This transcript has been edited for clarity.
Kenneth W. Lin, MD, MPH: My name is Dr. Kenny Lin, a family physician and Associate Director of the Family Medicine Residency at Lancaster General Hospital. I’m here today with Dr. Alka Gupta, who serves on the board of directors of the American College of Lifestyle Medicine (ACLM), to talk about lifestyle medicine in primary care. Dr. Gupta practices in Washington, DC, and has been one of the leaders at the forefront of the lifestyle medicine movement. I actually saw my personal doctor earlier today and he mentioned that he attended the ACLM virtual conference this year and was very excited about lifestyle medicine. A nice coincidence, and a perfect opportunity to talk about it.
Let’s start with the basics. When you tell your patients and colleagues that you have training and expertise in lifestyle medicine, how do you explain what it is and how it can help them?
Alka Gupta, MD: With patients, we usually talk about what they want from their health. So I link it to their goals. Are they looking to live longer or better? We sometimes talk about chronic diseases that can be avoided, or even reversed, by optimizing nutrition, physical activity and the way we cope with daily challenges. If their goal is something else, then we could show that person how working according to one of these lifestyle medicine principles can help them achieve that goal.
For clinicians, we know that lifestyle medicine has a huge impact on a person’s health – short-term, daily and long-term. This makes lifestyle medicine relevant to all living beings. It is therefore relevant for all clinicians. This doesn’t mean everyone has to know everything. But I think we’re realizing more and more that this is part of medicine.
Lin: Part of the appeal of lifestyle medicine is that clinicians are encouraged to practice what they preach. The six pillars of lifestyle medicine should be central to their own lifestyle and could reduce their risk of burnout. Could you tell us about the six pillars that are at the heart of lifestyle medicine?
Gupta: The six pillars we promote in lifestyle medicine are nutrition, physical activity, stress management, restful sleep, social connections, and avoidance of risky substances that can actively harm your health.
Lin: The pillars that intrigue me the most are stress management and social connections, because they are obviously very important for well-being, but I don’t talk about them as often as nutrition or physical activity. I’ve often felt like these things aren’t really in my control. How do you help patients better manage their own stress and spend more quality time building social connections?
Gupta: It’s hard, especially now. Many of us live and work in hybrid ways. I’ve seen a lot more isolation in recent years than before, which makes all of these things more difficult.
Stress tends to be a nebulous subject. My first goal is to help someone, whether a patient or someone else, understand if they are having a stress reaction that could negatively impact their health. Many people work or live in stressful situations, and we may not even be aware of the negative consequences on our health. Once we recognize that, I find the rest of the conversation becomes a little easier.
Changes are easier if you have a bit of community around you. It can be a small community made up of a few family members, friends or colleagues. I find it much easier to become physically active if I do it with someone else or take a class that connects me to other people. I’m more excited about this..
Lin: Medical training is not always conducive to a healthy lifestyle. I remember being on call and eating whatever was available in the hospital cafeteria and neglecting exercise. Is the ACLM considering any changes we could make to medical education and practice that might improve the situation?
Gupta: In general, we have seen improvements in the structure of medical education at all levels. For the good health of patients, we must also be attentive to the health of our teams and nursing staff. We are seeing clinicians leaving the profession in droves, which is a major problem. We must be able to take care of our own health by tackling these six pillars ourselves. Much work remains to be done in this area.
Lin: I looked at the ACLM website. The organization has experienced strong growth since its creation more than 20 years ago. How does this look for the next 20 years? Do you see lifestyle medicine remaining anchored in primary care or evolving into a subspecialty of primary care, such as sports medicine?
Gupta: ACLM has changed a lot. At first, it was a fairly small and grassroots group led by doctors. We have led a major effort to educate clinicians – during and after training – on how lifestyle medicine can realistically be put into practice.
As for whether lifestyle medicine should be anchored in primary care or elsewhere, we need to transform health at the population level, at the national level, and even at the individual level. We need depth. Primary care will always be an important entry point, perhaps the most important. But we can’t rely on primary care clinicians to do everything. We need other health professionals: nutritionists, registered dietitians, exercise physiologists, fitness specialists and behavioral health specialists. We need to get them to consider a connected, coordinated care delivery system that communicates well and wraps around the patient. So while it’s a great anchor (and it’s why I’m in primary care), we can’t rely on primary care alone. Lifestyle medicine should be integrated into all specialties. If an endocrinologist diagnoses diabetes, nutrition should be part of that conversation so the patient knows what is within their control in managing their diabetes.
Lin: Do you have an idea of the percentage of your members who practice in primary care versus other subspecialties?
Gupta: I don’t have the number in front of me, but we have many specialized representatives. Cardiology is one of the most represented specialties, which is great. Much of the work of cardiologists is prevention, so it has a perfect place in lifestyle medicine. If we’re talking about advanced therapies or diagnostics, even invasive tests, like left heart catheterization and stenting, it’s great to have the same clinicians delivering the message of prevention.
Lin: In a purely cynical sense, if you’re a cardiologist promoting lifestyle medicine, you’re trying to reduce a lot of your activity. Hopefully, patients won’t need as many invasive procedures, such as revascularization, if we can prevent the disease in the first place.
The ACLM recently published a expert consensus statement on the integration of lifestyle medicine into primary care practice. Many services require a lot of time. In terms of what we can do today in primary care, could you talk about shared medical appointments and other ways that family doctors and general internists can provide life in their practice?
Gupta: We spend a lot of time trying to work around this exact problem. With one practitioner and one patient, you can’t cover everything in one visit, including 20 minutes to teach them how to eat a balanced meal or what type of physical activity is best for them. So we help practices use shared medical appointments, where you bring in multiple patients at the same time. One benefit is that you can provide resources that would not otherwise be a covered benefit for some patients. For example, you might bring in a dietitian, psychologist, or other practitioners that patients don’t always have easy access to. You can deliver this training in a group environment that is also billable. It’s easier for a practice to reach more patients with this information, and patients also like shared appointments because they learn from each other.
Lin: Are there any takeaways about lifestyle medicine for family doctors that we haven’t already covered?
Gupta: The main catalyst for me was when I began to realize how chronic diseases can be prevented in the first place, and then how much they can be blocked or delayed, even after they appear. Once I realized this, it was much more important for me to incorporate it into my daily practice. This is the most important thing to know.
Clinicians are intrinsically motivated to do the best they can for their patients. You tend to find ways and resources to come up with things that you may not have the ability to do yourself. The ACLM has a treasure trove of resources that practices can take advantage of, including an excellent patient handout, “6 Ways to Take Control of Your Health.” ACLM is an incredible community to get involved in.
Lin: Many clinicians are ready to receive this message. Thank you so much for taking the time to speak with me today about lifestyle medicine.
Follow Medscape on Facebook, X (formerly known as Twitter), InstagramAnd Youtube
