Introduction To LM - Module 1, Week 1-1

INTRODUCTION TO
LIFESTYLE
MEDICINE
SOLONg Education Class 2020
Module 1, Week 1
Objectives
• To define Lifestyle Medicine and highlight its
pillars
• To compare and contrast lifestyle medicine to

other fields of health and medicine
• To understand the role of behavioural

determinants of positive health outcomes
• To understand the place and priority of lifestyle

in the spectrum of treatment options for chronic
lifestyle-related diseases
Definitions of LM
• ACLM: LM uses evidence-based lifestyle therapeutic approaches
to prevent, treat and oftentimes reverse lifestyle-related disease.
• 2018 LM Core Competencies: LM offers a unique approach

that leverages a whole food, plant-based diet, physical activity,
sleep, emotional well-being and avoiding risky substances to
prevent, treat and reverse lifestyle-related diseases.
• LM textbook by Garry Egger: The application of medical,

behavioural, motivational and environmental principles to the
management of lifestyle-related health problems in a clinical
setting.
Pillars/Modalities of LM
• Predominantly whole food, plant-based diet
• Regular physical activity
• Adequate sleep
• Stress management & emotional wellness
• Smoking cessation & avoidance of of risky substance use
• Positive psychology & connectedness

Lifestyle Medicine
1. Emphasis on promoting behaviour changes that allow the body to
heal itself.
2. Focus on evidence-based optimal nutrition, stress management and

fitness prescriptions
3. Patients are active partners in their care
4. Treats the underlying lifestyle causes of disease
5. Physician/Provider educates, guides and supports patients to make

behaviour changes
6. Medications used as an adjunct to therapeutic lifestyle changes
7. Patient’s home and community environment are assessed as

contributing factors
Conventional Medicine
1. Emphasis on making a diagnosis and treatment with pharmaceuticals

or surgery
2. Patient is passive recipient of care
3. Focuses on symptoms or signs of disease not the underlying lifestyle

causes.
4. Patient is not expected to make significant behavior changes
5. Physician/Provider directs care - medical model.
6. Medications are the primary therapeutic intervention.
7. Patient’s home and community environment are typically not

considered
Integrative Medicine
1. Emphasis on integrating conventional treatment with alternative

treatments.
2. Focus on treatments such as acupuncture, biofeedback and nutraceuticals

along with some evidence-based lifestyle interventions.
3. Patient may be an active or passive recipient of care
4. Treats symptoms or signs of disease not the underlying lifestyle causes.
5. Patient may not be required to make significant behaviour changes
6. Physician/Provider directs care - medical model
7. Patient’s home and community environment typically not considered

Functional Medicine
1. Emphasis on evidence-based, systems biology approach that addresses

underlying physiologic & biologic dysfunction.
2. Focus on testing of various metabolites and hormones in the body that are not well
proven or evidence-based medicine with the use of pharmaceuticals, nutraceuticals and
biologicals.
Mind-body Medicine
1. Investigates interactions between the mind and body behaviourally, emotionally,

mentally, socially and spiritually.
2. Modalities include yoga, hypnosis, visual imagery, biofeedback, tai chi some of
which are evidence-based
Preventive Medicine
1. Includes all aspects of morbidity and mortality prevention for the general public
2. Emphasizes population-based interventions that include immunisations, screening

and protection from bioterrorism.
The 10 leading causes of death
in US in 2015
Heart disease 31.5%
Cancer 29.6%
Chronic lower respiratory diseases 7.7%
Accidents 7.3%
Cerebrovascular dx 7.0%
Alzheimer’s dx 5.5%
Diabetes 4.0%
Influenza & Pneumonia 2.8%
Kidney dx 2.5%
Suicide 2.2%
10 leading causes of death in
Nigeria
Behavioural determinants of positive
health outcomes
• Lifestyle habits and practices are the most
important
• Two key elements to achieve this:
1. A trusting relationship between doctor and

patient
2. Patient support from a multi-disciplinary team,

loved ones and the greater community
• Predominantly lifestyle-related medical conditions are seen
in primary care
1. Obesity
2. Metabolic syndrome
3. Hypertension and CVD
4. Dyslipidemia
5. Arthritis
6. Diabetes
7. Osteoporosis
• 80% of all premature deaths are attributable to
tobacco use, poor diet and lack of physical
activity
• The 4 primary health behaviours are 1. Non-

smoking 2. Healthy weight 3. Five fruits and
veggies per day 4. Regular physical activity
• A study by Reeves et al in 2005 reported that

only 3% of Americans had healthy levels of all 4
health behaviours
Other health determinants
• Adverse childhood events
• Genetic and epigenetic predispositions
• Health literacy
• Local environmental pollution
• Socioeconomic status
The Place & Priority of LM as treatment
for lifestyle-related diseases
• LM is a foundational part of medical care
• It offers prevention and treatment and is essential for disease reversal
• It provides people with more control over their health
• It decreases reliance on medication and therefore medication side-effects.

