Patient Info on Polypharmacy Should Emphasize Lifestyle Behavior

Beth Frates, MD, FACLM, DipABLM
President, American College of Lifestyle Medicine

The Patient Page for “Polypharmacy and Deprescribing” published recently in the Journal of the American Medical Association (JAMA) brought much-needed attention to a critical issue. Patients have a right to know that taking too many pharmaceuticals may cause adverse health effects and that there are processes to safely and effectively “deprescribe” unnecessary or harmful medications. However, I would contend that, while the potential of lifestyle behavior change to address health conditions was mentioned, it deserved greater emphasis.

There is a substantial body of evidence supporting lifestyle medicine to treat and, when used intensively, reverse common chronic conditions such as cardiovascular disease and type 2 diabetes. Management of these conditions and associated chronic diseases through medications alone is a considerable driver of our overreliance on pharmaceuticals, as well as our unsustainable healthcare costs. Unknown to many patients is that an evidence-based lifestyle medicine approach is the first treatment plan recommended in the majority of chronic disease care guidelines.

How many patients know, for example, that is possible to achieve remission for type 2 diabetes through diet alone, as a 2022 expert consensus statement concluded? That is an empowering message for individuals who otherwise feel destined to a lifetime of taking ever-increasing amounts of medications and shouldering the associated costs. To help guide clinical decision making on when and how to describe medications following successful lifestyle medicine interventions for type 2 diabetes, the American College of Lifestyle Medicine (ACLM) recently produced the first published examples of deprescribing protocols.

The field of lifestyle medicine is growing. Since lifestyle medicine certification began in 2017, almost 2,500 U.S. physicians and 1,000 other health professionals have earned certification. Almost 100 health systems have joined ACLM’s Health Systems Council, a collaborative group supporting the implementation of lifestyle medicine into some of the country’s largest and most innovative health organizations.

New York City expanded lifestyle medicine services to six public health care sites, the most comprehensive expansion of lifestyle medicine programming in the country.

Lifestyle medicine professionals don’t eschew medications; their approach is whenever possible to first treat the root cause of many chronic diseases–by addressing nutrition, physical activity, sleep, stress, social connection, and substance use–with the clinical goal of health restoration rather than disease management. We should empower patients and clinicians with the knowledge that lifestyle behavior change is a viable and optimal solution to reduce polypharmacy and its many ails, both for the patient and our health care system.

Lifestyle Medicine News and Updates – Insider September 2023

Disclaimer: The information included in Insider is intended to give our readers a sense of what is happening in the news, research journals and other channels related to lifestyle medicine. Inclusion does not imply ACLM endorsement. Note that some links may require registration or subscription.

TO NOTE

• The U.S. doesn’t just have a lower life expectancy than much poorer countries, we’re a global leader in avoidable amputations. That appalling fact and others are discussed in this must-read opinion piece by Nicolas Kristof in the New York Times. (Note a free subscription to view this article is available.)
• Arianna Huffington writes in Time that whether for preventing disease or optimizing the treatment of disease, the combination of sleep, food, movement, stress management, and connection is a “miracle drug.” She says, “The science is clear that when we improve these daily aspects of our lives, dramatic improvements in our health and well-being follow. The breakthroughs this can bring in our health aren’t over the horizon—they’re here right now.”

DELIVERY AND PAYMENT MODELS

• The Centers for Medicare & Medicaid Services (CMS) has released a Request for Applications (RFA)detailing model payment, care delivery, quality, and other policies for its new Making Care Primary (MCP) Model.  Interested applicants should submit their application via web portal by Thursday, November 30, 2023, at 11:59 p.m. EST.
• Health Affairs provides perspectives on CMS’ new States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model to give states incentives and flexibility to redesign care delivery while improving access. As with other demonstrations, states will volunteer to participate, applying in the Spring of 2024.
• New public opinion findings from United States of Care show that people want to receive high-quality, affordable health care and prefer payment models that prioritize quality of care over quantity of services. “The issue is, no one knows what value-based care is, and it remains misunderstood and unrecognized by the public.”
• In Vermont, a program to scale an accountable care organization (ACO) model across all major payers in the state successfully reduced Medicare spending, lowered hospitalizations, and improved patient care. It is highlighted in this AJMC article.
• In a press release, CMS announced that the Medicare Shared Savings Program saved money for Medicare while continuing to support high-quality care. Specifically, the program saved Medicare $1.8 billion in 2022 compared to spending targets for the year.
• Findings of a new study published in JAMA Internal Medicine suggest that better chronic disease management through intensive lifestyle intervention can improve labor market productivity among older adults with type 2 diabetes.

FOOD AS MEDICINE

• Pharmacy Today says food as medicine is real, and touches on some of the food as medicine content discussed at its recent 2023 Annual Meeting & Exposition.

HEALTHY AGING

• “Healthspan” rather than “lifespan” is increasingly being recognized as an important concept because it emphasizes the importance of not only living a long life but also living a healthy and productive life, as described in this Fortune Well article.

HEALTH EQUITY

• 2022 HEAL scholar Rosandra Daywalker, MD, DipABLM, was selected by the Association of Clinicians for the Underserved (ACU) as its 2023 Excellence in Health Equity Award winner.

BEHAVIOR CHANGE

• A study published in Journal of Consumer Research found that considering short-term costs of unhealthy behaviors (e.g., irritability or indigestion after eating sugar) better curbs these behaviors than considering long-term costs or no costs.

GUT HEALTH

• Associations among the gut microbiome, epigenome, and diet have not been studied together during obesity treatment until this study published in Nutrients of microbiota (MB), DNA methylation (DNAme), and diet prior to and during a behavioral weight loss intervention.

CHRONIC DISEASE

DEPRESSION

• A healthy lifestyle reduces the risk of depression, new research published in Nature Mental Health has found. The study received media coverage, such as this NPR podcast from Allison Aubrey.
• This article in MDdge Psychiatry says that clinicians suggesting lifestyle behavior change make a strong statement to the patient that treating psychiatric disorders can be about more than passively swallowing a pill.
• A study published in Scientific Reports, based on longitudinal data from tens of thousands of South Korean adults, has found that increased consumption of sugary carbonated beverages is linked to a higher likelihood of depressive symptoms, irrespective of weight or blood sugar factors.

DYSLIPIDEMIA

• Statins vs. fibrates for dyslipidemia are compared in this Medscape article.

TYPE 2 DIABETES

• This systematic review published in Diabetes and Metabolic Syndrome: Clinical Research and Reviews showed several herbs could be considered as a valuable adjuvant therapy regarding glycemic control of type 2 diabetes patients.

