The Heart of Whole Health: Articles Based on Presentations at the 2024 National Meeting of the American College of Lifestyle Medicine

“The members who are drawn to ACLM are filled with passion, commitment, and energy and are determined to make the world a healthier place!”

In this issue of the American Journal of Lifestyle Medicine (AJLM) we are delighted to, once again, publish an issue devoted to presentations made at the previous national convention of the American College of Lifestyle Medicine (ACLM). This represents the 10th year that we have published an issue focused on these presentations.

Last year’s conference of ACLM based on the theme “The Heart of Whole Health” represented a very special milestone since in 2024 ACLM celebrated its 20th Anniversary! While I am very proud that information from the first edition of my Lifestyle Medicine textbook published in 1999 ¹ provided much of the background information and impetus for the founding of ACLM in 2004, I never would have predicted the amazing growth and power that the organization has achieved over the past 20 years!

While it is good to recognize the robust grown of lifestyle medicine, it is important that we not rest on our laurels! As the great American poet Robert Frost wrote, “We have miles to go before we sleep.”

The articles contained in this issue of AJLM are diverse and thought-provoking. They represent numerous ways that lifestyle medicine continues to expand and offer important clinical benefits for a wide variety of common chronic conditions. These articles also explore ways that lifestyle medicine is broadening its scope to focus on health equity and diversity.

One of the articles shows how lifestyle medicine has broadened its appeal and is now a major component of the emerging area of “lifestyle psychiatry.” Another interesting article demonstrates how lifestyle medicine has begun to influence one of the largest professional organizations in the United States, the Academy of Nutrition and Dietetics. Another article shows how lifestyle medicine has influenced national health care policy in a low resource country (the Philippines). Yet another shows how lifestyle medicine has embraced culinary medicine as a strategy for infertility and preconception health.

One article presents solid underpinnings for why personal health issues related to lifestyle medicine are also critically important to the health of the planet. In addition, several articles offer fresh perspectives on not only where the field of lifestyle medicine currently stands, but also where it came from and where it can go in the future. Finally, one article based on a panel discussion explores the key ways that lifestyle medicine will continue to grow and thrive by focusing on the important role of education.

Taken together, these articles show not only that lifestyle medicine is here to stay and thriving but also destined to lead the way to a new area of medicine and health care. All in all, a tour de force!

The Guest Editors for this issue, Drs. Melissa Bernstein and Megan Alexander, did a truly outstanding job of pulling together a diverse and thought-provoking collection of articles. Together they curated 13 excellent articles based on presentations made at the 2024 national meeting of ACLM. To accomplish this, they had to sort through over 100 excellent presentations and panel discussions where expertise and passion for lifestyle medicine were shared by over 150 presenters.

While the articles presented in this issue represent a number of important and diverse areas, they roughly fall into 3 general categories. The first category consists of a grouping of articles demonstrating how lifestyle medicine practices can significantly impact on the treatment and prevention a variety of chronic diseases. The second grouping of articles explores the use of lifestyle medicine as a key strategy to improve health equity. The third grouping elucidates how lifestyle medicine has expanded to related health care fields and professional organizations such as the American Psychiatric Association and the Academy of Nutrition and Dietetics.

Within the category of lifestyle medicine application to chronic conditions, the article by Bhanusali “Leveraging Lifestyle Medicine for Better Outcomes in Connective Tissue Diseases” explores how virtually every one of the 6 pillars of lifestyle medicine has a place in helping to either prevent or treat a variety of connective tissue diseases (CTDs). As the author points out, CTDs encompass a group of over 200 disorders characterized by inflammation or damage to the body’s structural proteins including collagen and elastin. While many conditions fall under the umbrella of CTDs the various pillars of lifestyle medicine have been demonstrated to play a role in helping to treat virtually all of these conditions.

The superb article by Rosenfeld et al. “Lifestyle Interventions for Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults: Implications for Clinicians” summarizes an extremely important initiative sponsored by ACLM. I had the pleasure of reading the entire extensive Clinical Practice Guideline (CPG) in this area which was generated by some of the same authors. This massive, evidence-based Clinical Practice Guideline will be published as a separate supplement to AJLM. I was proud to write an Editorial to accompany this CPG.

The key understanding that underlies this CPG is that lifestyle medicine occupies a unique position within American health care by emphasizing practical, evidence-based strategies for helping to either reduce the risk or assist in the treatment of type 2 diabetes and prediabetes.

These conditions are extremely common in the United States and, indeed, around the world. Almost 15% of adults in the United States suffer from diabetes and 38% have prediabetes. Thus, these 2 conditions impact over half the adult population in the United States. The CPG is a much needed and welcomed approach to applying lifestyle measures to assist in the prevention and treatment of these diseases. Dr Rosenfeld, who co-authored this CPG provides a summary of the key strategies in this article in AJLM.

