How I found the “secret sauce” missing from health care

I practiced family medicine for more than 20 years before I discovered what I describe as “the secret sauce.”

I was encountering more and more patients dispirited by ever-growing quantities of pharmaceuticals or high-cost, low-yield interventions to manage symptoms of common chronic diseases such as type 2 diabetes or heart disease. Not being addressed were the root causes that enabled those diseases to develop in the first place. They were sick – and tired of it.

That led me to explore lifestyle medicine and conclude that evidence-based, adequately dosed lifestyle behavior interventions were the missing “secret sauce” in patient care. Medications and surgeries will always have their time and place, but the lack of attention to lifestyle behavior prevented patients from achieving whole health and me, as a doctor, from truly practicing holistic care with authenticity. It became my passion to encourage colleagues, particularly those
in family medicine, to develop a foundation of knowledge in lifestyle medicine.

So I was overjoyed to see lifestyle medicine highlighted at the White House Conference on Hunger, Nutrition and Health in September that resulted in $8 billion of public-private sector commitments to help impact hunger and reduce diet-related diseases. For example, the American College of Lifestyle Medicine (ACLM) will provide 5.5 complimentary hours of continuing medical education in lifestyle medicine and food as medicine to 100,000 health professionals.

Registration for the free course bundle is available here.

This opportunity comes as health leaders, health systems and policymakers increasingly recognize the role of lifestyle behaviors in the epidemic of chronic disease in the United States, where 60% of adults already have at least one chronic disease and almost half the entire adult population has pre-diabetes or diabetes. The U.S. Gross Domestic Product spent on health care is almost double that of other high-income countries but our overall health is worse. Poor overall diet quality is the single leading cause of premature death in the U.S. today.

What is lifestyle medicine? It is a specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions including, but not limited to, cardiovascular diseases, type 2 diabetes, and obesity. Lifestyle medicine certified clinicians are trained to apply evidence-based, whole-person, prescriptive lifestyle change to treat and, when used intensively, often reverse such conditions. Applying the six pillars of lifestyle medicine—a whole food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connections—also provides effective prevention for these conditions.

It is a growing field. Since certification began in 2017 by the American Board of Lifestyle Medicine, more than 2,445 physicians in the U.S. have become board certified in lifestyle medicine, along with 946 other health professionals.

Developing the knowledge and ability to communicate the science that supports lifestyle behavior change was a game changer for me and my patients. My confidence increased discussing lifestyle behavior with patients, who often felt newly empowered to take a more active role in their treatment. It provided me with the resources to show them how and why prescribed modifications to their diet or sleeping patterns can impact their health and the skill to prescribe sufficiently dosed lifestyle behavior interventions. Lifestyle medicine, just like pharmaceuticals, must be dosed appropriately to achieve optimal results.

As a result of this knowledge, my engagement with patients became richer. A visual I find effective is to hold up five fingers and tell patients I can prescribe a medication for each of the symptoms represented by the five fingers. But if I can determine the root cause of those symptoms represented by my palm – whether that is diet, sleep, physical activity, stress or a combination of several -- I may be able to make the majority of those finger symptoms and a great deal of suffering go away.

These interactions create a sense of partnership and shared decision making between doctor and patient that I find otherwise difficult to achieve. And that gives me a sense of satisfaction and joy that our disease care system too often drains out of us.

I believe changes to health care are coming. Our trajectory of disease and spending is not sustainable and policymakers and payors are seeing that a shift to high value care must happen -- and that’s exactly what lifestyle medicine can offer.

Dr. Mechley is a Direct Primary Care physician at Integrated Family Care of Cincinnati.

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