CANCER

• A cohort study just published in JAMA Network Open shows the incidence rates of cancer among people younger than 50 in the U.S. increased from 2010 to 2019. Although breast cancer had the highest number of incident cases, gastrointestinal cancers had the fastest-growing incidence rates among all early-onset cancers.  Another analysis just published in BMJ Oncology shows global incidence of early-onset cancer increased by 79.1% and the number of early-onset cancer deaths increased by 27.7% between 1990 and 2019.
• Consuming more plant-based food is preventative to prostate cancer but also beneficial after diagnosis to reduce the risk of progression and side effects after treatment, according to this Urology Times article.

BRAIN HEALTH

• A study published in the Journal of Alzheimer’s Disease showed the brains of patients with Alzheimer’s had substantially lower concentrations of some, but not all, xanthophylls, carotenes, and tocopherols, and several-fold higher concentrations of an unidentified xanthophyll metabolite (XMiAD).
• This Conversation feature discusses brain health and aging, and how lifestyle changes could help prevent up to 40% of dementia cases.

PILLARS

PHYSICAL ACTIVITY

• Exercise physiologist Christopher Travers, MS, explains in Cleveland Clinic Health Essentials why swimming and other aquatic exercises like water walking and water aerobics are so good for the body and mind.
• Moving quickly, even for as little as three minutes a day, may lower your risk of developing more than 10 types of cancer, a new study published in JAMA Oncology found.
• The commitment to physical activity and making it stick is the subject of this Psychology Today article.
• British research published in Diabetes Care, based on data from more than 18,000 participants in the U.K. Biobank, suggests that the minimal level of self-reported activity to reduce the risk for both neuropathy and nephropathy may be the equivalent of less than 1.5 hours of walking per week.

NUTRITION

• As reported in Tufts Now about the largest such study to date, an analysis of participant records by Friedman School of Nutrition Science and Policy researchers found programs that provide free fruits and vegetables have measurable benefits for health and food security.
• An article published in the International Journal of Disease Reversal and Prevention reviewed several large studies linking cancer to dairy consumption and pointed to two possible reasons why milk may increase prostate cancer risk.
• The Economist devoted an entire special edition to food. Find it here.

STRESS MANAGEMENT

• The American Heart Association News explores venting for stress management in this article.

PARTNERS IN THE NEWS

• The Corewell Health Teaching Kitchen, part of its lifestyle medicine practice, was featured on ABC13 in Grand Rapids, Michigan.

MEMBERS IN THE NEWS

• Lifestyle medicine specialist Amber Orman, MD, DipABLM, says nutrition is just as important to the fight against breast cancer as a patient’s medical treatment in this Kissimmee, Florida, Spectrum News segment.
• Monique Middlekauff, PhD, DipACLM, with St. Luke’s Lifestyle Medicine, tells KVMT 10 in Twin Falls, Idaho, that most Americans tend to do pretty well with cardio, but it’s the strength training where people struggle.
• ACLM Director of Guidelines and Quality Rich Rosenfeld, MD, MPH, MBA, was a guest on a “Run to the Top” episode dedicated to lifestyle medicine, plant-forward eating and healthy supplements for runners.
• Elevance Health interviewed its new Food as Medicine Director and ACLM member Kofi Essel, MD, MPH, FAAP.
• Former ACLM President Dexter Shurney, MD, MBA, MPH, FACLM, authored “The Evolution of Lifestyle Medicine” in the September 2023 issue of American Journal of Health Promotion (AJHP).
• A feasibility pilot on culinary medicine e-consults headed by Jaclyn Albin, MD, DipABLM, was published in Nutrients.

LMIGs IN THE NEWS

• The Greenville chapter of Walk with a Future Doc, organized by medical students and run by the USC SOMG Lifestyle Medicine Interest Group, received recent mention in the Greenville News.

ACLM Advocacy Priorities in Support of its Members and Lifestyle Medicine

By Jean Tips, Sr. Director of Communications & Public Affairs

One year after the White House Conference on Hunger, Nutrition and Health, we take a look at ACLM’s advocacy efforts on behalf of our members since we began that work in 2019. Our priority areas of focus are lifestyle medicine in medical education; reimbursement and quality measures; health equity as it relates to lifestyle-related chronic disease health disparities; and military health for recruits and active-duty personnel.

Included in the wide array of American College of Lifestyle Medicine’s member benefits is ACLM’s bipartisan advocacy work on Capitol Hill in support of the integration of lifestyle medicine as the foundation of healthcare and, more specifically, to support our members in their clinical practices. We began our advocacy activities in 2019, initially focused on introductions and orientations with key Congressional members and staff, as well as key representatives of federal agencies such as the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS).

As a 501(c)(3) nonprofit organization, ACLM is a tax-exempt entity that is prohibited from engaging in certain types of political activities such as lobbying. However, we can work to influence and provide critical background for federal stakeholders involved in areas of public policy and issues that affect our work.  Over the past four years, our priorities have remained the same: 1) advance lifestyle medicine, including food as medicine, in medical and other health professional education, 2) remove reimbursement barriers and improve quality measure misalignment, 3) improve military health as a matter of national security and military preparedness, and 4) foster health equity by addressing lifestyle-related chronic disease health disparities.

We have executed our work with the deft on-the-ground assistance in D.C. of health policy consultants Alston and Bird.

Our ongoing work to date has included a variety of tactics:

• continued introduction, briefing, and relationship management of key legislative champions and their staff, especially those who are members of committees of jurisdiction governing healthcare and key caucuses
• direct origination of responses to requests for information (RFIs) from Congress and federal agencies such as CMS on topics that include the Physician Fee Schedule and Agriculture Improvement Act (the “Farm Bill,”) as well as sign-on to other organizations’ letters related to specific lifestyle-related topics
• identification of, membership in and collaboration on the work of special advocacy-related nonprofits and industry partners (such as the Primary Care Collaborative, Partnership to Fight Chronic Disease, Population Health Alliance, Physical Activity Alliance, Diabetes Advocacy Alliance, and The Root Cause Coalition) and legislation-specific groups (such as the Medical Nutrition Therapy Act Coalition) to amplify efforts with a larger and more influential voice
• support to onsite visits of ACLM member practices for key Congressional staff and agency members
• obtaining “a seat at the table” at key summits and public forums, often comprising ACLM leadership and members providing testimony to present their views and influence reports and decision-making, including for the Dietary Guidelines for Americans 2025-2030
• proposal of lifestyle-medicine language insertion to bills and proposed regulations
• “ear-to-the-ground” scanning of activities and opportunities
• media engagement through op-eds and pitches to raise awareness of lifestyle medicine and its role and relevance in current conversations, in both industry and consumer media outlets

Nutrition in Medical Education

Not long after starting our advocacy work came the COVID-19 pandemic and the glaring public realization of the obvious role chronic disease (“underlying conditions”) played in the worst cases and outcomes of COVID-19, especially among our most vulnerable populations. The “silver lining,” if you will, has been the awareness of the urgent need to address lifestyle-related disease root causes.  The cracks in our state of national health were so alarming and the causes so apparent that the phrase “diet-related disease” has become frequently used on Capitol Hill.

