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Are Your Physicians Practicing Lifestyle Medicine?

Analysis  |  By Christopher Cheney  
   January 14, 2019

Physicians who do not counsel patients about lifestyle factors that impact health are missing an opportunity.

A longtime advocate of lifestyle medicine is calling on his fellow physicians to step up efforts to counsel patients about the benefits of healthier lifestyles such as good nutrition and smoking cessation.

A mounting body of evidence shows lifestyle factors are linked to serious health conditions such as obesity causing more than a dozen forms cancer and cigarettes' link to multiple diseases including cardiovascular disease, lung cancer, and stroke.

In an article published this month in The American Journal of Medicine, James Rippe, MD, founder and director of the Rippe Lifestyle Institute, says more widespread adoption of lifestyle medicine is needed to maximize clinical care and financial benefits.

"Employing the principles of lifestyle medicine in the daily practice of medicine represents a substantial opportunity to enhance the value equation in medicine by improving outcomes for our patients and simultaneously controlling costs," wrote Rippe, who serves as editor-in-chief of the American Journal of Lifestyle Medicine.

Rippe cited data from the Nurses' Health Study to demonstrate the effectiveness of lifestyle medicine. The study found that more than 80% of heart disease and more than 91% of diabetes in women could be averted with attention to several lifestyle factors such as healthy body weight, physical activity, and avoiding tobacco use.

Despite indications of lifestyle medicine's potential, many physicians have not embraced it, Rippe wrote. "Unfortunately, less than 40% of physicians routinely counsel their patients on lifestyle issues. This represents a squandered opportunity, because more than 70% of adults see a primary care physician on at least an annual basis."

Getting past barriers

Time is the biggest obstacle blocking physicians from discussing lifestyle factors with their patients, Rippe told HealthLeaders last week.

"The first barrier to overcome is to make sure that these topics are at least talked about to some degree despite the lack of time. If you don't talk about these topics, the message that goes out is that the physician—who is an authority figure to some degree—doesn't care about them," he said.

To overcome the lack of time, physicians should have the ability to alert patients about lifestyle factors then make referrals for further counseling with another clinician such as a nurse practitioner, Rippe said. "The clinician can use the authority of the white coat but not have to take the time to provide the counseling."

There also is a gap in medical education that needs to be filled, he said.

"Physicians tend to get focused on their education. I went to Harvard Medical School many years ago, and we didn't have a single lecture on nutrition or physical activity. Many physicians focus so much of their effort on not missing a disease state that they don't see the enormous body of evidence that daily habits and practices probably drives more disease than anything else."

Lifestyle medicine should be included in clinician training, Rippe said.

"Even though there is a mantra about practicing evidence-based medicine, there is an enormous field of evidence-based medicine related to nutrition and other habits that physicians ignore. It's partly because physicians are not trained to see lifestyle factors as key drivers of either good health or bad health."

Easing physician burnout

Clinicians can benefit from applying lifestyle medicine to their own lives, Rippe told Healthleaders. "Physicians are human beings; so, all of the lifestyle medicine we talk about for our patients apply equally well to physicians."

Adopting healthy habits can help avoid physician burnout, he said. "Physicians should be using all of the principles of lifestyle medicine to enhance their own health—both physical and mental. A lot of lifestyle factors like physical activity are potent stress reducers."

Clinicians can benefit both professionally and personally from healthy habits, Rippe said.

"Research has shown about 50% of physicians are showing signs of burnout. We need to get physicians to understand that the same things they talk to their patients about will make their practices more enjoyable and should be applied to their own lives."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


Many lifestyle factors such as obesity and smoking have been linked to serious illness.

Lifestyle medicine encourages evidence-based lifestyle habits such as regular physical activity and adequate sleep to prevent and treat disease.

Less than 40% of physicians routinely counsel patients about lifestyle factors.

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