By Blecenda Varona, DRPH, FACLM, DIPIBLM, RND, MPH
Lifestyle Medicine is first-line therapy, supplemented as necessary with medications. Lifestyle Medicine treatment is used as initial treatment unless medically contraindicated, such as with medical emergency. –American College of Lifestyle Medicine
Lifestyle Medicine (LM) is the evidence-based practice of helping individuals and families adopt and sustain healthy behaviors that affect health and quality of life. Examples of target patient behavior include, but are not limited to eliminating tobacco use, improving diet, increasing physical activity, and moderating alcohol consumption.
History and pioneers
Hippocrates often quoted “Let your food be your medicine, and your medicine be your food,” the best evidence indicates this statement, while consistent with his general philosophy and practice, is not from Hippocrates. He was an advocate of teaching healthful diet, nutrition and exercise to avoid and combat disease.
Tomas Edison once said, “The doctor of the future will give no medicine but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease.” Through the years the healthy living program continues—Nathan Pritikin Longevity Center (c. 1970s); John McDougall Program (c. 1070s); Dean Ornish Preventive Medicine Research Center (c. 1980s); Caldwell B. Esselstyn Jr. Cleveland Clinic(c.1990s); Hans Diehl Coronary Health Improvement Project (CHIP, now Complete Health Improvement Program (c. 1990s); WHO diet, nutrition, and the prevention of chronic diseases: Report of a WHO Study Group (WHO Technical Report Series 797) (1990); James Rippe (c. 1990s).
The American College of Lifestyle Medicine (ACLM) was organized in early 2004 by Dr. John Kelly in collaboration with small group at Loma Linda University (AMA Foundation awarded Kelly the Excellence in Medicine Award in 2004 for leadership in establishing the ACLM). ACLM presidents include John Kelly, Marc Braman, Wayne Dysinger, Liana Lianov, David Katz, George Guthrie and Dexter Shurney.
Core LM competencies, intervention modalities
In 2009, the Blue Ribbon Panel (BRP) of LM experts from the American Academy of Family Physicians, American Medical Associations, American College of Physicians, American College of Preventive Medicine, American College of Lifestyle Medicine, American Osteopathic Association, American Academy of Pediatrics, and American College of Sports Medicine agreed on a definition of LM and 15 core competencies for primary care physicians.
As published in JAMA in 2010, the 15 core competencies include: Leadership in promoting:
1. Healthy behaviors as foundational
2. Practicing healthy behaviors and creating healthy environments
3. Evidence that specific lifestyle changes can have positive health outcomes
4. Physician engagement with patients can positively affect patients’ health behaviors.
Assessment skills in:
5. Predispositions of patients’ behaviors and outcomes.
6. Readiness, willingness, and ability to make health behavior changes.
7. History and physical examination, including lifestyle factors and “vital signs” such as physical activity level, body mass index, stress level, and sleep; and obtain and interpret appropriate tests.
8. Use nationally recognized practice guidelines
9. Established effective relationships with patients and their families to sustain behavioral change
10. Collaborate with patients and their families to develop written action plans.
11. Refer patients to appropriate health care professionals
Use of office and community support:
12. Practice in an interdisciplinary team
13. Apply office systems to support lifestyle medicine care
14. Measure processes and outcomes to improve quality of lifestyle interventions
15. Use appropriate community referral resources
Here are the Lifestyle Intervention Modalities:
2. Physical Activity
3. Stress Management/Emotional Wellness
5. Smoking Cessation
6. Avoiding Risky Substance Use
7. Non-Drug Modalities
8. Emphasis on behavioral interventions and social/ relationships, including happiness
LM offers a spectrum of intervention intensity based on the conditions treated from primary prevention to palliative care.
Not alternative medicine
Lifestyle Medicine is not Complementary/Alternative Medicine. It is not an Integrative Medicine, nor a Functional Medicine and Mind-Body Medicine. It is different from Preventive Medicine.
LM is unique and focuses on lifestyle behaviors that can be applied to every practice, and every patient. It emphasizes the use of a collaborative care model with incorporation of allied health care professionals to provide much of the direct counseling. It also uses defined number of intervention approaches.
It involves more prescriptive lifestyle interventions for specific diseases or risk conditions. It is recommended in many guidelines for use in both prevention and treatment.
Its successful outcomes are contingent upon active participation of patients. Approaches include: cognitive behavioral therapies, motivational counseling, health coaching, and group-based interventions.
Lifestyle Medicine is different from Conventional Medicine
Designing LM for The Philippines
Since 1988, I actively helped people in the country follow and sustain a healthy living lifestyle. I served as director the ‘Health and Wellness’ Department (now, the Lifestyle Center Department) of the Adventist Medical Center-Manila.
In 2006, I was invited to work in the Guam Wellness Program, as LM educator and coach. But after realizing the need for LM in the Philippines, I went back and founded the Asian Institute of Lifestyle Medicine (AILM), Inc. The AILM is providing free LM educational lectures to different religious groups and low-income communities, which are considered vulnerable sectors prone to an unhealthy lifestyle. AILM is providing also LM programs to corporate companies, some of which give donations which are channeled to implement and sustain the LM programs of AILM particularly for the poor or less fortunate. I also design and redesign the program fitted for the community and the budget- which is one of the keys to the program’s success.
In 2010, I brought the Complete Health Improvement Project (CHIP) to the Philippines and other Southeast Asian countries. CHIP is one of the scientifically and medically tested LM programs in United States. We did the facilitators’ training program to 40 health professionals who are now active in LMe serving different countries of Southeast Asia-Pacific Region. Dr. Johann Manez participated in the second batch of CHIP, who later organized Asian Society of Lifestyle Medicine (ASLM) and Philippine College of Lifestyle Medicine.
Lifestyle Medicine is expensive in USA. In 2001, I saw the Lifestyle Center of America in Oklahoma billing $8,000 per participant (stay-in). In 2006, Guam Wellness Program was charging $4,000 per participant. The CHIP in the Philippines is the cheapest which is charging $600 per patient. At present Adventist Medical Center Manila and Bacolod are regularly running CHIP.
I was part of the founding member of ASLM – Community Outreach. After one year of conference meetings, the group officially named it as Community Engaged Lifestyle Medicine (ASLM-CELM). The ASLM-CELM aims to inspire and help LM practitioners create low-cost lifestyle medicine programs for low-income countries.
In the 2018 ASLM Conference, the first seminar/workshop on ASLM-CELM was held, wherein I shared our experiences here in the Philippines. Through the Global Alliance of LM, many low-income countries including the Philippines will benefit from CELM.
It was also a great blessing to be invited as the third author of Healthy Choices, the first LM book in the Philippines and Asia. This is lifestyle medicine book tailored to fit the Philippine and Asian culture, lifestyle, and practices. Grounded on landmark scientific studies but written in simple and practical terms. Healthy Choices exposes how certain beliefs and behaviors lead to chronic lifestyle diseases. More importantly, this book equips readers with tips and tools on how to make the right decisions. Healthy Choices is coauthored by the world-renowned pioneers of LM, namely –Dr. Hans Diehl and Dr. Arleen Ludington.
In 2018, I joined FAME Leaders Academy (FLA), as a pioneering faculty. FAME provides Lifestyle Medicine seminars and workshops to governmental and nongovernmental organizations, and corporations. Since 2002, FAME, which publishes H&L (Health and Lifestyle) magazine, has been staunchly advocating for doctors and healthcare professionals to serve as role models and emphasize the importance of a healthy lifestyle as the foundation of preventive and therapeutic care to help stem the tide of non-communicable diseases in the country.