Lifestyle Medicine in Medical Education: Maximizing Impact

Abstract

The relationship between lifestyle behaviors and common chronic conditions is well established. Lifestyle medicine (LM) interventions to modify health behaviors can dramatically improve the health of individuals and populations. There is an urgent need to meaningfully integrate LM into medical curricula horizontally across the medical domains and vertically in each year of school and training. Including LM content in medical and health professional curricula and training programs has been challenging. Barriers to LM integration include lack of awareness and prioritization of LM, limited time in the curricula, and too few LM-trained faculty to teach and role model the practice of LM. This limits the ability of health care professionals to provide effective LM and precludes the wide-reaching benefits of LM from being fully realized. Early innovators developed novel tools and resources aligned with current evidence for introducing LM into didactic and experiential learning. This review aimed to examine the educational efforts in each LM pillar for undergraduate and graduate medical education. A PubMed-based literature review was undertaken using the following search terms: lifestyle medicine, education, medical school, residency, and healthcare professionals. We map the LM competencies to the core competency domains of the Accreditation Council for Graduate Medical Education. We highlight opportunities to train faculty, residents, and students. Moreover, we identify available evidence-based resources. This article serves as a “call to action” to incorporate LM across the spectrum of medical education curricula and training.

Article Highlights.

• •Medical and health care professional students and trainees educated in lifestyle medicine have the potential to positively impact patient outcomes.
• •Currently, there are minimal instructional hours for the 6 pillars of lifestyle medicine in medical school and residency.
• •Established resources and curricula are available to teach lifestyle medicine across the continuum of medical education.
• •Innovative opportunities exist to deliver medical education programs, overcome barriers to curricular integration, and research education outcomes in lifestyle medicine.
• •Lifestyle medicine knowledge and skills align well with the Accreditation Council for Graduate Medical Education core competency framework, and a focus on competency-based learning is the future of lifestyle medicine educational design.

Frontline health care professionals (HCPs) have the responsibility to address chronic conditions such as diabetes, hypertension, cardiovascular disease, metabolic syndrome, cancer, and obesity with lifestyle medicine (LM) interventions as first-line therapy for the prevention and, in many cases, treatment, aligning with guidelines from the American Heart Association,¹ American Cancer Society,² American Diabetes Association,³ and the American Association of Family Physicians.⁴ The US health care system is set up to be a reactive “sick care” system for which reimbursement is higher when patients have chronic conditions requiring medications and procedures. Moving the system to one that values health restoration will require incentives for deprescribing and keeping patients out of the hospital and emergency department. This calls for physicians and HCPs who are certified in LM and thus competent at prescribing evidence-based LM interventions. Education and training related to therapeutic LM interventions and mastery of the LM competencies⁵ can offer dramatic and far-reaching effects. Addressing lifestyle behaviors can improve clinical outcomes and decrease health care costs.6, 7, 8

Although 60% of Americans have 1 or more diet-related chronic conditions,⁹ only 25%-40% of primary care visits include nutrition counseling.10, 11, 12, 13 Physicians receive little formal nutrition education.¹⁴ In addition, 94% of primary care residents feel obligated to discuss nutrition with their patients, yet only 14% feel prepared to do so.¹⁵ Since 1985, the National Academy has recommended 25-30 hours of nutrition education in US medical schools.¹⁶ Although nearly 85% of medical students recognize that nutrition education is a necessary part of their training,¹⁷ 71% of medical schools provide less than the recommended minimum of 25 hours nutrition education.¹⁸ Physicians report a lack of confidence in their ability, knowledge, and skills to address lifestyle behaviors19, 20, 21, 22 and are, therefore, often unable to support patients in making impactful lifestyle changes.

In addition to nutrition, other lifestyle behaviors are necessary for physical and mental health. For example, it is well-accepted that exercise has several health benefits and is like medicine.^23,24 The American Heart Association added sleep to Life’s Simple 7 in 2022 to create the Essential 8 framework highlighting vital health behaviors and health factors to follow for cardiovascular health.²⁵ The importance of sleep is well documented.²⁶ Stress management is also critical for physical and mental health.²⁷ Mental stress can increase inflammatory markers, increase blood pressure, and play a role in insulin resistance and adiposity.²⁸ This stress may be counteracted by resilience activities like 13 minutes of meditation a day.²⁹ The Surgeon General, Vivek Murthy, highlighted the importance of social connection for health. He declared that the United States was experiencing an epidemic of loneliness and called on the health care sector to take action.³⁰ Another lifestyle factor to consider is the use of risky substances, including tobacco³¹ and the excessive use of alcohol because it is also adding to poor health outcomes.³²

Lifestyle medicine is defined as “a medical specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions including, but not limited to, cardiovascular diseases, type 2 diabetes, and obesity.”³³ These 6 pillars of LM include:³³

• 1.a whole-food, plant-predominant eating pattern;
• 2.routine physical activity (PA);
• 3.restorative sleep;
• 4.stress management;
• 5.avoidance of risky substances;
• 6.positive social connections.

The practice of LM is best accomplished with an interprofessional team trained in LM.^34,35 Not only do LM physicians and HCPs need to know the guidelines for each pillar, but they also need to understand how to empower patients to make lifestyle changes.³⁶ Empowering patients to change requires a set of skills not often emphasized in medical school or residency training.³⁷ Lifestyle medicine clinicians work to collaborate with their patients to create personalized SMART (specific, measurable, achievable, relevant, and timebound) goals.³⁸ Keeping up with the latest evidence-based practices allows LM clinicians to be effective with their counseling and comprehensive in their approach by factoring in essential areas such as social determinants of health, health equity, and nutrition insecurity. Referring to lifestyle behaviors such as eating as eating “patterns” rather than eating “choices and decisions” is now recommended, as is avoiding the use of the term “willpower” when speaking to patients about lifestyle change.³⁹

Opportunities for Integrating LM into the Continuum of Education

Primary and Secondary Education

The 6 LM pillars can be introduced as early as elementary, middle, and high school. Electives in middle school and high school focused on LM have been successfully implemented.⁴⁰ At this young age, LM classes should focus on inspiring young people to enjoy healthy lifestyle behaviors through informational and experiential learning.⁴¹ The American College of Lifestyle Medicine (ACLM) has a free full curriculum with slide decks and a teacher’s manual replete with suggested activities that accompany the Teen Lifestyle Medicine Handbook⁴² to help teachers deliver LM courses. Medical residents have used the teen curriculum to teach high school students in underserved areas of Boston.⁴³ These same teen resources were used to help create an LM microcredential for high school students.⁴⁴ Figure 1 shows a summary of LM education opportunities available across the continuum. Further options with links can be found in Supplemental Table (available online at http://www.mcpiqojournal.org).

