treating, and reversing the vast majority of chronic diseases caused by behaviors and environmental factors. LM focuses on six pillars-a plant-predominant eating pattern; physical movement; restorative sleep; management of stress; avoidance of risky substances; and positive social connections. Advances in LM competencies, education, certification, resources, and practice models are accelerating with a particular need and focus on underserved and most seriously impacted patients and communities. A comprehensive and integrated strategy addressing "whole person health" is emerging as a compelling framework for providers and health systems which combines a foundational commitment to prevention with a systematic approach to the actual and root causes of premature disease, disability, and death.

A Hybrid Value-Based Lifestyle Medicine Practice Model.

A lifestyle medicine approach to primary care that is value based can provide positive triple aim outcomes and demonstrate market equivalent reimbursement for the practitioner.

Lifestyle Medicine Prescriptions.

Lifestyle Medicine prescriptions are a foundational component to the practice of Lifestyle Medicine. With expanding technology, prescriptions are moving from single sheets of paper to customizable ongoing feedback that encourages continuous dialogue and feedback between patient and provider.

Prioritized Research for the Prevention, Treatment, and Reversal of Chronic Disease: Recommendations From the Lifestyle Medicine Research Summit.

Declining life expectancy and increasing all-cause mortality in the United States have been associated with unhealthy behaviors, socioecological factors, and preventable disease. A growing body of basic science, clinical research, and population health evidence points to the benefits of healthy behaviors, environments and policies to maintain health and prevent, treat, and reverse the root causes of common chronic diseases. Similarly, innovations in research methodologies, standards of evidence, emergence of unique study cohorts, and breakthroughs in data analytics and modeling create new possibilities for producing biomedical knowledge and clinical translation. To understand these advances and inform future directions research, The Lifestyle Medicine Research Summit was convened at the University of Pittsburgh on December 4-5, 2019. The Summit's goal was to review current status and define research priorities in the six core areas of lifestyle medicine: plant-predominant nutrition, physical activity, sleep, stress, addictive behaviors, and positive psychology/social connection. Forty invited subject matter experts (1) reviewed existing knowledge and gaps relating lifestyle behaviors to common chronic diseases, such as cardiovascular disease, diabetes, many cancers, inflammatory- and immune-related disorders and other conditions; and (2) discussed the potential for applying cutting-edge molecular, cellular, epigenetic and emerging science knowledge and computational methodologies, research designs, and study cohorts to accelerate clinical applications across all six domains of lifestyle medicine. Notably, federal health agencies, such as the Department of Defense and Veterans Administration have begun to adopt "whole-person health and performance" models that address these lifestyle and environmental root causes of chronic disease and associated morbidity, mortality, and cost. Recommendations strongly support leveraging emerging research methodologies, systems biology, and computational modeling in order to accelerate effective clinical and population solutions to improve health and reduce societal costs. New and alternative hierarchies of evidence are also be needed in order to assess the quality of evidence and develop evidence-based guidelines on lifestyle medicine. Children and underserved populations were identified as prioritized groups to study. The COVID-19 pandemic, which disproportionately impacts people with chronic diseases that are amenable to effective lifestyle medicine interventions, makes the Summit's findings and recommendations for future research particularly timely and relevant.

Formation of a National Lifestyle Medicine Network to Benefit Patients and Lifestyle Medicine Providers.

The American College of Lifestyle Medicine (ACLM) is forming a Lifestyle Medicine Provider Network (LMPN). The goal of this network is 2-fold: (1) to provide significant benefits to patients by focusing on the adoption of intensive evidence-based lifestyle medicine (LM) therapies to treat and reverse chronic disease and (2) to benefit LM providers by supporting their practice operations and optimizing contracting and reimbursement opportunities. The 2 phases of the network development will include (1) network formation and practice standardization and (2) deployment for group contracting. LMPN will be organized as a special project of the ACLM, with leadership provided through the ACLM LMPN Task Force. As part of this first phase, ACLM will devote the necessary resources to establish the network and promote LM training, certification, and sharing of best practices across the network. The second phase will necessitate the establishment of a separate corporate entity, enabling the acquisition of the required capital and expertise to fully realize the potential of LMPN deployment. Strategic direction will be provided by a LMPN Board of Advisors, consisting of select network members as well as select members of ACLM's Board of Directors. The first priority of the LMPN will be to recruit interested and qualifying LM practitioners and standardize the LM approach and process of care delivery, starting with high-value services, such as chronic care management. The focus on maximizing existing provider program incentives avails the LMPN the fastest and most efficient path to demonstrating value to its members and to its client base.

