To the Editor:
Lifestyle medicine is defined as the “evidence-based practice of assisting individuals and their families to adopt and sustain behaviors that can improve health and quality of life.”1 It is estimated that 80% of chronic disease can be prevented by improving lifestyle behaviors, specifically smoking cessation, weight management, physical activity, and a healthy diet.2 Less than 50% of U.S. primary care physicians provide specific guidance on nutrition, physical activity, or weight control.3 This may be a direct result of insufficient training, as there is no curricular model for the discipline of lifestyle medicine in medical education. Only 27% of medical schools indicate that they provide the 25 hours of nutrition education recommended,4 and only 6% report a core course or required curriculum that addresses exercise prescription.5 Despite the existence of a clear definition of lifestyle medicine competencies,1 there are no curriculum guidelines, validated assessment tools, evaluations, or implementation plans in place.
To address this critical gap, we have launched a collaborative to integrate lifestyle medicine curricula into medical school education in a strategic alliance with invested stakeholders, including medical school deans and students, curriculum developers and researchers, medical societies, governing bodies, and policy institutes. Our mission: Lifestyle factors including nutrition, physical activity, and stress are critical determinants of health, causing a pandemic of chronic disease and unsustainable health care costs. We will provide an array of evidence-based curricular resources for prevention and treatment of lifestyle-related diseases throughout medical education. Medical school curricula, however, are only an initial component of lifestyle medicine integration, and this collaborative will require acknowledgment and adoption on a national scale throughout the collective levels of medical education and clinical practice.
The incorporation of lifestyle medicine curricula into medical schools is an important first step in fundamentally altering clinical practice, and we believe these efforts will have important public health implications by promoting the prevention and treatment of chronic disease.
Rachele M. Pojednic, EdM, PhD
Research fellow, Institute of Lifestyle Medicine, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts; Rachele.email@example.com.
Jennifer Trilk, PhD
Clinical assistant professor, Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, South Carolina.
Edward M. Phillips, MD
Director, Institute of Lifestyle Medicine, Joslin Diabetes Center, and assistant professor, Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts.
1. Lianov L, Johnson M.. Physician competencies for prescribing lifestyle medicine. JAMA. 2010;304:202–203
2. Ford ES, Bergmann MM, Kröger J, Schienkiewitz A, Weikert C, Boeing H.. Healthy living is the best revenge: Findings from the European Prospective Investigation Into Cancer and Nutrition–Potsdam study. Arch Intern Med. 2009;169:1355–1362
3. Barnes PM, Schoenborn CA.. Trends in adults receiving a recommendation for exercise or other physical activity from a physician or other health professional. NCHS Data Brief. February 2012:1–8
4. Kris-Etherton PM, Akabas SR, Bales CW, et al. The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness. Am J Clin Nutr. 2014;99(5 suppl):1153S–1166S
5. Connaughton AV, Weiler RM, Connaughton DP.. Graduating medical students’ exercise prescription competence as perceived by deans and directors of medical education in the United States: Implications for Healthy People 2010. Public Health Rep. 2001;116:226–234