Figure 1.

Integration of lifestyle medicine content into medical and health professions curricula. CE, continuing education; CME, continuing medical education; LMIG, Lifestyle medicine interest groups.

Associate and Bachelor’s Education

Multiple college faculty across the country are leading efforts to move LM into premedical and undergraduate health professions curricula through didactic courses and experiential learning opportunities. Core and elective LM course options introduce LM concepts as well as different career paths in health professions. Lifestyle medicine can be introduced as part of other entry-level science courses, such as nutrition. Interdisciplinary experiences like student-run clinics provide opportunities to learn how to collaboratively apply LM in the clinical setting.

The ACLM offers a full LM 101 Curriculum, including a teacher’s manual and slide decks for 13 modules. This curriculum covers the science of the 6 pillars and the art of putting the pillars into practice with counseling strategies. This LM 101 Curriculum follows the 13 chapters in the Lifestyle Medicine Handbook making it a readymade option for faculty. Faculty from different universities have used this curriculum to teach LM in bachelor’s and master’s courses.⁴⁵

Graduate Health Professions Education

Professors in graduate health profession master’s and doctorate programs can incorporate LM-related content and activities within their didactic and clinical courses. These courses can be effective online, hybrid,⁴⁵ or in person. Upon graduation, students enrolled in ACLM-approved Academic Pathway programs receive credit for meeting some or all prerequisites for the ACLM certification examination.³³

LM Education in Undergraduate Medical Education

Current State of Undergraduate Medical Education

On average, US medical schools provide only 14.3 hours of nutrition education, mostly during preclinical training.¹⁸ It has been reported that medical schools offered about 12 hours of education on substance use disorders, but this was in 2001,⁴⁶ with unpublished data⁴⁷ that has been cited for over 20 years, even by the New York Times in 2018.⁴⁸ In response to the opioid epidemic, the Association of American Medical Colleges (AAMC) ran an Opioid Education Challenge Grant Program in 2019. According to the AAMC, in 2021-2022, most medical schools offered a course on substance use disorder recognition and treatment.⁴⁹ Required PA education is only present in 17% of US medical schools,⁵⁰ with an average of 8 hours of education on the subject.⁵¹ In 1993, less than 5% of US medical schools offered 4 or more hours of education on sleep.⁵² Almost 20 years later, medical schools across the globe were providing approximately 2.5 hours of sleep education.⁵³ The hours of sleep medicine education ranged from 0 to 8 hours, with an average of 2.6 hours in 5 medical schools from Saudi Arabia.⁵⁴ In the United Kingdom, 25 medical schools were surveyed, and the average time spent on sleep was 3.2 hours, slightly better than the global average.⁵⁵ Little research data have been reported studying medical school education surrounding stress management and maintaining positive social connections.

According to the AAMC, the average contact hours of education in the first 2 years of medical school range from 635 to 799 hours per year.⁵⁶ This demonstrates that, on average, each of these important LM pillars accounts for <1% of total education time in the preclinical years—a time when most of the basic medical education occurs.

Quantifying exact hours of LM content embedded in medical curricula is challenging as the pillars are often threaded into lectures, cases, and clinical rotations. Shifts toward competency-based medical education have the potential to allow students to learn and practice LM skills when aligned with the AAMC Entrustable Professional Activities and Accreditation Council for Graduate Medical Education (ACGME) core competencies.^57,58 The American Heart Association and the National Heart, Lung, and Blood Institute have proposed frameworks for US medical schools to integrate learning objectives that will improve LM knowledge, skills, and competencies, and these efforts are needed to ensure that future physicians are well-prepared to address common lifestyle-related health issues.59, 60, 61

Improving LM in Undergraduate Medical Education

LM Student Interest Groups

Lifestyle medicine interest groups (LMIGs) are student-led organizations with faculty advisors that are focused on the 6 pillars. The first LMIG was created in the 2008-2009 academic year.⁶² Lifestyle medicine interest groups are supported at the undergraduate medical education (UME) and graduate medical education (GME) levels, and there are currently over 140 within various academic and health system programs, including 95 LMIGs in medical schools. Grounded in social learning theory,⁶³ LMIGs nurture communities of learning and practice that can help students, faculty, and the local community build healthy habits through involvement in LM-related activities. This model of learning and teaching has been shown to be effective in increasing medical student knowledge and confidence in counseling on behavior change even after just an hour presentation.⁶⁴ Similarly, just 1 hour of a virtual session on exercise prescription found that medical students and residents increased their knowledge and confidence after the intervention.⁶⁵ To foster a national community and create resources that can be shared among all LMIGs, the ACLM holds 6 online meetings to gather LMIG members from various schools nationwide in the same virtual space. These meetings are recorded to create a repository of videos from national leaders in LM, which are available to all LMIGs.

These LMIGs provide a parallel curriculum⁶² that can be delivered as “lunch and learns” or evening workshops. Lifestyle medicine interest group leaders host events to support healthy habits for students, trainees, staff, and the local community. The ACLM LM 101 Curriculum can be used as the basis for the material presented on each pillar. There has been steady growth in the number of LMIGs in medical schools, bachelor’s programs, master’s programs, and doctorate programs, as well as the health systems council at ACLM.

Electives

Electives provide an opportunity to offer LM courses and meet required credits at the same time. Several LM electives and track structures have been described. The open access Foundations of Lifestyle Medicine Curriculum provides a comprehensive document including a summary of LM literature, goals, objectives, and assigned work for an LM elective, as well as a sample structure for the course.⁶⁶ A culinary medicine elective provides a unique opportunity for an engaging and active learning pedagogy.⁶⁷

Curricular Themes, Case Studies, Distinction, and Master’s Degree Programs

Only a small number of schools have been able to integrate LM content throughout the UME curriculum. Some schools are integrating LM education into existing curricula by including LM content in case studies, problem-based learning, and clinical activities in a theme, track, or thread.⁶⁰ Other medical schools are offering distinction, concentration, or track programs in LM. By participating in a distinction program, medical students will graduate with an LM-focused expertise that will enhance their patient care and medical practice. A master’s degree in LM provides medical and health professionals the opportunity to add advanced skills and knowledge to their practice.

Resources to help medical school faculty integrate LM into their curricula include the open access LMEd curriculum providing about a dozen slide decks organized by organ system and several LM case studies. The ACLM UME Question Bank is available to aid faculty with evaluation of student LM knowledge.

