Liana S. Lianov, MD, MPH


August 15, 2011

In This Article

Competency in Prescribing Lifestyle Interventions

In the summer of 2009, under the leadership of the ACPM and the ACLM, an expert panel with representatives from major physician organizations was convened not only to define lifestyle medicine, but also to identify core competencies for primary care providers who offer healthy lifestyle interventions and services. The panel issued the following statement: "Lifestyle medicine is the evidence-based practice of helping individuals and families adopt and sustain healthy behaviors that affect health and quality of life. Examples of target patient behaviors include but are not limited to eliminating tobacco use, improving diet, increasing physical activity, and moderating alcohol consumption."[9] Fifteen knowledge, skill, and practice areas were delineated, and a year of discussion ensued to secure consensus on the wording of both the definition and the competencies.

Lifestyle Medicine Core Competencies

  1. Promote healthy behaviors as foundational to medical care, disease prevention, and health promotion.

  2. Seek to adopt and follow healthy behaviors and create school, work, and home environments that support healthy behaviors.

  3. Demonstrate knowledge of the evidence that specific lifestyle changes can have a positive effect on patients' health outcomes.

  4. Describe ways that clinician engagement with patients and families can have a positive effect on patients' health behaviors.

  5. Assess the social, psychological, and biological predispositions of patients' behaviors and the resulting health outcomes.

  6. Assess patient and family readiness, willingness, and ability to make health behavior changes.

  7. Perform a history and physical examination specific to lifestyle-related health status, including lifestyle 'vital signs,' such as tobacco use, alcohol consumption, diet, physical activity, body mass index, stress level, sleep, and emotional well being. Based on this assessment, obtain and interpret appropriate tests to screen, diagnose, and monitor lifestyle-related diseases.

  8. Use nationally recognized practice guidelines (such as those for hypertension and smoking cessation) to assist patients in self managing their health behaviors and lifestyles.

  9. Establish effective relationships with patients and their families to affect and sustain behavioral change using evidence-based counseling methods and tools and follow-up.

  10. Collaborate with patients and their families to develop evidence-based, achievable, specific, written action plans, such as lifestyle prescriptions.

  11. Help patients manage and sustain healthy lifestyle patterns, and refer patients to other healthcare professionals as needed for lifestyle-related conditions.

  12. Have the ability to practice as an interdisciplinary team of healthcare professionals and support a team approach.

  13. Develop and apply office systems and practices to support lifestyle medical care including decision support technology.

  14. Measure processes and outcomes to improve quality of lifestyle interventions in individuals and groups of patients.

  15. Use appropriate community referral resources that support the implementation of healthy lifestyles.

These competencies were published in the Journal of the American Medical Association on July 14, 2010. The article serves as a call to action by underscoring the key role of healthcare providers as well as the need for a response and involvement by the larger medical community. In fact, the article was the first publication to use the term "lifestyle medicine" outside of a book review.[9] Application of these competencies into practice, such as leveraging the interdisciplinary team, using clinic processes to improve service flow, and linking to community resources, offers solutions to some of the barriers to the prescription of lifestyle medicine. Other barriers, such as reimbursement, will need to be addressed by the lifestyle medicine community's leadership. Practice improvement interventions are also needed to advance lifestyle medicine in the clinical setting. The need for these actions is incorporated into the competencies.


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