It is written that Hippocrates said, “Let food be thy medicine and medicine be thy food” and Plato said, “Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it.” So how, thousands of years later, did the human race get into a situation in which the World Health Organization predicts that by the year 2020, two-thirds of global disease will be the result of lifestyle behaviors such as poor diet, a physically inactive lifestyle, and high stress levels?1 In the United States especially, 86% of annual healthcare costs are spent on its citizens who have lifestyle-related chronic health conditions including cardiovascular disease, diabetes, and cancer.2 Clearly, we have not listened to these wise medical doctors/philosophers.
At the Lifestyle Medicine Education Collaborative (LMEd), we believe that physicians can be essential game-changers of these national and global chronic disease statistics through clinical counseling and patient education.3 However, current reports demonstrate that >85% of physicians who graduate from medical school do not possess the necessary knowledge and clinical skills to provide counseling in prevention and treatment of chronic disease.4 Therefore, in addition to being a co-founder and co-director of LMEd, I also am a Lifestyle Medicine educator at the University of South Carolina School of Medicine Greenville (USC SOM Greenville), where we endeavor to change the model of medical education by training physicians who are well-trained in the evidence-based knowledge and clinical skills on the power of nutrition, physical activity, behavior change, self-care, and resiliency for value-based patient care, preventive medicine, and population health management.5-8 The USC SOM Greenville medical students feel that Lifestyle Medicine training is essential in their success as future doctors. The USC SOM Greenville Lifestyle Medicine curriculum has received recognition in U.S. News and World Report, Chicago Tribune, and CNN.
In addition to the classroom teaching and providing curriculum in Lifestyle Medicine, USC SOM Greenville has fostered a “classroom-to-community” model of Lifestyle Medicine in Greenville County through a partnership with Greenville Health System (GHS), the Greenville YMCAs, and American College of Sports Medicine to improve healthcare delivery in upstate South Carolina using the clinical program Exercise is Medicine Greenville® (EIM Greenville®) that launched in August 2016. As Program Director and Chair of the Advisory Board, I strive to reach an overarching goal to teach students, physicians, fitness professionals, and the community how physician-counseling and referrals for physical activity plays a well-documented role in reducing morbidity and mortality from lifestyle-related chronic diseases for successful population health management. USC SOM Greenville was named first in the country to implement the program at the National Press Club in Washington, D.C. alongside former U.S. Surgeon General, Regina Benjamin, MD. I am witnessing the success of the program full-circle as my students who were taught the Lifestyle Medicine curriculum and have graduated into residency training at GHS, are now utilizing the EIM Greenville® program and referring their patients.
As successful as our curriculum at USC SOM Greenville has been, Eddie, Dennis, and I understand that Lifestyle Medicine training needs to occur beyond just a few medical schools. We have worked with national representation from the National Institutes of Health, Association of American Medical Colleges, National Board of Medical Examiners, American College of Sports Medicine, American College of Lifestyle Medicine, American College of Preventive Medicine and the Bipartisan Policy Center in Washington, DC, and the European Lifestyle Medicine Organization, among many others. As mentioned previously, we have reached out to or received requests from >150 United States and international medical schools, have created a AAMC MedEdPORTAL Lifestyle Medicine Curriculum Collection, and furthered the mission by supporting the H.R.1413 – ENRICH Act and the H.R.1634 – EAT for Health Act of 2017 through an LMEd and American College of Preventative Medicine co-hosted Lifestyle Medicine presentation on Capitol Hill in Washington, DC.
It is LMEd’s vision that “Lifestyle medicine will become an integral component of medical school curricula.” The vision is supported through the mission, “To provide an array of evidence-based curricular resources to be adopted throughout medical education for the prevention and treatment of lifestyle-related diseases.” Through USC SOM Greenville and LMEd, we are spearheading a ripple-effect in the United States by modeling for other medical school leaders on how to adopt similar changes in curriculum and training for medical school students.9 Circling back to the wise statements from Hippocrates and Plato, Lifestyle Medicine training in medical education is vital for transforming healthcare and decreasing the healthcare costs of our nation and globally.
Jennifer Trilk, PhD, FACSM
- Chopra M, Galbraith S, Darnton-Hill I. A global response to a global problem: The epidemic of overnutrition. Bull World Health Organ. 2002;80(12):952-958.
- National Center for Chronic Disease Prevention and Health Promotion. Chronic disease overview: https://www.cdc.gov/chronicdisease/overview/. Updated 2015. Accessed June/02, 2017.
- Lianov L, Johnson M. Physician competencies for prescribing lifestyle medicine. JAMA. 2010;304(2):202-203.
- Vetter ML, Herring SJ, Sood M, Shah NR, Kalet AL. What do resident physicians know about nutrition? an evaluation of attitudes, self-perceived proficiency and knowledge. J Am Coll Nutr. 2008;27(2):287-298.
- Sallis RE, Matuszak JM, Baggish AL, et al. Call to action on making physical activity assessment and prescription a medical standard of care. Current Sports Medicine Reports (Lippincott Williams & Wilkins). 2016;15(3):207-214. http://search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=115308284&site=ehost-live&scope=site.
- Trilk JL, Phillips EM. Incorporating ‘exercise is medicine’ into the university of south carolina school of medicine greenville and greenville health system. Br J Sports Med. 2014;48(3):165-167. http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=104003083&site=ehost-live&scope=site. doi: 10.1136/bjsports-2013-093157.
- Hivert M, Arena R, Forman DE, et al. Medical training to achieve competency in lifestyle counseling: An essential foundation for prevention and treatment of cardiovascular diseases and other chronic medical conditions. Circulation. 2016;134(15):e308-e327. http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=118699303&site=ehost-live&scope=site. doi: 10.1161/CIR.0000000000000442.
- Bipartisan Policy Center. Teaching nutrition and physical activity in medical school: Training doctors for prevention-oriented care. http://bipartisanpolicy.org/sites/default/files/Med_Ed_Report.PDF. Updated 2014. Accessed July, 2017.
- Trilk JL, Muscato D, Polak R. Advancing lifestyle medicine education in undergraduate medical school curricula through the lifestyle medicine education collaborative (LMEd). American Journal of Lifestyle Medicine. 2016:1559827616682475.