Barriers to Implementing LM into UME

Because time is a large barrier to the implementation of new curricular topics in UME, integration of LM into existing courses allows for a comprehensive and holistic education of future HCPs, facilitating collaboration among faculty and alignment of priorities without the heavy burden of revamping the entire curriculum. One barrier to the inclusion of nutrition in medical education noted in the literature is competition with other medical disciplines for time and space in the curriculum.⁶⁸ Other barriers include the lack of application of nutrition science into clinical practice, the perception that nutrition counseling is not the responsibility of the physician, poor collaboration with nutrition specialists, lack of prioritizing nutrition, and lack of faculty to teach the topic.⁶⁹ For LM education in all 6 pillars, barriers include lack of time and space in the already full curriculum and lack of faculty who have knowledge and skills in LM topics, including the guidelines, research, and different dosing of LM interventions. Social, commercial, and political pressures may influence content decisions within UME, and it is important to acknowledge, understand, and navigate these forces as new content is considered. Undergraduate medical education needs to use strategies to teach clinically relevant and practical LM content. These teaching opportunities can be created in ways that do not compete with established curricular priorities, but the long-term goal is to have LM embedded into the core curriculum. Collaborating and connecting with faculty already teaching in the core curriculum is important. “The key to spreading lifestyle medicine is connection: connection with colleagues, connection with research, connection with CME, connection with students, and connection with community.”⁴³

Bridging the UME GME Transition for LM

The ACGME uses a conceptual framework centered on 6 core competency domains to describe the requirements for a “trusted physician to enter autonomous practice.”⁵⁷ These core competency domains include the following:

• 1.Professionalism;
• 2.Patient care and procedural skills;
• 3.Medical knowledge;
• 4.Practice-based learning and improvement;
• 5.Interpersonal and communication skills;
• 6.Systems-based practice.

The LM UME core competencies map across the ACGME’s 6 competency domains.⁷⁰ Continuing to update these competencies and respond to the needs of patients and medical communities is important. Competencies, for example, on determining when LM should be started as an adjunct to a prescription for medication or other therapeutic intervention and how to deprescribe medication when a patient has been responding to lifestyle modifications are all important to consider.

Graduate Medical Education

Current State of Incorporation of LM Pillars Into GME Curricula

Despite patients’ reliance on their physician for preventive medical guidance, practicing physicians may be uncomfortable counseling patients in lifestyle modifications. A lack of training in GME can lead to low self-efficacy and a lack of counseling in nutrition. Of 451 family physicians in British Columbia surveyed, 82.3% reported inadequate training in nutrition, and they also reported that the maximal impact on their nutrition education came from self-directed learning, with only 30% using nutrition resources.⁷¹ In another study, 95% of 930 cardiologists surveyed believed nutrition counseling was part of their personal responsibility to their patients, and 90% reported no or minimal nutrition education.⁷² In a different study, it was reported that of 40 internal medicine program directors surveyed, less than 50% reported providing “quite a bit/extensive training in dietary counseling” on hypertension, hyperlipidemia, and obesity.⁷³ The most frequently noted “moderate-to-major barriers” to education were competing curricular demands, lack of physician faculty with expertise in nutrition, inadequate financial resources, and lack of administrative support.⁷³ In that same study, 61% of 133 residents reported having very little or no training in nutrition.⁷³ Interestingly, the eating habits of the residents, specifically how many vegetables and fruits they consumed, had an impact on their nutrition counseling.⁷³

Of 72 residency directors surveyed across family medicine, internal medicine, surgery, and anesthesia, 72% thought nutrition should be required, 63% felt lack of adequate resources was a barrier to implementing nutrition education, 43% noted other requirements and time as a barrier, and 28% noted faculty issues.⁷⁴ Participation in interactive online nutrition courses provides opportunities to improve nutritional knowledge and enhance the residents’ attitudes that maintaining a healthy diet is important for patient care and their own self-care.⁷⁵ Recognizing the importance of nutrition for medical students and trainees, the ACGME, along with the AAMC and the American Association of Colleges of Osteopathic Medicine, held a summit to address ways to include more nutrition in medical education.⁷⁶ In an editorial, National Institutes of Health Office of Nutrition Research Director Dr Andrew Bremer clearly expressed the urgent need to prioritize nutrition in medical education.⁷⁷

There are similar trends with the PA pillar in terms of barriers and training. Systematic reviews on this topic reveal a lack of evidence for PA education in family medicine residency programs.⁷⁸ Lack of time and training in primary care providers were noted as barriers to PA counseling.⁷⁹ Of 25 Ohio family medicine, internal medicine, and obstetrics and gynecology programs in 1 study, only 4 programs provided guidance on how to use and implement obesity, nutrition, and PA guidelines, and the 25 programs offered an average of only 2.8 hours of didactics related to obesity, nutrition, and PA.⁸⁰ Another study revealed that only 26% of 115 US pediatric residencies had planned PA counseling curriculum.⁸¹ Programs with a PA curriculum noted a lack of time and space in the current curriculum to be a major barrier to developing curriculum, whereas those without a curriculum noted a lack of trained faculty to be a major barrier.⁸¹

Sleep medicine is a well-defined subspecialty with board certification requirements and over 100 sleep medicine fellowship programs. Despite this, education at the prerequisite residency stages is lacking. Researchers leading a global study on this topic revealed that 152 pediatric programs across 10 countries averaged 4.4 hours dedicated to formal sleep education, with 23.3% of programs offering none.⁸² In a study of 479 residencies across family medicine, ear, nose, and throat (ENT), psychiatry, pulmonary and critical care, neurology, and pediatrics, researchers found that more than half of the ENT, family medicine, and psychiatry programs had no faculty member who specialized in sleep medicine and the mean duration of sleep education was 4.75 hours.⁸³ Only 41.3% of 46 ENT programs in another study had a faculty member who was board certified in sleep medicine or who spent more than 50% of their practice on sleep medicine, underscoring the lack of trained faculty.⁸⁴ The programs with trained faculty were markedly more likely to respond “extremely” or “very” satisfied with resident sleep exposure than those without.⁸⁴

With respect to research about education in the stress management pillar, from the results of 1 study, 83% of 212 family medicine residencies provided lectures/workshops on stress management, 79% provided residency retreats, and there was a strong relationship between programs that had lectures on stress management techniques for patients and those that had education for resident stress management.⁸⁵ To help with stress management during residency, 97% of the 212 family medicine residencies surveyed provided access to counselors and mental health services, and 97% provided Balint/support group access.⁸⁵ A Balint group consists of 6-10 members and 1-2 facilitators/leaders where an hour is spent discussing a case from memory in a space without judgment.⁸⁶

