What is lifestyle medicine and what will it take to get more clinicians to incorporate it into their practices? That was the topic of a lively panel discussion at the Jacobs School of Medicine and Biomedical on Sept. 28 during 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 of health care known as lifestyle medicine, centered on nutrition, exercise, stress reduction, good sleep, avoidance of risky substances and social relationships. Connections.
Panelists discussed how these principles, revered around the world for centuries and recognized as essential to disease prevention and reduction of chronic disease, can be sustainably integrated into conventional health care.
These pillars of lifestyle medicine, which are integral to quality of life, constitute the raison d’être of the Jacobs School, moving from a focus on disease treatment to disease prevention, a Brashear said.
But, she noted, the movement faces challenges, including finding ways for current reimbursement models to properly reflect the value of lifestyle medicine.
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 research director, American College of Lifestyle Medicine.
Panelists discussed the importance of dietary changes, including relying more on plant-based foods and promoting a plant-based diet. They spoke about the need to align lifestyle medicine with health equity issues, how best to advocate and publicize its successes, and how to “operationalize” education and support for patients who are needed to reap the benefits of this healthcare approach. .
It is not difficult to find clear evidence of the effectiveness of lifestyle medicine. In trial According to the panelists cited, the lifestyle intervention was compared to the diabetes medication metformin in reducing the incidence of type 2 diabetes. They found that metformin reduced the incidence of diabetes by 30%, which was significant, but the lifestyle intervention reduced the incidence of diabetes by almost two times, or 58%. In this case, lifestyle medicine proved to be much better than the best medication available.
But, Karlsen pointed out, the standards for accepting this evidence are very different for lifestyle medicine and for new pharmaceuticals. When a new drug comes out and shows a slight improvement, no one questions it and it is often approved, she said. The situation is quite different, even when it comes to the dramatic differences achieved with lifestyle medicine.
“There is compelling evidence,” Barnett said, “but the challenge lies in translation.”
Ross-Lee emphasized that the effectiveness of lifestyle medicine also depends on cultural and socioeconomic factors. “This needs to include affected communities,” she said, emphasizing that providers cannot tell patients they need to walk or run in their neighborhood without understanding whether or not that is realistic. She said a patient might very well think, “Well, I don’t have anywhere to run around the block…not if I want to come back.” »
“We don’t have a health system,” she said. “We have a system of care for illnesses.”
And reimbursement models pose a crucial challenge, the panelists agreed.
“Clinically, lifestyle medicine is not yet operationalized,” Karlsen said. “It is very difficult to provide education and support. Research shows these behaviors work! The gap lies in their implementation in practice.
Katz insisted that reimbursement models must change. “This is an ‘income-based’ system, not evidence-based.”
These changes will require comprehensive advocacy, but medical education also has a key role, Brashear said. For example, the Jacobs School now has more students planning to focus on primary care and psychiatry, as well as a fellowship program designed to encourage more students to pursue those fields.
Participants discussed the role of today’s healthcare providers in finding ways to adopt lifestyle medicine in their own lives and practice.
The final word came from a dietitian in the audience, who warned that health care providers are ignoring the value dietitians can bring to the team.
“Stop leaving dietitians out of the conversation,” she said. “There is a huge opportunity here, but we are not recognized as our peers in the system. It’s time to play this game collectively.
