I used to frequently ask myself, “What is wrong with this picture?” As an Ob-Gyn, I commonly treated women with gynecologic problems with the only tools I had been trained to use: surgical and pharmaceutical interventions. Although I recognized that lifestyle behaviors often contributed to their health concerns, I lacked the knowledge toolkit to address the underlying cause.
Like many other physicians I have met in my decade-plus membership in the American College of Lifestyle Medicine, I entered private practice with the confidence that patient wellness could be fostered through advanced medical education and a commitment to empathetic dialogue. However, it often felt like my efforts were predominantly focused on eleventh-hour interventions to reverse outcomes impacted by years of unhealthy lifestyle behaviors. It became clear that our broken health-care system was resulting in the excessive utilization of costly, invasive treatments and was otherwise failing to provide the education and infrastructure required to address unhealthy lifestyle behaviors. I became increasingly aware of the current health-care paradigm’s inaccessibility and marginalization of major segments of our population.
A new set of questions arose in response to these frustrations. How could we, as medical professionals, paint a revitalized, transformative picture of health-care? Furthermore, how could this picture be guided by an overarching goal for the promotion of authentic well-being? If patients were partnered with wellness coaches and also received lifestyle medicine education, would they be empowered to prevent lifestyle related illness? How could our “medicine” primarily consist of the tools and support to improve whole-health across the lifespan and address health equity for diverse populations? Could prenatal epigenetics education, if paired with familial behavior change support, improve the health trajectory of future generations?
A pivotal point in my career was when I was first introduced to the concept of lifestyle medicine and wellness coaching over a decade ago. Dr. Edward Phillips from the Harvard Institute of Lifestyle Medicine (ILM) visited my health system’s family medicine residency program that had a lifestyle medicine emphasis. I came to realize that there were other physicians who saw the potential for lifestyle medicine to truly transform lives. I joined the ACLM, partnered with Dr. Phillips to author the Bone Health and Healthy Lifestyle ILM course, and became one of the first physicians certified in wellness coaching.
In 2014, I began teaching a bachelor’s level undergraduate Lifestyle Medicine course at Metropolitan State University of Denver (MSU Denver). Since the initial launching, countless students have expressed how the evidence-based healthy lifestyle curriculum inspired them to make personal healthy behavior changes and also provided the skills for them to empower others through lifestyle medicine education. In both online and in-classroom formats, multiple sections of this class are now offered every semester allowing the Lifestyle Medicine curriculum to reach a wide swath of future health care and allied health professionals.
The lifestyle medicine movement continues to grow at our institution driven by students who push for transforming health care education at the pre-professional level. MSU Denver is an urban, diverse campus and we just received our federal designation as a Hispanic serving institution. Approximately two-thirds of our majors demonstrate significant financial need making them Pell Grant eligible. In addition, many of our students have first-hand experiences of health disparities and/or have witnessed them within their communities. These educated, empowered, and service-oriented students are inspired to facilitate change in the lives of others through lifestyle medicine. New courses available to these students include Lifestyle Medicine across Gender and Lifespan, and Applied Learning in Lifestyle Medicine. Students can minor in Lifestyle Medicine, complete a Lifestyle Medicine Major Independent Degree Program, or fulfill the Wellness Coaching Pathway requirements approved by the ICHWC/NBHWC. We realize that lifestyle medicine is interdisciplinary and that through uniting disciplines such as Human Performance and Sport, Nutrition, Human Services, and Health Care Management, we can optimize health care delivery. In the near future, we anticipate the approval of a cross-curriculum Lifestyle Medicine Major representing the ten departments housed in our newly created Health Institute.
I stand with my ACLM colleagues who assert that lifestyle medicine must be foundational to the delivery of healthcare. Ideally, students would engage with lifestyle medicine curriculum prior to entering health profession graduate schools. I envision a Lifestyle Medicine 101 course as a required prerequisite for entrance to all health-related graduate schools. Although it is never too late to learn and incorporate new perspectives into medical practice, ensuring that practitioners understand healthy lifestyle principles at an undergraduate level could transform their medical or graduate school experience and create a culture of shared practice.