With the growing realization of diet’s relationship to chronic disease, and at the urging of Rep. Jim McGovern and others, came last fall’s White House Conference on Hunger, Nutrition and Health, the first of its kind in 50-plus years. It was an advocacy milestone for ACLM and a watershed for visibility.

ACLM made a $24.1 million commitment highlighted at that event to provide 5.5-hours of complimentary CME/CE/MOC through our Lifestyle Medicine and Food is Medicine Essentials online course, offered to 100,000 clinicians, and half the cost of certification for one primary care provider in each of our nation’s ~1,400 Federally Qualified Health Centers (FQHCs).

Now a year out from that seminal event, nearly 30,000 clinicians have registered for the course, and state funding partnerships are being launched on the FQHC portion of the commitment, which we now refer to as ACLM’s National Training Initiative . Health systems and insurance companies have offered the course to their employees and networks. ACLM has been invited to multiple stakeholder events organized on the topic of “food as medicine,” something that the College has championed since its inception in 2004, long before COVID or the White House Conference.

Visibility of ACLM on the national stage around our work on the first of our priorities has accelerated to a level far greater than ever expected when we started advocacy four years ago, and the Essentials course commitment has opened invitations to never-expected conversations, meetings, and partnerships. For example, ACLM is forging new partnerships to provide the complimentary course to organizations such as the National Medical Association, American Women’s Medical Association and Association of Clinicians for the Underserved. Other activity has recently included presentations and meetings with the Association of American Medical Colleges (AAMC), Accreditation Council for Graduate Medical Education (ACGME), and American Association of Colleges of Osteopathic Medicine (AACOM).

Now we are doubling down on the commitment, expanding the availability to 200,000 clinicians, extending the opportunity for complimentary registration in this $220 course offering through September 2025. Ongoing post-conference work includes attending monthly progress calls with the White House staff and reporting  to the Centers for Disease Control (CDC) Foundation, the agency charged with monitoring all commitments that were made.

Reimbursement

Reimbursement has been a multifaceted priority area focused on the points of pain our members experience in their daily practice of lifestyle medicine, specifically in payment and misalignment of quality measures that affect payment. Lifestyle medicine delivery simply does not fit existing payment and incentive structures, and, in general, there is a lack of incentives to restore a patient’s health.

Overall, fee-for-service (FFS) models do not easily support the delivery, reimbursement or incentivization of intensive lifestyle medicine care by a multi-disciplinary team of clinicians, often in a group-visit environment.

The following are examples of the known issues within the FFS arena that ACLM is committed to addressing through advocacy on behalf of our ALCM members:

• a Relative Value Units (RVU)-based system that pays for volume of care, not for performance/outcomes
• misaligned incentives/quality measures that reward process, focus on pharmaceutical compliance, and penalize health restoration
• Evaluation and Management (E/M) coding and billing that doesn’t fit the longer, multiple visits and shared medical appointments required for behavior change through lifestyle medicine. In fact, billing the same patient for multiple visits creates perceived compliance concerns
• patient co-pays for frequent visits that create a financial burden and modifiers that are not universally covered for prevention much less treatment of disease
• lack of space in offices that are built for 1:1 patient visits and thus curtail shared medical appointments, but place-of-service (POS) requirements that limit access and reimbursement for patients in community settings such as schools, places of worship and teaching kitchens even though these address social influencers of health
• limited or no reimbursement for interdisciplinary care team members such as health coaches, RDNs, exercise physiologists, OTs/PTs, behavioral health professionals and RNs for delivering LM services

On the other hand, while decidedly a better payment model for lifestyle medicine, value-based payment models are not without their challenges. For instance, risk scoring pays providers for taking on high risk patients. But, when a patient gets better (i.e., reverses their chronic disease), the risk score for the patient goes down, and the payment to the provider also goes down. There is not an incentive, and in fact there is a financial penalty, to achieve health restoration for sick patients.

To correct these issues, advocacy will take time, as making changes are complex, bureaucratic, lengthy and, in some cases, financially prohibitive. Awareness among decision-makers of these barriers is a first step, so ACLM is commenting on such issues in requests for information and in meetings and other venues—protocol for being “on the record”—is essential to further action.

Military Health

Recently published research shows the health of our military recruits and active-duty military has deteriorated to the point of being a national security threat.  Lifestyle medicine is starting to be integrated, and ACLM has been working with several branches of the military and the VA/DOD through several of our member interest groups and diplomates to make this happen. The interest in lifestyle medicine training and certification within military healthcare has been growing consistently and several large-scale training programs are in development.

Our specific strategy for advocacy is in its early stages, but being discussed as one idea is how to expand the incorporation of our Lifestyle Medicine Residency Curriculum into military residencies, beyond those residency programs already engaged.

Health Equity

ACLM’s federal advocacy for health equity focuses on strategies to provide lifestyle medicine access to historically medically underserved communities and lifestyle medicine knowledge to help underrepresented in medicine clinicians help patients make healthy lifestyle choices that curb lifestyle-related chronic disease health disparities.

These strategies to date have included conversations with health equity champions in Washington, D.C., such as the Congressional Black Caucus and CMS Office of Minority Health in order to introduce them to ACLM, to lifestyle medicine and to the efforts of our HEAL (Health Equity Achieved through Lifestyle Medicine) Initiative. We also are identifying and starting partnership conversations with minority medical associations such as the National Medical Association and National Association of Hispanic Nurses to offer the Essentials course  and potentially join forces in advocacy efforts to support their underrepresented in medicine (UIM) members who are often on the front lines of providing care to minority patients.

Other advocacy efforts in support of health equity include participating in opportunities in which we can learn about the policy efforts that align with addressing lifestyle-related chronic disease health disparities in underserved communities. For example, ACLM’s Director of Advocacy and Health Equity Stacia Johnston this year has participated in the Congressional Black Caucus Foundation’s recent Policy for the People Health Equity Summit and CMS’ inaugural Health Equity Conference, which convened policymakers and community stakeholders to discuss ways to address social influencers of health on a federal level to create sustainable impact in historically disadvantaged communities.

ACLM has also supported onsite meetings of Congress members and staff and CMS staff to showcase ACLM members who are doing lifesaving work in communities of need.

FQHCs, which provide invaluable health services to upwards of 30 million patients in vulnerable populations across the country, are ACLM’s new health equity focus area. To learn how to reach FQHC clinicians with lifestyle medicine resources and determine advocacy opportunities, we have met with senior leadership of the Health Resources and Services Administration (HRSA) and the Association of Clinicians for the Underserved (ACU), and exhibited at the National Association of Community Health Centers (NACHC) CHI & Expo, the largest conference for community health center professionals.

