COMMENTARY

Should You Pursue Certification in Lifestyle Medicine? Yes

Cate Collings, MD

Disclosures

October 05, 2022

Physician colleagues often ask me what the future holds for lifestyle medicine and whether they should pursue board certification. My short answer to the second question is "Yes, absolutely!" But first I'll share why I am confident that lifestyle medicine will become a foundation of all health and healthcare and that clinicians should prepare for it.

Cate Collings, MD

There is increasing recognition among policymakers and health leaders of the unsustainable costs — in human suffering and the $4.1 trillion spent on US healthcare in 2020 — of lifestyle- and diet-related chronic diseases such as type 2 diabetes, obesity, and heart disease. COVID-19 and the worse outcomes associated with underlying chronic conditions contributed to awareness of just how sick Americans have become. The pandemic also shone a light on health disparities related to underlying lifestyle-related chronic disease prevalence and insufficient healthcare resources in many communities. Lifestyle medicine offers a promising path to narrow the health disparities gap.

Notably, for the first time in 50 years, the White House hosted a Conference on Hunger, Nutrition, and Health in September, with the goal to "[e]nd hunger and increase healthy eating and physical activity by 2030, so that fewer Americans experience diet-related diseases."

This growing recognition that we must reduce lifestyle-related diseases and prepare future and practicing clinicians to address the root causes of those diseases will ideally accelerate the US transition to high-value care. Lifestyle medicine leverages behavior changes in nutrition, physical activity, sleep, stress management, social connections, and use of risky substances as the first and primary way to treat many conditions, with medications and procedures as adjunctive treatment. It supports the Quintuple Aim of improved outcomes, lower costs, improved patient satisfaction, and improved provider satisfaction and has the potential to address health equity.

There is a strong case that value is precisely what lifestyle medicine can deliver, and this paves the way for paradigm change.

Health systems are increasing recognizing this value. The Health Systems Council, a collaborative community of health systems interested in integrating lifestyle medicine founded by the American College of Lifestyle Medicine (ACLM) in May 2021, already has more than 70 health system members. Accountable care organizations with a focus on lifestyle medicine have been created to help providers sustainably implement lifestyle behavior interventions. Even the US military is incorporating lifestyle medicine into its medical care for service members.

Momentum is growing for embedding lifestyle medicine into undergraduate medical education and build a new physician workforce tailored to current and future times. In November 2021, Rep. James McGovern introduced House Resolution 784, a resolution that passed the House supporting activities to ensure that health professional training programs, including medical schools, residency programs, and fellowships, incorporate substantive training in nutrition and diet.

The University of South Carolina School of Medicine Greenville is the first school to integrate lifestyle medicine into all 4 years of its curriculum. The Lifestyle Medicine Education Collaborative, a collection of open-access lifestyle medicine curricular resources developed there, provides a curriculum that other medical programs can integrate. Medical students have a hearty appetite for lifestyle medicine, and lifestyle medicine interest groups (LMIGs) for medical and other health professions students have exploded from a single campus in 2009 to 95 LMIGs today.

As of September 1, ACLM's Lifestyle Medicine Residency Curriculum (LMRC), a comprehensive curriculum piloted in 2018 that prepares residents to make evidence-based, lifestyle behavior interventions, is being implemented in 200 residency programs across 96 sites, with 1190 faculty and 4185 residents.

Lifestyle medicine education for physicians who trained 10 or more years ago may have consisted only of a few hours of learning about abject nutrient deficiencies and general suggestions to inspire patients to "exercise more" and "eat better." That's why I strongly urge practicing clinicians to pursue certification in lifestyle medicine. Education and certification will modernize their practice to meet current healthcare system needs.

As health systems or practices embrace lifestyle medicine and work within value-based contracts or population health goals, clinicians prepared with lifestyle medicine tools and knowledge will be valued and sought. More and more physicians and other clinicians are pursing board certification. Since 2017, 2004 US physicians and 778 other health professionals have certified.

Physicians are certified by the American Board of Lifestyle Medicine (ABLM). There are two pathways for physicians to qualify to take the exam. One is the experiential pathway for physicians who are already board-certified by a medical specialty board recognized by the American Board of Medical Specialties or the American Osteopathic Association. Those physicians must be primary board-certified and have practiced medicine for at least 2 years before qualifying to take the ABLM exam.

 The other emerging pathway is educational. Physicians who complete the LMRC through a residency site are eligible to sit for the certification exam, though certification will not be issued until the physician successfully passes the primary board exam.

To prepare for the board exam, ACLM provides a catalogue of on-line courses for continuing medical education as well as a lifestyle medicine board review course. In addition, ACLM recently became a content provider to Ed Hub, the American Medical Association's online learning platform. And the annual ACLM conference is a learning and networking event in the journey towards board certification.

The healthcare landscape is shifting rapidly. Transformative changes are occurring, and I am confident that lifestyle medicine will be at the forefront to address our alarming trajectory of chronic disease and its associated misery and financial impact.

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