The Art and Science of Group Visits in Lifestyle Medicine.

Lifestyle medicine group sessions present a promising approach to clinical care. Based on decades of work in shared medical appointments and group visits for diabetes and other chronic conditions, a lifestyle medicine group session has the potential to provide a fresh and rewarding way of interacting with patients that fuels the practitioner and feeds patients' needs to spend time with the lifestyle medicine practitioner, connect with him or her, connect with others, learn the latest recommendations regarding healthy habits, practice these behaviors, and discuss their obstacles, motivations, and strategies for healthy living. The lifestyle medicine group session discussed in this article is a combination of group coaching, education, and group support.

The Complete Health Improvement Program (CHIP): History, Evaluation, and Outcomes.

The Complete Health Improvement Program (CHIP) is a premier lifestyle intervention targeting chronic disease that has been offered for more than 25 years. The intervention has been used in clinical, corporate, and community settings, and the short-term and long-term clinical benefits of the intervention, as well as its cost-effectiveness, have been documented in more than 25 peer-reviewed publications. Being an easily administered intervention, CHIP has been presented not only by health professionals but also by non-health-trained volunteers. The benefits of the program have been extensively studied under these 2 delivery channels, consistently demonstrating positive outcomes. This article provides a brief history of CHIP and describes the content and structure of the intervention. The published evaluations and outcomes of the intervention are presented and discussed and future directions are highlighted.

Lifestyle Medicine Practice: Exploring Workable Models.

The practice of lifestyle medicine is different than typical medical practices. Reimbursement systems are strong drivers of practice models. Lifestyle Medicine Solutions (LMS) has developed a primary care lifestyle medicine practice that implements: 1) a new clinical care model, and 2) innovative reimbursement strategies. The key assumptions, care model, reimbursement model and financial partners used by LMS are discussed. To achieve the promise that lifestyle medicine brings for decreasing both the chronic disease burden and rising health care costs, new lifestyle medicine delivery models must continue to be explored and implemented. The goal is for the lifestyle medicine choice to be available to each patient and each provider.

The Complete Health Improvement Program (CHIP) and reduction of chronic disease risk factors in Canada.

PURPOSE: The short-term effectiveness of the nutrition-centred Complete Health Improvement Program (CHIP) lifestyle intervention for improving selected chronic disease risk factors was examined in the Canadian setting. METHODS: A total of 1003 people (aged 56.3 ± 12.1 years, 68% female) were self-selected to participate in one of 27 CHIP interventions hosted in community settings by Seventh-day Adventist churches throughout Canada, between 2005 and 2011. The program centred on the promotion of a whole-food, plant-based eating pattern, and daily physical activity was also encouraged. Biometric measures, including body mass index (BMI), blood pressure (BP), blood lipid profile, and fasting blood sugar (FBS), were determined at program entry and 30 days into the intervention. RESULTS: Over 30 days, significant overall reductions (P<0.001) were recorded in the participants' BMI (-3.1%), systolic BP (-7.3%), diastolic BP (-4.3%), total cholesterol ([TC] -11.3%), low-density lipoprotein cholesterol ([LDL-C] -12.9%), triglycerides ([TG] -8.2%), and FBS (-7.0%). Participants with the highest classifications of TC, LDL-C, TG, and FBS at program entry experienced approximately 20% reductions in these measures in 30 days. CONCLUSIONS: The CHIP intervention, which centres on a whole-food, plant-based eating pattern, can lead to rapid and meaningful reductions in chronic disease risk factors in the Canadian context.

