Creating a Lifestyle Medicine Center: From Concept to Clinical Practice [1st ed.] 9783030480875, 9783030480882

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Jeffrey I. Mechanick Robert F. Kushner Editors

Creating a Lifestyle Medicine Center From Concept to Clinical Practice

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Creating a Lifestyle Medicine Center

Jeffrey I. Mechanick  •  Robert F. Kushner Editors

Creating a Lifestyle Medicine Center From Concept to Clinical Practice

Editors Jeffrey I. Mechanick The Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, and the Division of Endocrinology, Diabetes and Bone Disease Icahn School of Medicine at Mount Sinai New York, NY USA

Robert F. Kushner Departments of Medicine and Medical Education Northwestern University Chicago, IL USA

ISBN 978-3-030-48087-5    ISBN 978-3-030-48088-2 (eBook) https://doi.org/10.1007/978-3-030-48088-2 © Springer Nature Switzerland AG 2020 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

We wish to thank our friends and colleagues at the Kravis Center for Cardiovascular Health at Mount Sinai Heart and Northwestern Medicine Center for Lifestyle Medicine who share our passion and commitment to providing exceptional care, our patients who teach us how to be better doctors, and our families who keep us grounded. – JM and RK

Foreword

Cardiovascular disease is the number one cause of mortality worldwide and impels the coordinated quest for scientifically valid strategies, along with safe and effective actions. Unfortunately, humans have had to bear witness to the many false starts, misdirections, and premature conclusions to what have been regarded as best laid plans. Where are the failings? What are we doing wrong inasmuch as epidemiological evidence continues to demonstrate worsening of cardiovascular disease and prevalence rates of modifiable risk factors in certain populations? My lifelong aspiration is to better understand not only the nature of human disease, but more importantly the nature of human health. It is the purpose of our healthcare system to optimize human health for all people, taking into account pathophysiology and diversity. The framework I have structured and formally detailed [1] focuses on prevention. In a nutshell, rather than the conventional way of waiting for disease to take root and cause harm before any meaningful intervention is performed, a diligent process of screening, case finding, and intervention to abrogate or mitigate the disease process, in a manner that improves health, is implemented. At first, this may be on a small scale, but the ultimate goal is far-reaching, grounded in science, with demonstrable wellness for individuals and populations. There are six dimensions to this plan. First, we focus on the eight behavioral aspects of cardiometabolic prevention: healthy eating, healthy weight and body composition, healthy glucose levels, healthy blood pressure, healthy cholesterol levels, plenty of physical activity, avoidance of tobacco products, and psychological health. Second, the term “health” is classified as poor, intermediate, and ideal for the purposes of study and messaging. Third, there must be a global scope that involves people of all ethnicities, cultures, and ways of living. Fourth, mitigation strategies are included for other chronic diseases, such as cancer and degenerative disease prevention. Fifth, there are important roles of technology, economics, education, quality of life, and behavior that must be considered and leveraged for best outcomes. And sixth, prevention programs must be implemented early and in a sustainable fashion; this means targeting our children and creating an infrastructure that works over a relatively long timeframe. It is this last dimension that has proven to be the most challenging, yet most intriguing and rewarding when one devotes energy and thoughtfulness to the problem. The FAMILIA Trial, published last year, was a cluster-randomized controlled study of 562 children aged 3–5 years, demonstrating that a multidimensional school-based educational intervention strategy (a form of primordial prevention) can improve healthy behaviors in a diverse, socioeconomically disadvantaged community [2]. No doubt, this model will need to be scaled up and validated in different settings—but here is the rub. How do we actually build physical structures with successful operations and management to truly realize superior outcomes on a scale that durably transforms healthcare? This is the practice gap that has been so elusive over the years and must be closed in the lifestyle medicine space so that scientifically sound strategies can result in a pervasive elevation of health. This book by my colleagues, Drs. Jeffrey Mechanick and Robert Kushner, succeeds in providing the blueprint for closing this practice gap. This book builds on the concepts, theory, and science of lifestyle medicine in their first book, and now provides not only the broad strokes on vii

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Foreword

what a Lifestyle Medicine Center is, but also the details for how to imagine, build, and operate this enterprise in a host of settings. Challenges, examples, and technical factors are all discussed in a way that captures interest and spurs on action. My dream is to improve health for all people at all points in the lifecycle. A book on implementation fills the gap to enable me, and you, to realize this shared dream.

References 1. Turco J, Inal-Veith A, Fuster V.  Cardiovascular health promotion. J Am Coll Cardiol. 2018;72:908–13. 2. Fernandez-Jimenez R, Jaslow R, Bansilal S, et al. Child health promotion in underserved communities: the FAMILIA Trial. J Am Coll Cardiol. 2019;73:2011–21.

Valentin Fuster Physician-in-Chief, The Mount Sinai Hospital Director, Mount Sinai Heart New York, NY, USA

Preface

Lifestyle medicine is a discipline that is growing in popularity for three reasons. First, there are more scientific studies supporting the role of structured lifestyle change, benefits of healthy behaviors, and positive impact of individual lifestyle components on nearly every chronic disease state examined. Second, lifestyle medicine can be clinically delivered in the outpatient setting to produce these benefits for the patient. Third, educational programs have promulgated the message of lifestyle medicine to healthcare professionals, other stakeholders, and the general public. The net effect of these three drivers is the transformation of how we think about and deliver healthcare. This is a much-needed event, given the confused medical economic climate, growing nature of healthcare inequities in society, and unfortunate disenchantment of many workers in the medical profession. Yet, a gap exists between the enthusiasm for lifestyle medicine and its implementation. Despite all the accumulated scientific evidence in the lifestyle medicine literature, the increasing expertise and experience acquired by students of lifestyle medicine, and the overt successes resulting from the instances where lifestyle medicine is practiced, there is still a lack of largescale, pervasive use of this new discipline. The clinical demand to deliver lifestyle medicine programs is overwhelming based on the rarity of good health practices among Americans and the very small percentage of patients (