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The Lifestyle Medicine Movement: An Extention of Public Health into Medicine

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (31 August 2021) | Viewed by 48130

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Guest Editor
The George Washington School of Medicine and Health Sciences, Washington, DC 20037, USA
Interests: nutrition; microbiome; obesity; public health; integrative medicine; Vitamin D; bariatric surgery; immunology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Lifestyle is linked to the leading causes of death globally, including overconsumption of alcohol, use of tobacco, sedentary behavior, and poor dietary choices. Despite the growing recognition of the importance of lifestyle factors in the prevention of disease and promotion of health and wellness (including their inclusion into practice guidelines), many patients have not been receiving counselling on this topic, sparking the Lifestyle Medicine movement.

This Special Issue will utilize the following definition of Lifestyle Medicine based on those of the American College of Lifestyle Medicine and the American College of Preventative Medicine:

The whole person approach to medicine, health, and wellness using evidence-based behavioural interventions to promote dietary patterns emphasizing whole foods and plants, being physically active, sufficient and restorative sleep, stress management, positive social support, and environmental exposure management.

This Special Issue offers an opportunity to publish high-quality multidisciplinary research and reviews that focus on the impact of the Lifestyle Medicine movement. Investigators who have conducted research on these topics are invited to submit manuscripts for consideration for this Special Issue in IJERPH.

Dr. Leigh A. Frame
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • lifestyle medicine
  • health
  • wellness
  • prevention
  • nutrition
  • physical activity
  • behavior change
  • environment

Published Papers (10 papers)

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11 pages, 366 KiB  
Article
Sleeping Disorders in Healthy Individuals with Different Dietary Patterns and BMI, Questionnaire Assessment
by Magda Piekarska, Martyna Pszczółka, Damian Parol, Paweł Szewczyk, Daniel Śliż and Artur Mamcarz
Int. J. Environ. Res. Public Health 2021, 18(23), 12285; https://doi.org/10.3390/ijerph182312285 - 23 Nov 2021
Cited by 3 | Viewed by 2910
Abstract
The COVID-19 pandemic and abiding restrictions have affected every life domain. Sleep disturbances are a major health issue that is linked with a higher prevalence of metabolic syndrome, obesity, and psychological burdens. Research of sleeping disorders among vegetarian and non-vegetarian subpopulations is limited. [...] Read more.
The COVID-19 pandemic and abiding restrictions have affected every life domain. Sleep disturbances are a major health issue that is linked with a higher prevalence of metabolic syndrome, obesity, and psychological burdens. Research of sleeping disorders among vegetarian and non-vegetarian subpopulations is limited. The aim of the study was to assess the prevalence of sleeping disorders during the COVID-19 pandemic among people with different dietary patterns. Using a web-based cross-sectional survey, data were collected from 1987 people. A total of 1956 respondents met all study conditions. The questionnaire consisted of sociodemographic information, assessment of dietary habits, and assessment of the prevalence of insomnia and sleepiness, based on the Athens Insomnia Scale (AIS) and Epworth Sleepiness Scale (ESS). A total of 36.04% (n = 705) respondents declared that they noticed a change in the quality of their sleep during the last year. According to AIS and ESS, non-vegetarians suffered from insomnia or sleepiness more often than vegetarians. Insomnia and sleepiness were also more prevalent among those respondents who declared consumption of fruit and vegetables less often than once a day compared with those who consumed fruit and vegetables daily. Respondents with BMI within the recommended limit (18.5–24.99) suffered from insomnia less often when compared with underweight (BMI < 18.5) or obese (BMI ≥ 25) respondents. Those results may be useful for public health workers and medical professionals in terms of establishing new instruments that help treat sleeping disorders. Full article
16 pages, 347 KiB  
Article
Lifestyle Medicine Reimbursement: A Proposal for Policy Priorities Informed by a Cross-Sectional Survey of Lifestyle Medicine Practitioners
by Kelly J. Freeman, Meagan L. Grega, Susan M. Friedman, Padmaja M. Patel, Ron W. Stout, Thomas M. Campbell, Michelle L. Tollefson, Liana S. Lianov, Kaitlyn R. Pauly, Kathryn J. Pollard and Micaela C. Karlsen
Int. J. Environ. Res. Public Health 2021, 18(21), 11632; https://doi.org/10.3390/ijerph182111632 - 05 Nov 2021
Cited by 7 | Viewed by 5690
Abstract
Lifestyle medicine (LM) is a rapidly emerging clinical discipline that focuses on intensive therapeutic lifestyle changes to treat chronic disease, often producing dramatic health benefits. In spite of these well-documented benefits of LM approaches to provide evidence-based care that follows current clinical guidelines, [...] Read more.
