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          American College of Lifestyle Medicine. 
          It was edited and peer reviewed by  
          The Journal of Family Practice.
          Copyright © 2022
          Frontline Medical Communications Inc. 
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                                                                  |  JANUARY/FEBRUARY       |
                                                     VOL 71, NO 1                     2022    MDEDGE.COM/FAMILYMEDICINE
                                                                      A FAMILY PHYSICIAN'S  
                                                                           INTRODUCTION TO 
                                                                     LIFESTYLE 
                                                                    MEDICINE
        Contents 
        Acknowledgment                                           The entire A Family Physician’s Introduction to 
        S1                                                       Lifestyle Medicine supplement, including the online 
                                                                 exclusive articles below, can be found at https://
        Introduction                                             www.mdedge.com/familymedicine/Introduction-to-
        Making the Case for Lifestyle Medicine                   Lifestyle-Medicine.
        S2-S4 
        Defining Lifestyle Medicine: Six Pillars                 ONLINE EXCLUSIVES 
        Nutrition—An Evidence-Based, Practical Approach          Factors Affecting the Pillars of Lifestyle Medicine 
        to Chronic Disease Prevention and Treatment              The Call for Lifestyle Medicine Interventions 
        S5-S16                                                   to Address the Impact of Adverse Childhood 
        Lifestyle Medicine: Physical Activity                    Experiences
        S17-S23                                                  eS73-eS77
        Lifestyle Medicine and Stress Management                 Optimizing Health and Well-Being: The Interplay 
        S24-S29                                                  Between Lifestyle Medicine and Social Determinants 
                                                                 of Health 
        Sleep and Health—A Lifestyle Medicine Approach           eS78-eS82
        S30-S34 
        Avoidance of Risky Substances: Steps to Help             Power and Practice of Lifestyle Medicine in 
        Patients Reduce Anxiety, Overeating, and Smoking         Chronic Disease
        S35-S37                                                  Lifestyle Intervention and Alzheimer Disease 
                                                                 eS83-eS89
        Positive Social Connection: A Key Pillar of Lifestyle    Lifestyle Medicine as Treatment for Autoimmune 
        Medicine                                                 Disease 
        S38-S40                                                  eS90-eS92
        Power and Practice of Lifestyle Medicine in              Lifestyle Medicine Practice 
        Chronic Disease                                          A Coach Approach to Facilitating Behavior Change 
        Type 2 Diabetes Prevention and Management With a         eS93-eS99
        Low-Fat, Whole-Food, Plant-Based Diet
        S41-S47                                                  A Lifestyle Medicine Approach to Medication 
        Cardiovascular Disease and Lifestyle Medicine            Deprescribing: An Introduction 
        S48-S55                                                  eS100-eS104
        Primary Care Clinicians, Cancer Survivorship, and        Reimbursement as a Catalyst for Advancing Lifestyle 
        Lifestyle Medicine                                       Medicine Practices 
        S56-S61                                                  eS105-eS109
                                                                 A Framework for Culture Change in a Metropolitan 
        Lifestyle Medicine Practice                              Medical Community 
        Lifestyle Medicine: Shared Medical Appointments          eS110-eS116
        S62-S65                                                  An Approach to Nutritional Counseling for Family 
        Future Vision                                            Physicians: Focusing on Food Choice, Eating 
        Lifestyle Medicine Education: Essential Component        Structure, and Food Volume 
        of Family Medicine                                       eS117-eS123
        S66-S70
        The Future of Lifestyle Medicine for Family Physicians
        S71-S72
          Acknowledgments 
          The American College of Lifestyle Medicine would 
          like to thank the following people for their help with 
          manuscript preparation 
          Ron Stout, MD, MPH, FACLM, FAAFP
          Dexter Shurney, MD, MBA, MPH, FACLM, DipABLM
          Jean Tips, BS
          Susan Benigas, BS
          Micaela Karlsen, PhD, MSPH
          Alexandra Kees, BS
          Steven Mauro, BA, MS, LMFT
          TL Max McMillen, BA, ELS
          Paulina Shetty, MS, RDN, CPT, DipACLM
          With special appreciation to:  
          Frontline Medical Communications Inc.
