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President's Desk, August 2015
David L. Katz, MD, MPH

The Lifestyle Medicine Wave

Those of you who attended our annual conference last year in San Diego don’t need me to tell you how special it was.  You felt it, as did I.  I have long lost track of the number of medical conferences I’ve attended over the years, but no inventory is required to tally those that were more redolent with enthusiasm, hope, passion, and promise.  Exactly none. 

The palpable energy of our meeting was in a class of its own in my experience, and with good reason.  Nothing else in all of medicine can advance the human condition as lifestyle medicine can.  Where people live the longest, get sick the least, and most often manage to go peacefully and gently into that good night in the fullness of time- they have neither pharmacotherapy nor advanced medical tech to thank for it.  They have lifestyle, carried along in the salutary currents of Blue Zone culture.

The timing of this column is ideal to highlight our upcoming Lifestyle Medicine 2015 conference in Nashville.  If you plan to attend, I look forward to seeing you there.  If you don’t, permit me to suggest you reconsider.  The energy you felt (or missed) in San Diego was merely the early coalescence of this mighty, global wave.  Over the intervening year, it has swelled impressively.

On the home front, during my term as president ACLM has been strengthening its infrastructure as membership continues to expand on a monthly basis. With our commitment to provide tremendous value and exceptional resources to our members, a new website will soon launch, complete with updated membership categories and corresponding benefits.  As it prepares for what we believe will be exponential growth and impact, ACLM is initiating or advancing a number of exciting initiatives, the progress of which will invigorate the Nashville meeting. 

Globally, the lifestyle medicine movement has had a stunningly eventful year.  Our colleagues in France, Germany, Italy, Lithuania, Korea, Australia, Brazil and Canada –to name a few- are developing, or expanding, lifestyle medicine societies and initiatives as diverse as our cultures, but all directed at the same key objectives, and founded on the same core convictions.  There, as here, the recognition is spreading that lifestyle as medicine has the potential to prevent, arrest and even reverse, up to 80% of chronic disease, and that no other medicine can match that.

While this year’s conference will be a showcase for the diverse advances in the field, both far-flung and domestic, it has the potential to figure among such advances in its own right.  The ineluctable linkages among lifestyle practices, culture, and health outcomes will be delivered by the founder and CEO of the Blue Zones, Dan Buettner.  The ground-breaking combination of health and sustainability in the 2015 report of the Dietary Guidelines Advisory Committee, and its relevance to lifestyle medicine, will be described by committee member and preeminent nutritional epidemiologist, Frank Hu.  Other luminaries, some very familiar and others less so, will take their turn at the podium, and enrich our collective knowledge.

I will be privileged to join in that rarefied procession, and among other things, chronicle the gratifying progress of the GLiMMER Initiative about which I daydreamed publicly in San Diego for the first time.  A daydream then, GLiMMER is now a thriving effort-in-development, supported by several hundred thousand dollars in private philanthropy, and a dedicated management team.  The Council of Directors of the initiative’s signature ‘True Health Coalition’ is a global who’s who, growing steadily but already representing the collective voices of more than 200 from more than 25 countries.  How will we be harnessing the power of that unity?  Come to Nashville, and you’ll hear all about it.

In addition to the stellar line-up of keynotes, plenary and breakout session presenters, Lifestyle Medicine 2015 will of course host an exhibit pavilion- showcasing an impressive array of conference sponsors, including Headline Sponsor Healthways- all featuring exceptional products and services that facilitate lifestyle in medicine and lifestyle as medicine. We’ll also use our Nashville gathering as the time to present our newly minted Lifestyle Achievement and Trailblazer awards, recognizing outstanding contribution to what we believe is the future of both health and healthcare. Attendees will enjoy diverse poster presentations- research abstracts selected from an intimidatingly large batch of submissions for their scientific merit. The annual membership meeting of ACLM will also take place in Nashville; I will be privileged to share once again a brief ‘State of the College’ address, welcome four new Board members and two new officers, and express public and heartfelt thanks to those Board members who will be concluding their terms of service.

