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:

Food As Medicine

Chronic disease clinical guidelines for multiple conditions, including overweight and obesity, promote lifestyle interventions as a first treatment. Patients’ best interests call for a compassionate, evidence-based approach addressing the six lifestyle pillars, as defined by the American College of Lifestyle Medicine (ACLM), to achieve a goal of health restoration.

These pillars include: 1.) regular physical activity, 2.) whole-food, plant-predominant nutrition, 3.) restorative sleep, 4.) stress management, 5.) positive social connection, and 6.) avoidance of risky substances; also acknowledging each individual’s lived environment and genetic predisposition, as many people live in a home or societal environment that promotes and exacerbates weight gain.

While adequately dosed lifestyle interventions may unilaterally achieve success, obesity is a complex, multifactorial disease wherein patients may require approaches beyond lifestyle alone. However, lifestyle interventions are too often not adequately “dosed” for success. Lifestyle medicine clinicians are trained to prescribe a therapeutic dose of all six pillars. Evidence supports the efficacy of these interventions in addressing the underlying causes of disease, including gut dysbiosis, endothelial dysfunction, oxidative stress, and chronic inflammation.

A comprehensive lifestyle medicine approach prevents and treats many other co-morbidities associated with overweight and obesity, including, but not limited to, hypertension, high cholesterol, heart disease, type 2 diabetes, and arthritis, and a lifestyle medicine approach can also reduce the risk of many types of cancer. Lifestyle medicine must become the foundation of comprehensive treatment, with or without surgery and/or medications as adjunctive therapies. ACLM stands ready to be a resource to help clinicians and patients in treatment of adult and pediatric overweight and obesity.

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.

Evidence-based lifestyle changes are the cornerstone of optimal approaches to prevent, treat or reverse many non-communicable chronic conditions.

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.

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.

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.