See study by Sarathi et al
• It is also more effective than medication in many cases. See the Diabetes
Prevention program
• It offers safer control of some biologic markers than some medication. See
Jenkin's Portfolio diet
• It’s effective use can lower health care costs and make the health care
system more sustainable. See DPP and CHIP Lifestyle Program
Objectives for week 2
• To understand the efficacy of LSM and its impact

on disease
• To cite scientific evidence to demonstrate the

influence of risk factors on health outcomes
• To describe the ‘Physician Competencies for

prescribing LM”
Efficacy of LM/Impact on disease
pathophysiology
• A healthy lifestyle affects gene expression positively
(epigenetics), reduces insulin resistance, provides
antioxidants and reduces chronic systemic inflammation
• The Cochrane Collaboration, the AHA and US Preventive

Task Force have established evidence that tobacco
cessation, increased physical activity and dietary changes
can reduce M&M from CVD, CVA and cancers in adults
• Nutritional counselling effective in changing dietary habits

and reducing medication costs
• Evidence exists for the 4 main lifestyle factors in

preventing 30% of the most common cancers in the U.S
• Poor diet is associated with elevated BP, coronary heart
disease, CVA (stroke), T2DM, osteoporosis, some
cancers even without one being overweight
• Study by Merrill et al on health behaviour decay

investigated maintenance of health behaviours after an
18 month intervention.
• It was reported that health behaviours were most

improved at 6 weeks into the program and more
sustained improvements observed over the baseline in
over 50% of participants in several categories - physical
activity, lower calorie intake, increased fruit & veg
servings, less intake of saturated fats and added
sugars.
Scientific evidence
• We will highlight some studies that demonstrate how risk
factors influence health outcomes:
1. Interheart study
2. InterSTROKE study
3. Chicago Heart Association Detection Project
4. Framingham Heart study
5. Nurses’ health study
6. Adventist health study
7. The Lyon Diet heart study

Interheart study
• By Yusuf S et al
• Standardized case control study about acute MI risk factors in

patients having their first MI
• Data collected from centres in 52 countries
• Nine significant risk factors were identified: smoking, lipids,

HTN, D.M, obesity, unhealthy diet, physical inactivity, alcohol
consumption, psychosocial factors with the first 5 factors
accounting for 80% of the population attributable risk
• Psychosocial risk factors accountable for 33% PAR

comparable to effects of HTN & obesity
• What are the examples of psychosocial factors?

InterSTROKE study
• By O’Donnell, MJ et al
• A prospective case control study
• Used to identify stroke risk factors based on data from

32 countries
• 10 significant risk factors: HTN, DM, current smoking,

abdominal obesity, unhealthy diet, physical activity,
alcohol intake, lipids, psychological stress &
depression, cardiac causes
• These risk factors associated with 90% of the risk of

stroke in men and women of all ages
• Chicago Heart Association Detection Project: The risk of heart
disease is determined by the number of cardiac risk factors a person
has.
• Framingham Heart study: Assessed the lifetime risk for

atherosclerotic CVD in people who were free of CVD at age 50. Men
with optimal risk status had a 5% lifetime risk versus men with 2 or
more who had a 69% lifetime risk. In women it was 8% versus 50%
within similar categories. Men and women with optimal risk status had
a median life expectancy of 10 years longer than those with 2 or more
risk factors.
• Nurses Health study: Prospective study that assessed relative risk

for coronary heart disease in 84,129 women over 14 years. Five health
factors were associated with a lower risk of CHD. All 5 factors present
versus none : 82% lower risk of CHA.
• Adventist Health study 2: Reported a reduced risk of
mortality in people consuming a total vegetarian diet (TVD)
versus a non-vegetarian diet from ischaemic heart dx, CVD,
cancers and all-cause mortality. TVD also reported to be
associated with a lower BMI and lower odds of becoming
diabetic, hypertensive or having MetS.
• Lyon Diet Heart study: Investigated the secondary

prevention of coronary heart disease with a Mediterranean diet
versus the AHA step 1 diet. Protective effects were maintained
after the first MI for 4 years following the study compared to
those on the AHA diet.
Physician Competencies
for prescribing LM
• Identified by a national consensus in the 2010 JAMA -Journal of the
American Heart Association article
• A practicing primary care physician should possess the following
knowledge, skills, attributes and values.
• A. Leadership (2 competencies)
• Promote healthy lifestyle behaviours
• Practice healthy lifestyle behaviours
• B. Knowledge (2 competencies)
• Demonstrate knowledge that lifestyle can positively affect health outcomes
• Describe ways in which physicians can effect health behaviour change
• C. Assessment skills (3 competencies)

