Advancing research to scale lifestyle medicine across health systems

ACLM recently updated its dietary position statement to align with current evidence and best practices in Food as Medicine; this update clarifies key principles across dietary patterns, chronic disease nutrition, and care delivery.

It is the position of ACLM that:

1. Food As Medicine | Food as Medicine (FAM), also referred to as Food is Medicine (FIM), is the use of food and nutrition interventions, guided by trained healthcare professionals, to improve health outcomes and nutrition security across the lifespan. These initiatives are supported through person-centered, culturally tailored, and collaborative decision-making. FAM may include nutrition education and counseling, culinary medicine education, behavioral support, and, in some cases, the provision of healthy food and related resources, particularly to underserved populations.
2. Dietary Continuum | Healthy dietary patterns exist along a continuum of food-based interventions that span from health promotion and prevention to treatment and reversal of lifestyle-related chronic disease, with variation in intensity and therapeutic dosing.
3. Optimal Nutrition for Chronic Disease | For the treatment, reversal, and prevention of lifestyle-related chronic diseases, an optimal dietary pattern has two key elements. First, the core diet should be centered on a wide variety of whole and minimally processed plant foods including vegetables, fruits, whole grains, legumes, mushrooms, nuts, and seeds while meeting but not exceeding energy requirements. Second, it should minimize red and processed meats, foods high in saturated fat, and ultra-processed foods containing added sugars, sweeteners, unhealthy fats/oils, refined carbohydrates, and excess sodium.
4. Delivery of Care | Effective implementation of Food as Medicine in clinical practice is best achieved with an interprofessional healthcare team all working within their scope of practice and trained in nutrition-related lifestyle medicine competencies. An optimal team includes registered dietitian nutritionists (RDNs) certified in lifestyle medicine.

It is the position of the American College of Lifestyle Medicine (ACLM) that:

1. Obesity is a chronic, progressive, relapsing, and manageable disease that benefits from comprehensive, patient-centered care integrating evidence-based lifestyle medicine, obesity medications, and bariatric surgical interventions.
2. Evidence-based lifestyle medicine approaches, including intensive therapeutic lifestyle change (ITLC), form the foundation for optimal medical care for individuals with overweight and obesity.
3. Optimal obesity treatment integrates evidence-based lifestyle medicine approaches alongside GLP-1 receptor agonists (GLP-1 RAs) and other highly effective obesity medications (AOMs) to support long-term health and quality of life improvement outcomes, and patient-centered care.
4. Collaborative efforts among clinicians, health systems, payers, policymakers, and industry partners are essential to reduce barriers to equitable access to both effective pharmacotherapy and comprehensive lifestyle medicine interventions.

It is the position of ACLM that Intensive Therapeutic Lifestyle Change (ITLC) treatment has the following characteristics:

1. intention of the intervention is disease remission or reversal to the greatest extent possible;
   treatment is multifactorial and multimodal, with maximal dosing;
2. maximal dosing means using high intensity clinical encounters (frequency and duration), aiming for high patient engagement with substantive behavior change;
   appropriate monitoring and deprescribing of
3. medications by trained professionals at intervals aligned with the intensity of intervention and rate of change patients experience, and;
4. clinical oversight is provided by an ABLM/IBLM Certified LM Intensivist or clinician with equivalent competencies and practice standards

It is the position of the American College of Lifestyle Medicine (ACLM) that:

1. The LM care delivery model addresses the escalating chronic disease healthcare burden;
2. LM is a powerful catalyst for healthcare transformation that delivers the Quintuple Aim;
3. LM is whole-person care implemented for all populations, across various settings, intensities and modalities;
4. LM providers are trained, interdisciplinary experts in chronic disease care across the continuum, from prevention to treatment and remission of disease;
5. Nine core elements are essential to an effective and evidence-based LM Care Framework.

1. Urgent and coordinated action is required to address rapidly accelerating health impacts from the coalescing chronic disease and triple planetary crises of biodiversity loss, climate change, and environmental pollution.
2. Lifestyle interventions offer significant reciprocal benefits for individual, community, and planetary well-being.
3. Integrating lifestyle medicine into health care delivery promotes individual health, facilitates personal and community resilience, and reduces the environmental footprint of the health care sector.
4. Integrating lifestyle medicine principles into health professional education, clinical care, public health initiatives, and policy frameworks is a critical strategy to ensure widespread adoption of high-quality, cost-effective, environmentally sustainable, and equitable health care that safeguards population and planetary health.

It is the position of the American College of Lifestyle Medicine (ACLM) that:

1. Evidence-based lifestyle changes are the cornerstone of optimal approaches to prevent, treat or reverse many non-communicable chronic conditions.
2. Medications may be necessary in an acute or initial diagnosis/treatment phase or when therapeutic lifestyle changes alone are inadequate.
   The use of medications should be supported by robust evidence of efficacy and positive patient outcomes.
3. Regular reassessment and deprescribing of medications by interprofessional care teams reduces inappropriate or unnecessary medication use, minimizes adverse effects and prioritizes patient engagement in lifestyle interventions to target underlying causes of chronic disease.
4. Approaches that consider the whole person and prioritize person-centered care while emphasizing shared decision-making should guide both the prescribing and deprescribing of medications.