Lifestyle Medicine - Pre-Professional Education
 By Michelle Tollefson, MD, FACOG, DipABLM

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 groups@lifestylemedicine.orgDr. 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

ACLM

·       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/

 

 

Leading Experts Propose a New Metric For Protein Quality
An Update to an Outdated and Harmful Protein Quality Definition


- True Health Initiative has convened top nutrition experts to define a new, modernized protein quality metric that can be applied to our food system.
- The paper will be published in the high-impact, peer-reviewed journal, Advances in Nutrition on May 8th and is co-authored by David Jenkins, PhD, MD, University of
Toronto; Kate Geagan, MS, RD; Kimberly N. Doughty, MPH, PhD, Yale-Griffin Prevention Research Center, Christopher D. Gardner, PhD, Stanford University and
David L. Katz, MD, MPH, Yale-Griffin Prevention Research Center.
- Quality protein foods should be those that have a net positive effect on both peoples’ and planetary health.
- The current definition of protein quality is outdated, incorrect and harmful to public health.

Derby, CT, May 8th, 2019: In the comprehensive new paper, "The Public Health Case for Modernizing the Definition of Protein Quality” published in Advances in Nutrition , True Health
Initiative, with leading experts, redefines protein quality based on current scientific evidence. The researchers then adapted this new definition into a metric that can be applied to national
food regulatory and labeling systems. The paper outlines why our current definition of protein quality is obsolete, inaccurate, and harmful to both human and planetary health.
Consumers depend on accurate nutrition information to make food choices that benefit their health and longevity. The current definition of protein quality does not account for the net health
effect of protein foods and can promote foods that are in direct opposition to the current Dietary Guidelines for Americans, human health and environmental sustainability.

The True Health Initiative puts forth a new definition of protein quality that includes:
●     The concentration of protein and individual amino acids in the food.
●     Assessment of the evidence of health outcomes associated with consumption of the
food.
●     Assessment of potential environmental impacts of producing the food.

The application of this new metric has the potential to improve public health outcomes, cut healthcare costs and accelerate the transition to a more sustainable food system by increasing
public perception of healthy, affordable and widely available protein sources. The paper’s authors set forth to meet the urgent needs of public health. “There really is a perfect
storm in modern culture driving misconceptions about protein. There is the idea that the more the better; there is the idea that you need to eat 'complete' protein from animal foods like meat;
and there is the idea that foods with the highest protein content are the highest quality food sources of protein. None of these is true.”- David L. Katz. MD, MPH.

What is true is that in the United States and in other developed economies, protein deficiency is not a prevailing health concern; far greater in the 21st century is the epidemic of costly, chronic
illness that is directly preventable by changes in diet and lifestyle. Cardiovascular disease, type 2 diabetes and cancer have all been linked to unhealthy diets in general and excessive intake of
red and processed meats in particular. In direct contrast, plant forward diets and diets that include: fish, nuts and seeds, have been linked to favorable health outcomes, reduced all-cause
mortality and reduced cardiovascular mortality.

“The original goal was to promote growth in a vertical direction in the young (height) but if applied to older people, the only direction to grow is laterally (horizontal growth equals =
obesity). The dietary metrics used now must encourage a lifestyle of health. That is why a new approach to defining protein quality is urgently required that recognizes the value of plant
proteins and will allow people to eat for their own health and the health of the environment.”- David Jenkins MD, PhD

“The current criteria for determining protein quality are obsolete, particularly for the large proportion of the planet where chronic diseases have displaced infectious diseases as the more
prevalent public health concern. The proposed redefinition addresses an urgent need to better align human health with the health of the environment and the sustainable future of food.”-
Christopher Gardner, PhD.

“I think it’s pretty clear that we have the wrong approach to defining protein quality when processed meats and frozen dinners that are laden with sodium and saturated fat can be
labeled ‘good sources of protein.’ That these claims can be made to help sell foods known to be associated with chronic disease risk to consumers who already consume more than enough
protein is perverse. The update we have proposed is just common sense.”- Kimberly N. Doughty, MPH, PhD

“This “protein fix” is long overdue: consumers deserve an updated definition that better reflects the actual impact of dietary protein sources on public health, aligns with the latest scientific
evidence, and helps eaters obsessed with protein make the best choices to match their budget and their health goals. It’s rare to find a single switch that holds this kind of potential to help
solve some of our most urgent public health crises- but "protein quality" is one of them.”- Kate Geagan, MS RD.

True Health Initiative is a global coalition of world-renowned experts, converging to fight fake facts or cherry picked data, challenging false narratives and working to create a world free of
preventable disease while conjointly safeguarding planetary health. Studies have shown that nutrient content claims can increase consumers’ perception of a food’s overall healthfulness and
are a desirable factor in food purchasing. Updating this metric to reflect the latest science gives consumers necessary, evidence-based information, enabling the public to make choices that
improve health.

This new protein definition would update protein content claims to 21st century science-and help meet the challenges of feeding 10 billion people on a healthy planet in 2050.
True Health Initiative’s, “The Public Health Case for Modernizing the Definition of Protein Quality" is a step in the global movement towards a healthier and more sustainable future.
This project was run by the True Health Initiative, a federally authorized 501c3 not-for-profit, and funded by KIND Healthy Snacks.