Lifestyle medicine (LM) is a rapidly emerging clinical discipline that focuses on intensive therapeutic lifestyle changes to treat chronic disease, often producing dramatic health benefits. In spite of these well-documented benefits of LM approaches to provide evidence-based care that follows current clinical guidelines, LM practitioners have found reimbursement challenging. The objectives of this paper are to present the results of a cross-sectional survey of LM practitioners regarding lifestyle medicine reimbursement and to propose policy priorities related to the ability of practitioners to implement and achieve reimbursement for these necessary services. Results from a closed, online survey in 2019 were analyzed, with a total of n = 857 included in this analysis. Results were descriptively analyzed. This manuscript articulates policy proposals informed by the survey results. The study sample was 58% female, with median age of 51. A minority of the sample (17%) reported that all their practice was LM, while 56% reported that some of their practice was LM. A total of 55% of practitioners reported not being able to receive reimbursement for LM practice. Of those survey respondents who provided an answer to the question of what would make the practice of LM easier (n = 471), the following suggestions were offered: reimbursement overall (18%), reimbursement for more time spent with patients (17%), more support from leadership (16%), policy measures to incentivize health (13%), education in LM for practitioners (11%), LM-specific billing codes and billing knowledge along with better electronic medical record (EMR) capabilities and streamlined reporting/paperwork (11%), and reimbursement for the extended care team (10%). Proposed policy changes focus on three areas of focus: (1) support for the care process using a LM approach, (2) reimbursement emphasizing outcomes of health, patient experience, and delivering person-centered care, and (3) incentivizing treatment that produces disease remission/reversal. Rectifying reimbursement barriers to lifestyle medicine practice will require a sustained effort from health systems and policy makers. The urgency of this transition towards lifestyle medicine interventions to effectively address the epidemic of chronic diseases in a way that can significantly improve outcomes is being hindered by current reimbursement policies and models. Full article
13 pages, 365 KiB  
Article
Lifestyle Medicine and Economics: A Proposal for Research Priorities Informed by a Case Series of Disease Reversal
by Kara A. Livingston, Kelly J. Freeman, Susan M. Friedman, Ron W. Stout, Liana S. Lianov, David Drozek, Jamie Shallow, Dexter Shurney, Padmaja M. Patel, Thomas M. Campbell, Kaitlyn R. Pauly, Kathryn J. Pollard and Micaela C. Karlsen
Int. J. Environ. Res. Public Health 2021, 18(21), 11364; https://doi.org/10.3390/ijerph182111364 - 29 Oct 2021
Cited by 7 | Viewed by 7079
Abstract
Chronic disease places an enormous economic burden on both individuals and the healthcare system, and existing fee-for-service models of healthcare prioritize symptom management, medications, and procedures over treating the root causes of disease through changing health behaviors. Value-based care is gaining traction, and [...] Read more.
Chronic disease places an enormous economic burden on both individuals and the healthcare system, and existing fee-for-service models of healthcare prioritize symptom management, medications, and procedures over treating the root causes of disease through changing health behaviors. Value-based care is gaining traction, and there is a need for value-based care models that achieve the quadruple aim of (1) improved population health, (2) enhanced patient experience, (3) reduced healthcare costs, and (4) improved work life and decreased burnout of healthcare providers. Lifestyle medicine (LM) has the potential to achieve these four aims, including promoting health and wellness and reducing healthcare costs; however, the economic outcomes of LM approaches need to be better quantified in research. This paper demonstrates proof of concept by detailing four cases that utilized an intensive, therapeutic lifestyle intervention change (ITLC) to dramatically reverse disease and reduce healthcare costs. In addition, priorities for lifestyle medicine economic research related to the components of quadruple aim are proposed, including conducting rigorously designed research studies to adequately measure the effects of ITLC interventions, modeling the potential economic cost savings enabled by health improvements following lifestyle interventions as compared to usual disease progression and management, and examining the effects of lifestyle medicine implementation upon different payment models. Full article
15 pages, 1894 KiB  
Article
PaLS Study: How Has the COVID-19 Pandemic Influenced Physical Activity and Nutrition? Observations a Year after the Outbreak of the Pandemic
by Alicja Monika Jodczyk, Grzegorz Gruba, Zuzanna Sikora, Przemysław Seweryn Kasiak, Joanna Gębarowska, Natalia Adamczyk, Artur Mamcarz and Daniel Śliż
Int. J. Environ. Res. Public Health 2021, 18(18), 9632; https://doi.org/10.3390/ijerph18189632 - 13 Sep 2021
Cited by 13 | Viewed by 3402
Abstract
The restrictions implemented to prevent the spread of the SARS-CoV-2 virus have impacted the majority of life domains. To evaluate their potential consequences on physical activity (PA) and dietary habits among Polish undergraduates, a survey consisting of the IPAQ-SF, authors’ questions based on [...] Read more.