The article by Do and Tolos employs an integrative approach to utilizing the 6 pillars of lifestyle medicine to lower the risk of falls. Fall prevention represents a very important and often overlooked practical application of lifestyle medicine principles. It is important to recognize that falls are the leading cause of unintentional injuries resulting in emergency room visits across all age groups. Falls are the number one cause of traumatic brain injuries and cause over 95% of hip fractures. My family experienced the sequelae of a significant fall from my father in law several years ago. He fell while working in his garage and fractured both elbows. He was unable to get up for several hours and eventually was found and taken to a nearby hospital. He experienced one complication after another and never recovered. This depicts a sad but true sequela from a fall experienced by many families.

It is important to understand that falls are preventable and not just a normal part of aging. It is also important to understand that lifestyle medicine principles such as healthy nutrition, sleep, stress reduction, avoidance of risky substances, and regular physical activity can make a huge difference in the preventable occurrence of falls which cause enormous morbidity and mortality, particularly in the older population.

Health equity was the underlying theme of 4 other articles in the current issue of AJLM. The article by Thomas and Kudesia “Healthy Moms, Healthy Babies: Culinary and Lifestyle Medicine for PCOS and Preconception Health” highlights how healthy eating patterns can make an enormous difference in PCOS and other causes of infertility. Importantly, this article also provides useful information by blending culinary practices along with lifestyle medicine. This is an emerging trend which we are going to see a lot more of in the future.

The article by Duplantier et al offers a specific strategy for expanding lifestyle medicine to an often under resourced segment of the population. The model that they have successfully developed is called “Community as Medicine” (CAM). This model provides group health coaching strategies emphasizing affordable and accessible lifestyle practices. This innovative approach also highlights the interconnected elements of a person’s social and physical environment to their overall health. Many people have been concerned that lifestyle medicine has not been as aggressive as it should be in the area of health equity. This article provides a useful, concrete, and practical way of advancing lifestyle medicine principles to a chronically underserved population.

The article by Williams, “Advancing Health Equity and Addressing Health Disparities” provides important information about ethnic disparities and their impact on health equity in the United States. Historical precedents exist for this problem as outlined by Dr Williams. These date back as far back as the American colonies in the early 17th Century. In the 1700s, the American colonies experienced an epidemic of small pox in the African slave population but the only available therapy was restricted to the White population.

Dr Williams also recounts how health care disparities continue to exist in cardiovascular disease treatment, systemic hypertension, type 2 diabetes and chronic inflammation. It is important that a cardiologist of Dr Williams’ stature has chosen to focus on health equity. This will undoubtedly stimulate further interest in this area. Unfortunately, the medical profession in the United States still remains one where only a very small minority of physicians are African American. This needs to be addressed and mitigated as we move forward in the area of health equity. ACLM, through its HEAL Initiative has taken important steps in identifying health equity as a key concern moving forward as have the American Heart Association and the American College of Physicians.

The theme of the third grouping of articles in this issue contains articles expanding lifestyle medicine in a variety of areas. One important area of expansion is lifestyle psychiatry. The article by Merlo and Sugden entitled “The Power of Lifestyle Psychiatry: A New Approach to Mental Health” makes the compelling case that multiple interactions exist between lifestyle medicine and psychiatry. Dr Merlo has been a leader in this area and has now been tasked by the American Psychiatric Association to develop the area of “lifestyle psychiatry.” Hundreds of psychiatrists have already evidenced interest in this area by attending Dr Merlo’s speeches on this topic at APA meetings. This indicates a high level of interest in the shared lineage between lifestyle medicine and psychiatry. We will look forward to hearing more from Dr Merlo as she continues to lead the effort to blend lifestyle medicine with the practice of psychiatry.

The article by Wilson and McCleary “Registered Dietitian Nutritionists as Leaders in Lifestyle and Culinary Medicine” carries importance for several reasons. First, registered dietitian nutritionists are a natural ally as we seek to improve nutrition in the United States and around the world. It is gratifying to see an increasing number of RDNs who have joined the lifestyle medicine movement. Furthermore, as Wilson et al point out, lifestyle and culinary medicine share common ground. We are destined to see more articles and research in this area in the months and years to come. Indeed, at AJLM we will be publishing a themed issue on “Lifestyle and Culinary Medicine” in early 2026. The Food is Medicine and the Healthy Kitchens initiatives are components of this emerging effort and will play an increasingly prominent role in the area of lifestyle medicine.

The article by Palma et al shows how lifestyle medicine principles can be integrated into the overall national health plan in an under resourced country such as the Philippines. Lifestyle medicine practices, which are by their nature very cost effective, can play a particularly important role in countries where limited resources are available.

