How lifestyle medicine physicians treat patients

Osteopathic physicians are trained to treat the whole person, address the root cause of health problems and focus on preventive health care.

Physicians who practice lifestyle medicine seek to achieve many of the same goals via the counseling of patients on healthy lifestyle choices. Here’s an explainer on lifestyle medicine.

What is lifestyle medicine?

The American College of Lifestyle Medicine (ACLM) defines lifestyle medicine as “the evidence-based practice of helping individuals and families adopt and sustain healthy behaviors that affect health and quality of life.”

David Drozek, DO, a lifestyle medicine physician in Athens, Ohio, says lifestyle medicine uses three main modalities to promote wellness:

• Nutrition.
• Physical activity.
• Stress management.

“My hope for my patients is that they’ll get to a 90% plant-based whole foods diet, that they’ll take 10,000 steps a day or get 30 minutes of moderate exercise a day, and that they’ll practice a stress management technique daily,” he says.

How is lifestyle medicine typically practiced?

Any physician, DO or MD, of any specialty can practice lifestyle medicine by incorporating lifestyle counseling into their usual practice of medicine, says Robyn Dreibelbis, DO, who teaches a course on nutrition in medicine at the Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Northwest in Lebanon, Oregon.

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“Every single physician should be an expert in lifestyle medicine,” she says. “We all need to engage conversations on lifestyle determinants of health with our patients.”

Many physicians who practice lifestyle medicine incorporate group wellness classes into their treatment approach.

Dr. Drozek, who shifted his practice from general surgery to a combination of endoscopy and lifestyle medicine, leads group classes sponsored by his institution, OhioHealth/O’Bleness Hospital.

“The patients set goals together in the group setting,” he says. “They build peer relationships and get support from one another.”

Dr. Drozek also sees individual patients for 45-minute lifestyle counseling sessions, which are usually the result of a referral from another physician.

“In the session, I’ll learn what the patient’s needs and interests are, and I explain what lifestyle medicine is and what it can do for them,” he says. “I give them some basic information on how to apply the principles, such as nutrition and activity guidelines.”

What are the challenges of practicing lifestyle medicine?

Time and reimbursement: Physicians may have trouble squeezing lifestyle counseling into a 15-minute appointment, and they often hit roadblocks when they try to obtain reimbursement for the time spent advising patients on lifestyle changes.

Under the Affordable Care Act, certain patients should receive lifestyle counseling from physicians without a copay as a preventive care benefit, but insurance companies don’t always honor that, Dr. Drozek says.

Dr. Drozek says his earnings for practicing lifestyle medicine are meager, and that most physicians would find practicing lifestyle medicine full time to be a financial challenge.

Many physicians incorporate lifestyle medicine into a traditional medical practice or, as Dr. Drozek does, conduct hospital-sponsored group classes, says Ingrid Edshteyn, DO, MPH, the associate executive director with the ACLM. Dr. Edshteyn adds that the transition from a fee-for-service reimbursement model to an outcomes-based model may pave the way for better reimbursement for lifestyle medicine.

How does lifestyle medicine align with osteopathic medicine?

“Osteopathic medicine and lifestyle medicine are, in my mind, extremely similar,” Dr. Dreibelbis says. “The lifestyle determinants of health speak very strongly to the tenets of osteopathic medicine.”

Dr. Edshteyn agrees.

“The osteopathic oath resonates with the whole idea of lifestyle medicine,” she says. “The person is a complete unit of body, mind and spirit. That’s what lifestyle interventions address. It’s not just your diabetes or your hypertension. It’s going to the root causes of the condition and addressing them.”