“...Obesity may triple the risk of hospitalization due to COVID-19 and also decreases lung capacity and reserve which can make ventilation difficult...”
The year 2022 marks the 16th anniversary of the American Journal of Lifestyle Medicine (AJLM). The year has been marked by great progress both for the journal and the field of lifestyle medicine; however, enormous challenges remain. Over the past year, AJLM has continued to grow and expand its presence around the world. We currently have over 14,000 subscribers, and in the year 2021, we had over 133,000 full-text downloads.
There is interest in lifestyle medicine in virtually every corner of the world. We have seen an increased number of submissions to AJLM from Europe, Asia, South America, Mexico, and the Middle East, in addition to the United States and Canada. The scope of these submissions has been remarkable and gratifying.
We founded AJLM many years ago with the vision that a forum for the exchange of evidence and concepts in the area of lifestyle medicine was much needed. As we enter our 16th year of publication, we have continued to see that vision fulfilled and expanded. While there has been great progress, challenges remain which are particularly relevant to the field of lifestyle medicine.
The importance of these areas is underscored by the World Health Organization (WHO) which has launched an initiative to combat non-communicable diseases. In the 6 areas of highest importance worldwide, the WHO identified lack of physical activity, improper nutrition, high blood pressure, cigarette smoking, and excessive alcohol consumption. Combatting all of these is central to the mission of lifestyle medicine.
I was pleased to see that the American College of Lifestyle Medicine (ACLM) has joined WHO as a contributing member to this significant worldwide campaign. It is clear that non-communicable diseases (NCDs) have become increasingly dominant throughout the world. In fact, the WHO now estimates that 71% of all mortality worldwide comes from NCDs.
An added challenge worldwide has come through the COVID-19 pandemic. COVID-19 has also underscored the importance of lifestyle modalities, not only in the traditional areas of physical activity and nutrition, weight management, and smoking cessation but also in the areas of infectious disease and health equity.
In the area of health equity, I was pleased to see that ACLM has taken a strong position by sponsoring a Health Disparities Solution Summit (HDSS). We are very pleased to publish the summary statement from this summit in AJLM.
It is clear that physicians need to address lifestyle habits and practices with all of their patients but particularly disadvantaged populations. For example, health disparities played a role in the alarming racial and ethnic differences related to COVID-19. Age-adjusted hospital rates for COVID-19 among Native Americans and Black Americans are between 4.5 and 5 times those of Caucasian Americans. Hispanic Americans have also been disproportionately affected and are hospitalized at a rate of approximately 4 times that of Caucasians. Moreover, the mortality of Black Americans in a number of cities is more than twice as high as a proportion of Black residents in these geographic areas.
There is no question that both obesity and poor nutritional habits have contributed to the disparities of how COVID-19 has affected Americans. For example, obesity increases the risk of severe illnesses from COVID-19. It appears that individuals who are overweight may also be at an increased risk. Obesity may triple the risk of hospitalization due to COVID-19 and also decreases lung capacity and reserve which can make ventilation difficult. Obesity has also been linked to increased inflammation and impaired immune function. It is also possible that obesity may be linked to lower vaccine responses including tetanus, influenza, and hepatitis B. Perhaps COVID-19 may also fall into this category although data in the area of obesity and COVID-19 vaccine responses are yet to be completely validated.
Sadly, the level of both overweight and obesity in the United States has continued to increase. According to the most recent National Health and Nutrition Evaluation Survey (NHANES) over 73% of the adult population in the United States is either overweight or obese.
It is important to note that both obesity and poor nutrition are more common in disadvantaged populations than in more affluent ones. Both the American College of Physicians and the American Heart Association have articulated positions on health equity. I am pleased that ACLM has now joined these other prestigious medical organizations by articulating a position of how lifestyle practices and habits impact health equity.
In 2021, the relationship between AJLM and ACLM continued to grow and thrive. In 2021, we published the seventh annual issue of AJLM devoted to the previous year’s findings from the National Meeting of ACLM. ACLM has also experienced phenomenal growth. In the past decade, ACLM has grown an astounding 1200%, making it the fastest growing medical organization in the United States.
AJLM was pleased this year for the first time to publish abstracts accepted at the national meeting of the American College of Lifestyle Medicine. A group of 40 abstracts representing great diversity and high quality were accepted at the ACLM national meeting and published in the November/December 2021 issue of AJLM. The ability to publish abstracts in AJLM is another added benefit of the strong collaboration between ACLM and AJLM.