The strength of positive social connections in building stress resilience among residents is well known and has been incorporated into GME-level care for residents through programs such as Balint groups and support groups, which can help reduce burnout, and there is an emphasis on the fact that peer social support is an important part of overall support throughout the training process.⁸⁶ Although there is a strong case for creating structured opportunities for social connections in the GME space, education on social connections for residents is lacking.⁸⁷

Contrary to what is found for nutrition, PA, stress, sleep, and social connection, substance use content in GME curricula has been persistently evolving and expanding. Highly successful national training programs have been documented. One example is the National Screening, Brief Intervention, and Referral to Treatment (SBIRT), which has trained thousands of residents to screen for substance use, provide brief interventions if appropriate, or refer to appropriate treatment programs on the basis of the patient’s needs.⁸⁸ Respondents of the grant in SBIRT stated that 100% of the residents trained in SBIRT utilized SBIRT clinically afterward.⁸⁸ These grant-funded national programs demonstrate that GME can provide sufficient education in LM when appropriate support, resources, and training (of both faculty and residents) are offered. Programs such as SBIRT can provide a basis for a curriculum, which can then be modified to better fit the specific needs of different specialties. A competency-based substance use disorder training program for family medicine residencies on the basis of SBIRT practice was developed as an open access curriculum that can meet both the specific needs of family medicine programs and address the common barriers identified by these programs.⁸⁹ Given the persistent barriers of a lack of time, a lack of resources, and a lack of LM expertise, creating large-scale national resources and training with subsequent specialized curricula to meet the specific needs of the diverse specialties can lead to easier integration, training, and practice of LM among HCPs in all fields. Information on medical education in the areas of the 6 pillars of LM is summarized in Table 1^18,49, 50, 51^,53,73,74,81, 82, 83^,85,86,90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103 for both UME and GME.

Table 1.

Estimates of Current Lifestyle Medicine in Undergraduate Medical Education and Graduate Medical Education

Pillar	UME	GME
Nutrition	Average of 14.3 h largely occurring in preclinical courses and 71% of US medical schools provided less than the recommended 25 h.18	10% (n=133) of IM residents reported receiving nutrition education via a formal curriculum. 61% of the residents reported having none or little bit of training in nutrition.73
		72% (n=72) US residency program directors thought a nutrition course should be required. Only 26.4% of programs had a formal course in nutrition education and length of course varied from a single 45-min to 10 1-h long sessions.74
Physical Activity	17% of US medical schools offer a required course on exercise and 35.5% of programs offered courses with the terms exercise prescription, exercise, fitness, or physical activity in the course description or list of topics.50	Less than 1% of total didactic and clinical education time for internal medicine residents is devoted to exercise.90
	Of 74 US medical schools surveyed, an average of 8 h of required physical activity education was offered during the 4 y of medical school.51	Less than 50% of Canadian Family Medicine Residency Program directors reported including structured physical activity counseling education into resident curriculum and teaching.91
		24-h curriculum delivered over 6-12 wk was feasible, efficacious, well received, and easy to include in the integrative residency curriculum.92
Sleep	Sleep education was noted to be under 2.5 h and about one third of international schools sampled provided no sleep education.53	152 pediatric programs across 10 countries averaged 4.4 h dedicated to formal sleep education with 23.3% of programs offering none.82
		Of 479 residencies (family medicine, otorhinolaryngology, psychiatry, pulmonary and critical care, neurology, and pediatrics) more than 50% of the ear, nose, and throat (ENT), family medicine, and psychiatry programs had no faculty member who specialized in sleep medicine and the mean duration of sleep education was 4.75 h.83
Stress	Insufficient data to report on the number of hours of stress management material in the medical school curriculum.	83% of family medicine residencies (n=212) provided lectures or workshops on stress management.85
	There was evidence of improved mindfulness and relationships with peers after an elective course on mind-body medicine that was targeted to both medical student well-being and patient care.93	79% of family medicine residencies provided residency retreats.85
Smoking cessation; substance use disorder education	Of 561 international medical schools: 27% taught a specific module on tobacco; 77% integrated teaching on tobacco; 31% taught about tobacco informally as the topic arose; 4% did not teach about tobacco.94	60% of US OB/GYN residencies (n=158) did not have formal curriculum in smoking cessation.96
	There was evidence that as little as 2 h of interactive, case-based education in the fourth year of medical school could have a considerable impact.95	65% of US OB/GYN residencies did not evaluate residents’ competence on smoking cessation counseling.96
	According to 2021-2022 data from AAMC, 149/155 medical schools offered preclerkship courses on recognition of opioid substance use disorders and 150/155 had required clerkships in this topic.49	42%-57% of US OB/GYN residencies spent less than 1 h per year on tobacco use education.96
		28.6% (n=227) of family medicine directors surveyed, reported a required addiction medicine curricula.97
Positive relationships and social connection; behavior change motivational interviewing (MI); and health coaching	Insufficient data to report on the number of hours of social connection material in the medical school curriculum.	Peer support is an important component for residents. Balint groups are a good example, Balint groups increases a participant’s coping ability, psychological mindedness, and patient-centredness.86
	There is evidence that social support for medical students needs to be explored as cultural and contextual support specific to the students is crucial for creating safe learning spaces.98	National survey results from internal medicine and medicine/pediatric residents revealed 67% of residents received MI training in medical school, 27.2% received it in residency, and 22.7% received it in both. 23.5% received no training in MI.101
	No reliable data on the number of medical schools that provide MI training, or the number of hours included in schools that do have this training.	A 12-h MI course increased the use of MI by residents in a written measure, and the course was rated favorably.102
	A pilot program in Germany using e-learning, lectures, and small groups to teach MI to medical students was effective with objective MI skills improving.99	Even a 1-h didactic session in MI could be beneficial.103
	Little available research on medical students and health coaching but what does exist is promising.100

Abbreviations: AAMC Association of American Medical Colleges; GME, graduate medical education; IM, internal medicine; OB/GYN, Obstetrics and gynaecology; UME, undergraduate medical education.

