Lifestyle Medicine: A Primary Care Perspective

Camille A. Clarke; Michelle E. Hauser

摘要

“Patients don't change.” The memory brought back uneasy feelings as I recalled the admonitions given by several of my medical school attending physicians. “Don't waste your valuable few minutes on counseling; better to use medications, which we know work.” A few years later, in residency clinic at a community health center, I met Rosa (name has been changed). At age 45, she struggled with hypertension, depression, and obesity; her blood work that day added prediabetes to the list. Rosa had a stable job and intact family, but felt overwhelmed by her health problems. She tried dieting countless times, only to regain more weight than she had lost. Previous primary care physicians told her she needed to lose weight, but to that end, she had not been offered any realistic solutions. During our first visit, I helped Rosa assess her strengths and weaknesses, resources, preferences, and stage of change. Then, collectively, we came up with an action plan. She decided to attend our shared medical appointments (SMAs)—group visits to help overweight and obese patients with risk factors for cardiovascular disease make healthy lifestyle changes.1 During these visits, Rosa spoke with others who had similar health conditions, participated in health and wellness activities, and learned to set achievable goals. She especially enjoyed the stress reduction sessions, exercise classes, and cooking demonstrations of quick, inexpensive, healthy meals. In addition to SMAs, Rosa learned about culturally appropriate, healthy foods from our dietician and safe exercise techniques from our physical therapist. Armed with the information and skills needed to make healthy lifestyle changes, Rosa felt empowered. She began exercising several times per week at a community gym. Her husband took charge of cooking meals and made healthy lunches for her to take to work. When her work schedule made it difficult for her to continue attending the SMAs, our medical assistant arranged for her to have a “buddy” who was also trying to lose weight. They held each other accountable and provided much-needed camaraderie on the road to health. In 12 months' time, Rosa's hemoglobin A1c returned to normal and her weight stabilized at 15 pounds less than it had been at our initial visit. Her mood and blood pressure improved, so she was able to stop taking medications for both depression and hypertension. She continued to eat healthily and exercise. Inspired, her husband also began exercising. Seeing Rosa and her family become healthier made our care team feel proud that we had been part of the transformation. Rosa's story illustrates the power of lifestyle medicine. While the specialty of preventive medicine is well known to physicians, lifestyle medicine is elusive for many. Lifestyle medicine is defined as “the systematic practice of assisting individuals and families to adopt and sustain behaviors that can improve health and quality of life.”2 The first textbook on this subject was published in 1999, and the certifying board, the American College of Lifestyle Medicine, convened its first meeting in 2004.3 In 2007, the American College of Preventive Medicine Board of Regents decided to become actively involved in lifestyle medicine, and convened a panel of experts in 2009 to develop 15 evidence-based competencies for practicing physicians.2 Examples include collaborating with patients and families to develop action plans such as lifestyle prescriptions, practicing and promoting healthy behaviors, and drawing on an interdisciplinary team of care providers. In 2012, the American Medical Association called for physicians to “acquire and apply these competencies, and offer evidence-based lifestyle medicine interventions as the first and primary mode of preventing and, when appropriate, treating chronic disease within clinical medicine.”4 However, many primary care physicians find this recommendation challenging to implement in time-strapped clinical practices. Limited training in li

机译：“患者不会改变。”当我回想起我的几所医学院就读医生的训诫时，记忆带回了不安的感觉。 “不要将宝贵的时间浪费在辅导上;最好使用我们知道有效的药物。”几年后，我在社区保健中心的居民诊所里遇到了罗莎（名字已经改变）。她在45岁时患有高血压，抑郁症和肥胖症。那天她的血液检查使糖尿病患者增加了。罗莎（Rosa）拥有稳定的工作和完整的家庭，但因健康问题而感到不知所措。她尝试了无数次节食，但是却又重新获得了比失去的体重还要多的体重。以前的初级保健医生告诉她，她需要减肥，但是为此，她没有得到任何现实的解决方案。在我们的第一次访问中，我帮助罗莎评估了她的长处和短处，资源，偏好和变更阶段。然后，我们共同提出了一项行动计划。她决定参加我们的共同医疗预约（SMAs）—小组访问，以帮助具有心血管疾病危险因素的超重和肥胖患者改变健康的生活方式。1在这些访问中，罗莎与其他具有类似健康状况的参与者交谈，参加了健康和健康活动，并学会设定可实现的目标。她特别喜欢减压课程，健身课程以及演示快速，廉价，健康餐点的烹饪示范。除了SMA外，Rosa还从营养师那里学到了适合文化的健康食品，并从理疗师那里学到了安全的锻炼技巧。有了改变健康的生活方式所需的信息和技能，Rosa感到有能力。她每周开始在社区体育馆锻炼几次。她的丈夫负责做饭，并为她准备健康的午餐，以便上班。当她的工作日程安排使她难以继续参加SMA时，我们的医疗助理安排了她的“伙伴”，他也在努力减肥。他们互相追究责任，并在健康的道路上提供了急需的友情。在12个月的时间内，Rosa的血红蛋白A1c恢复正常，她的体重稳定在比我们初次访问时少15磅的水平。她的情绪和血压有所改善，因此她能够停止服用针对抑郁症和高血压的药物。她继续健康饮食和运动。受到启发，她的丈夫也开始锻炼。看到Rosa和她的家人变得更健康，我们的护理团队为我们参与了这一转变感到自豪。罗莎的故事说明了生活方式医学的力量。虽然预防医学的专长是医生所熟知的，但生活方式医学对许多人来说却遥不可及。生活方式医学被定义为“协助个人和家庭采取并维持可以改善健康和生活质量的行为的系统性实践。” 2该主题的第一本教科书于1999年出版，认证委员会为美国生活方式医学，于2004年召开了第一次会议。32007年，美国预防医学学会董事会决定积极参与生活方式医学，并于2009年召集了一个专家小组，为执业医师发展了15种基于证据的能力。2这样的例子包括与患者和家人合作制定行动计划，例如生活方式处方，练习和促进健康行为，以及利用跨学科的护理提供者团队。 2012年，美国医学会呼吁医师“获得和运用这些能力，并提供循证生活方式的医学干预措施，作为预防和在适当情况下在临床医学中治疗慢性病的首要方法。” 4许多初级保健医师发现，在时间紧迫的临床实践中实施该建议具有挑战性。李的有限培训

Lifestyle Medicine: A Primary Care Perspective

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