In addition, AJLM is also happy to partner with ACLM to determine an article in each issue of AJLM that can be utilized for CE/CME credits. This new feature will be an added benefit of ACLM membership and the collaboration with AJLM. ACLM will recommend an individual who will sit on the AJLM Editorial Board to write quiz questions for all the CE/CME accredited articles.
The field of lifestyle medicine has continued to spawn a number of significant publications. I am proud to serve as the Editor of the Lifestyle Medicine Series, which is a series of single-topic books on various topics in lifestyle medicine. In late 2020, we published the first volume of this Series entitled “Increasing Physical Activity: A Practical Guide.” In 2021, we added the “Manual of Lifestyle Medicine” and “Obesity Prevention and Treatment: A Practical Guide” as well as an important volume in “Improving Women’s Health Across the Lifespan: A Lifestyle Medicine Approach.”
In 2022 and 2023, there will be more volumes in the Lifestyle Medicine Series including a book on “Lifestyle Medicine and Cardiovascular Disease,” a volume on “Lifestyle Medicine: Diabetes, Pre-diabetes and the Metabolic Syndrome,” a book on “Lifestyle Medicine and Preventive Neurology” as well as volumes on “Lifestyle Medicine and Mental Health” and “Nursing Lifestyle Principles and Practice.”
The intent of these volumes is to provide a point of entry for individuals who have specific interests in particular aspects of lifestyle medicine. The breadth of these books shows how the field of lifestyle medicine continues to expand and offer valuable information in a variety of disciplines. Members of ACLM have played critical roles in writing and editing many of these books.
I am also proud to announce that the fourth edition of the major Lifestyle Medicine textbook that I edit will be published in 2023. Once again, numerous members of ACLM have played important roles in multiple aspects of this large, comprehensive textbook.
While great progress has been made, it is important to also acknowledge that enormous challenges remain both in the United States and worldwide. For example, the difficulty in converting knowledge into action remains a central challenge in the area of lifestyle medicine. The public generally understands the value of positive lifestyle measures, yet their actions speak louder than their beliefs. For example, while the Physical Activity Guidelines 2018 Scientific Report (PAGA 2018) presents an overwhelming compendium of evidence of the multiple benefits of regular physical activity, only 25% of adults in the United States participate in the 150 minutes of moderate or vigorous physical activity which the Report recommends.
Diabetes has continued to grow in the United States. It is now estimated that 12% of the adult population in the United States has diabetes. Furthermore, pre-diabetes and the metabolic syndrome continue to be highly prevalent in the United States. Recent estimates document between 36% and 38% of the adult population with these conditions which are highly likely to eventually lead to an enormous and economically unsustainable tsunami of diabetes unless we can reverse these trends.
NHANES data also reports that less than 9% of adults consume the recommended servings of vegetables and only 12% consume the recommended servings of fruit. The Dietary Guidelines for Americans 2020-2025 reports that Americans are not consuming enough whole grains, fruits, and vegetables and consuming too much salt and sugar.
While we have made some headway in the area of smoking cessation, it appears that progress has stalled with between 15% and 16% of the adult population still smoking.
Between 30%-40% of adults and children report inadequate sleep, and over 40% of adults in the United States experience enough stress in their daily lives to impair function at home or work. Both depression and anxiety remain highly prevalent in the United States and may also undercut individuals’ willingness to make important behavioral changes. Thus, enormous challenges remain that interact with every pillar of lifestyle medicine.
The good news is that we are now seeing an increasing number of physicians and other healthcare providers who are deeply committed to advancing the field of lifestyle medicine and articulating how to convince the public to adopt these simple, cost-effective, and enormously powerful habits and actions. Thus, there is every reason to feel positive about the future of lifestyle medicine!
When I contemplate the future of lifestyle medicine it reminds me of the final lines in one of my favorite poems from Robert Frost “Stopping by Woods on a Snowy Evening.” The narrator in this poem (presumably Robert Frost) concludes the poem by saying:
The woods are lovely, dark and deep, But I have promises to keep, And miles to go before I sleep, And miles to go before I sleep.
When we think about the challenges in front of us, I think it is fair to say that the challenges are both “dark and deep”; however, the high level of commitment amongst those who practice lifestyle medicine to make a difference in these areas truly leads me to believe that we all have “promises to keep and miles to go before we sleep.” Even though we may have “miles to go,” if we stay the course, I believe we will keep our promises to keep our patients and the world healthier.
Footnotes
Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.