Improving LM Education in GME

Individuals in medical residency programs across the United States can access ACLM’s lifestyle medicine residency curriculum (LMRC). This didactic and practicum offering began in 2018 with 4 sites and is now being used in over 170 sites including 368 residency programs in a variety of specialties. Didactic components of the LMRC require 40 hours of interactive virtual learning and 60 hours of application activities. The curriculum is based on the LM core competencies.⁵ The practicum component includes at least 400 LM-related patient encounters, exposure to therapeutic lifestyle change programs, and group facilitation. Upon completing a primary residency program and LMRC, physicians are eligible to take the American Board of Lifestyle Medicine (ABLM) certification examination. Feedback has been positive in that the material taught is considered engaging, and residents participate with enthusiasm and the desire to continue learning.¹⁰⁴ The ACLM is in the process of a full evaluation and research protocol to test the impact of the LMRC. There is one approved LM intensivist fellowship with the goal of creating many more throughout the country in the coming years.¹⁰⁵

Core Competencies in LM

In 2010, the first paper describing the core competencies in LM was published¹⁰⁶ and it was updated in 2022.¹⁰⁶ Below is a list of the 10 core competency areas in LM. There are a total of 88 competencies that relate to these 10 core competency categories.

The 10 Core Competency Areas in LM

• 1.Introduction to LM;
• 2.The role of the practitioner’s personal health and community advocacy;
• 3.Nutrition science, assessment, and prescription;
• 4.Physical activity science, assessment, and prescription;
• 5.Sleep health science and interventions;
• 6.Treating tobacco use disorder and managing other toxic exposures (including vaping, alcohol use, and other illicit substances);
• 7.Key clinical processes in LM;
• 8.Fundamentals of health behavior change;
• 9.Emotional and mental health assessment and interventions;
• 10.The role of connectedness and positive psychology.

Lifestyle medicine practices and principles align well with the ACGME’s 6 core competency domains, which include patient care, medical knowledge, professionalism, interpersonal and communication skills, practice-based learning, and improvement and systems-based practice.¹⁰⁷ Table 2 provides a framework to map the 88 LM subcompetencies as presented in the updated 2022 article.⁵

Table 2.

Mapping the LM Subcompetencies to the ACGME Core Competencies

ACGME Core Competencies

Patient care and procedural skills

Medical knowledge

Practice-based learning and improvement

Interpersonal and communication skills

Professionalism

Systems-based practice

LM Subcompetencies

A. Introduction to LM 1. Discuss LM and its unique role in health care practice (Medical Knowledge and Systems-Based Practice) 2. Describe the LM core competencies as identified by a national consensus panel (Medical Knowledge) 3. Compare and contrast LM with other fields of health and medicine (Medical Knowledge) 4. Summarize the scientific evidence that shows health behaviors are associated with key health outcomes (Medical Knowledge) 5. Describe the evidence showing that lifestyle interventions effectively impact disease pathophysiology (Medical Knowledge) 6. Describe the priority of LM in the spectrum of treatment algorithms for chronic, lifestyle-related diseases across the lifespan (Medical Knowledge) 7. Discuss the prevalence and associated cost burden of lifestyle-related disease, such as hyperlipidemia, cardiovascular disease, prediabetes, diabetes, hypertension, obesity, and cancer (Medical Knowledge and Systems-Based Approach) 8. Explain the impact of lifestyle choices on planetary health and sustainable living (Medical Knowledge and Systems-Based Approach)

B. The role of the practitioner’s personal health and community advocacy 1. Examine scientific evidence that suggests practitioners who practice healthy lifestyles are more likely to offer counseling, serve as role models, and improve patient outcomes (Medical Knowledge) 2. Develop a culture of leadership by modeling personal health behaviors (Professionalism) 3. Describe strategies for incorporating personal wellness for practitioners into clinics, medical offices, or other health care settings, including wellness programs (Systems-Based Practice) 4. Examine essential practitioner characteristics and practices that increase the capacity and impact of the therapeutic alliance (Interpersonal and Communication Skills) 5. Integrate personal readiness assessments and lifestyle action plans into sustainable life patterns for practitioners (Professionalism) 6. Explore the role of LM in promoting personal practitioner resiliency and reducing burnout (Professionalism) 7. Advocate for LM directly with patients and their families, as well as policy and decision makers within the community (Interpersonal and Communication Skills and Systems Based Practice)

C. Nutrition science, assessment, and prescription 1. Assess food intake patterns and nutrients of deficit and excess (Patient Care and Procedural Skills) 2. Analyze food labels for the health impacts of ingredients (Medical Knowledge and Patient Care And Procedural Skills) 3. Discuss commonalities and key messages of global dietary guidelines (Medical Knowledge) 4. Summarize the health impact of prominent dietary patterns, including plant-predominant and non–plant-predominant patterns (Medical Knowledge) 5. Describe how the level of processing in a food affects health and discuss the evidence base for these effects (Medical Knowledge) 6. Describe the practice of culinary medicine and its role in sustainable healthy eating behavior (Medical Knowledge) 7. Summarize the major studies of nutrition in the prevention, treatment, and reversal of hyperlipidemia, cardiovascular disease, prediabetes, diabetes, hypertension, obesity, and cancer (Medical Knowledge) 8. Apply nutrition prescriptions on the basis of science that shows how nutrition can address the pathophysiology of most chronic diseases, including inflammation, oxidation, glycosylation, epigenetic expression, and the microbiome (Practice Based Learning and Improvement and Patient Care and Procedural Skills) 9. Demonstrate the ability to write evidence-based nutrition prescriptions (Patient Care and Procedural Skills) 10. Describe indications for referral to a LM-trained registered dietician to translate and further personalize nutrition prescriptions (Systems-Based Practice)

D. Physical activity science, assessment, and prescription 1. Discuss the aerobic, strength, flexibility, and balance components of physical activity (Medical Knowledge) 2. Examine the evidence and pathophysiology between physical activity components and health outcomes (Medical Knowledge) 3. Describe the benefits of physical activity in preventing or treating disease in special populations, such as healthy older adults, pregnant women, children and adolescents, persons with obesity or disability, cardiovascular disease, diabetes, cancer, disability, and stroke (Medical Knowledge) 4. Summarize the role of physical activity guidelines (Medical Knowledge) 5. Integrate key physical activity assessment tools into clinical practice (Patient Care and Procedural Skills) 6. Define fitness terminology relevant to writing exercise prescriptions (Medical Knowledge) 7. Integrate evidence from relevant physical activity literature into treatment protocols for management, remission, or reversal in patients with diabetes, cancer, cardiovascular, and cerebrovascular disease (Practice Based Learning and Improvement and Patient Care and Procedural Skills) 8. Describe indications for referral to health fitness professionals (Systems-Based Practice) 9. Develop physical activity prescriptions appropriately modified for special populations, such as healthy older adults, pregnant women, children and adolescents, persons with obesity or disability, cardiovascular disease, diabetes, cancer, disability, and stroke (Patient Care and Procedural Skills)