          With special thanks to:
                         Ardmore 
                         Institute of Health ™
                                                Home of Full Plate Living
          Cover Images: Center: Jose Louis Pelaez Inc/Getty Images; Clockwise: Oliver 
          Rossi/Getty Images; Suntorn Somtong/EyeEm/Getty Images; Tetra Images/
          Getty Images; Enviromantic/Getty Images; PeopleImages/Getty Images
           
                                               Supplement to The Journal of Family Practice  |  Vol 71, No 1  |  JANUARY/FEBRUARY 2022    S1
          Making the Case  
          for Lifestyle Medicine
          Susan Benigas, BS; Dexter Shurney, MD, MBA, MPH, FACLM, DipABLM; Ron Stout, MD, MPH, FACLM, 
          FAAFP
          doi:10.12788/jfp.0296
                  wo global pandemics—SARS-CoV2 infection and                         Regarded by some as a new and emerging field, history 
                  obesity—recently intersected; this convergence exac-           indicates that components of lifestyle medicine were first 
                                                              1
          Terbated the virus’ most harmful effects  and dispro-                  documented as early as 2500 years ago. Hippocrates, the 
                                                               2,3
          portionately affected underserved communities.  To a large             Greek physician regarded as the father of medicine, often 
          extent, the underlying health conditions—reported by the               used lifestyle modifications, such as diet and exercise, to 
          US Centers for Disease Control and Prevention (CDC)—that               treat disease. He is quoted as saying, “Illnesses do not come 
          heightened vulnerability to the virus are lifestyle-related and        upon us out of the blue. They are developed from small daily 
          directly impacted by social determinants of health (SDoH) that,        sins against Nature. When enough sins have accumulated, 
          all too often, prevent the healthy choice from being the easy          illnesses will suddenly appear.” He is also reported to have 
                  4
          choice.  These unhealthy lifestyle behaviors increasingly affect       said, “Just as food causes chronic disease, it can be the most 
          healthcare expenditure, driving as much as 90% of healthcare           powerful cure.”
                         5
          dollars spent.  This has made the precepts of lifestyle medicine            Today, 60% of American adults—and, sadly, too many 
          (LM) more relevant and more urgently needed than ever.6                children—now live with at least 1 chronic disease, and more 
                                                                                                                                       7
               LM, as defined by the American College of Lifestyle               than 40% have been diagnosed with 2 or more.  Too many 
          Medicine (ACLM), is the use of evidence-based, lifestyle,              physicians and patients alike may believe they are victims 
          therapeutic intervention—including a whole-food, plant-                of their genes and they are destined to become chronically 
          predominant eating pattern, regular physical activity, restor-         ill and dependent on pharmaceuticals. It should be alarm-
          ative sleep, stress management, avoidance of risky substances,         ing that type 2 diabetes (T2D) can no longer be referred to 
                                                                                                                                  8
          and positive social connection—as a primary modality, deliv-           as “adult-onset diabetes” as many children  are now being 
          ered by clinicians trained in these modalities, to prevent, treat,     diagnosed with this lifestyle-related chronic condition. The 
                                                                                                                                       9
          and often reverse disease. ACLM’s vision is to have lifestyle          occurrence of Alzheimer’s disease, linked to T2D,  is also ris-
          medicine be the foundation of all healthcare, fully integrated         ing at startling levels. 
          into family medicine and primary care.                                      Early detection of chronic disease has too often been 
                                                                                 defined as prevention; despite early detection, trends of obe-
                              1                                                  sity, T2D, hypertension, and cardiovascular disease continue 
           Susan Benigas, BS  
                                                                                                           10,11 
                                                                                 their upward trajectory.
                                                                2
           Dexter Shurney, MD, MBA, MPH, FACLM, DipABLM                               Mounting evidence indicates that modifiable behavioral 
                                                 3                               risk factors drive the leading causes of mortality in the United 
           Ron Stout, MD, MPH, FACLM, FAAFP
                                                                                 States.12 The Institute of Health Metrics and Evaluation, in its 
           AUTHOR AFFILIATIONS                                                                                              13
                                                                                 2019 Global Burden of Disease Report,  analyzed data from 
           1 
            Executive Director, American College of Lifestyle Medicine,          more than 190 countries and found that what people eat, and 
           Chesterfield, MO                                                      fail to eat, is the leading cause of disease and death. 
           2
            Senior Vice President, Chief Medical Officer Well-Being Division,         Addressing lifestyle is recommended as a first-line treat-
           Adventist Health and President, Blue Zones Well-Being Institute;                                                            14 However, 
           Past-President, American College of Lifestyle Medicine, Roseville, CA ment option in many chronic disease guidelines.
           3                                                                     when surveyed, physicians indicate having received little 
            President & CEO, Ardmore Institute of Health, Ardmore, OK
                                                                                                                                                  15
                                                                                 training in clinical nutrition and LM therapeutic modalities.
           DISCLOSURES                                                                Promising change, though, is underway: Patient demand 
           The authors have no conflicts of interest to disclose.                is mounting, and provider awareness is growing about the 
           S2      JANUARY/FEBRUARY 2022  |  Vol 71, No 1  |  Supplement to The Journal of Family Practice