Lifestyle Medicine and the Far Horizon: Before, Since, and Beyond

The American College of Lifestyle Medicine was founded just over 20 years ago. As the organization grew, it incubated an impressive array of structures and processes to foster professional standards, training, credentialing, networking, and scholarship. A compelling and accelerating drumbeat of peer-reviewed publications has demonstrated the advancing base of evidence in which lifestyle medicine practice is rooted. Despite all this good effort, however, the indicators of population health that matter most-longevity and vitality and healthspan, years in life and life in years-have largely trended away from, rather than toward, aspirations. The life course of ACLM has introduced an area of great allure and tremendous promise to health professionals seeking beyond reactive disease care. The processes, structures, and knowledge are in place to advance the goals of vitality and longevity at the population level. Needed, still, are the means of translating that accumulated knowledge into the power of routine, and effective action. Those of us committed to the full potential of lifestyle both in and as medicine have promises yet to keep and miles to go before we sleep. We can, however, see the light on the horizon from here.

Plant-Based Diets for Reversing Disease and Saving the Planet: Past, Present, and Future

The relative contributions of meat and plants to the native human diet, and human adaptation to these dietary constituents, are a matter of debate among paleoanthropologists. Indisputable, however, is the imprint of both on the anatomy and physiology of Homo sapiens: our species is constitutionally omnivorous. That means we have choices to make. At present, we are making mostly bad ones, with poor diets of highly processed plant and animal foods alike leading contributors to chronic disease, premature death, and environmental degradation. The evidence is strong, consistent, and compelling that a diet of predominantly, or even exclusively, whole plant foods can promote health, selectively treat and reverse disease, and confer comparable benefit to the planet. Omnivores have dietary choices, but the choices of nearly 8 billion hungry Homo sapiens on a small imperiled planet have narrowed. The future of food, for the sake of people and planet alike, is plant centric.

Psychosocial Determinants of Chronic Disease: Implications for Lifestyle Medicine

We have previously identified a number of "determinants" of chronic disease, using the acronym NASTIE ODOURS. These have been given the collective term "anthropogens," in this journal and other publications, to help direct the management of modern chronic ailments to a monocausal focus, akin to that afforded infectious diseases by the "germ theory." We suggested the acronym NASTIE ODOURS as a starting point for a taxonomy of lifestyle medicine determinants. In the current article, we add 3, less quantifiable, but currently increasingly more important psychosocial experiences to these: Lack of Meaning, Alienation, and Loss of culture, changing the previous acronym to NASTIE MAL ODOURS. As with other determinants, all have accumulating evidence of an underlying low-grade, systemic, inflammatory physiological base ("metaflammation"), but with the need for further research to solidify these findings.

Audience Responses to Physical Activity in the Biggest Loser Australia

The popular reality television show The Biggest Loser Australia (TBL) is a significant source of media content about physical activity. This study examined audience responses to and interpretations of physical activity in TBL. A qualitative study using in-depth interviews was conducted in New South Wales, Australia. A sample of 46 viewers of TBL was recruited, stratified by gender, age group, area of residence, and body mass index. Interview data were thematically analyzed to identify how viewers evaluated TBL. Respondents were most positive about TBL as public health education, premised on personal responsibility, the need for extreme action, and the possibilities of human agency (individually and collectively). Conversely, they were critical about whether the portrayal of physical activity could guide and inspire them personally. They expressed feelings of disgust and fear in response to the exercise challenges, questioned the practicality of the behavior change process in light of their own experience, and were skeptical about the purpose of the program itself. TBL's representation of physical activity may be limited in its capacity to encourage physical activity. Despite the wide viewership of this program, encouraging physical requires innovation in the development of practical, persuasive and evidence based media messages about physical activity.

Defining a Structure and Methodology for the Practice of Lifestyle Medicine

Lifestyle medicine (LM) is a relatively new branch of clinical practice (like travel medicine, sports medicine, etc), but to date with little accepted structure or methodology. The current review extends a previous attempt to define the determinants of chronic disease by expanding this to include (1) the knowledge base (the science) or epidemiology of chronic disease, (2) the skills (the art) or practice of LM, (3) the tools (the materials) that can add to LM diagnoses and prescription, and (4) the procedures (the actions) that help update conventional medicine to include practices required for a new era of lifestyle and environmentally related chronic disease.

Lifestyle Medicine Education

The actual causes of premature adult deaths, the preponderance of noncommunicable chronic diseases, and their associated costs are related to unhealthy behaviors, such as poor nutrition, physical inactivity, and tobacco use. Although recommended as the first line of prevention and management, providers often do not provide behavioral change counseling in their care. Medical education in lifestyle medicine is, therefore, proposed as a necessary intervention to allow all health providers to learn how to effectively and efficiently counsel their patients toward adopting and sustaining healthier behaviors. Lifestyle medicine curricula, including exercise, nutrition, behavioral change, and self-care, have recently evolved in all levels of medical education, together with implementation initiatives like Exercise is Medicine and the Lifestyle Medicine Education (LMEd) Collaborative. The goal of this review is to summarize the existing literature and to provide knowledge and tools to deans, administrators, faculty members, and students interested in pursuing lifestyle medicine training or establishing and improving an LMEd program within their institution.