Short Lifestyle Medicine Interventions in Primary Care

Lifestyle medicine (LM) is defined by the American College of Lifestyle Medicine (ACLM) as "the use of evidence-based lifestyle therapeutic approaches, such as a predominantly whole food, plant-based diet, regular physical activity, adequate sleep, stress management, avoidance of risky substance use, and other non-drug modalities, to prevent, treat, and, oftentimes, reverse the lifestyle-related, chronic disease that's all too prevalent."

Lifestyle medicine (LM) is supported by six pillars, each equally important in helping gain and maintain general health and wellness.

• Nutrition--the most commonly discussed (and hotly debated) pillar of LM-- most practitioners currently support the Mediterranean Diet, which emphasizes the consumption of fruits, vegetables, whole grains, nuts, seeds, legumes, fish, and olive oil (limited amounts), with moderate intake of poultry, dairy products, and red wine, and LIMITED consumption of red meat and processed foods. It does not include your typical kebabs and falafel dishes, for example, that we see in our neighborhood Mediterranean eateries.
• Physical Activity--the pillar that most patients adopt for LM; it may be the least effective intervention (especially for weight loss) when not combined with the other pillars--the current recommendation is at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week. It's been estimated that 85% of Americans do not achieve this goal. Interestingly, in general there is no stigma associated with being sedentary and many of my patients freely admit they do little to no activity per week.
• Restorative Sleep--the current guidelines recommend 7 - 9 hours of sleep per night--this is one LM bank that is routinely depleted in our daily lives, as we seek to be more productive or more engaged in activities in our waking moments. Sleep debt is truly a taxing disease over time, one that is very difficult to repay and affects your ability to heal and properly think. Those who are perceived to be productive on little sleep are celebrated in our current society while those who need a nap simply are not.
• Stress Management--there are many triggers to the stress in our lives; the causes often appear to be out of our control, be it having little to no influence over our community (worldwide and local), our professional lives, our wealth, our friends, our families, or even our own health. Therefore, managing stress involves creating an awareness of stress triggers, managing your responses to them, and coping with them in a manner that promotes your resilience. This does not necessarily require a behavioral or mental health provider, but rather the adoption of LM tools.
• Avoidance of Risky Substances--I typically do not have to preach to my patients about how risky substances affect health (particularly smoking cigarettes or using illegal drugs), yet patients are surprised when I warn them of alcohol overuse (no more than 1 glass/serving per day on average and NO binging) or the unknown dangers of vaping, be it nicotine or THC (marijuana). This is one area where Healthcare has raised awareness in our communities and helped patients in need by providing resources.
• Positive Social Connections--it has been said that loneliness is the new epidemic of our times, particularly among adult males. This is seldom discussed in the Healthcare setting until a patient becomes dependent on others for care and struggles to find help. This societal problem is rarely discussed and interventions are few. Social media paradoxically has caused some to retreat from real-person interactions that could have been more nurturing and less transactional.

Healthcare Organizations that embrace the concept of Lifestyle Medicine (LM) will see that these interventions will add value to the care they provide to their patients, namely in disease reduction and prevention, avoidance of unnecessary interventions or studies, decreased utilization of services for acute and chronic diseases, and decreased overall utilization of medications and treatments.

Yet when I ask my healthcare colleagues across many specialties in different practice styles what prevents them for fully engaging in a discussion of Lifestyle Medicine with their patients, they cite a number of concerns:

1. The fear that they are not a content expert qualified to have the discussion, and therefore might give conflicting and confusing information as well as recommendations
2. The patient is focused on the problem for which the appointment was made, and therefore any discussion beyond it may be viewed as a distraction
3. The lack of time, during a patient encounter, to have a meaningful discussion

I've been a faculty member in our well-established Family Medicine Residency at Los Angeles for the past three decades, and I have always maintained an open dialogue with my residents about current topics and concerns in Health Care. Naturally, then, I discussed the barriers to Lifestyle Medicine in a Primary Care setting. Their solutions were intriguing.

In 2023 my second and third year residents proposed these simple queries to spark an appropriate conversation about the LM pillars:

In 2024 the residents added the following questions:

A final synopsis from the 2023 and 2024 Family Medicine residents about sparking a conversation about LM in Primary Care:

Healthcare Organizations should embrace the concept of Lifestyle Medicine (LM) as they will see that these interventions will add value to the care they provide to their patients. Similarly these organizations should be aware that their physicians and providers will need to have ready access to evidence-based content in LM medicine but also should be taught the tools of how to initiate a safe and quick conversation with their patients. We can learn from our residents.