Lifestyle Medicine – helping individuals and families adopt and sustain healthy behaviors : A practitioner’s unexpected Journey

By Dr. Bobby Masocol

March 25meditationI’m a new sports medicine doctor, fresh out of training and now in academic practice teaching family medicine residents and sports medicine fellows. Prior to this job, I was asked by one of my mentors to develop a Lifestyle Medicine Clinic to compliment the unique curriculum at the University of South Carolina-School of Medicine Greenville. After collaborating with faculty at the medical school and attending a few conferences, we started a lifestyle medicine clinic that integrates medical students and residents to the clinical practice. I know, I know… we’re still working on the website. Lifestyle medicine (LM) is in its infancy and is steadily growing throughout the United States. In my practice, I see athletes as well as patients with chronic diseases such as obesity, diabetes and hypertension… and I love it!

Obesity and inactivity are discussed frequently in the BJSM and it excites me to read about all the ways people are getting their patients to be more physically active. Personally, I have adopted the #makeyourdayharder campaign, which is so simple, but gets me to consciously think about moving my body while I’m in the hospital or I’ve been sitting at my desk for a long time. The simplest ideas are often the best and Lifestyle medicine is simple. It has completely changed the way I practice medicine, and the purpose of this blog is to share some of these ideas.

What is lifestyle medicine? Is it really just” eat better” and “get exercise”?

In a word…yes! However, just like characterizing family medicine physicians as simply seeing colds and treating hypertension, there is much more to the story. The same goes for Lifestyle medicine.

Lifestyle medicine is the evidence-based practice of helping individuals and families adopt and sustain healthy behaviors that affect health and quality of life. It’s not only a way to prevent non-communicable disease but a great way to treat chronic disease. The body has a tremendous ability to heal itself, and with the right changes, can often reverse disease. That’s right, if you have coronary artery disease, we know that by adopting intensive lifestyle modifications, a person can actually reverse atherosclerosis, which has better outcomes than getting stents placed. Lifestyle medicine gets at the root cause of chronic disease and treats the problem, not the symptoms.

How does Sports Medicine fit with Lifestyle Medicine?

Sports medicine providers play a unique role in patient care in that we frequently prescribe physical therapy and exercise for many of the common issues that we see. As many of the readers here probably know, there are sports medicine leaders advocating exercise as medicine. Exercise and movement are at the core of how we practice medicine on a daily basis and making it part of our patient counseling should be second nature. We are knowledgeable about injury prevention and rehabilitation so when our patients start getting those aches and pains from starting an exercise program, who better to see than a sports medicine provider.

While we are rightfully ambassadors of exercise, we are also learning that diet cannot be ignored in the treatment of chronic disease. This is an area that sports medicine providers likely need to improve. I am slowly getting to know the literature and am kind of disturbed that I did not get training in this during medical school or residency. Diet can be complex and confusing. I will share more about diet in future posts.

How do you get patients to change their behavior?

This is the heart of Lifestyle medicine. I use motivational interviewing which has been discussed on this blog. It really empowers patients to take an active role in their health and allows the physician to not feel discouraged when some goals are not met. It has made my interactions with patients more positive and I believe that we accomplish more with each session. Working in a team of providers also helps sustain behavior change. I utilize medical students to call our patients and to follow up on whether patients are meeting their goals

There is nothing necessarily sexy about lifestyle medicine. The beauty is that you can adopt it and start advocating for your patient immediately. If you’re a sports doctor giving an obese type 2 diabetic patient a steroid injection into the knee, take 2 minutes to counsel the patient about how diet changes can dramatically improve their diabetes. Try it. You might just get hooked like I did.

Resources

http://www.lifestylemedicine.org/Core-Competencies

Ornish, D, et al. Intensive lifestyle changes for reversal of coronary Heart disease, JAMA 1998 : 280: 2001-2007

Boden, W. et al. Optimal medical therapy with or without PCI for stable coronary disease, NEJM 2007: 356:1503-1516

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Dr. Bobby Masocol is faculty at the Greenville Health System Family Medicine Residency and Sports Medicine Fellowship in Greenville, South Carolina.

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