The insights, innovations, excitement, and feeling of community in San Diego may have appeared quite well formed at the time.  But with these past months since that meeting to clarify where we are headed, we know that meeting to have been but an indication of incipient energy.  Ordinarily, San Diego would seem to be a more promising place to catch a great wave than Nashville, but I believe we constitute an exception.  Our wave is rising.  So with or without a surfboard, I do hope to see you there.

Preventive Medicine, Lifestyle Medicine, and Functional Medicine all profess to target the true causes of disease, and there is a valid basis for each such claim.  The specific contentions of each enterprise are the substance of that manuscript now in the works; it’s not my place here to preempt those better arguments, by better sources.

I can, however, illustrate the effort by noting the pedigree of Lifestyle Medicine’s claim.

We might trace the origins of our mantle to Hippocrates, who famously advanced the cause of lifestyle medicine with such admonishment as: “let food be thy medicine.”  There is little left to append there other than: amen.

We might, alternatively, constrain our timeline to the modern era, in which case McGinnis and Foege, rather than Hippocrates, are parents to our cause, flag bearers in our forward progress.  Their seminal publication in JAMA in 1993 made the case for causes not only explicit, but even eponymous: “Actual causes of death in the United States.”

Those “causes” extended to a list of ten factors.  Most noteworthy for our camp is the overwhelming predominance of lifestyle on that list.  The first three entries, accounting for 80% of premature deaths in 1990, and reaffirmed in diverse publications since and current to this day, were tobacco use, dietary pattern, and physical activity.  As this readership likely knows, I refer to those routinely as our daily applications of feet, forks, and fingers.  The evidence base substantiating these as master levers of medical destiny is little short of irrefutable.

So the legitimacy of our claim to causal devotion is not to be trifled with; it is not to be discredited.  But there is perhaps some danger in the very blatancy of that legitimacy. 

We in Lifestyle Medicine may be overly inclined to invoke that robust and riveting literature.  We might get carried away with the idea that lifestyle practices are, indeed, the actual causes of most of what ails us in modern society- or the remedy to that very problem.  We are right to do so, up to a point.  Beyond that point, though, the claim may make us proud, and insular.  It may isolate us.  It might make us exclusive.

But in fact, our claim, however legitimate, cannot be exclusive; for it is contingent on a more nuanced reality.  Even causes have causes.

The treatment of an effect we can administer may be better than the treatment of its cause we cannot.  The closer we get to bedrock, the better – but whatever we do in the neighborhood of roots will reverberate far more profoundly than the pruning of peccant branches in the canopy.

Consider, for instance, the social determinants of health.  We in lifestyle medicine are not prone, I trust, to dismiss the fundamental importance of poverty versus privilege; of environmental security versus squalor.  Poverty is not a lifestyle choice, however; it is a circumstance in which lifestyle choices play out.  The choices we make are, ultimately, subordinate to the choices we have.  Some lives are so focused on the immediate exigencies of survival, there is no place for “style.”  The appendage of “style” to life is, itself, something of a privilege.  Perhaps we focus on lifestyle because the deeper layers of causality are beyond our reach.

There is a need to highlight the primacy of causes, to rally in defense of the respect they warrant, to allocate more resources in their direction.  Modern, conventional medicine is routinely, if inadvertently neglectful of causes, in its preferential attention to effects.  This was elaborated recently and well by our colleague from South Africa, Dr. Derek Yach, and his co-authors writing in the American Journal of Preventive Medicine.

If we are to change something so formidable as the established allocations of the NIH, it will require a considerable counterforce.  Such strength is unlikely in the absence of unity.

If we can allow that lifestyle factors have causes upstream, and effects downstream that matter; if we can acknowledge that none of us has a monopoly on best methods; if we can concede that the “good” we can do may trump the “better” we cannot- it has the potential to illuminate common ground.  If we can recognize that even causes have causes, it may unite us in common cause.

Therein lies the best way forward, for there are arduous miles to go – and only, I think, in unity, the strength to go the distance.

As I write this, the American College of Lifestyle Medicine and the American College of Preventive Medicine have made considerable progress toward a prenuptial agreement that may allow for the mutual rewards of marriage in the foreseeable future.  As I write this, those two entities along with the Institute for Functional Medicine have made considerable progress toward the drafting and submission of a joint manuscript elucidating the perhaps overlooked architecture of our native alignment.