Four years into its advocacy work, even if disrupted somewhat by the pandemic, ACLM is making significant progress in influencing those on The Hill to understand the value of lifestyle medicine as the foundation of health and make it easier to practice this high-value care so critical to the success and sustainability of our nation’s healthcare going forward.

Making the Healthy Choice the Easy Choice with Lifestyle Medicine

Dr. Meagan Grega co-founded an organization to transform the “choice architecture” in her Pennsylvania community so that unhealthy options are no longer the default lifestyle choice.

A leader in lifestyle medicine is at the forefront of an ambitious effort to make healthy choices the easy choices for families in eastern Pennsylvania’s Lehigh Valley.

Meagan Grega, MD, DipABLM, FACLM, co-founder and chief medical officer of the nonprofit Kellyn Foundation, spearheads a unique and collaborative healthy neighborhood immersion initiative to improve the short- and long-term health of the almost 700,000 people living in this one-time steel manufacturing hub north of Philadelphia.

The program utilizes schools and other community locations to pursue four areas of focus: access to healthy food, intensive lifestyle medicine interventions, school programming and teaching families to prepare delicious and healthy meals. Kellyn Foundation impacts more than 10,000 students in 36 elementary schools within nine school districts annually. Since 2016, it has operated the Eat Real Food Mobile Market, selling 136,000 pounds of nutrient-dense food during the past year in areas that lack access to healthy food options. The intensive lifestyle intervention program has documented success reducing HgbA1c levels of participants with prediabetes into the normal range over a three-month period.

Dr. Grega, who earned lifestyle medicine board certification in 2017 and is a faculty member implementing ACLM’s Lifestyle Medicine Residency Curriculum in the family medicine and internal medicine residency programs at St. Luke’s University Health Network-Anderson Campus, said the Kellyn program’s longevity and impact has attracted attention from other communities interested in replicating the model.

“Our big picture strategy is focusing on how we can shift the social norms of our community to healthier choices, and how can we shift the choice architecture so that healthy options are the default choice,” Dr. Grega said. “Making the healthy choice the easy choice is our mission for what we do in the Lehigh Valley.”

‘I wish I could do that too’

Dr. Grega has practiced family medicine for over 25 years and co-founded the Kellyn Foundation in 2007. In the early 2000s, she had noticed a great deal of obesity in both adult and pediatric patients.

“I knew the parents I treated already had diabetes, hypertension and heart disease; but I saw that their children were on track to develop the same diseases their parents had,” Dr. Grega said. “I saw increasing pediatric obesity and decreased cardiorespiratory fitness among kids who couldn’t run a lap around the gym without getting out of breath. I was providing lifestyle counseling during well checks but wasn’t making an impact. And there was nowhere to refer them that could support the children and their families in shifting to healthier lifestyle choices, especially in regard to physical activity, restorative sleep, stress management, decreased screen time and nutrient-dense food.”

She shared her frustration with a family friend and businessman, Eric Ruth, who suggested they cofound an organization that would impact the health of Lehigh Valley children and their families. She decided to change the trajectory of her career and try to build the type of programs that she wished she could refer her patients to.

“Some friends and family members said ‘You went to an Ivy League medical school, devoting all these years to medical training and building a practice and now you’re just going to stop?’” Dr. Grega said. “But when I told my colleagues in family medicine or cardiology or gastroenterology what I was planning to do, every one of them said ‘I wish I could do that, too.’”

Neighborhood Immersion

The Kellyn Foundation initially offered an intensive lifestyle medicine intervention program for families. It included three months of structured group nutrition and physical activity classes, along with individualized lifestyle assessment and goal setting. It was largely successful in teaching new lifestyle habits. But once families completed the program, they almost always struggled to maintain those habits when they were no longer surrounded by a supportive environment.

Educating and supporting families in making healthy choices during the intensive intervention accomplished little if once the families returned to their regular routines and social interactions the conditions reverted to those most conducive to make unhealthy choices. That realization led to the creation of the Kellyn Foundation “Healthy Neighborhood Immersion Strategy,” which grew to include the following:

• Kellyn Food Access strives to ensure that neighborhoods have healthy whole food options that are convenient and affordable, including local produce and delicious, prepared lifestyle medicine meals. Consistent weekly visits by the Eat Real Food Mobile Market deliver fresh produce to community gathering spots and includes nutritional education, recipes and food samples.
• Kellyn Kitchens provides medically based, hands-on cooking classes at senior centers, schools and community centers, as well as for employers. The classes are designed to embrace individual food heritage and cultures while providing a deep understanding of the benefit of a plant-predominant eating pattern.
• Kellyn Schools educates elementary school children, their families and teachers on healthy foods and lifestyle choices. Participants learn how to grow food from seed and to train their taste buds to enjoy healthy food.
• Kellyn Lifestyle Medicine provides the education, tools, and support that allow families and individuals to reduce disease risk factors with a scientifically proven intervention through the adoption of better health habits and appropriate lifestyle modifications. The program serves community groups and ​self-insured employers, including healthcare systems, school districts and institutions of higher learning.  Additionally, the program engages resident physicians and medical students from Lewis Katz School of Medicine Temple University, introducing them to the power of lifestyle medicine approaches.

Doctors often refer patients to the program. Testimonials collected by the Kellyn Foundation reflect the program’s popularity among the individuals who benefit.

“I lost 17 pounds, dropped two pant sizes, lowered cholesterol, decreased medication, slept better and lowered blood sugar to normal levels,” a participant in a therapeutic lifestyle change program said. “The Kellyn staff were informative, caring, and available, making the changes that I wanted to make easier.”

A customer at the Eat Real Food Mobile Market said “I have diabetes and I have a hard time getting things to prepare for me. With the fresh produce, I was able to add different things to my meals. All thanks to this program.”

Here to Stay

The program is funded by a variety of sources, including foundation, government and community grants, individual donors and corporate sponsorships. More than 1,300 unique individuals utilized food-as-medicine prescription vouchers to purchase fruits and vegetables at the Eat Real Food Mobile Market during the past year. Kellyn Foundation hosts Lehigh Valley VegStock, an annual fundraising event with live music, healthy food vendors and artisans, family friendly activities and lifestyle medicine educational lectures.

“To pursue this path, you have to piece the funding together. I wish I could pay our wonderful staff more, because they are passionate advocates dedicated to helping our community to live long, healthy lives filled with vitality and purpose,” Dr. Grega said. “Funding is always a challenge. But once you are able to fully integrate into the fabric of the community and demonstrate that you are not only going to do this for a year or two and leave when the grant funding runs out, then people become more and more motivated to support the programs. They see the impact it has on the health of their community.”

It is hard but immensely satisfying work to assist people in accessing healthy food, learning new cooking skills and reversing their chronic diseases, she said. And other community efforts can make the same impact.

