Liana S. Lianov, MD, MPH


August 15, 2011

In This Article

Lifestyle Medicine Begins Outside the Clinical Setting

The competencies offer a common goal and direction to obtain training and develop and implement the skills for patient encounters. Moreover, the competencies call for action outside of the clinical setting. Healthcare providers can lend their expertise and authority in the community by serving as leading advocates on behalf of health promotion policies and environmental changes that support health behavior change. This leadership role is the first of the core competencies.

The practice of promoting healthy lifestyles begins with the clinician. The second core competency involves healthcare providers leading their own healthy lifestyles. Clinicians who follow healthy lifestyles themselves are more likely to counsel their patients on the subject. Physical and emotional well being also pave the way to being fully present with our patients and effectively engaging them to identify solutions for their health behavior change barriers and increase motivation both for initiating and sustaining healthy patterns.[35,36,37,38,39,40,41,42,43,44]

Lifestyle Medicine in the Office Setting

To successfully prescribe lifestyle medicine, healthcare providers need to perform elements of the standard clinical practice -- assess the full range of risk factors, perform the history and physical examination, and order appropriate screening and diagnostic testing according to national guidelines. Clinicians also need to comfortably prioritize the risk factors to determine areas of emphasis, including stress level and emotional well being. More importantly, the core competencies underscore the need for healthcare providers to apply their knowledge of lifestyle medicine, as well as understand the importance of their role in promoting health behavior as first-line prevention and treatment.

When health behavior is a priority in patients with and without chronic disease, it will be reflected in virtually every element of the practice. Such elements are summarized in the subsequent core competencies:

  • Using up-to-date national guidelines for physical activity and nutrition;

  • Working with the interdisciplinary team to ensure that adequate assistance is provided for health behavior change;

  • Designing office tools and processes to address health behaviors (such as incorporating a vital sign that reflects physical activity level); and

  • Implementing information technology for tracking health behaviors.

Referral to other healthcare professionals and community resources to support patients beyond the clinical practice will help patients receive the assistance they need outside the typical office setting.

Small changes in staff duties and office flow are an easy way to start -- such as asking intake staff to check a vital sign reflecting the patient's physical activity level or identify helpful online community resources. Even minimal initial changes such as these can reframe the clinical practice to place greater emphasis on lifestyle medicine. Furthermore, to guide ongoing improvements, these changes must be evaluated with process and outcome measures -- another core competency.

Lifestyle Medicine Relies on Effective Relationships

An important core competency in lifestyle medicine is effective engagement with patients and their families. Engagement is an approach that can be offered even in the limited timeframe of the typical patient visit. Active listening, eye contact, body language, and verbal support can help propel the patient through the stages of readiness to make and sustain health behavior change. Interventions that are culturally appropriate and matched to the patient's level of readiness may not always affect immediate behavior change but can encourage the patient to follow through with recommended reading, referrals, and outside resources that may lead to behavior change at a later time. Creating positive relationships with family members can increase the patient's support at home.


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