The former endeavor is, ultimately, much about the details of practice, and the practicalities of administration.  The latter is all about principles.  The first principle underlying a mutual devotion to causes is this: even causes have causes.

Preventive Medicine, Lifestyle Medicine, and Functional Medicine all profess to target the true causes of disease, and there is a valid basis for each such claim.  The specific contentions of each enterprise are the substance of that manuscript now in the works; it’s not my place here to preempt those better arguments, by better sources.

I can, however, illustrate the effort by noting the pedigree of Lifestyle Medicine’s claim.

We might trace the origins of our mantle to Hippocrates, who famously advanced the cause of lifestyle medicine with such admonishment as: “let food be thy medicine.”  There is little left to append there other than: amen.

We might, alternatively, constrain our timeline to the modern era, in which case McGinnis and Foege, rather than Hippocrates, are parents to our cause, flag bearers in our forward progress.  Their seminal publication in JAMA in 1993 made the case for causes not only explicit, but even eponymous: “Actual causes of death in the United States.”

Those “causes” extended to a list of ten factors.  Most noteworthy for our camp is the overwhelming predominance of lifestyle on that list.  The first three entries, accounting for 80% of premature deaths in 1990, and reaffirmed in diverse publications since and current to this day, were tobacco use, dietary pattern, and physical activity.  As this readership likely knows, I refer to those routinely as our daily applications of feet, forks, and fingers.  The evidence base substantiating these as master levers of medical destiny is little short of irrefutable.

So the legitimacy of our claim to causal devotion is not to be trifled with; it is not to be discredited.  But there is perhaps some danger in the very blatancy of that legitimacy. 

We in Lifestyle Medicine may be overly inclined to invoke that robust and riveting literature.  We might get carried away with the idea that lifestyle practices are, indeed, the actual causes of most of what ails us in modern society- or the remedy to that very problem.  We are right to do so, up to a point.  Beyond that point, though, the claim may make us proud, and insular.  It may isolate us.  It might make us exclusive.

But in fact, our claim, however legitimate, cannot be exclusive; for it is contingent on a more nuanced reality.  Even causes have causes.

The treatment of an effect we can administer may be better than the treatment of its cause we cannot.  The closer we get to bedrock, the better – but whatever we do in the neighborhood of roots will reverberate far more profoundly than the pruning of peccant branches in the canopy.

Consider, for instance, the social determinants of health.  We in lifestyle medicine are not prone, I trust, to dismiss the fundamental importance of poverty versus privilege; of environmental security versus squalor.  Poverty is not a lifestyle choice, however; it is a circumstance in which lifestyle choices play out.  The choices we make are, ultimately, subordinate to the choices we have.  Some lives are so focused on the immediate exigencies of survival, there is no place for “style.”  The appendage of “style” to life is, itself, something of a privilege.  Perhaps we focus on lifestyle because the deeper layers of causality are beyond our reach.

There is a need to highlight the primacy of causes, to rally in defense of the respect they warrant, to allocate more resources in their direction.  Modern, conventional medicine is routinely, if inadvertently neglectful of causes, in its preferential attention to effects.  This was elaborated recently and well by our colleague from South Africa, Dr. Derek Yach, and his co-authors writing in the American Journal of Preventive Medicine.

If we are to change something so formidable as the established allocations of the NIH, it will require a considerable counterforce.  Such strength is unlikely in the absence of unity.

If we can allow that lifestyle factors have causes upstream, and effects downstream that matter; if we can acknowledge that none of us has a monopoly on best methods; if we can concede that the “good” we can do may trump the “better” we cannot- it has the potential to illuminate common ground.  If we can recognize that even causes have causes, it may unite us in common cause.

Therein lies the best way forward, for there are arduous miles to go – and only, I think, in unity, the strength to go the distance.

As I write this, the American College of Lifestyle Medicine and the American College of Preventive Medicine have made considerable progress toward a prenuptial agreement that may allow for the mutual rewards of marriage in the foreseeable future.  As I write this, those two entities along with the Institute for Functional Medicine have made considerable progress toward the drafting and submission of a joint manuscript elucidating the perhaps overlooked architecture of our native alignment.