• Assess social, psychological, and biologic predispositions
• Assess readiness to change
• D. Management skills (4 competencies)
• Use nationally recognized practice guidelines
• Establish effective relationships with patients
• Collaborate with patients and their families to develop specific action plans like
lifestyle medicine prescriptions
• Help patients manage and sustain healthy lifestyle practices including referrals as
necessary
• E. Office and community support (4 competencies)
• Have the ability to practice in interdisciplinary and community teams
• Apply office systems and technologies to support of lifestyle medicine
• Measure processes and outcomes
• Use appropriate community referral resources to support implementation of healthy

lifestyles
Responsibilities of LM Physicians
• Screen for lifestyle risk factors and diseases
• Treat chronic diseases by prescribing and

following up on lifestyle changes
• Engage with a multi-disciplinary team and refer

patients to community resources
• Ensure patients understand the importance that

lifestyle changes have on their medical conditions
• Coach patients on behaviour change based on

their level of readiness to change.
Rationale for LM certification
• The rationale for Lifestyle Medicine certification is:
• To educate interested physicians, health and allied health professionals

about Lifestyle Medicine
• To set a common standard/language for Lifestyle Medicine protocols

globally
• To differentiate between the evidence-based Lifestyle Medicine

professionals and the non-evidence based Lifestyle Medicine practitioners
• To set a global Lifestyle Medicine benchmark
• To attract health insurance funding for evidence-based Lifestyle

Medicine (by requiring that any fund receivers be formally certified)
• To “legitimize” Lifestyle Medicine and have the American Board of

Lifestyle Medicine (ABLM) certification recognized by the American Board
of Medical Specialties. (Similarly to get SOLONg certification recognized
by Medical bodies in Nigeria)
References
• Kelly J, Shull J. Foundations of Lifestyle Medicine: The
Lifestyle Medicine Board review Manual. 2019.
American College of Lifestyle Medicine
• NextGenU.org. Course in Lifestyle medicine.

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INTRODUCTION TO

• To compare and contrast lifestyle medicine to

• To understand the role of behavioural

• To understand the place and priority of lifestyle

• 2018 LM Core Competencies: LM offers a unique approach

• LM textbook by Garry Egger: The application of medical,

• Regular physical activity

• Stress management & emotional wellness

• Smoking cessation & avoidance of of risky substance use

• Positive psychology & connectedness

2. Focus on evidence-based optimal nutrition, stress management and

3. Patients are active partners in their care

4. Treats the underlying lifestyle causes of disease

5. Physician/Provider educates, guides and supports patients to make

6. Medications used as an adjunct to therapeutic lifestyle changes

7. Patient’s home and community environment are assessed as

1. Emphasis on making a diagnosis and treatment with pharmaceuticals

2. Patient is passive recipient of care

3. Focuses on symptoms or signs of disease not the underlying lifestyle

4. Patient is not expected to make significant behavior changes

5. Physician/Provider directs care - medical model.

6. Medications are the primary therapeutic intervention.

7. Patient’s home and community environment are typically not

1. Emphasis on integrating conventional treatment with alternative

2. Focus on treatments such as acupuncture, biofeedback and nutraceuticals

3. Patient may be an active or passive recipient of care

4. Treats symptoms or signs of disease not the underlying lifestyle causes.

5. Patient may not be required to make significant behaviour changes

6. Physician/Provider directs care - medical model

7. Patient’s home and community environment typically not considered

1. Emphasis on evidence-based, systems biology approach that addresses

1. Investigates interactions between the mind and body behaviourally, emotionally,

2. Emphasizes population-based interventions that include immunisations, screening

Chronic lower respiratory diseases 7.7%

Influenza & Pneumonia 2.8%

• Two key elements to achieve this:

1. A trusting relationship between doctor and

2. Patient support from a multi-disciplinary team,

3. Hypertension and CVD

• The 4 primary health behaviours are 1. Non-

• A study by Reeves et al in 2005 reported that

• Genetic and epigenetic predispositions

• Local environmental pollution

• It offers prevention and treatment and is essential for disease reversal

• It provides people with more control over their health

• It decreases reliance on medication and therefore medication side-effects.

• To understand the efficacy of LSM and its impact

• To cite scientific evidence to demonstrate the

• To describe the ‘Physician Competencies for

• The Cochrane Collaboration, the AHA and US Preventive

• Nutritional counselling effective in changing dietary habits

• Evidence exists for the 4 main lifestyle factors in

• Study by Merrill et al on health behaviour decay

• It was reported that health behaviours were most

3. Chicago Heart Association Detection Project

4. Framingham Heart study

5. Nurses’ health study

6. Adventist health study