HEALing Our Nation - Health Equity Achieved Through Lifestyle Medicine Capturing Highlights From the "HEALing Our Nation" Session at LM2023 and Outlining the Important Work of the HEAL Initiative.

Since the COVID-19 pandemic, health equity has been placed front and center in the conversations surrounding healthcare as well other fields. This conversation has also been occurring in the field of lifestyle medicine with an intentional focus on developing solutions at the intersection of lifestyle medicine and health equity. Initiated by a call to action by ACLM Past President Dexter Shurney at the 2019 Lifestyle Medicine conference, the HEAL Initiative was created with that intention, to address health disparities and advance health equity through lifestyle medicine. Since 2019, the HEAL initiative has grown considerably in its work and impact, creating solutions aligned with the AMA strategic planning recommendations as well developing projects that are examples of community engaged-lifestyle medicine. The work of the HEAL initiative culminated in a full circle moment at the 2023 Lifestyle Medicine Conference which featured an interview (facilitated by Dr. Dexter Shurney) with former US Surgeon General Dr. Jerome Adams and review of HEAL's work over the past 3 years. This article will capture the key highlights of the HEALing our Nation opening session and the cumulative work of HEAL Initiative.

The Time is Now For Lifestyle Medicine: Lesson From Lifestyle Medicine Leaders.

The time is NOW for Lifestyle Medicine. In this review based on a presentation at the American College of Lifestyle Medicine (ACLM) 2021 annual conference, ACLM Current President Cate Collings, MD, Immediate Past-President Dexter Shurney, MD, and President Elect Beth Frates, MD, share insights on the current state of lifestyle medicine (LM). Interest in LM has greatly advanced in the face of disruptions from the COVID-19 pandemic, expanded educational opportunities in the field, and a rapidly changing healthcare landscape. With growing access to virtual care, advancing technologies, growing emphasis on home-based chronic care, continuing corporate healthcare mergers and acquisitions, and widening adoption of personalized, patient-empowered treatments, the time is ripe for LM interventions to move to the mainstream. As health investments and costs skyrocket, and new players enter the scene, traditional models of payments, reimbursements, and incentives are slowly being upended. Companies and healthcare systems are finally recognizing the scientific evidence and powerful but undervalued potential of LM to accelerate healthy outcomes while controlling costs. Taken together, the lessons from the COVID-19 pandemic, the growth in LM educational opportunities, and the evolving "business of medicine landscape" signal that the time for lifestyle medicine is NOW.

Future Directions for Health Equity and Lifestyle Medicine: Insights from Former US Surgeons General.

Lifestyle medicine practices address root causes in the realm of patient care, healthcare systems, community health, and public health policy. It often takes consistent messaging and robust scientific evidence to buy in support of patients, health administrators, community leaders, and government officials. Four former U.S. surgeons general-the Honorable Admiral David Satcher, MD; Vice Admiral M. Joycelyn Elders, MS; Vice Admiral Antonia Novella, MD; and Vice Admiral Richard Carmona, MD, MPH, FACS-participated in a town hall during the American College of Lifestyle Medicine's 2021 annual conference to discuss health equity and its relationship to LM. Moderated by Dexter Shurney, MD, MBA, MPH, immediate-past president of the American College of Lifestyle Medicine and president of the Blue Zones Well-Being Institute, the discussion also explored the challenging role and responsibilities of the nation's top medical officer, the emergence of LM as an undervalued but high-potential tool for addressing complex issues such as health disparities, and specific actions-especially related to leadership-that would accelerate wider adoption of LM. In this article, Drs. Shurney and Carmona share their insights and highlights from the conversation and consider future directions of LM.

Lifestyle Medicine and Economics: A Proposal for Research Priorities Informed by a Case Series of Disease Reversal.

Chronic disease places an enormous economic burden on both individuals and the healthcare system, and existing fee-for-service models of healthcare prioritize symptom management, medications, and procedures over treating the root causes of disease through changing health behaviors. Value-based care is gaining traction, and there is a need for value-based care models that achieve the quadruple aim of (1) improved population health, (2) enhanced patient experience, (3) reduced healthcare costs, and (4) improved work life and decreased burnout of healthcare providers. Lifestyle medicine (LM) has the potential to achieve these four aims, including promoting health and wellness and reducing healthcare costs; however, the economic outcomes of LM approaches need to be better quantified in research. This paper demonstrates proof of concept by detailing four cases that utilized an intensive, therapeutic lifestyle intervention change (ITLC) to dramatically reverse disease and reduce healthcare costs. In addition, priorities for lifestyle medicine economic research related to the components of quadruple aim are proposed, including conducting rigorously designed research studies to adequately measure the effects of ITLC interventions, modeling the potential economic cost savings enabled by health improvements following lifestyle interventions as compared to usual disease progression and management, and examining the effects of lifestyle medicine implementation upon different payment models.