The restrictions implemented to prevent the spread of the SARS-CoV-2 virus have impacted the majority of life domains. To evaluate their potential consequences on physical activity (PA) and dietary habits among Polish undergraduates, a survey consisting of the IPAQ-SF, authors’ questions based on the Polish National Institute of Public Health recommendations, and authors’ questions scaled −5/0/5 on personal opinion was created and administered between 22 February and 3 April 2021. A total of 1323 students met the study conditions (1021 females, 297 males, 5 did not specify gender, mean age: 22 years old (SD = 4), mean BMI = 22.27 kg/m2 (SD = 3.87)). A total of 27.21% of students were in the low, 48.53% in the moderate, and 24.26% in the high PA group. A total of 71.94% estimated that the pandemic had a negative impact on their PA, 8.16% no impact, and 19.9% a positive impact. A total of 35.5% had an insufficient intake of vegetables, 34.3% declared adding salt to meals, and 31.6% ate animal-based products the majority of days in a week or every day. A total of 51.02% assessed the impact of the pandemic on their nutrition as negative, 20.11% did not notice changes, and 28.87% reported a positive impact on their dietary habits. Most of the students saw harmful pandemic effects on their diet and PA compared to the times before restrictions. This can lead to a higher prevalence of non-communicable diseases (NCDs) in the future. Full article
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12 pages, 1503 KiB  
Article
PaLS Study of Sleep Deprivation and Mental Health Consequences of the COVID-19 Pandemic among University Students: A Cross-Sectional Survey
by Grzegorz Gruba, Przemysław Seweryn Kasiak, Joanna Gębarowska, Natalia Adamczyk, Zuzanna Sikora, Alicja Monika Jodczyk, Artur Mamcarz and Daniel Śliż
Int. J. Environ. Res. Public Health 2021, 18(18), 9581; https://doi.org/10.3390/ijerph18189581 - 11 Sep 2021
Cited by 27 | Viewed by 9227
Abstract
The COVID-19 pandemic has changed the way many people live. To assess its impact on sleep quality and quantity, blue light exposure, and the mental health of Polish university students, a cross-sectional survey was conducted. Almost half of the participants were medical students [...] Read more.
The COVID-19 pandemic has changed the way many people live. To assess its impact on sleep quality and quantity, blue light exposure, and the mental health of Polish university students, a cross-sectional survey was conducted. Almost half of the participants were medical students (47.62%; n = 630). The majority of students were suffering from insomnia (58.13%, n = 769). Almost every third student was sleeping less than 7 h a day (30.39%, n = 402). Our study showed that a short sleep duration correlates with poorer mental health outcomes. Respondents who declared sadness and depression were more likely to suffer from insomnia (OR = 5.6997, 95% CI: 4.3641–7.4441). Difficulty with tasks was also more likely to co-occur with insomnia (OR = 5.4723, 95% CI: 4.3007 to 6.9630). The results of this study showed that the COVID-19 pandemic contributed to the deterioration of sleep quality and quantity as well as the psychological well-being of Polish students. It is important to take steps to promote proper sleeping habits to alleviate the risk of mental health disorders in this group of people. Full article
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17 pages, 375 KiB  
Article
Associations between Suboptimal Sleep and Smoking, Poor Nutrition, Harmful Alcohol Consumption and Inadequate Physical Activity (‘SNAP Risks’): A Comparison of People with and without a Mental Health Condition in an Australian Community Survey
by Alexandra P. Metse, Tara Clinton-McHarg, Elise Skinner, Yogayashwanthi Yogaraj, Kim Colyvas and Jenny Bowman
Int. J. Environ. Res. Public Health 2021, 18(11), 5946; https://doi.org/10.3390/ijerph18115946 - 01 Jun 2021
Cited by 7 | Viewed by 4098
Abstract
Introduction: People with a mental health condition experience disproportionate morbidity and mortality compared to the general population. This inequity has been largely attributed to a higher prevalence of chronic disease risk behaviours including smoking, poor nutrition, harmful alcohol consumption and inadequate physical activity [...] Read more.