The former endeavor is, ultimately, much about the details of practice, and the practicalities of administration.  The latter is all about principles.  The first principle underlying a mutual devotion to causes is this: even causes have causes.

Preventive Medicine, Lifestyle Medicine, and Functional Medicine all profess to target the true causes of disease, and there is a valid basis for each such claim.  The specific contentions of each enterprise are the substance of that manuscript now in the works; it’s not my place here to preempt those better arguments, by better sources.

I can, however, illustrate the effort by noting the pedigree of Lifestyle Medicine’s claim.

We might trace the origins of our mantle to Hippocrates, who famously advanced the cause of lifestyle medicine with such admonishment as: “let food be thy medicine.”  There is little left to append there other than: amen.

We might, alternatively, constrain our timeline to the modern era, in which case McGinnis and Foege, rather than Hippocrates, are parents to our cause, flag bearers in our forward progress.  Their seminal publication in JAMA in 1993 made the case for causes not only explicit, but even eponymous: “Actual causes of death in the United States.”

Those “causes” extended to a list of ten factors.  Most noteworthy for our camp is the overwhelming predominance of lifestyle on that list.  The first three entries, accounting for 80% of premature deaths in 1990, and reaffirmed in diverse publications since and current to this day, were tobacco use, dietary pattern, and physical activity.  As this readership likely knows, I refer to those routinely as our daily applications of feet, forks, and fingers.  The evidence base substantiating these as master levers of medical destiny is little short of irrefutable.

So the legitimacy of our claim to causal devotion is not to be trifled with; it is not to be discredited.  But there is perhaps some danger in the very blatancy of that legitimacy. 

We in Lifestyle Medicine may be overly inclined to invoke that robust and riveting literature.  We might get carried away with the idea that lifestyle practices are, indeed, the actual causes of most of what ails us in modern society- or the remedy to that very problem.  We are right to do so, up to a point.  Beyond that point, though, the claim may make us proud, and insular.  It may isolate us.  It might make us exclusive.

But in fact, our claim, however legitimate, cannot be exclusive; for it is contingent on a more nuanced reality.  Even causes have causes.

The treatment of an effect we can administer may be better than the treatment of its cause we cannot.  The closer we get to bedrock, the better – but whatever we do in the neighborhood of roots will reverberate far more profoundly than the pruning of peccant branches in the canopy.

Consider, for instance, the social determinants of health.  We in lifestyle medicine are not prone, I trust, to dismiss the fundamental importance of poverty versus privilege; of environmental security versus squalor.  Poverty is not a lifestyle choice, however; it is a circumstance in which lifestyle choices play out.  The choices we make are, ultimately, subordinate to the choices we have.  Some lives are so focused on the immediate exigencies of survival, there is no place for “style.”  The appendage of “style” to life is, itself, something of a privilege.  Perhaps we focus on lifestyle because the deeper layers of causality are beyond our reach.

There is a need to highlight the primacy of causes, to rally in defense of the respect they warrant, to allocate more resources in their direction.  Modern, conventional medicine is routinely, if inadvertently neglectful of causes, in its preferential attention to effects.  This was elaborated recently and well by our colleague from South Africa, Dr. Derek Yach, and his co-authors writing in the American Journal of Preventive Medicine.

If we are to change something so formidable as the established allocations of the NIH, it will require a considerable counterforce.  Such strength is unlikely in the absence of unity.

If we can allow that lifestyle factors have causes upstream, and effects downstream that matter; if we can acknowledge that none of us has a monopoly on best methods; if we can concede that the “good” we can do may trump the “better” we cannot- it has the potential to illuminate common ground.  If we can recognize that even causes have causes, it may unite us in common cause.

Therein lies the best way forward, for there are arduous miles to go – and only, I think, in unity, the strength to go the distance.

As I write this, the American College of Lifestyle Medicine and the American College of Preventive Medicine have made considerable progress toward a prenuptial agreement that may allow for the mutual rewards of marriage in the foreseeable future.  As I write this, those two entities along with the Institute for Functional Medicine have made considerable progress toward the drafting and submission of a joint manuscript elucidating the perhaps overlooked architecture of our native alignment.