Sustaining weight loss among adults with obesity using a digital meal planning and food purchasing platform for 12, 24, and 36 months: a longitudinal study.

BACKGROUND: Previous studies have shown that lifestyle changes, such as diet and exercise, can lead to weight loss, resulting in dramatic improvements in overall health and chronic disease risk. However, while many traditional dieting, food tracking and weight loss coaching programs result in short-term weight loss, there is less evidence of their effectiveness on sustaining weight loss over time. METHODS: We conducted a retrospective analysis of 1,740 adults with obesity who used Foodsmart, a digital personalized dietary assessment, meal planning and food purchasing platform. Participants reported age, gender, at least three measures of weight, and their diet using a food frequency questionnaire. We defined sustained weight loss as participants who lost 5 % of initial weight between their first and second reported weights and lost weight or maintained weight between second and third reported weights. A healthy eating score, Nutriscore, was calculated to assess overall diet quality. We used multivariate logistic regression models to examine the association between user characteristics and odds of sustained weight loss. RESULTS: Over a median of 25 months, the mean (standard deviation) change in weight among participants was - 6.2 (19.8) pounds. In total, 39.3 % (684/1,740) of participants lost at least 5 % of their initial weight, and 22.4 % percent (389/1,740) of participants sustained weight loss. In the fully-adjusted logistic regression model, we found that obesity class 2 (odds ratio, OR: 1.69, 95 % confidence interval, CI: 1.27-2.24, P < 0.001), obesity class 3 (OR: 2.23, 95 % CI: 1.68-2.97, P < 0.001), baseline diet quality (OR: 1.06, 95 % CI: 1.02-1.09, P < 0.001), and greater change in diet quality (OR: 1.10, 95 % CI: 1.07-1.14, P < 0.001) were significantly associated with sustained weight loss. CONCLUSIONS: This study characterized and demonstrated the utility of Foodsmart, a digital platform that gives personalized nutrition recommendations and meal planning tools, in sustained weight reduction among users with obesity.

Weight Reduction Through a Digital Nutrition and Food Purchasing Platform Among Users With Obesity: Longitudinal Study.

BACKGROUND: Digital nutrition apps that monitor or provide recommendations on diet have been found to be effective in behavior change and weight reduction among individuals with obesity. However, there is less evidence on how integration of personalized nutrition recommendations and changing the food purchasing environment through online meal planning and grocery delivery, meal kits, and grocery incentives impacts weight loss among individuals with obesity. OBJECTIVE: The objective of this observational longitudinal study was to examine weight loss and predictors of weight loss among individuals with obesity who are users of a digital nutrition platform that integrates tools to provide nutrition recommendations and changes in the food purchasing environment grounded in behavioral theory. METHODS: We included 8977 adults with obesity who used the digital Foodsmart platform, created by Zipongo, Inc, DBA Foodsmart between January 2013 and April 2020. We retrospectively analyzed user characteristics and their associations with weight loss. Participants reported age, gender, height, at least 2 measures of weight, and usual dietary intake. Healthy Diet Score, a score to measure overall diet quality, was calculated based on responses to a food frequency questionnaire. We used paired t tests to compare differences in baseline and final weights and baseline and final Healthy Diet Scores. We used univariate and multivariate logistic regression models to estimate odds ratios and 95% CI of achieving 5% weight loss by gender, age, baseline BMI, Healthy Diet Score, change in Healthy Diet Score, and duration of enrollment. We conducted stratified analyses to examine mean percent weight change by enrollment duration and gender, age, baseline BMI, and change in Healthy Diet Score. RESULTS: Over a median (IQR) of 9.9 (0.03-54.7) months of enrollment, 59% of participants lost weight. Of the participants who used the Foodsmart platform for at least 24 months, 33.3% achieved 5% weight loss. In the fully adjusted logistic regression model, we found that baseline BMI (OR 1.02, 95% CI 1.02-1.03; P<.001), baseline Healthy Diet Score (OR 1.06, 95% CI 1.05-1.08; P<.001), greater change in Healthy Diet Score (OR 1.12, 95% CI 1.11-1.14; P<.001), and enrollment length (OR 1.28, 95% CI 1.23-1.32; P<.001) were all significantly associated with higher odds of achieving at least 5% weight loss. CONCLUSIONS: This study found that a digital app that provides personalized nutrition recommendations and change in one's food purchasing environment appears to be successful in meaningfully reducing weight among individuals with obesity.