functions of the body, investigating the balance and processes of cellular metabolism, digestive function, detoxification, and control of oxidative stress (Kelly and Shull 2019, p. 16).15 D In Conventional Medicine, medications and surgical interventions are often the highest level of care and ‘end’ of treatment. In this disease‐focused approach, patients are the recipients of care, while providers are considered responsible for care and outcomes (Kelly and Shull 2019, p. 16).
16 B Group consultations (the most common model used being Shared Medical Appointments) are fast gaining recognition as a viable adjunct clinical approach in the care of the patient. In the future, they are likely to become a standard procedure in clinical Lifestyle Medicine. Cognitive Behavioural Therapy is commonly used in the treatment protocols in Lifestyle Medicine. Lifestyle Medicine plays an important role in the prevention and treatment of many communicable diseases (Egger et al. 2017, p. 58).
17 D Preventive Medicine includes all aspects of morbidity and mortality prevention for the general public. It emphasizes population‐based interventions that include immunizations, screening, and protection from bioterrorism (Kelly and Shull 2019, p. 16).
18 A Behavioural change is the foundational activity through which Lifestyle Medicine works. Health coaching involves assessing readiness for change, collaboratively establishing client goals, evaluating successful steps and self‐limiting patterns, reassessing and modifying goals, articulating insights gained, and formulating post‐coaching plan to sustain changes that promote health and wellness. The health coach does not change the lifestyle for the client, does not enforce behavioural change, and does not set goals for the client (Rippe 2019, p. 236).
19 B The following is the most appropriate technique in the behaviour change process:In the early stages of change, use motivational interviewingIn the later stages of change, use cognitive behavioural therapy (CBT) techniqueIn all stages, use positive psychology(Kelly and Shull 2019, p. 42)
20 A The field of Lifestyle Medicine envisages a world in which all physicians and allied health professionals have been trained and certified in evidence‐based Lifestyle Medicine, integrating healthful behaviours into their own lives, while incorporating a Lifestyle Medicine‐first approach to treating root causes of lifestyle‐related diseases into their clinical practices. Therefore, ideally, physicians should serve as role‐models in the practice of healthy personal behaviours. Leaders in LSM should promote healthy behaviours as foundational to medical care, disease prevention, and health promotion. Referrals to other specialists are sometimes indicated and must be done in a timely manner. Lifestyle management, helping patients manage and sustain healthy lifestyle practices, is a key competency for the physician in the practice of Lifestyle Medicine (Lianov and Johnson 2010; Tips Box 1.2).
21 D Assessment skills required by a physician in Lifestyle Medicine are varied. Physicians should assess patients and family readiness, willingness, and ability to make health behaviour changes. They should also perform a history and physical examination specific to patients’ lifestyle‐related health status (Kelly and Shull 2019, p. 26).
22 C The patients and their family’s readiness and willingness is what is most required for a successful outcome in health coaching, much more than that of the community, employer, or support group (Kelly and Shull 2019, p. 26).
23 A Lifestyle Medicine treatment intensity has two components, namely intensity of contact hours and degree or extent of lifestyle changes made. Maximally effective intensive therapeutic lifestyle change generally maximizes both components (Rippe 2019, p. 1019).
24 B The intensive therapeutic lifestyle change (ITLC) produces the most dramatic treatment effects, just as higher dosing of pharmacological agents does. The ITLC maximizes Lifestyle Medicine treatment dosing to produce the induction phase needed to transform self‐efficacy and enable the patient to sustain lifestyle change. For a lasting result, it will be preferable if an ITLC intervention is followed by therapeutic lifestyle change (TLC) treatment with the patient’s primary care physician as follow‐up is commonly the weak link that negates a very successful ITLC program (Rippe 2019, p. 1019).TIPS BOX 1.2 Lifestyle Medicine Competencies for Primary Care PhysiciansLeadershipPromote healthy behavioursSeek to practice, and create school, work, and home environments supporting, healthy behaviours.KnowledgeShow knowing evidence on certain lifestyle changes improves patients’ health outcomesDescribe ways physicians engage with patients/families can improve health behavioursAssessment SkillsAssess social, psychological, and biological behaviours and resulting health outcomesAssess readiness, willingness, and ability for health behavioural changePerform lifestyle‐specific history and physical examination, including lifestyle “vital signs” (diet, exercise, alcohol, smoking, BMI, sleep, stress, relationships), informing apt testsManagement SkillsUse recognized guidelines (e.g hypertension/quitting smoking) to help patients self‐manage their lifestyles and choices.Establish effective therapeutic relationships effecting and sustaining behaviour change with evidence‐based counselling methods, tools and follow‐up.Collaborate with patients and their families to develop evidence‐based, SMART action plans like lifestyle prescriptions.Help patients manage/sustain healthy lifestyles and refer patients to appropriate healthcare professionals for lifestyle‐related conditionsUse of Office and Community SupportAble to practice as an interdisciplinary healthcare team and support a team approachFoster/use office routines supporting lifestyle medical care e.g decision support toolsSupport quality improvement for lifestyle interventions with dataRefer appropriately in the community to support implementing healthy lifestylesAdapted from Lianov & Johnson, 2010.
25 A The scientific foundation of the Erica Frank et al.’s ‘Healthy Doctor = Healthy Patient’ principle includes the following and more:North American physicians tend to live longer than their peersPhysicians live longer because they have healthier habits (including as medical students) than their contemporariesPhysicians and medical students with the healthiest habits are more likely to advise their patients about related preventive habitsCounselling patients makes a difference in patients’ habits and in their health(Rippe 2019, p. 1039)
References
1 Barnard, N.D., Cohen, J., Jenkins, D.J. et al. (2009). A low‐fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74‐wk clinical trial. American Journal of Clinical Nutrition 89 (5): 1588S–1596S. https://doi.org/10.3945/ajcn.2009.26736H.
2 Egger, G., Dixon, J., Meldrum, H., et al. (2015) Patients’ and providers satisfaction with shared medical appointments. Australian Family Physician 44(9): 674–679. PMID: 26488050.
3 Egger, G., Binns, A., Rossner, S. et al. (2017). Lifestyle Medicine: Lifestyle, the Environment and Preventive Medicine in Health and Disease, 3e. Academic Press.
4 Frank, E. (2004) STUDENTJAMA. Physician health and patient care. JAMA 291(5):637. https://doi.org/10.1001/jama.291.5.637. PMID: 14762049.
5 Kelly, J. and Shull, J. (2019). The Lifestyle Medicine Board Review Manual, 2ee. American College of Lifestyle Medicine.
6 Lianov, L. and Johnson, M. (2012). Physician competencies for prescribing lifestyle medicine. JAMA 304(2):202‐203. https://doi.org/10.1001/jama.2010.903. PMID: 20628134.
7 Noffsinger E.B. (2012). The ABCs of group visits: an implementation manual for your practice, 1e. Springer.
8 Ornish, D., Brown, S.E., Scherwitz, L.W. et al. (1990). Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 336 (8708): 129–133. https://doi.org/10.1016/0140‐6736(90)91656‐u.
