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Lifestyle Medicine: There's Never Been a Better Time to Take Care of Yourself
U of U Health Lifestyle Medicine Program physician leaders Rachel Goossen and Rich Doxey provide support for care teams that empowers patients to make positive changes to their daily habits and overall well-being.

What is the lifestyle medicine program? 

T

hough the lifestyle medicine program is new, the ideas behind it are ancient. The understanding of how healthy eating, exercise and good sleep influence our health has been around for centuries. In recent decades, data has emerged to support these observations; lifestyle habits can influence our health in positive and negative ways.

Primary care physicians and many specialists can use lifestyle interventions to augment treatment of many chronic illnesses, reduce medication burden, and improve outcomes.1,2,3,4,5 In fact, many of the guidelines for the treatment of chronic disease, such as hypertension, cardiovascular disease and diabetes recommend lifestyle change as first-line therapy.6,7

With the significant time pressures on clinicians today, writing a prescription can feel easier and more efficient than taking the time necessary to help patients make meaningful behavior change. Surveys of clinicians show that one of the perceived barriers to counseling patients is the time it takes; in addition, many don’t think patients can make substantive changes in their diet or physical activity.8 Other studies have shown that physicians often feel ill prepared to counsel patients on making lifestyle changes.9

With that in mind, one of the main goals of the new, formalized lifestyle medicine program is to create a dedicated visit in which physicians have more time and resources to counsel patients on lifestyle interventions, coordinate care, and make appropriate referrals. With an appointment focused on lifestyle, we are able to take the time necessary to counsel patients on behavior change, and set up the appropriate support and follow-up.  

A secondary goal is to collect data that may help change how medical care is reimbursed. Right now, the medical billing system does not reward or reimburse for lifestyle interventions. As a major academic medical center, we hope to generate data to support improved patient outcomes with provider-guided lifestyle interventions. Ideally, this could lead to needed systemic change that would improve reimbursement for a preventive approach to patient care. 

A case for the dedicated lifestyle consultation 

In many primary care visits, we find ourselves faced with such numerous or complicated problems that taking the time to discuss diet or exercise feels unrealistic.  

With dedicated time for a focused lifestyle consult, we are able to quickly build strong relationships with our patients. Our jobs are not to tell patients what to do, but to discover what they are ready and willing to do. By focusing the appointment, acknowledging that our sole objective is to review current lifestyle choices and identify areas for evidence-based change, we emphasize the authentic value of this strategy for mitigating or managing chronic disease. 

Our commitment to blocking out time to make lifestyle medicine a priority empowers patients to do the same.

A model for lifestyle intervention  

While the exact flow of the appointment depends on the individual and their health, each lifestyle consultation is structured to help patients identify opportunities for lifestyle improvement, guide them through the process of setting realistic goals, and make actionable plans to meet them.  

1. Partner with patients 

First, we ask questions. Interventions should be patient-guided, so providers need to identify the behaviors the patient wants to change. Questions about nutrition, sleep, exercise, stress management and mental health all give a glimpse into aspects of their health patients identify as areas for improvement. By setting their own goals and the timeline for reaching them, patients are able to communicate their personal needs and priorities. For example, some patients are ready to make major changes to their dietary habits or exercise routine, while others know they will succeed better with steady, gradual changes over time. We also collaborate to set up the most convenient follow-up, often touching base with a message or call from an MA in a few weeks, and then spacing visits out as the patients and providers agree feels appropriate. When patients generate their own goals and timelines and these parameters are respected by their provider, the patient-provider partnership feels equal, and patients feel more empowered and confident in their ability to make changes. 

2. Troubleshoot barriers 

Next, we help patients anticipate barriers to implementing these interventions by asking them about what challenges they think they will face. The most common barrier cited by patients is time. It takes time to exercise. It takes time to prepare healthy meals. We use our acquired knowledge of lifestyle modification strategies to offer recommendations on how to simplify these changes, such as suggestions for healthy meals that are easy to make or how to select healthier meals when eating out.  

Another common problem is lack of peer and family support. Patients often express feeling a lack of adequate support from friends or family members. It's hard to sit down and eat a kale salad while the rest of the family is eating cheeseburgers. Patients need support and buy-in from the people they live with to have success. 

We find it beneficial to have family members attend appointments, when possible, to help them feel included and engage more fully in the lifestyle plan.  