Dr. Beth Frates and I co-chair the ACLM Pre-Professional Lifestyle Medicine Education Member Interest Group which is committed to the development and integration of evidence-based lifestyle medicine curriculum into pre-professional (associate, bachelor’s, master’s level) health education. As an ACLM Board member, Dr. Frates’ commitment to pre-professional education has been instrumental in advancing the field. She created and teaches the Lifestyle Medicine course at Harvard, wrote and has shared the Lifestyle Medicine Syllabus with over 1700 people through ACLM’s website, and authored the Lifestyle Medicine Handbook which is ideal for introductory pre-professional Lifestyle Medicine courses. It is our belief that, regardless of which health professional graduate field a student plans to enter, their education should include lifestyle medicine competencies and foundational behavior change principles. Dr. Frates is currently developing PowerPoint slides to accompany her handbook. These slides will enable faculty to easily integrate lifestyle medicine into any pre-professional health education course or to create new Lifestyle Medicine 101 courses, in either a classroom or online format.
At the pre-professional level, I encourage any faculty member who is passionate about lifestyle medicine to advocate for a Lifestyle Medicine 101 course at their academic institution. Utilizing Dr. Frates’ syllabus, handbook and subsequent slides will allow faculty to introduce the material with minimal additional work, though they can customize the material to fit their students’ and institution’s needs. Additionally, opportunities for expansion lie within discovering ways to integrate lifestyle medicine into existing curriculum. Many health pre-professional programs are already teaching several lifestyle medicine foundational pillars but often use different language or do not refer to the concepts as “lifestyle medicine.” I encourage faculty to advocate for the use of “lifestyle medicine” terminology and principles in all health related curriculum to examine where existing health curriculum can be strengthened, and where new curriculum could be proposed and launched.
Mentorship is crucial for anyone introducing lifestyle medicine curriculum, regardless of the level. Personally, I have had an eight-year journey of advancing lifestyle medicine at my progressive and supportive university. In the last year, I connected with Dennis Muscato, Co-Director LMEd (Lifestyle Medicine Education Collaborative) who provides mentorship to US medical schools introducing lifestyle medicine curriculum. Dennis now leads the mentoring and outreach section of our Lifestyle Medicine Pre-Professional Member Interest Group. He connects and encourages administrators, faculty, and student interest groups thereby supporting the next generation of lifestyle medicine champions.
The true potential of lifestyle medicine at the pre-professional level cannot be fully recognized without students at the center of the movement. While I was busy with curriculum, an exceptional teaching assistant, Alexandra Kees, spearheaded the establishment of the ACLM affiliated Lifestyle Medicine Trainees Student Organization (Lifestyle Medicine Interest Group) at our university which has united student leaders from various health departments across campus. This student organization has catalyzed powerful outreach to our campus and local community and is changing the way that undergraduate students view health care. These students are engaging in lifestyle medicine related community service, leadership, research, and mentorship programs that are influencing their health career trajectories while also reshaping the future of healthcare. Throughout my clinical medical and academic career, I have never been more hopeful for the true transformation of health care. The passion that these students have for changing the world through lifestyle medicine cannot be understated.
If you are interested in joining with our ACLM Member Interest Group to change the face of pre-professional health education with lifestyle medicine, please email email@example.com. Dr. Frates and I welcome your participation as there is still much work to be done.
As I’ve become more involved in academia, I have less time for my ob-gyn role, though I still volunteer at a local non-profit clinic providing lifestyle medicine education and women’s office gynecology. Along with Dr. Cindy Geyer from Canyon Ranch (former ACLM board member), I co-chair the recently launched Women’s Health Member Interest Group for ACLM which is also welcoming new members. If you are interested in the intersection of lifestyle medicine with women’s health and are attending the October ACLM conference, please consider joining us for the pre-conference workshop, Leveraging Lifestyle for Hormonal Health: Optimizing Women’s Health Across the Lifespan and/or the conference concurrent session, Women’s Health: A Foundational Approach to Lifestyle Medicine.
Whether it is healthy maternal pregnancy behaviors as the foundation of health for a developing fetus or lifestyle medicine knowledge as the foundation of education for a future health professional, I will continue to devote my life’s work to laying the foundation for health and well-being through lifestyle as medicine.
Michelle Tollefson, MD, FACOG, DipABLM
· Women’s Health Member Interest Group Co-Chair
· Lifestyle Medicine Pre-Professional Education Member Interest Group Co-Chair
· Education Committee Member
· Conference Planning Committee Member
For a list of and to join ACLM Member Interest Groups click here
Lifestyle Medicine at MSU Denver Lifestyle Medicine https://msudenver.edu/hep/lifestylemedicine/
Health Institute at MSU Denver https://msudenver.edu/health-institute/