“We would love to help others launch similar initiatives by sharing the lessons we have learned,” Dr. Grega said. “In the end, the most important ingredients are relationships and a willingness to commit for the long haul while always being open to evolving your approach based on the partnerships available and the feedback of the community.”

Meeting People Where They Are: A Community Health Center’s Approach to Lifestyle Medicine

Medical students from A.T. Still School of Osteopathic Medicine collaborated with Kent, Washington’s Pacific Islander community to improve their health through culturally sensitive dietary changes, resulting in a 67% increase in vegetable and fruit consumption and 83% positive feedback on dietary choices and education.

An Article Written by: Ruth Michaelis, MD, DipABLM, FAIHM

Each year, our Community Health Center’s (CHC) embedded osteopathic medical students from A.T. Still School of Osteopathic Medicine in Mesa, Arizona, work with CHCs across the country to address health-related issues impacting historically medically underserved communities. At any given year, Health Point, the clinic that I’ve worked at for the last 21 years, hosts up to 30 medical students from A.T. Still.

This year, the third-year medical students placed at our clinic chose to work with the local Pacific Islander community near our Kent, Washington, Community Health Center after data from our clinic showed that these patients had higher hemoglobin A1c (HbA1c) levels than other patients. Pacific Islanders represent five percent of my clinic’s patient population, yet nearly 10 percent of those patients have been diagnosed with diabetes.

Our medical students wanted to learn more about this unique patient population as a way to inform a strategy to help them make healthier lifestyle changes. Starting with a visit to a Pacific Islander neighborhood grocery store, they got first-hand accounts of this ethnic group’s preference when it came to traditional ingredients.

“To effectively connect with a community, it’s essential to immerse within culturally resonant dietary options while placing emphasis on patient autonomy,” said Adam Martorana, A.T. Still School of Osteopathic Medicine medical student. “This creates a powerful tool for empowering individuals within the population, driving lasting and meaningful change.”

In addition, Martorana and the other rising physicians met with local church leaders to find out more about culturally relevant recipes and the community needs around health and nutrition. There were several emerging themes, but the dominant one was the notion around honoring what individuals from the Pacific Islander community consider to be “traditional foods.”

Lifestyle medicine can address up to 80% of chronic diseases. Lifestyle medicine certified clinicians are trained to apply evidence-based, whole-person, prescriptive lifestyle change to treat and, when used intensively, often reverse such conditions. Undoubtedly, food and nutrition are gamechangers when it comes to treating diabetes and lowering HbA1c levels. The nutritional aspect coupled with the other pillars of lifestyle medicine—physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connections—are also effective in treating cardiovascular diseases and obesity.

When working with historically medically underserved groups, who are at a higher risk for lifestyle-related chronic disease, it is important to understand their cultural norms and how to work within those means to make realistic nutritional plans and adaptations to their diets. That said, the medical students decided to adapt traditional recipes to incorporate many of the same foods (even meat) and with a healthier ingredient list.

They cooked the foods, taste-tested them, and offered the meals to the community, for free, after a church service. There, they gathered more feedback about the food and created modified recipes for breakfast, lunch, dinner, and even snacks. We created handouts of the recipes and a healthy food flyer that were available for congregants.

The Results:

When the students called the patients a few weeks later, they found their daily reported consumption of vegetables and fruits increased by 67%. Additionally, half of respondents started or increased the practice of measuring food portions, and 83% stated the provided information helped them improve dietary choices and interested them in further education.

Seeing this project come full circle, I am proud to serve as advisor for our medical students, who set out to better understand the patient population and launch a pilot that would put their cultural values first. We see from the data that pilots like this one have great potential because they’re created with realistic goals and in observance of and respect for cultural differences—a cornerstone of cultural competence.

“Normally, we are told what to change in our diets and lifestyles, which usually requires getting rid of our culture,” said a participant from the pilot. “Providing education and being willing to help us make smarter choices, while not changing our culture, opens up a lot more options and willingness from our community.”

Lifestyle Medicine News and Updates – Insider August 2023

Disclaimer: The information included in Insider is intended to give our readers a sense of what is happening in the news, research journals and other channels related to lifestyle medicine. Inclusion does not imply ACLM endorsement. Note that some links may require registration or subscription.

TOP NEWS:

• Lifestyle medicine champion Hans Diehl, DrHSc, MPH, FACN, 77, a member of the ACLM Advisory Board and founder of the Lifestyle Medicine Institute and the Complete Health Improvement Program (CHIP), passed away at Loma Linda University Medical Center on August 2, 2023, due to an AFib-related stroke. Read his full obituary here.
• Availability of ACLM’s 5.5-hour complimentary CME/CE/MOC Lifestyle Medicine & Food as Medicine Essentials course, a commitment highlighted at last fall’s White House Conference on Hunger, Nutrition and Health, has been extended to September 14, 2025, at 11:59 p.m. PT. Learn more and enroll here.
• Newly published research is the first to show success of a dietary intervention to reduce the need for insulin without drugs or surgery. The crossover trial, which showed effects of a DASH diet and a whole food, plant-based diet on insulin requirements and related cardiometabolic markers in individuals with insulin-treated type 2 diabetes, was explained in this Diabetes Research and Clinical Practice article by the research team spearheaded by ACLM members Thomas Campbell, MD, and Erin Campbell, MD, MPH, DipABLM.

PAYMENT

• LM2022 keynote speaker Robert Pearl, MD, was featured on a recent segment of the “Evolution of Medicine” podcast highlighting payment models that support lifestyle medicine.
• ACLM is hosting a members-only Lifestyle Medicine Reimbursement Summit on Saturday, Sept. 23, 2023, from 7:00 a.m.-12:15 p.m. PT.

HEALTH STATISTICS

• In a study published in JAMA Network Open comparing National Health and Nutrition Examination Survey trends in lifestyle factors among U.S. adults from 1999-2000 with those from 2017 to March 2020, improvements occurred in smoking habits, diet quality, and physical activity levels. However, a decrease occurred in healthy weight and there was no significant change in moderate or less alcohol consumption. It also showed worsening disparities by age group and persistent disparities by race, ethnicity, and socioeconomic level.
• The American College of Sports Medicine has released its 2023 ACSM American Fitness Index. The index aims to quantitatively measure the overall health and fitness level of the 100 largest cities by population in America based on 34 personal and community health indicators, including physical activity levels, access to parks, recreational facilities, and healthy food options.

MEDICAL EDUCATION

• Medscape Medical News asked physicians what they learned in med school that they now contest. Interviewees included ACLM members Dolapo Babalola, MD, FAAFP, DipABLM, DipABOM; Bisi Alli, DO, DipABLM; and John McHugh, MD, FACOG, DipABLM, FACLM.

PRIMARY CARE

• Healthcare Dive recently published an op-ed, “Strengthening primary care key to fix healthcare system woes,” authored by ACLM strategic partner Primary Care Collaborative’s President and CEO Ann Greiner and AAFP EVP and CEO Shawn Martin.