E. Sleep health science and interventions 1. Describe sleep’s role with health and chronic disease pathophysiology (Medical Knowledge) 2. Perform sleep assessments to identify patients with insufficient or poor-quality sleep (Patient Care and Procedural Skills) 3. Summarize lifestyle-based interventions that can improve sleep health (Medical Knowledge) 4. Assess the risk for common sleep disturbances, such as obstructive sleep apnea, chronic insomnia, and restless legs syndrome and refer to sleep specialists when applicable (Patient Care and Procedural Skills) 5. Describe the indications for referral to a sleep specialist or for a sleep study to assess for sleep apnea (Systems-Based Practice) 6. Describe indications for referral to a program or specialist in cognitive behavior therapy for insomnia (Systems-Based Practice)

F. Treating tobacco use disorder and managing other toxic exposures (including vaping, alcohol use, and other illicit substances) 1. Describe the health effects of tobacco, alcohol, and other frequently used substances and the benefits of cessation (Medical Knowledge) 2. Apply patient screening tools for substance use (Patient Care and Procedural Skills) 3. Create patient-centered substance use treatment plans using practice guidelines and behavioral interventions (Patient Care and Procedural Skills) 4. Summarize the diagnostic criteria for common substance use disorders (Medical Knowledge) 5. Integrate behavior therapy with pharmacotherapy for tobacco and other substance use disorder plans and refer to a substance use disorder specialist when indicated (Patient Care and Procedural Skills and Systems-Based Practice) 6. Apply the United States Preventive Services Task Force guidelines for patients with tobacco use disorder (Patient Care and Procedural Skills)

G. Key clinical processes in LM 1. Integrate lifestyle vital signs into components of the patient history and physical examination (Patient Care and Procedural Skills) 2. Analyze and implement evidence-based clinical practice guidelines relevant to LM for prevention, treatment, and reversal of chronic diseases (Practice Based Learning and Improvement and Patient Care and Procedural Skills) 3. Describe the treatment of disease with the LM pillars as compared with medication (Medical Knowledge) 4. Demonstrate how to screen, diagnose, treat, and monitor a lifestyle-related disease and provide LM-focused anticipatory guidance (Patient Care and Procedural Skills) 5. Discuss strategies for a clinical practice to access and implement use of local, national, and global resources (Systems-Based Practice) 6. Describe the key strategies for leveraging interprofessional teams to enhance health behavior change interventions (Systems-Based Practice) 7. Examine how group visits and telehealth can optimize LM treatment encounters (Practice Based Learning and Improvement) 8. Create and use data from office systems, such as electronic health records with LM guidance, in clinical decisions and care, including tracking screening frequency, test results, referrals, and recommended follow-up (Systems-Based Practice) 9. Analyze the evidence for collaborative and chronic care models on improved lifestyle outcomes (Practice Based Learning and Improvement) 10. Discuss successful primary care and office-based models for lifestyle modification (Systems-Based Practice) 11. Design a quality improvement project for LM clinical practice, using tools, such as Plan-Do-Study-Act cycles (Practice Based Learning and Improvement) 12. Explain principles of evidence-based medicine and their application to LM (Medical Knowledge and Practice Based Learning) 13. Describe methods of assessing effectiveness of interventions, such as patient activation measures and the therapeutic alliance measures (Medical Knowledge and Practice Based Learning and Improvement)

H. Fundamentals of health behavior change 1. Summarize health behavior change theories, such as the health belief model, the social learning theory, and the transtheoretical model (TTM), and their application to LM practice (Medical Knowledge) 2. Demonstrate key elements of conducting a patient assessment within the TTM and collaborate to develop stage-matched responses (Patient Care and Procedural Skills) 3. Apply the process of building effective and therapeutic alliances with patients that foster their personal growth (Interpersonal and Communication Skills) 4. Explain how to collaborate with your patients to promote health behavior changes (Medical Knowledge) 5. Apply motivational interviewing, cognitive behavioral, health coaching, and positive psychology techniques (Interpersonal and Communication Skills) 6. Summarize the evidence to support the use of behavior change techniques in clinical practice (Medical Knowledge) 7. Use the skills of open inquiry, reflections, and empathy to develop and maintain a therapeutic alliance (Interpersonal and Communication Skills) 8. Describe the impact of positive emotions on the success of health behavior change (Medical Knowledge) 9. Develop patient-centered, written action plans on the basis of the appropriate stage of change of the TTM (Patient Care and Procedural Skills) 10. Summarize the process of follow-up for ongoing lifestyle change progress, including building patient self-efficacy and relapse prevention (Medical Knowledge and Patient Care and Procedural Skills) 11. Describe the factors that support sustained behavior change (Medical Knowledge and Interpersonal and Communication Skills) 12. Explain the role of family and other support to initiate and maintain health behavior change (Medical Knowledge) 13. Manage disruptions to the therapeutic alliance (Interpersonal and Communication Skills) 14. Identify patient resources for sustainable behavior change in relation to the pillars of LM (Medical Knowledge)

I. Emotional and mental health assessment and interventions 1. Apply screening tools for stress, depression, and anxiety in clinical practice (Patient Care and Procedural Skills) 2. Explain the relationship and pathophysiology between emotional and physical health (Medical Knowledge) 3. Summarize the nature of stress, the role of stressors, such as adverse child experiences, and identify manageable elements of pathogenic stress reactions (Medical Knowledge) 4. Describe and use evidence-based and patient-centered mental and emotional health, including self-management and resilience-building techniques (Patient Care and Procedural Skills) 5. Analyze the clinical relevance and evidence base for mindfulness-based stress reduction and related stress management strategies (Practice Based Learning and Improvement) 6. Manage treatment plans for lifestyle-related mental health diseases, such as depression and anxiety (Patient Care and Procedural Skills) 7. Describe indications for referral to mental health professionals (vs when clinically indicated) (Systems-Based Practice) 8. Apply mindfulness skills to enable presence, clarity, and curiosity in the clinical encounter (Patient Care and Procedural Skills and Interpersonal and Communication Skills)

J. The role of connectedness and positive psychology 1. Apply positive psychology in health behavior change counseling (Patient Care and Procedural Skills) 2. Describe how positive psychology strategies support achieving and sustaining healthy behaviors (Medical Knowledge) 3. Compare and contrast eudaimonia and hedonia and explain their effect on physical health, including longevity (Medical Knowledge) 4. Describe how social connectedness and social networks effect emotional well-being, physical health, and longevity (Medical Knowledge) 5. Summarize the deleterious and positive effects social media has on emotional well-being and flourishing (Medical Knowledge) 6. Explain the relationship among the lifestyle pillars, positive emotions, and flourishing (Medical Knowledge) 7. Describe positive psychology activities that can boost emotional well-being and flourishing (Medical Knowledge)

Abbreviations: ACGME, Accreditation Council for Graduate Medical Education; LM, lifestyle medicine.

