The Beginnings of the American College of Lifestyle Medicine
John H. Kelly, MD
Every major advance in science or medicine seems to involve years of pioneering work by those with passion and conviction about the need for change, followed by a quantum leap forward. The formation of the American College of Lifestyle Medicine in early 2004 illustrates this phenomenon. After years of diligent effort and slow, steady progress by pioneers including John Kellogg, Nathan Pritikin, Dean Ornish, John McDougall, Michel de Lorgeril, Caldwell Esselstyn, David Jones, James Rippe and others, the body of published evidence for the superior effectiveness of lifestyle interventions in the treatment of chronic disease reached a tipping point. While a healthy lifestyle was known to reduce risk and prevent chronic disease, it was thought that once disease was present it was too late for lifestyle interventions to make a meaningful difference. While lifestyle was considered good for primary prevention, it had little or no value as secondary or tertiary prevention. But studies like the Lyons Diet Heart Study and the Diabetes Prevention Program found lifestyle interventions so powerful, the studies were ended early because it was unethical to deny the treatment to control subjects experiencing poor outcomes.
In view of such overwhelming evidence it became obvious this new medical treatment needed to be available to the millions of patients who were dying without it. While small, incremental lifestyle interventions may be sufficient to prevent disease, intensive interventions are required to treat and reverse existing disease. Though the science was solid and the treatments proven to be effective, there were few if any champions in medicine trumpeting this new medical advance. For those specializing in other fields, this was one of many lamentable situations in modern medicine, but for anyone with a calling to practice lifestyle medicine it was a tragedy of the highest proportions and one that demanded action.
For me, a new physician with a singular passion to bring therapeutic lifestyle interventions to the practice of medicine, it was a call to action. In 2003 I was just finishing residency training. In choosing a specialty, I had wanted something of a cross between Family Medicine and Preventive Medicine, something I referred to as “Lifestyle Medicine,” but no such specialty existed. Upon completing a Preventive Medicine residency, I decided it was time for a new specialty in Lifestyle Medicine so others would have options that I had been unable to find. As a medical student, I had successfully established an elective rotation in Lifestyle Medicine and it seemed the time was right to establish a specialty society for those who wished to specialize in using therapeutic lifestyle interventions to treat disease.
During residency, I had conducted a multicenter study of residential lifestyle programs in the US. I had noticed that though the physicians in these centers had a variety of specialty training from surgery to ophthalmology, or family medicine to obstetrics, the common set of skills and knowledge they utilized in practicing LM vastly differed from any of those specialties. The treatment setting was also different from a typical doctor’s office or hospital. All of this argued that LM qualified as a unique specialty of its own, requiring a special set of skills and knowledge applied in a unique setting but in dialoging with others, I found a divergence of opinion. Some felt LM was something needed in every specialty and practice setting, while others felt it was indeed a unique specialty and needed its own society to represent and promote it. I decided it was similar to neurology where every doctor needs to know how to do a neurological exam, yet there is a place for specialists in neurology. Or like obstetrics where, although other doctors make deliveries, there is a place for obstetrical specialists. While every doctor should know basic LM principles and support and promote healthy lifestyles, there is nonetheless a need for lifestyle intervention specialists and clinicians who specialize in the application of intensive therapeutic lifestyle changes to treat and reverse disease. Knowing the value of good counsel and believing that two heads are better than one, I assembled a coalition of willing colleagues to explore ideas and launch an organization to advance the science, education and practice of Lifestyle Medicine. And so the American College of Lifestyle Medicine was born. The first annual meeting was held at Loma Linda University in February 2004. In March of the same year, I received an Excellence in Medicine Award from the AMA Foundation as a 55-year old Young Physician for his efforts in establishing the ACLM.
ACLM has come a long ways since its beginnings in 2003-2004 and I deeply appreciate the efforts of the many who have contributed to its current and future success. While many great ideas are launched by a single individual with passion and vision, very few amount to anything without the combined efforts of many others who catch the vision and expand the passion. It was my privilege to serve as a ‘spark plug’ to ignite the fire, but it could not have been done without the efforts of many others.
I still hope to see a genuine specialty in Lifestyle Medicine formed with proper residency and/or fellowship training, though I appreciate the value of promoting lifestyle competencies in primary care and other specialties. I continue to practice as a LM specialist rather than doing “lifestyle-friendly primary care” and primary care doctors in my community refer their patients to me for intensive lifestyle treatment, something they would not likely do if I were providing primary care services. We have not yet begun to tap the potential of true LM specialists. I believe it will yet be found that maximum treatment effects depend upon the skillful application of intensive LM by trained LM specialists, backed up by ongoing support from LM-friendly primary care clinicians.