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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: rkushner@northwestern.edu 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