CHRONIC DISEASE

OBESITY

• Intensive lifestyle intervention was one of three keys for obesity treatment recommended in this recent AMA article.
• Strategies to improve the implementation of intensive lifestyle interventions for obesity are explored in this Frontiers in Public Health opinion piece.

DIABETES

• ACLM member Rob McNab, DO, FACP, FACOI, writes about how he uses lifestyle medicine for his own diabetes over the course of a day in this Joplin Globe article.

ADHD

• The use of lifestyle medicine for ADHD is discussed in this Medium story.

PILLARS

NUTRITION

• What to eat in hot weather was examined in this Time article.
• Each 50 mg higher intake of dietary nitrate from vegetable sources per day was linked to an 8% lower dementia risk, according to this study published in American Journal of Clinical Nutrition.
• Ultra-processed foods may raise mortality risk in patients with type 2 diabetes and healthy diet may not be enough to overcome the negative effects, according to this study published in American Journal of Clinical Nutrition.
• All things fiber are discussed in this recent article published in The Conversation.

SLEEP

• The American Academy of Sleep Medicine offers tips to help you talk to your patients about healthy sleep.

PHYSICAL ACTIVITY

• Weekend warriors are supported by a new study published in JAMA that shows efforts to optimize activity, even if concentrated within just a day or two each week, should result in improved cardiovascular risk.
• Research from Poland published in the European Journal of Preventive Cardiology has shown that as few as 3,967 daily steps reduce your risk of early death from any cause, and if you only do 2,337 steps, you still decrease your risk of dying from cardiovascular disease.

SOCIAL CONNECTION

• In a nationally representative study of 11,517 older adults published in the Journal of Internal Medicine, social isolation was significantly associated with higher odds of skilled nursing facility stays and nursing home placement, but not with hospitalization.

AVOIDANCE OF RISKY SUBSTANCES

• Drinking just one alcoholic beverage a day is enough to raise blood pressure (BP) in healthy adults, results of a “dose-response” meta-analysis published in Hypertension
• Just how bad is alcohol? NBC News had eight experts weigh in on the risks and supposed benefits of drinking.

HYDRATION

• Fortune examines how much water to drink in this feature.

WELL-BEING

• ACLM staff and members published a study in the American Journal of Health Promotion showing those clinicians using a greater proportion of lifestyle medicine in their practice experience less burnout.

PLANETARY HEALTH

• Oxford scientists say a vegan diet is massively better for the planet, in a study published in Nature Food.

PARTNER NEWS

• Bitewell, a food-as-medicine marketplace for employers, has closed a $4 million seed round of funding. The Denver-based company is the first-ever corporate food health benefits provider, according to this Axios Pro article.

MEMBER NEWS

• Lifestyle medicine luminaries Michael Parkinson, MD, MPH, FACPM; Ron Stout, MD, MPH-HA, FACLM; and Wayne Dysinger, MD, MPH, DipABLM, FACLM, have authored an article on lifestyle medicine for prevention, treatment and reversal of chronic disease.
• Naomi Parrella, MD, chief of lifestyle medicine at Rush University in Chicago, was interviewed for this Women’s Health article on menopausal weight gain.
• ACLM members Terri Stone, MD, FACP, DipABM; Milette Siler, RDN; and Jaclyn Albin, MD, DipABLM, were part of a team that authored an article in Dove Press on the case for culinary medicine in teaching kitchens.

FOOD FOR THOUGHT

• An analysis published in European Heart Journal and reported on in MDedge that was based on the international Prospective Urban and Rural Epidemiological (PURE) study as well as data from five other international trials showed things that don’t usually end up in heart-protective recommendations.
• A writer in ConscienHealth says that although nutrition is quite important for managing diabetes and obesity, it is not a substitute for medicine and challenges sloganizing “food is medicine.”
• The food-as-medicine movement is gaining momentum, but there are several challenges, according to a PitchBook report that was reported on by MedCity News.
• Stanford nutritional scientist Dr. Christopher Gardner offers thoughts on whether a plant-based or animal-based diet is better in this Clinical Endocrinology News commentary interview.
• A recent study published in The Lancet indicates that advanced agers share three significant things in common regarding movement, sleep, and mental health.
• Laughter really is the best medicine, says University of Warwick researcher Dr. Stephanie Schnurr.

Developing Solutions to the Lifestyle-related Threat to U.S. National Security

The same lifestyle-related health issues that have had a long-standing impact on disease and death in the U.S. are now recognized as an immediate threat to national security. This threat spans throughout every stage of the military lifecycle, significantly impacting recruitment, retention, and readiness across all branches of the U.S. Armed Forces; veteran populations are also disproportionately burdened by these lifestyle-related health concerns . Recent military media reports have highlighted this problem, but missing from media coverage thus far have been the collaborations across government, NGOs, industry, and academia, providing evidence-based solutions for the problem.

The Need for Sustainable Health Solutions is Clear

Recent studies show the vast majority of age-eligible Americans are unfit for military service. A 2022 Pentagon study shows that 77% of young Americans would not qualify for military service without a waiver due to being overweight, having mental or physical health problems, or a history of prior drug use. This is an increase from the Pentagon’s 2020 Qualified Military Available Study that shows a 6% increase from the 2017 Department of Defense research that showed 71% of Americans would be ineligible for service.

Another recent study showed that recruits from Southern States, which have higher prevalence of chronic disease, are generating a disproportionately higher health care cost burden that is linked to significantly higher rates of musculoskeletal injures (MSKIs) sustained during basic training. MSKIs are considered the greatest medical impediment to military readiness, are highly correlated with physical fitness, and cost the U.S. Department of Defense an estimated $3.7 billion annually across all service branches. In this most recent study, Army recruits from a cluster of Southern states accounted for nearly 50% of total national costs related to MSKIs amongst all Army recruits nationally.

In addition, another recent study showed that between 2018 and 2021, the prevalence of obesity, prediabetes, and diabetes increased among active service members. The largest relative increases in obesity prevalence were in the youngest (<30 years) age categories. This is of significant concern as service members with elevated BMI and other metabolic disorders may not meet requirements for theater deployment.

Lifestyle Medicine Practice is Growing Within the Military

However, efforts are underway to solve this alarming issue. The breadth of lifestyle medicine practice is growing within the military as a whole. Already, there are multiple clinics implementing Lifestyle & Performance Medicine approaches to optimize warfighter health in the U.S. Air Force and U.S. Navy, as well as the National Guard and Reserve. These clinics deliver the same foundational six tenets of lifestyle medicine with an added focus on human performance and typically integrate care deliver through a range of various health care providers across many specialties. There are also eight military graduate medical education programs that have adopted the lifestyle medicine residency curriculum.