Introduction: People with a mental health condition experience disproportionate morbidity and mortality compared to the general population. This inequity has been largely attributed to a higher prevalence of chronic disease risk behaviours including smoking, poor nutrition, harmful alcohol consumption and inadequate physical activity (‘SNAP risks’). Suboptimal sleep is highly prevalent among people with a mental health condition and, as an identified risk behaviour for several chronic diseases, has been implicated as an additional contributor to this health inequity. Research involving people without a mental health condition suggests associations between poor sleep and each SNAP risk; however, interactions with mental health status have not been reported in an Australian population. This study explored associations between suboptimal sleep and all four SNAP risks, and assessed whether they vary by mental health status. Materials and Methods: A descriptive study (n = 1265) was undertaken using self-report data from a cross-sectional telephone survey of Australian adults. Based on national guidelines and recommendations that indicate when someone might be at risk of adverse health effects, SNAP risks and sleep variables were reduced to two levels: ‘at risk’ or ‘not at risk’; and ‘appropriate’ or ‘suboptimal’, respectively. Chi square tests and multivariable logistic regression models explored associations between suboptimal sleep, SNAP risks and mental health status. Results: Fifteen per cent (n = 184) of participants identified as having a mental health condition in the past 12 months. Being at risk of adverse health effects due to smoking had the strongest association with several measures of suboptimal sleep (ps < 0.05). Two-way interactions revealed that being at risk of adverse health effects due to alcohol use and physical inactivity resulted in a significantly greater likelihood of suboptimal sleep duration (OR 3.06, 95% CI 1.41 to 6.64; OR 3.06, 95% CI 1.41 to 6.69) and nap duration (OR 7.96, 95% CI 1.90 to 33.22), respectively, for people with a mental health condition compared to those without. Conclusions: The findings suggest associations between suboptimal sleep and smoking, risky alcohol consumption and physical inactivity, with the latter two perhaps being stronger among people with a mental health condition compared to those without such a condition. Poor sleep should be considered in interventions to address smoking, alcohol and physical activity; and vice versa. This study lends further support for the value of multirisk lifestyle interventions to promote physical and mental health for people with mental health conditions. Full article
13 pages, 313 KiB  
Article
Identification of Important Factors Affecting Use of Digital Individualised Coaching and Treatment of Type 2 Diabetes in General Practice: A Qualitative Feasibility Study
by Pernille Ravn Jakobsen, Jeanette Reffstrup Christensen, Jesper Bo Nielsen, Jens Søndergaard, Dorte Ejg Jarbøl, Michael Hecht Olsen, Jens Steen Nielsen, Jette Kolding Kristensen and Carl J. Brandt
Int. J. Environ. Res. Public Health 2021, 18(8), 3924; https://doi.org/10.3390/ijerph18083924 - 08 Apr 2021
Cited by 3 | Viewed by 2592
Abstract
Most type 2 diabetes patients are treated in general practice and there is a need of developing and implementing efficient lifestyle interventions. eHealth interventions have shown to be effective in promoting a healthy lifestyle. The purpose of this study was to test the [...] Read more.
Most type 2 diabetes patients are treated in general practice and there is a need of developing and implementing efficient lifestyle interventions. eHealth interventions have shown to be effective in promoting a healthy lifestyle. The purpose of this study was to test the feasibility, including the identification of factors of importance, when offering digital lifestyle coaching to type 2 diabetes patients in general practice. We conducted a qualitative feasibility study with focus group interviews in four general practices. We identified two overall themes and four subthemes: (1) the distribution of roles and lifestyle interventions in general practice (subthemes: external and internal distribution of roles) and (2) the pros and cons for digital lifestyle interventions in general practice (subthemes: access to real life data and change in daily routines). We conclude that for digital lifestyle coaching to be feasible in a general practice setting, it was of great importance that the general practitioners and practice nurses knew the role and content of the intervention. In general, there was a positive attitude in the general practice setting towards referring type 2 diabetes patients to digital lifestyle intervention if it was easy to refer the patients and if easily understandable and accessible feedback was implemented into the electronic health record. It was important that the digital lifestyle intervention was flexible and offered healthcare providers in general practice an opportunity to follow the type 2 diabetes patient closely. Full article
17 pages, 1198 KiB  
Article
Connections between Family Assets and Positive Youth Development: The Association between Parental Monitoring and Affection with Leisure-Time Activities and Substance Use
by Maider Belintxon, Alfonso Osorio, Jokin de Irala, Marcia Van Riper, Charo Reparaz and Marta Vidaurreta
Int. J. Environ. Res. Public Health 2020, 17(21), 8170; https://doi.org/10.3390/ijerph17218170 - 05 Nov 2020
Cited by 7 | Viewed by 3263
Abstract
This study aimed to determine the associations between parental monitoring and affection and three adolescent lifestyle aspects: constructive leisure, non-constructive leisure and substance use. A cross-sectional study was conducted in four countries (Chile, Mexico, Spain and Peru). Adolescents aged 12–15 self-completed a multi-purpose [...] Read more.
