ACSH Explains: Lifestyle Medicine

What is Lifestyle Medicine?

According to the American College of Lifestyle Medicine (ACLM), Lifestyle Medicine is

“A medical specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions including , but not limited to, cardiovascular diseases, type 2 diabetes, and obesity.”

There are six pillars of Lifestyle Medicine Let’s take these one by one to understand them.

Whole food, plant-based diet

“Whole food” has become quite the buzz phrase in the wellness and nutrition world, but what does it mean? It does not appear to have a specific definition, leaving plenty of room for shades of grey. It emphasizes avoiding ultra-process foods while  eating plants—fruits, vegetables, legumes, whole grains, seeds, and nuts, “as close to their natural state as possible.” It may also include milk and meats. The idea behind this is “food as medicine.”

Food as medicine emphasizing eating fruits and vegetables to people is perfectly fine medical advice, and advice regularly provided by those physicians that don’t even practice “Lifestyle Medicine.” However, some people do not have access to these types of foods due to their cost and/or living in a food desert. Additionally, these foods are often “ingredients,” requiring time to turn into meals. People with multiple jobs and caretaker duties (e.g., children, family members) may be extremely pressed for time.

Do most people know they should be eating fruits and vegetables? Yes. Do people actively choose to consume less than they should? Also, yes. However, these recommendations blindly ignore disparities of income and circumstance.

Physical activity

ACLM recommends both “general physical activity” and “purposeful exercise.” Again, recommending exercise to patients is sound medical advice and is, again, advice regularly provided during routine medical visits. However, the same people with time constraints making it difficult to prepare a meal three times a day, probably also don’t have time to purposefully exercise. Do most people know they should be exercising? Yes. Do some people choose to exercise less than they should? Also, yes. But this again ignores those without access to safe, open spaces for exercise, unable to afford a gym membership, or do not have the time to seek these activities out.

Stress management

Stress management is a very lofty and non-specific kind of goal. We all struggle with this - advising patients about healthy versus unhealthy coping mechanisms is fine medical advice. But we must recognize that very real pressures are difficult to alleviate by simply adjusting your frame of mind, meditating, etc. 

One of the ways to help cope with stress is to make more money, have more time, and have fewer responsibilities. Are you starting to sense a theme here? Talking to someone with multiple jobs, juggling caretaker duties, and who doesn’t make much money about their stress management is impractical. What they actually need is money and help. On an individual level, learning to meditate can only relieve so much stress.

Avoidance of risky substances

This pillar could probably be wrapped into stress management. Is stress the only reason that people use drugs and alcohol? No, but it can be a significant contributing factor. Healthy versus unhealthy coping mechanisms. The word is out amongst the public that drugs and alcohol aren’t great for you. Every time I go to the doctor, they always ask if I drink or use drugs. And while this is not indicative of every doctor, most physicians already counsel patients on this pillar.

Restorative sleep

This pillar is sleep with “restorative” smashed in front of it. If you sleep, it is restorative. That’s why we sleep. The real question is, are you getting enough of it? The answer for most people seems to be no or that they are dissatisfied with the sleep they get. Yet again, it is good medical advice to counsel people on good sleep practices to improve their sleep quality. This, too, is advice regularly given during routine medical visits. But what about parents with small children? People who are caretakers and work round the clock? People (including physicians) who switch shifts to cover nights? More sleep is what most adults seem to strive for, but there just aren’t enough hours in the day and too many responsibilities for most people.

Social connection

Having deep, meaningful relationships with others is important for our health; we are social creatures. I’ve never seen any serious medical professional assert otherwise. But there are natural ebbs and flows to socialization throughout our lives. Children and elder care demand much of our time, and relationships with others become less of a priority. Do people know spending social time with friends, family, and loved ones is important? Yes. Are some people that choose to be more secluded than ideal? Also, yes. But a huge factor is again time, money, and help. Most people would probably love to spend more time with friends, but given the limitations around time, money, and help, it’s often not feasible.

Lifestyle Medicine seems to offer an individual solution to more systemic issues. The people who can afford to access Lifestyle Medicine physicians are likely not the ones who need it. The ones who can’t afford Lifestyle Medicine are likely the ones who need it the most. Having more money would significantly boost someone’s lifestyle, including but not limited to freeing up time and responsibilities to focus on the six pillars. However, it’s fundamentally unattainable for many of us. Finally, I have yet to find a physician who doesn’t already think that an ounce of prevention is better than a pound of treatment. As a result, it is common practice to talk to patients about these “pillars,” whether you’re trained in Lifestyle Medicine or not.

This is not to say that there couldn’t be more of a focus on preventive factors in routine medical visits. Lifestyle Medicine does not appear to bring a new perspective to the table. Instead, its old ideas were rebranded for a new wellness era.