3. Give them the skills to succeed 

Finally, we help patients see that they do have the skills and abilities to change their health. Confidence is essential for meaningful behavior change. By identifying past successes, such as avoiding sugary beverages or quitting smoking, patients recognize that they are capable of lifestyle change, even when it feels challenging or uncomfortable. We also readily acknowledge any small success they have as we go along, and focus on the positive actions and results of their journey toward better health.  

Bringing people together to move the needle 

Culinary medicine. One of our exciting new projects is the kick-off of a culinary medicine class in the community clinics. Food brings people together, and a culinary medicine class offers a community centered approach to healthy eating that will help support patients in making healthy choices. By participating in these courses, our patients will be able to connect with others facing similar challenges while learning about nutrition and food preparation. This community setting will bolster patients with the support of both their physicians and peers that is so needed for permanent lifestyle change.  

Family connection. The closest communities are within families, which is why the most effective lifestyle changes tend to happen when the whole family is on board.  With children and adolescents, there is a real opportunity to form healthy habits that will carry into adulthood. Working with family units to employ healthier lifestyle strategies can offer intergenerational benefits. When we help parents see that making healthy choices now helps their kids make healthy choices later, they feel motivated to help their children by modeling the behaviors themselves.  Parents are often willing to make efforts for their children that they struggle to make for themselves, and making the changes together as a family can be the key to motivation for all involved. 

Parents see how hard it has been to unlearn their less healthy habits as an adult, and make that extra push for change in hopes of making their child’s future more healthy and bright.  

Community building. Our vision is to create a community of patients and providers who want to come together to live life in a more healthful way. If our program is successful, we will have patients learning the skills they need in their classes and sharing them with their families and friends to form a lifestyle medicine community:  a network of like-minded patients and providers who can support each other and move together toward their goals.  

References:

  1. Du H, Li L, Bennett D, Guo Y, Turnbull I, Yang L, et al. (2017) Fresh fruit  consumption in relation to incident diabetes and diabetic vascular complications: A 7-y prospective study of 0.5 million Chinese adults. PLoS Med 14(4): e1002279. https://doi.org/10.1371/journal
  2. Kelly J, Karlsen M, Steinke G. Type 2 Diabetes Remission and Lifestyle Medicine: A Position Statement From the American College of Lifestyle Medicine. Am J Lifestyle Med. 2020 Jun 8;14(4):406-419. doi: 10.1177/1559827620930962. PMID: 33281521; PMCID: PMC7692017
  3. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin PH, Karanja N. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med. 1997 Apr 17;336(16):1117-24. doi: 10.1056/NEJM199704173361601. PMID: 9099655.
  4. Filippou CD, Tsioufis CP, Thomopoulos CG, Mihas CC, Dimitriadis KS, Sotiropoulou LI, Chrysochoou CA, Nihoyannopoulos PI, Tousoulis DM. Dietary Approaches to Stop Hypertension (DASH) Diet and Blood Pressure Reduction in Adults with and without Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Nutr. 2020 Sep 1;11(5):1150-1160. doi: 10.1093/advances/nmaa041. PMID: 32330233; PMCID: PMC7490167.
  5. de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999 Feb 16;99(6):779-85. doi: 10.1161/01.cir.99.6.779. PMID: 9989963.
  6. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Muñoz D, Smith SC Jr, Virani SS, Williams KA Sr, Yeboah J, Ziaeian B. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019 Sep 10;140(11):e596-e646. doi: 10.1161/CIR.0000000000000678. Epub 2019 Mar 17. Erratum in: Circulation. 2019 Sep 10;140(11):e649-e650. Erratum in: Circulation. 2020 Jan 28;141(4):e60. Erratum in: Circulation. 2020 Apr 21;141(16):e774. PMID: 30879355; PMCID: PMC7734661.
  7. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC Jr, Sperling L, Virani SS, Yeboah J. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019 Jun 25;73(24):e285-e350. doi: 10.1016/j.jacc.2018.11.003. Epub 2018 Nov 10. Erratum in: J Am Coll Cardiol. 2019 Jun 25;73(24):3237-3241. PMID: 30423393.
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Contributors

Rachel Goossen

Clinical Attending, Family & Preventive Medicine, University of Utah Health

Richmond Doxey

Assistant Professor, Internal Medicine, and Culinary Medicine Specialist, University of Utah Health

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