It is important for relatively newer specialties such as LM to consider how best to integrate their work into the existing frameworks and initiatives of more established organizations. For example, how should LM education be considered in the context of the ACGME’s core competencies as well as specialty-specific ones? There are opportunities to explore ways of meaningfully integrating LM core competencies into primary care with family medicine, internal medicine, and pediatrics. It will be important to embed nutrition and LM into specialties where these topics are most relevant, such as cardiology, endocrinology, and gastroenterology.¹⁰⁸ Another avenue to consider is developing Clinician Educator Milestones¹⁰⁹ for the LM core competencies. These milestones represent a combined effort and collaboration among the ACGME, the Accreditation Council for CME, the AAMC, and the American Association of Colleges of Osteopathic Medicine.¹⁰⁹ The milestones are subcompetencies that help faculty develop and improve teaching and learning skills across the continuum of medical education. This competency-based approach should be the main focus of LM education.

Board Certification in LM

Certification distinguishes physicians and HCPs as ABLM or ACLM diplomates with expert knowledge, having achieved competency in LM. Physicians seeking ABLM certification complete an experiential pathway. They must be board certified in their primary specialty by the American Board of Medical Specialties. Medical residents can follow the educational pathway, which involves completion of the LMRC. There is also an option for experienced LM physicians to become LM intensivists, which requires previous ABLM board certification along with a series of documented clinical disease remission patient outcomes. Nonphysicians can also be certified in LM. Health care professionals holding a master’s or doctorate degree can achieve certification through ACLM. This pathway can also be experiential or educational through participation in an ACLM-approved Academic Pathway program. The International Board of Lifestyle Medicine certifies physicians and professionals globally.

Pathways Forward with LM Education

The Readiness to Change Model¹¹⁰ can be applied when supporting medical schools and other HCP education programs. Depending on the stage of change for the academic center, different implementation suggestions apply. Stage-specific strategies are listed for each stage in Table 3.

Table 3.

Suggestions for Including More LM Based on Readiness for Change for Medical and Health Professional Schools and Programs

Stage of change	Suggestions
Precontemplation	•Start a Lifestyle Medicine Interest Group (LMIG) with at least 1 interested faculty and 1 student leader.
	•Offer to help with case presentations in your specialty such as cardiology, endocrinology, or oncology.
Contemplation	•Start an LMIG.
	•Talk to fellow faculty members to discuss how LM could be included in current cases or course presentations that cover heart disease, diabetes, hypertension, metabolic syndrome, obesity, dementia, cancer, and other lifestyle-related chronic conditions.
	•Invite colleagues with expertise in LM to speak or invite speakers from outside your academic center to deliver presentations on the 6 pillars and behavior change.
	•Inquire about longitudinal curricular themes or threads.
Preparation	•Use readymade LM content and curricula available through ACLM and other organizations.
	•Evaluate and/or advocate for local needs assessments for LM in your community.
	•Build relationships among LM experts, course and clerkship directors, and educational leaders.
Action	•Evaluate and enhance course offerings.
	•Consider adding an elective in one of the 6 pillars if there is not one already offered at the school.
	•Propose adding LM as a longitudinal theme in collaboration with curriculum committees/deans of education.
Maintenance	•Evaluate the LM courses, themes, and/or graduate questionnaire feedback. Are the students translating knowledge into clinical practice? What is most helpful to them? What would the students like to see more of in their medical school years?
	•Consider offering a masters in LM.

Abbreviations: ACLM, American College of Lifestyle Medicine; LM, lifestyle medicine.

In addition to understanding the different stages of change an academic institution may be in, it is important to identify common barriers holding up progress and to provide solutions around these barriers. Table 4^43,111, 112, 113, 114, 115 reviews barriers and solutions.

Table 4.

Common Barriers to Including Lifestyle Medicine in Medical and Health Professional Education

Barriers	Solutions	Examples
Core curriculum is full	Offer a separate elective Create optional opportunities for LM education Parallel curriculum Weave LM into current courses and cases Create a Master’s program	•LM elective •LM distinction •LM certificate •Postgraduate advanced practice provider LM residency programs •LMIG •LM theme •Master of science in LM
Not enough trained faculty to teach	Increased training in LM Increased knowledge Bring in experts Live or recorded lecture offerings	•Board certification in LM •Certificate course in LM •Training the trainer •Attend CME courses •Grand rounds •Lectures from DipABLM/IBLM/ACLM-certified professionals •Virtual ACLM LMIG •Webinars on ACLM’s connect platform •LM summits
Lack of established resources	Complementary resources Resources with costs associated Viewing documentaries Lifestyle medicine textbooks	•ACLM LM101 curriculum •LMEd curriculum •LM foundation curriculum •ACLM essentials bundle •ACLM culinary medicine syllabus •LM question bank •ACLM LMRC •American College of Culinary Medicine health meets food curriculum or certified culinary medical specialist course •Gaples Institute CME on nutrition •LM journals such as the American Journal of Lifestyle Medicine •Code Blue, You are What You Eat, Forks over Knives, Game Changers, Blue Zones, They’re Trying to Kill Us, What the Health? Eating You Alive •Manual of Lifestyle Medicine Edited by Rippe111 •Rippe Series in Lifestyle Medicine112 •The Lifestyle Medicine Handbook113 •The Lifestyle Medicine Pocket Guide114 •Health Promotion and Disease Prevention for Advanced Practice115
Lack of funding	Apply for research grants to study the impact of lifestyle medicine education courses and workshops on medical students, residents, and physicians	•Ardmore Institute of Health has funded lifestyle medicine programs and education efforts •Local funding with grants from the medical school or hospital •Clinical and Translational Science Awards program, Health Resources and Services Administration awards, National Institute of Health grants •Taste of lifestyle medicine microgrants
Lack of understanding of and familiarity with LM Lack of LM questions on licensing examinations	Educate deans Educate faculty Educate students Educate medical school course directors and residency program directors Publish articles in the medical literature Bring awareness to current LM research Collaborate with STEP 1, 2, and 3 licensing boards	Give grand rounds on a LM topic at the hospital. Deliver LM workshop at ACGME and AAMC national meetings Create special lifestyle medicine editions in major medical journals Run a journal club on LM topics43 ACLM UME Question Bank and other resources to help jump start question creation

Abbreviations: AAMC, Association of American Medical Colleges; ABLM, American Board of Lifestyle Medicine; ACGME, Accreditation Council for Graduate Medical Education; ACLM, American College of Lifestyle Medicine; IBLM, International Board of Lifestyle Medicine; LM, lifestyle medicine; LMIG, lifestyle medicine interest group; LMRC, lifestyle medicine residency curriculum; UME, undergraduate medical education.

