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US Endocrinology Highlights
Lifestyle Medicine—An Emerging New Discipline
Robert F Kushner, MD 1 and Jeffrey I Mechanick, MD 2
1. Professor of Medicine, Northwestern University Feinberg School of Medicine; Director, Center for Lifestyle Medicine, Northwestern Medicine, Chicago,
Illinois, US; 2. Clinical Professor of Medicine; Director, Metabolic Support, Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine
at Mount Sinai, New York City, New York, US
Abstract Unhealthful lifestyle behaviors are a primary source of the global burden of noncommunicable diseases (NCDs) and account for about 63 % of
all global deaths. Recently, there has been an increased interest in evaluating the benefit of adhering to low-risk lifestyle behaviors and ideal
cardiovascular health metrics. Although a healthful lifestyle has repeatedly been shown to improve mortality, the population prevalence of
healthy living remains low. The new discipline of lifestyle medicine has recently emerged as a systematized approach for the management of
chronic disease. The practice of lifestyle medicine requires skills and competency in addressing multiple health risk behaviors and improving
self-management. This article focuses on the effects of a healthful lifestyle on chronic disease and defining lifestyle medicine as a unique
discipline. It also reviews the role of effective provider–patient communication as an essential element for fostering behavior change—the
main component of lifestyle medicine. The principles of communication and behavior change are skill based and are grounded in scientific
theories and models. Communication and counseling must be contextualized to the patients’ economic situation, access to care, social
support, culture, and health literacy.
Keywords Noncommunicable diseases, lifestyle medicine, prevention, risk factor reduction
Disclosure: Robert F Kushner, MD, and Jeffrey I Mechanick, MD, have no conflicts of interest to declare. No funding was received for the publication of this article.
Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation,
and reproduction provided the original author(s) and source are given appropriate credit.
Received: February 25, 2015 Accepted: April 2, 2015 Citation: US Endocrinology, 2015;11(1):36–40
Correspondence: Robert F Kushner, MD, Northwestern University Feinberg School of Medicine, Northwestern Comprehensive Center on Obesity, 750 North Lake Shore
Drive, Rubloff 9-976, Chicago IL, US. E: email@example.com
Rationale for Development of a New Discipline
Lifestyle medicine is a nascent discipline that has recently emerged
as a systematized approach for management of chronic disease.
The individual elements and skillsets that define lifestyle medicine
are determined, in large part, by the primary contributors to
noncommunicable diseases (NCDs). Unhealthful lifestyle behaviors
are among the leading risk factors for increased disability-adjusted life
years (DALYs) in the US 1 and around the world. 2 DALYs have become
an important metric for assessing health outcome and are defined as
the sum of years of life lost to premature mortality and years lived with
disabilities. Globally, NCDs account for about 63 % of all deaths. By 2030,
it is estimated that NCDs may account for 52 million annual deaths
worldwide. 3 One of the primary aims of the 2011 UN high-level meeting
of the General Assembly on noncommunicable diseases was as
follows: “Reducing the level of exposure of individuals and populations
to the common modifiable risk factors for NCDs, namely, tobacco use,
unhealthful diet, physical inactivity, and the harmful use of alcohol, and
their determinants, while at the same time strengthening the capacity
of individuals and populations to make healthier choices and follow
lifestyle patterns that foster good health.” 4 More recently, the World
Health Organization (WHO) published its 2008–2013 Action Plan for the
Global Strategy for the Prevention and Control of Noncommunicable
Diseases to prevent and control the four NCDs (cardiovascular diseases
[CVDs], diabetes, cancers, and chronic respiratory diseases) and the
four shared risk factors (tobacco use, physical inactivity, unhealthful
114 diets, and harmful use of alcohol). 5 These diseases are preventable.
It is estimated that up to 80 % of heart disease, stroke, and type 2
diabetes (T2D) and more than a third of cancers could be prevented by
eliminating these four shared risk factors. These four types of diseases
and their risk factors are considered together in the WHO action plan
to emphasize common causes and highlight potential synergies in
prevention and control.
In the US, the five leading causes of death in 2010 were diseases of
the heart, cancer, chronic lower respiratory diseases, cerebrovascular
disease (stroke), and unintentional injuries. 6 Among persons younger
than 80, these five diseases represented 66 % of all deaths. Table 1
displays selected modifiable lifestyle risk factors for these diseases.
Other modifiable risk factors associated with these diseases include sun
exposure, ionizing radiation, and hormones (cancer); and air pollutants,
occupational exposure, and allergens (lower respiratory disease).
There is a similarity of modifiable lifestyle risk factors for the five leading
causes of death. The strength of the evidence regarding the effects of daily
habits on health outcomes is further supported by comparing the leading
clinical guidelines on prevention and treatment of disease (see Table 2). 7–11
Individual lifestyle behaviors are among the five multiple determinants
of health as defined by Healthy People 2020, the science-based 10-year
national objectives for improving the health of all Americans. 12 The other
Tou c h ME d ica l ME d ia