A fourth-year medical school rotation in quality, patient safety, and population medicine.

BACKGROUND: Quality improvement and population medicine are skills that are increasingly important for physicians to possess. Methods to achieve foundational acquisition of these skills in medical school have not been well described in the past. PURPOSE: The primary goal of this project is to provide hands-on, experiential learning in full-cycle population-based care. METHODS: A description is given of a 4-week, team-based, rapid-cycle quality improvement project embedded in a required fourth-year medical school rotation. Over the course of 4 years a nonspecialty generic Ambulatory Care rotation was converted to a population-based learning rotation. For the last 3 years this rotation has required students to participate in teams of three to four students to assess, plan, implement, and evaluate a quality improvement project. RESULTS: Between 2008 and 2010 a total of 510 students completed the rotation. During this time the project component of the rotation received a 53% average rating of "excellent" or "above average." Qualitative evaluation indicates the project to be an acceptable and worthwhile educational experience for medical students, adding new insights and occasionally career-changing perspectives. CONCLUSIONS: Although experiential team-based quality improvement projects are a new format for learning in the medical school environment, it can be implemented in a format that is acceptable and beneficial to future physicians and healthcare systems.

Incorporating population medicine into primary care residency training.

BACKGROUND AND OBJECTIVES: Expanded competencies in population health and systems-based medicine have been identified as a need for primary care physicians. Incorporating formal training in preventive medicine is one method of accomplishing this objective. METHODS: We identified three family medicine residencies that have developed formal integrated pathways for residents to also complete preventive medicine residency requirements during their training period. Although there are differences, each pathway incorporates a structured approach to dual residency training and includes formal curriculum that expands resident competencies in population health and systems-based medicine. RESULTS: A total of 26 graduates have completed the formally combined family and preventive medicine residencies. All are board certified in family medicine, and 22 are board certified in preventive medicine. Graduates work in a variety of academic, quality improvement, community, and international settings utilizing their clinical skills as well as their population medicine competencies. Dual training has been beneficial in job acquisition and satisfaction. CONCLUSIONS: Incorporation of formal preventive medicine training into family medicine education is a viable way to use a structured format to expand competencies in population medicine for primary care physicians. This type of training, or modifications of it, should be part of the debate in primary care residency redesign.

Residency education, preventive medicine, and population health care improvement: the Dartmouth-Hitchcock Leadership Preventive Medicine approach.

In 2003, Dartmouth-Hitchcock Medical Center (DHMC) inaugurated its Leadership Preventive Medicine residency (DHLPMR), which combines two years of leadership preventive medicine (LPM) training with another DHMC residency. The aim of DHLPMR is to attract and develop physicians who seek to become capable of leading change and improvement of the systems where people and health care meet. The capabilities learned by residents are (1) leadership -- including design and redesign -- of small systems in health care, (2) measurement of illness burden in individuals and populations, (3) measurement of the outcomes of health service interventions, (4) leadership of change for improvement of quality, value, and safety of health care of individuals and populations, and (5) reflection on personal professional practice enabling personal and professional development. The DHLPMR program includes completion of an MPH degree at The Dartmouth Institute for Health Policy and Clinical Practice (formerly the Center for Evaluative Clinical Sciences) and a practicum during which the resident leads change to improve health care for a defined population of patients. Residents also complete a longitudinal public health experience in a governmental public health agency. A coach in the resident's home clinical department helps the resident develop his or her practicum proposal, which must then be approved by a practicum review board (PRB). Twelve residents have graduated as of July 2007. Residents have combined anesthesia, family medicine, internal medicine, infectious disease, pain medicine, pathology, psychiatry, pulmonary and critical care medicine, surgery, gastroenterology, geriatric psychiatry, obstetrics-gynecology, and pediatrics with preventive medicine.