American College of Lifestyle Medicine Expert Consensus Statement: Lifestyle Medicine for Optimal Outcomes in Primary Care

Meagan L Grega; Jennifer T Shalz; Richard M Rosenfeld; Josie H Bidwell; Jonathan P Bonnet; David Bowman; Melanie L Brown; Mollie E Dwivedi; Ngozi M Ezinwa; John H Kelly; Amy R Mechley; Lawrence A Miller; Rajiv K Misquitta; Michael D Parkinson; Dipak Patel; Padmaja M Patel; Karen R Studer; Micaela C Karlsen

doi:10.1177/15598276231202970

American College of Lifestyle Medicine Expert Consensus Statement: Lifestyle Medicine for Optimal Outcomes in Primary Care

Am J Lifestyle Med. 2023 Oct 25;18(2):269-293. doi: 10.1177/15598276231202970. eCollection 2024 Mar-Apr.

Authors

Meagan L Grega¹, Jennifer T Shalz², Richard M Rosenfeld³, Josie H Bidwell⁴, Jonathan P Bonnet⁵, David Bowman⁶, Melanie L Brown⁷, Mollie E Dwivedi⁸, Ngozi M Ezinwa⁹, John H Kelly¹⁰, Amy R Mechley¹¹, Lawrence A Miller¹², Rajiv K Misquitta¹³, Michael D Parkinson¹⁴, Dipak Patel¹⁵, Padmaja M Patel¹⁶, Karen R Studer¹⁷, Micaela C Karlsen¹⁸

Affiliations

¹ St. Luke's University Health Network, Easton, PA, USA; Kellyn Foundation, Tatamy, PA, USA (MLG).
² Lifestyle Medicine Department, St. Luke's Health System, Boise ID, USA (JTS).
³ Department of Otolaryngology, SUNY Downstate Health Science University, Brooklyn, NY, USA (RMR).
⁴ Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, MI, USA (JHB).
⁵ Palo Alto VA Health Care, Palo Alto, CA, USA; Department of Medicine and Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA (JPB).
⁶ Department of Pediatrics, Howard University College of Medicine, Washington, DC, USA; Lifestyle Med Revolution, LLC, Upper Marlboro, MD, USA (DB).
⁷ Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA (MLB).
⁸ Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Washington University Living Well Center, St. Louis, MO, USA (MED).
⁹ Loma Linda University Health Care, Redlands, CA, USA (NME).
¹⁰ Loma Linda University, Loma Linda, CA, USA; Lifestyle Health Education Inc., Rocky Mount, VA, USA (JHK).
¹¹ University of Cincinnati College of Medicine, Cincinnati, OH, USA (ARM).
¹² Department of Psychiatry & Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA (LAM).
¹³ Department of Lifestyle Medicine, The Permanente Medical Group, Sacramento, CA, USA (RKM).
¹⁴ P3 Health, Pittsburgh, PA, USA (MDP).
¹⁵ Community Health Center, Inc., Meriden, CT, USA; Connecticut Lifestyle Medicine, CT, USA (DP)Community Health Center, Inc., Middletown, CT, USA (DP).
¹⁶ Lifestyle Medicine Center, Midland Health, Midland, TX, USA (PMP).
¹⁷ Preventive Medicine, Loma Linda University Health, Loma Linda, CA, USA (KRS).
¹⁸ Department of Research, American College of Lifestyle Medicine, Chesterfield, MO, USA; Departments of Applied Nutrition and Global Public Health, University of New England, Biddeford, ME, USA (MCK).

Abstract

Objective: Identify areas of consensus on integrating lifestyle medicine (LM) into primary care to achieve optimal outcomes.

Methods: Experts in both LM and primary care followed an a priori protocol for developing consensus statements. Using an iterative, online process, panel members expressed levels of agreement with statements, resulting in classification as consensus, near consensus, or no consensus.

Results: The panel identified 124 candidate statements addressing: (1) Integration into Primary Care, (2) Delivery Models, (3) Provider Education, (4) Evidence-base for LM, (5) Vital Signs, (6) Treatment, (7) Resource Referral and Reimbursement, (8) Patient, Family, and Community Involvement; Shared Decision-Making, (9) Social Determinants of Health and Health Equity, and (10) Barriers to LM. After three iterations of an online Delphi survey, statement revisions, and removal of duplicative statements, 65 statements met criteria for consensus, 24 for near consensus, and 35 for no consensus. Consensus was reached on key topics that included LM being recognized as an essential component of primary care in patients of all ages, including LM as a foundational element of health professional education.

Conclusion: The practice of LM in primary care can be strengthened by applying these statements to improve quality of care, inform policy, and identify areas for future research.

Keywords: Delphi method; delivery models; expert consensus; lifestyle medicine; primary care integration; social determinants of health.