Partnerships are Key to Making Further Headway

Some examples:

• The Air Force Lifestyle & Performance Medicine Working Group has formally adopted the field and practice of lifestyle medicine into what is rapidly gaining traction in the Department of Defense as Lifestyle & Performance Medicine. Focusing on not only preventing, treating, and reversing disease, but also leveraging human performance optimization, this approach to health maintenance is a modality to achieve preserved deployment readiness and sustain general health for service members. The foundations of this approach were developed in partnership with the American College of Lifestyle Medicine (ACLM). A recent news article highlights this work.
• The Physical Activity Alliance (PAA) is one of the nation’s broadest coalitions dedicated to promoting physical activity, with representation from government, industry, NGOs and academia. In an effort to address the national security crisis posed by a physically underactive population, the PAA recently supported the addition of a Military Settings Sector to one of its cornerstone initiatives, the National Physical Activity Plan (NPAP). The NPAP is a comprehensive set of policies, programs, and initiatives designed to increase physical activity in all segments of the U.S. population, in order to increase the health, safety, and security of the nation.
• The National Guard and the Uniformed Services University’s Consortium for Health and Military Performance (CHAMP) have collaborated in developing and delivering curriculum to Guard members to become “human performance optimization integrators.” These integrators return to their formations as embedded assets helping their fellow service members improve all aspects of their fitness, health, and readiness.
• The Citadel, American Heart Association and the University of South Carolina partnered with the U.S. Army Public Health Center to conduct the research cited above that highlights the MSKI problem and associated costs.
• Another research collaboration between CDC, private industry, and the Uniformed Services University resulted in this study published in the Journal of Preventive Medicine.

Initial Progress at the Policy Level

Efforts are also underway at the policy level. For example, IHRSA, the Global Health and Fitness Association, is urging that the FY 2024 National Defense Reauthorization Act include provisions for improved exercise programming and access for active-duty military personnel and families as well as pre-basic training recruits.

Former US Air Force Flight Surgeon Regan Stiegmann DO, MPH, FACLM, who has actively participated in integration of lifestyle medicine into the military, is optimistic about the potential it has for addressing the health issues impacting national security. “Implementing lifestyle medicine (and Lifestyle & Performance Medicine) are the most robust and evidence-based approaches to effectively and sustainably achieve the Military Health System and Defense Health Agency’s quadruple aim of improving readiness, improving health, improving care and decreasing cost,” Dr. Stiegmann said.

Advances in Lifestyle and Performance Medicine in the Military

A lifestyle medicine Story Project

Whole Food, Plant-Based Diets’ Impact on Insulin-Treated Type 2 Diabetes: A Breakthrough Study

A recent study published in Diabetes Research and Clinical Practice offers important insights into the potential benefits of adopting plant-based diets, specifically whole food, plant-based (WFPB) diets, to address insulin resistance and blood sugar control in patients with type 2 diabetes. The study titled “The Acute Effects of a DASH Diet and Whole Food, Plant-Based Diet on Insulin Requirements and Related Cardiometabolic Markers in Individuals with Insulin-Treated Type 2 Diabetes” was led by Thomas M. Campbell, MD, assistant professor of family medicine at the University of Rochester Medical Center.

Main Takeaway

The study’s key finding is that in individuals with insulin-treated type 2 diabetes, adopting a whole food, plant-based (WFPB) diet can lead to notable reductions in insulin requirements due to improved insulin sensitivity and reduced insulin resistance. Larger dietary changes, as observed with the WFPB diet, may result in even more substantial reductions in insulin.

Methodology and Results

Conducted as a nonrandomized crossover trial, the study involved 15 participants with insulin-treated type 2 diabetes. The participants underwent four one-week phases: Baseline, Dietary Approaches to Stop Hypertension (DASH) diet, WFPB diet, and a second round of DASH diet. Throughout the trial, participants were provided with ad libitum meals to ensure compliance. The results showed a reduction in insulin requirements by 39% after one week on the DASH diet, and a 49% decrease in insulin resistance after one week on the WFPB diet, along with other notable improvements in cardiometabolic markers.

Unique Aspects

This study is unique in its focus on a relatively advanced population of individuals with insulin-treated type 2 diabetes. Most nutrition interventions primarily target prevention or recently diagnosed cases. However, this study addressed the challenge of patients already requiring daily insulin, with an average dose of 90 units per day. Moreover, it achieved significant dietary changes in participants through provided meals and a whole food, plant-based approach.

Significance

Prior to this research, limited information existed for patients and healthcare providers on the potential speed and extent of insulin requirement adjustments when significant dietary changes were introduced. By offering valuable insights into the outcomes of individuals with advanced type 2 diabetes, the study helps physicians make informed decisions about insulin deprescribing when patients adopt a plant-based diet.

Application in Clinical or Academic Settings

This study has significant implications for clinical practice and academic research. Healthcare providers can use its findings to guide and tailor patient treatment plans, particularly when patients with insulin-treated type 2 diabetes transition to a plant-based diet. Physicians may anticipate reductions in insulin requirements, improved insulin sensitivity, and enhancements in related markers, contributing to more personalized and effective diabetes management.

In the Words of the Author

“If people with type 2 diabetes make large dietary changes toward unprocessed, plant-based diets, they may realize significant and rapid benefits. If they are on insulin, they may end up needing significantly less insulin while still achieving much better blood sugar control.”

Conclusion

This study offers valuable insights into the potential benefits of whole food, plant-based diets for patients with insulin-treated type 2 diabetes. It provides evidence for considering dietary interventions as part of a comprehensive approach to managing diabetes. By encouraging further research and exploration in this area, the study paves the way for potential advancements in diabetes management and improved health outcomes.

Read the full study: The Acute Effects of a DASH Diet and Whole Food, Plant-Based Diet on Insulin Requirements and Related Cardiometabolic Markers in Individuals with Insulin-Treated Type 2 Diabetes

If you are interested in learning more about the treatment of type 2 diabetes with a whole food, plant-predominant diet and other healthy lifestyle changes, while gaining essential skills to support medication de-escalation, the American College of Lifestyle Medicine (ACLM) offers a CME/CE course titled “Remission of Type 2 Diabetes and Reversal of Insulin Resistance with Lifestyle Medicine.” This comprehensive course equips healthcare professionals with evidence-based strategies and practical knowledge to effectively incorporate lifestyle interventions into their clinical practice, empowering them to guide patients towards improved diabetes management and better health outcomes.

Lifestyle Medicine News and Updates – July 2023

The information included in Insider is intended to give our readers a sense of what is happening in the news, research journals and other channels related to lifestyle medicine. Inclusion does not imply ACLM endorsement. Note that some links may require registration or subscription.

PRODUCE PRESCRIPTIONS

• In a study modeling implementation of a nationwide produce prescription program providing free or discounted fruits and vegetables to eligible Americans living with diabetes just published in the Journal of the American Heart Association, Tufts researchers projected at least a $40 billion reduction in national rates of cardiovascular disease and associated healthcare costs.