Ideally, medical and HCP students will learn the research, guidelines, and behavior change strategies to help patients adopt and sustain healthy lifestyles for a lifetime. This will involve assessing, assisting, and arranging for follow-up and referral for all 6 pillars. This follows the 5 As (assess, advise, agree, assist, arrange),¹¹⁶ which most clinicians know and understand. Figure 2 shows some of the many ways physicians and HCPs can empower patients to adopt and sustain healthy lifestyles. In this version, the advise, agree, and assist steps were condensed into 1 step labeled “assist.” The first step of assessing the 6 pillars is accomplished by asking open-ended questions and using evidence-based tools. Examples for each pillar include the ASA24 Automated Self-Administered 24-Hour Dietary Assessment Tool,^117,118 Physical Activity Vital Signs,¹¹⁹ Perceived Stress Scale,¹²⁰ Pittsburgh Sleep Quality Index,¹²¹ the University of British Columbia’s University of British Columbia State Social Connection Scale,¹²² and alcohol screening with Alcohol Use Disorders Identification Test (AUDIT).¹²³ Nutrition, sleep, and exercise logs are also useful to establish a baseline and track progress.

Figure 2.

Lifestyle consulting 101: assess, assist, and arrange for the 6 pillars of lifestyle medicine. Source: Pillars of Lifestyle Medicine graphic logo included with permission from the American College of Lifestyle Medicine.

Lifestyle medicine education emphasizes that the 6 pillars are like medicine with prescription doses and intensities.¹²⁴ The higher the dose and intensity, the greater the change, and the more likely there will be a need for medication deprescribing, especially with chronic conditions like hypertension and type 2 diabetes. The LM clinician must consider the individual patient, their social determinants of health, their readiness for change, and other personal factors to develop a specific prescription that clearly identifies the frequency, intensity, time, and type of interventions. These can be remembered as F.I.T.T. prescriptions and can be created for all 6 pillars.¹¹³ For example, an exercise prescription may be 3 times a week, at moderate intensity, 50 minutes of stationary biking, whereas a nutrition prescription may be once a day, ¼ cup of almonds for a snack at 3 pm, based on someone’s unique goals.

There are several options for medical schools and HCP schools to incorporate more LM education. Starting with an LMIG, they should identify the faculty and students able to put time and energy into the 6 pillars and then work toward an LM curricular theme and offer electives such as culinary medicine. Taking deliberate steps forward to plan and integrate LM into UME and GME is a vital way to build momentum. Analyzing the programs’ readiness for change, current barriers to implementation, and identifying resources that can be used ensures the process is targeted to the needs of the specific school and is in alignment with the LM curriculum implementation standards.⁷⁰ Evaluation drives curriculum. When the national medical examinations and board certifications include more questions on the 6 pillars, medical and health professions school faculty and deans will be required to fortify these topics in the core curriculum. Lifestyle medicine champions need to take the next step toward integrating LM into UME and GME.

Summary of Recommendations Future Directions for LM Education

• •
  Promote awareness of LM

  • o
    Establish-of LMIGs.
  • o
    Train the trainer and become certified in LM: train faculty, course directors, and program directors in LM so that they can become certified by ABLM/International Board of Lifestyle Medicine/ACLM.
  • o
    Use grand rounds, electives, webinars, lunch and learns, national meeting presentations, and workshops to teach others about LM.
  • o
    Promote LM research via grants and share current research through journal clubs.
  • o
    Lobby for policy change by partnering with leaders at AAMC and ACGME as well as government officials.
• •
  Revamping current curricula

  • o
    During curricular review, discuss how to fully integrate LM competencies into existing curricula.
  • o
    Consider the addition of established curricular resources into UME and GME, such as the LM101 curriculum or LMRC.
  • o
    Identify current barriers to implementation and establish a task force to address barriers.
  • o
    Implement LM competencies into UME and GME. Redefine and refine competencies to better suit various residency/fellowship needs.
  • o
    Establish evaluation metrics to ensure competencies are met. Consider OSCEs, 360° evaluations, quizzes, direct observation tools, or other evaluation tools to ensure LM education is valuable, competency-based, and put into practice.

Figure 3 shares several recommendations for focus areas to move forward with LM education.

Figure 3.

Focus areas to move forward with lifestyle medicine education. AAMC, Association of American Medical Colleges; ACGME, Accreditation Council for Graduate Medical Education; CE, continuing education; LM, lifestyle medicine.

Conclusion

Reversal of the chronic disease burden requires a paradigm shift in the approach to patient care where chronic disease guidelines emphasizing lifestyle interventions and offering optimal dosages and intensities, are followed. Lifestyle medicine is high-value, person-centered care that encourages the patient to be active in their own health outcomes through therapeutic lifestyle interventions where, in most cases of chronic disease, “LM pillars are preferred to pills and procedures.” Physicians and HCPs are responsible for offering LM as an option for prevention and treatment for their patients with chronic medical conditions. Lifestyle medicine includes a team approach centered on the patient, and all members of the team play a role in the process. Thus, they all need education. Lifestyle medicine education must be competency-based to provide the foundation for physicians and HCPs to be knowledgeable, trained, and skilled at managing lifestyle-related chronic conditions. Lifestyle medicine is urgently needed to reverse the course of the chronic disease crisis. This article is a call to action to make the principles of LM a curricular priority and advocate for these principles as HCPs. The collaborative efforts of health and medical educators, stakeholders, policymakers, and accreditation organizations will help make change happen. Lifestyle medicine is the antidote to the chronic medical conditions plaguing the nation and the world. The time is now for LM education and training to be a priority.

Potential Competing Interests

Dr Frates has served as a consultant for Jenny Craig Scientific Advisory Board, obVus Solutions, and Clearing.com. Dr Freeman is the Director of Workforce Development at the American College of Lifestyle Medicine and President of the Indiana Lifestyle Medicine Network; receives grant funding through the Ardmore Institute of Health. Dr Co is one of the Board of Directors, ACGME. Dr Bernstein receives royalties as a Nutrition Textbook Author for Jones and Bartlett Learning. The other author reports no competing interests.