What is lifestyle medicine? How can we get more clinicians to integrate this into their practice? That was the subject of a lively panel discussion on Sept. 28 at the Jacobs School of Medicine and Biomedical Sciences’ third annual Food as Medicine forum hosted by the Buffalo Niagara Medical Campus.
The panel, moderated by Allison Brashear, vice chancellor for health sciences and dean of the Jacobs School, focused on the emerging field of health care known as lifestyle medicine, which focuses on It’s nutrition, exercise, stress reduction, good sleep, avoiding dangerous substances and social connection.
Panelists discussed how to sustainably integrate these principles into traditional healthcare, which have been revered globally for centuries as key to preventing disease and reducing chronic disease.
Brashear said these pillars of lifestyle medicine are integral to quality of life, which is what the Jacobs School is all about, shifting from an emphasis on treating disease to an emphasis on preventing disease.
However, she noted that the movement faces challenges, including finding ways to make current reimbursement models properly reflect the value of lifestyle medicine.
Panelists include: Barbara Ross-Lee, founding director of the American Osteopathic Association’s Health Policy Fellowship and founding dean of the Maryland College of Osteopathic Medicine at Morgan State University; Ted D. Barnett, founder of the Rochester Lifestyle Medicine Institute; David Katz, DietID , President and CEO of True Health Initiative; Micaela Karlsen, Senior Director of Research at the American College of Lifestyle Medicine.
Panelists discussed the importance of dietary changes, specifically relying more on plant-based foods and promoting plant-based diets. They discuss the need to integrate lifestyle medicine with health equity issues, how best to advocate and disseminate information about its success, and how to “implement” patient education and support for accessing this health care approach. Necessary for benefits.
It’s not hard to find clear evidence that lifestyle medicine works. In one trial cited by panelists, a lifestyle intervention was compared with the diabetes drug metformin in reducing the incidence of type 2 diabetes. They found that metformin reduced diabetes incidence by a remarkable 30%, but lifestyle intervention nearly tripled the reduction to 58%. So, in this case, lifestyle drugs are proving to be much better than the best drugs available.
However, Carlson noted that the criteria for accepting evidence for lifestyle medicine are very different from those for new drugs. When a new drug comes out and shows small improvements, no one questions it, and it usually gets approved, she said. Even with the huge differences being made through lifestyle medicine, the picture is very different.
“There is compelling evidence,” Barnett said, “but the challenge is translation.”
Ross-Lee noted that the role of lifestyle medicine also depends on cultural and socioeconomic factors. “It has to include the affected community,” she said, noting that health care providers can’t tell patients they need to walk or run in the community without knowing whether that’s realistic. She said patients are likely thinking, “Well, I don’t have anywhere to run around the block … not if I want to go back.”
“We don’t have a health care system,” she said. “We have a disease care system.”
Panelists agreed that the reimbursement model poses a serious challenge.
“Clinically, lifestyle medicine is not yet in use,” Carlson said. “Providing education and support is very challenging. Research shows these behaviors work! Gap is putting them into practice.”
Katz insists the reimbursement model must change. “This is an ‘income-based’ system, not an evidence-based system.”
Brashear said the changes require comprehensive communication, but medical education also plays a key role. For example, the Jacobs School now has more student programs focusing on primary care and psychiatry, as well as scholarship programs designed to encourage more students to enter these fields.
Audience participants discussed the current role of healthcare providers in finding ways to incorporate lifestyle medicine into their own lives and practices.
The final words came from a nutritionist in the audience who warned that healthcare providers continue to ignore the value that nutritionists can bring to their teams.
“Stop excluding nutritionists from the conversation,” she says. “There’s a huge opportunity out there, but we’re not seen as peers in the system. It’s time to play the game as a collective.”