Forum focuses on integrating lifestyle medicine into conventional health care

What is lifestyle medicine and what will it take to get more clinicians to integrate it into their practices? That was the topic of a lively panel discussion at the Jacobs School of Medicine and Biomedical on Sept. 28 at the third Food as Medicine forum sponsored by the Buffalo Niagara Medical Campus.

Moderated by Allison Brashear, vice president for health sciences and dean of the Jacobs School, the panel focused on the emerging field in health care known as lifestyle medicine, which centers around nutrition, movement, stress reduction, good sleep, avoiding risky substances and social connections.

Panelists discussed how these principles, which have been revered around the globe for centuries and are known to be key to preventing disease and reducing chronic disease, can be sustainably integrated into conventional health care.

These pillars of lifestyle medicine, which are integral to quality of life, is what the Jacobs School is all about, changing from an emphasis on treating disease to preventing disease, Brashear said.

But, she noted, the movement faces challenges including in finding ways to get current reimbursement models to properly reflect the value of lifestyle medicine.

The panelists included: Barbara Ross-Lee, founding director of the American Osteopathic Association Health Policy Fellowship and founding president of the Maryland Osteopathic College of Medicine at Morgan State University; Ted D. Barnett, founder of the Rochester Lifestyle Medicine Institute; David Katz, president and CEO of DietID, True Health Initiative; and Micaela Karlsen, senior director of research, American College of Lifestyle Medicine.

Panelists discussed the importance of dietary changes, especially relying more on plant-based foods and promoting a plant-based diet. They talked about the need to align lifestyle medicine with health equity issues, how to best advocate and spread the word about its successes, and how to “operationalize” the education and support for patients that is necessary to reap the benefits of this health care approach.

It isn’t hard to find clear evidence that lifestyle medicine works. In one trial the panelists cited, lifestyle intervention was compared to the diabetes drug metformin in reducing the incidence of Type 2 diabetes. They found that metformin reduced incidence of diabetes by 30%, which was significant, but lifestyle intervention reduced incidence of diabetes by nearly twice as much at 58%. So in that case, lifestyle medicine proved to be far better than the best drug available.

But, Karlsen pointed out, the standards for accepting that evidence are far different for lifestyle medicine than they are for new pharmaceuticals. When a new drug comes out and shows just a tiny improvement, nobody questions it, and it’s often approved, she said. The situation is far different even for dramatic differences achieved with lifestyle medicine.

“There is compelling evidence,” said Barnett, “but the challenge is in translation.”

Ross-Lee pointed out that making lifestyle medicine work also depends on cultural and socioeconomic factors. “It must include the communities that are impacted,” she said, noting that providers can’t be telling patients they need to walk or run in their neighborhoods without an understanding of whether or not that’s realistic. She said, a patient may well be thinking, ‘Well I don’t have any place to run around the block…not if I want to get back.’

“We don’t have a health care system,” she stated. “We have a disease care system.”

And reimbursement models pose a critical challenge, the panelists agreed.

“Clinically, lifestyle medicine is not yet operationalized,” said Karlsen. “It’s very challenging to deliver education and support. Research shows these behaviors work! The gap is putting them into practice.”

Katz insisted that reimbursement models must change. “It’s a ‘revenue-based’ system, not an evidence-based system.”

Those changes will require comprehensive advocacy, but medical education also has a key role, Brashear said. For instance, the Jacobs School now has more students who plan to focus on primary care and psychiatry, as well as a scholarship program designed to encourage more students to enter these fields.

Audience participants discussed the roles of current health care providers in finding ways to adopt lifestyle medicine in their own lives and in their practices.

The final word came from a dietitian in the audience, who cautioned that health care providers have been ignoring the value that dietitians can bring to the team.

“Stop leaving dietitians out of the conversation,” she said. “An enormous opportunity is here, but we aren’t recognized as peers in the system. It’s time to play this game as a collective.”