HEALTH EQUITY

• A newly issued policy from the American Medical Association’s Council on Science & Public Health advises doctors to pay less attention to body mass index (BMI) in determining if a patient is at a healthy weight, saying the measure does not predict disease risk equally well across racial and ethnic groups.
• The Supreme Court’s recent ruling on affirmative action will hurt healthcare, as diversity in medical school has life or death implications, according to this Bloomberg opinion author.
• A new series in The Lancet uses a health equity perspective to review the large body of work on diabetes and its consequences, and discusses the complex and intersecting ways in which structural inequity impacts social drivers of health and diabetes outcomes on a global scale. It predicts more than 1.3 billion people worldwide will have diabetes by 2050, more than double the current number.

CHRONIC DISEASE

TYPE 2 DIABETES

• The CDC recently published a research study about the use of incentives in lifestyle modification programs (like the National Diabetes Prevention Program) and how they can benefit participants.

CARDIOVASCULAR DISEASE

• Training materials and related resources for TAKEheart, an AHRQ initiative to help hospitals increase participation in cardiac rehabilitation, are available here.
• A research letter published in Circulation: Genomic and Precision Medicine discusses predicting the presence of raised coronary plaque among adolescents and young adults.

CANCER

• Following her own diagnosis, a Memorial Sloan Kettering Cancer Center researcher’s focus became plant-based diets for cancer patients, as featured in MSK News.

MENTAL HEALTH

• A JAMA Psychiatry article discussed findings of a clinical trial on the effectiveness of outpatient lifestyle intervention among 224 people with severe mental illness compared with treatment as usual. The lifestyle intervention was effective in reducing weight in people with severe mental illness and may lead to reduced risk of cardiometabolic disorders.
• A comprehensive study published in NeuroScience News underscores the alarming link between social isolation, loneliness, and heightened mortality risks. The meta-analysis, involving over two million participants, found a significant increase in all-cause mortality rates for socially isolated and lonely individuals, with risks exacerbated for individuals with pre-existing health conditions like cardiovascular disease or breast cancer.
• A Patient Centered Outcomes Research Institute (PCORI) study comparing meditation with medicine for patients with anxiety disorders is in progress.

PILLARS

NUTRITION

• The Washington Post examines ultra-processed food in this feature. [Note: requires subscription]
• Frequent nut consumption was linked to reduced cognitive decline for at-risk older adults, according to the results of research published in The American Journal of Clinical Nutrition.
• Medicare Advantage beneficiaries given home-delivered meals in the four weeks after being discharged from a hospital were not only less likely to be readmitted within 30 days, they were also less likely to die, according to a study in JAMA Health Forum.
• Only 5% of men and 9% of women are getting the recommended daily amount of dietary fiber, according to a study presented at the recent American Society for Nutrition’s Nutrition 2023 meeting.

PHYSICAL ACTIVITY

• The HHS Office of Disease Prevention and Health Promotion has issued its “Physical Activity Guidelines for Americans Midcourse Report: Implementation Strategies for Older Adults.”
• A systematic review and meta-analysis of exercise interventions on inflammation markers in patients with overweight/obesity and heart failure was published in IJC Heart and Vasculature.
• This study published in Cureus encourages clinicians to advise high-risk patients on physical activity for the reduction of weight in prediabetic, obese, and type 2 diabetes patients.
• Higher-intensity activity has greater effects on cardiorespiratory fitness and is likely to be more protective against the risk of developing and dying from certain cancers according to this study in JAMA Network Open.

SLEEP

• A study in Sleep Health explored another perk of regular power naps beyond logging additional sleep: that they can be positively linked to brain health.
• Short sleep negates benefits of exercise for the brain, according to a study published in The Lancet.

MILITARY HEALTH

• The six pillars of lifestyle and performance medicine continue to spread throughout care in the Military Health System, as reported in this Health.mil story featuring ACLM member and U.S. Air Force Col. (Dr.) Mary Anne Kiel, chair of the Defense Health Agency Primary Care Clinical Community.

PARTNERS IN THE NEWS

• A CDC research brief published in Preventing Chronic Disease by researchers from ACLM Health Systems Council member Massachusetts General suggests that taking a “food is medicine” approach could increase nutrition security for families and lead to reductions in children’s body mass index (BMI). The study examined receipt of plant-based family food packages from Mass General’s Revere Food Pantry during the COVID-19 pandemic.
• Better Therapeutics received FDA authorization for AspyreRx to treat adults with type 2 diabetes. It is the first prescription digital behavioral therapeutic device delivering a novel form of cognitive behavioral therapy via smartphone.
• More than 400 staffers from 37 Congressional offices participated in the Physical Activity Alliance’s 2023 Congressional Physical Activity Challenge. You can see the results here.

MEMBERS IN THE NEWS

• Dawn Lewis, PA, DrPH, MBA, MAS, DipACLM, who recently graduated alongside her daughter in public health at Loma Linda University, was featured in this Adventist Review story.
• Jennifer Rooke, MD, MPH, FACPM, DipABLM, explains why people with diabetes should keep fruit on the menu in this article she wrote for Blue Zones.
• Kofi Essel, MD, MPH, FAAP, the first-ever food as medicine director for Elevance Health (formerly Anthem), was interviewed by Modern Healthcare.
• Saray Stancic, MD, DipABLM, FACLM, producer of the 2019 documentary “Code Blue” is one of the physicians featured in “Docs Making Docs: How Filmmaker MDs Tackle Big Health Issues,” an article recently published in Medscape.
• Recent poster presenters at the International Conference of Nurses Congress included Karla Rodriguez, DNP, CNE, NC-BC, DipACLM; Meryl Fury, MS, RN; and JoAnne Evans, MEd, RN, PMHCNS-BC.
• South Carolina Public Radio interviewed Erika Blank, MD, DipABLM, about treating certain chronic conditions with lifestyle changes.
• Michelle McMacken, MD, DipABLM, was named as one of “The Most Influential Women Leaders in Health Promotion” in this American Journal of Health Promotion editorial.
• Dawn Woods, PharmD, DipACLM’s article, “Lifestyle Medicine Presents Unexpected Opportunity for Pharmacists,” was recently published in Pharmacy Times.
• Orlando oncologist Amber Orman, MD, DipABLM, shared how a plant-based diet can help cancer patients in this “Florida Foodie” podcast.

FOOD FOR THOUGHT

• To encourage plant-based diets, one writer in Behavioral Scientist suggests restaurants expand their plant-based selection and complement this expansion with changes to the structure of customer choices.
• One author, writing in Psychology Today, says we need to prioritize play.
• A satire of a physician’s typical day, as envisioned by a non-clinician healthcare MBA, was published in KevinMD.