Lifestyle medicine has been gaining traction since cardiologist Dr. James Rippe published a textbook on the topic in 1999. Rippe, founder of the Rippe Lifestyle Institute in Florida, is a professor of biomedical sciences at the University of Central Florida.
Its practitioners believe changing priorities of payers, policymakers and patients will create a huge demand for their expertise in the years ahead. To be successful in the patient-centered medical home and accountable care organization models, physicians must learn how to help their patients adopt healthy habits, says Dr. Edward Phillips, the Harvard Medical School assistant professor who heads the Institute of Lifestyle Medicine in Boston.
“All of a sudden doctors are being told, 'We're thinking that if you could actually get (patients) to lose weight and get active and manage their stress, all the literature shows that that's going to save our organization money,' ” he says. “We're seeing folks that two years ago weren't ready to take a trip to Boston to learn about this, and now their livelihood may depend on it. So we are really at the edge of a wave.”
Braman considers lifestyle medicine to be the clinical approach that supports the medical-home delivery model.
“The challenge with the patient-centered medical home is that (practitioners) are all focused on process efficiency,” he says. “If your system is just pills and procedures to treat consequences and never treat the causes (of chronic disease), it's never going to work—I don't care how efficient you get.”
Lifestyle medicine has no credentialing process for practitioners and it is not recognized by the American Board of Medical Specialties. But its adherents are preparing to jump the hurdles needed to be recognized by the medical establishment.
A few physicians started the ACLM in 2004 as the first step toward creating an official discipline. After a few years of all-volunteer leadership, Braman became executive director, assigned to build the organizational infrastructure—from professional standards to reimbursement models—that are needed for lifestyle medicine to advance.
“The science clearly shows this is the biggest, most important, most powerful stuff you can do,” Braman says. “We're really out to make this accepted healthcare.”
To that end, the ACLM has assembled an advisory board that includes former U.S. Surgeon General Dr. Richard Carmona; best-selling author Dr. Dean Ornish, president of the Preventive Medicine Research Institute;
T. Colin Campbell, co-director of the Cornell-Oxford-China Diet and Health Project at Cornell University; and Dr. David Jenkins, director of the Risk Factor Modification Centre at the University of Toronto.
The field took a step forward in 2010 when the Journal of the American Medical Association published “Physician competencies for prescribing lifestyle medicine,” the first published standards for the emerging field. The competencies were identified by a panel of representatives from the American Medical Association, the American Academy of Family Physicians, the American College of Physicians, the American College of Preventive Medicine, the ACLM and other organizations.
The ACLM's official publication—the American Journal of Lifestyle Medicine—disseminates research findings. Meanwhile, ACLM leaders are working with the MGMA-ACMPE on a practice model initiative designed to help payers understand how lifestyle medicine practitioners should be paid.