The former endeavor is, ultimately, much about the details of practice, and the practicalities of administration.  The latter is all about principles.  The first principle underlying a mutual devotion to causes is this: even causes have causes.

Preventive Medicine, Lifestyle Medicine, and Functional Medicine all profess to target the true causes of disease, and there is a valid basis for each such claim.  The specific contentions of each enterprise are the substance of that manuscript now in the works; it’s not my place here to preempt those better arguments, by better sources.

I can, however, illustrate the effort by noting the pedigree of Lifestyle Medicine’s claim.

We might trace the origins of our mantle to Hippocrates, who famously advanced the cause of lifestyle medicine with such admonishment as: “let food be thy medicine.”  There is little left to append there other than: amen.

We might, alternatively, constrain our timeline to the modern era, in which case McGinnis and Foege, rather than Hippocrates, are parents to our cause, flag bearers in our forward progress.  Their seminal publication in JAMA in 1993 made the case for causes not only explicit, but even eponymous: “Actual causes of death in the United States.”

Those “causes” extended to a list of ten factors.  Most noteworthy for our camp is the overwhelming predominance of lifestyle on that list.  The first three entries, accounting for 80% of premature deaths in 1990, and reaffirmed in diverse publications since and current to this day, were tobacco use, dietary pattern, and physical activity.  As this readership likely knows, I refer to those routinely as our daily applications of feet, forks, and fingers.  The evidence base substantiating these as master levers of medical destiny is little short of irrefutable.

So the legitimacy of our claim to causal devotion is not to be trifled with; it is not to be discredited.  But there is perhaps some danger in the very blatancy of that legitimacy. 

We in Lifestyle Medicine may be overly inclined to invoke that robust and riveting literature.  We might get carried away with the idea that lifestyle practices are, indeed, the actual causes of most of what ails us in modern society- or the remedy to that very problem.  We are right to do so, up to a point.  Beyond that point, though, the claim may make us proud, and insular.  It may isolate us.  It might make us exclusive.

But in fact, our claim, however legitimate, cannot be exclusive; for it is contingent on a more nuanced reality.  Even causes have causes.

The treatment of an effect we can administer may be better than the treatment of its cause we cannot.  The closer we get to bedrock, the better – but whatever we do in the neighborhood of roots will reverberate far more profoundly than the pruning of peccant branches in the canopy.

Consider, for instance, the social determinants of health.  We in lifestyle medicine are not prone, I trust, to dismiss the fundamental importance of poverty versus privilege; of environmental security versus squalor.  Poverty is not a lifestyle choice, however; it is a circumstance in which lifestyle choices play out.  The choices we make are, ultimately, subordinate to the choices we have.  Some lives are so focused on the immediate exigencies of survival, there is no place for “style.”  The appendage of “style” to life is, itself, something of a privilege.  Perhaps we focus on lifestyle because the deeper layers of causality are beyond our reach.

There is a need to highlight the primacy of causes, to rally in defense of the respect they warrant, to allocate more resources in their direction.  Modern, conventional medicine is routinely, if inadvertently neglectful of causes, in its preferential attention to effects.  This was elaborated recently and well by our colleague from South Africa, Dr. Derek Yach, and his co-authors writing in the American Journal of Preventive Medicine.

If we are to change something so formidable as the established allocations of the NIH, it will require a considerable counterforce.  Such strength is unlikely in the absence of unity.

If we can allow that lifestyle factors have causes upstream, and effects downstream that matter; if we can acknowledge that none of us has a monopoly on best methods; if we can concede that the “good” we can do may trump the “better” we cannot- it has the potential to illuminate common ground.  If we can recognize that even causes have causes, it may unite us in common cause.

Therein lies the best way forward, for there are arduous miles to go – and only, I think, in unity, the strength to go the distance.


AMERICAN COLLEGE OF LIFESTYLE MEDICINE

The American College of Lifestyle Medicine (ACLM) is the world's flagship professional medical association for physicians, clinicians and allied health professionals, as well as those in professions devoted to advancing the mission of lifestyle medicine.

       

© 2015 American College of Lifestyle Medicine

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