This study aimed to determine the associations between parental monitoring and affection and three adolescent lifestyle aspects: constructive leisure, non-constructive leisure and substance use. A cross-sectional study was conducted in four countries (Chile, Mexico, Spain and Peru). Adolescents aged 12–15 self-completed a multi-purpose questionnaire. Multiple logistic regressions were performed to analyse the association between the parental monitoring and affection variables and the outcomes in terms of the children’s lifestyles. The results indicate that parental monitoring is conducive to more constructive leisure and less non-constructive leisure and seems to be conducive to the prevention of substance use. Furthermore, parental affection is conducive to constructive leisure and the prevention of substance use. The discussion focuses on the fact that the family can be a protective resource associated with positive adolescent development. Full article
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9 pages, 311 KiB  
Opinion
Social Prescribing and Lifestyle Medicine—A Remedy to Chronic Health Problems?
by Alicja Baska, Donata Kurpas, Joyce Kenkre, Josep Vidal-Alaball, Ferdinando Petrazzuoli, Miriam Dolan, Daniel Śliż and Joanne Robins
Int. J. Environ. Res. Public Health 2021, 18(19), 10096; https://doi.org/10.3390/ijerph181910096 - 26 Sep 2021
Cited by 13 | Viewed by 4292
Abstract
Social prescribing has been identified as a chance to take a holistic approach to people’s health and wellbeing, especially for people with one or more long-term conditions. Its systemic implementation was a part of the recent United Kingdom National Health Service Long Term [...] Read more.
Social prescribing has been identified as a chance to take a holistic approach to people’s health and wellbeing, especially for people with one or more long-term conditions. Its systemic implementation was a part of the recent United Kingdom National Health Service Long Term Plan. With a lifestyle medicine focus on equipping patients in tools necessary for self-care and self-management of their lifestyle-related health problems that coexists with the need for creating an environment supporting healthy choices, a social prescribing model seems to offer a promising strategy for advancing lifestyle medicine. This idea was discussed during a meeting hosted by the Polish Society of Lifestyle Medicine in collaboration with European Rural and Isolated Practitioners Association, Polish Society of Young Family Doctors (“Młodzi Lekarze Rodzinni”), British Society of Lifestyle Medicine and European Lifestyle Medicine Council in June 2020. The aftermath—this position statement is an Authors’ attempt at summarizing the common ground for social prescribing and lifestyle medicine. It collects experiences of practitioners and researchers from five European countries as well as making recommendations for applying this model in Poland. Despite referring to local conditions, it might provide universal takeaway messages for any healthcare providers interested in combining social prescribing with lifestyle medicine practice. Full article
11 pages, 301 KiB  
Opinion
Nutrition, a Tenet of Lifestyle Medicine but Not Medicine?
by Leigh A. Frame
Int. J. Environ. Res. Public Health 2021, 18(11), 5974; https://doi.org/10.3390/ijerph18115974 - 02 Jun 2021
Cited by 2 | Viewed by 3288
Abstract
Nutrition is a foundation of health and one of six pillars of Lifestyle Medicine. The importance of nutrition in clinical care is now widely recognized by health care professionals and the public. However, clinicians are not comfortable counselling their patients on nutrition due [...] Read more.
Nutrition is a foundation of health and one of six pillars of Lifestyle Medicine. The importance of nutrition in clinical care is now widely recognized by health care professionals and the public. However, clinicians are not comfortable counselling their patients on nutrition due to inadequate or lack of training, leaving a significant need in patient care. This gap can be closed with evidence-based curricula in medical schools and in the trainings of other health care professionals. This communication presents the current state of nutrition knowledge in health care, emphasizing nutrition education for physicians, and presents a model of how pre- through post-professional health care providers may become proficient in nutrition counseling including appropriate referral to more specialized providers. With these skills, health care professionals will be able to initiate patient-centered lifestyle plans. This includes improving diet and utilization of team-based medicine and referrals. Full article
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