The article by Kanabar “Are we Hooked on our Screens? A Reflective Review on Current Evidence and New Directions” highlights an emerging area of great concern in the United States. In his seminal book written almost 2 decades ago, Dr Robert Putnam from the Harvard Business School, sounded an early alarm by concluding that the internet, which was supposed to bring people closer together actually, in many cases, isolated them. ²

These concerns, along the attendant adverse health implications, were persuasively amplified by former Surgeon General Vivek Murthy in his Surgeon General’s Advisory “Our Epidemic of Loneliness and Isolation” ³ which documents that loneliness significantly increases the risk of heart disease, stroke and multiple other chronic diseases and, indeed, is more dangerous than obesity for a person’s health.

These considerations are very important for lifestyle medicine, since they underpin the sixth pillar of lifestyle medicine, namely, the power of positive connections to other people.

The considerations of the multiple health benefits from interpersonal connections is further underscored by the superb article by Dan Buettner “Lessons from the Blue Zones: There is no Silver Bullet (or Magic Pill) for a Long Healthy Life.”

Buettner points out that in many of the Blue Zones that he has investigated, the health and longevity of centenarians are partially based on the interconnections that they have with each other and with other people in their communities. Buettner also ties healthy living to multiple other daily habits and actions such as regular movement (physical activity), a plant forward diet, and stress reduction. These are, of course, familiar to practitioners of lifestyle medicine and show the significant synergy between the findings of the Blue Zone research project and the core values of lifestyle medicine.

I have been an enthusiastic supporter of the concept of Blue Zones for a number of years. Indeed, we published an early scientific article about Blue Zones co-authored by Buettner and Skemp in AJLM in 2016. ⁴

In addition to the above findings that Buettner discovered, I was personally struck by several of his observations. The first was that one of the key considerations for a long and healthy life is to have a daughter. Since I have 4 daughters this is yet another reason for me to feel blessed! Buettner also emphasizes that the key area strategy for enhancing physical activity is to recommend walking. This is also music to my ears since I engage in several long daily walks on our properties in Massachusetts, often accompanied by my rambunctious Labrador Retrievers (I should also point out that I hold a black belt in Okinawan karate, although it sounds from Buettner’s continuing analysis of Okinawa as a previous Blue Zone that ship may have already sailed…)

I am also proud that my research team generated some of the first definitive studies on the health benefits of walking and spread this information, not only to the public at large, but also to the medical community.^5,6 This came at a time when many people thought you needed to run in order to get health benefits. Times have really changed! I completely agree with Dan Buettner that walking should be the centerpiece of regular movement that we recommend to all individuals.

Finally, I was pleased that Dan Buettner in his title emphasized that one of the lessons from the Blue Zones was that there is “no silver bullet or magic pill for a long healthy life.” Some controversy has arisen about whether or not findings from the Blue Zones completely predict the number of people who live to be over 100 years old. Buettner handles this controversy in a straightforward manner by emphasizing the health benefits of the daily habits and actions that centenarians practice without focusing solely on the fact that there seems to be an increased number of centenarians in certain corners of the world. This should go a long way in combating controversies that some of the epidemiologists in the area of aging have raised about making too direct of a link between Blue Zone research and the likelihood of individuals will live to be over 100 years old.

In order to continue to expand and deepen the value of lifestyle medicine throughout the United States and around the world, it will be critically important to expand on the already extensive efforts made by the American College of Lifestyle Medicine in the area of lifestyle medicine education. This issue of AJLM contains an important panel discussion which occurred at the 2024 meeting of ACLM resulting in the paper by Rea et al “Cultivating the Future: The Intersection of Education and Lifestyle Medicine.”

This paper combines the points of view of thought leaders in lifestyle medicine with interactions with various professional organizations such as the American Association of Medical Colleges. Individuals who are interested in learning more about the state of the art in lifestyle medicine education and its important role in the future will find this to be an important and comprehensive reference.

Two additional articles round out the diversity of presentations we are publishing in this issue of AJLM. The first is by David Katz who many will remember as a former President of ACLM. His Perspective article “Lifestyle Medicine and the Far Horizon: Before, Since and Beyond” blends the origins of lifestyle medicine, the current status and then offers some salient thoughts about how lifestyle medicine must evolve to meet the pressing and prevalent chronic health care needs of the future. The other Perspective article written by Robbins makes the critically important connection that lifestyle medicine modalities are important not only for personal health but also for the health of the planet.

A number of prestigious panels have buttressed the concern with raised by Robbins with ominous and stark predictions of the adverse effects on the health of the planet emanating from current individual food choices. Perhaps the most comprehensive of these assessments comes from the Lancet-EAT panel which sounded a clarion call that we must engage in a great food transformation with a plant forward diet within the next 2 decades to prevent further irreparable harm to our planet. ⁷

These concerns are summarized in the article by Robbins who notes that livestock farming is the leading emitter of greenhouse gases on the planet. Beef production, in particular, generates ten times more toxic emissions than pork and poultry and over 100 times more of the amount of greenhouse gasses than plant-based, protein rich foods such as lentils and beans!

Many people do not realize that agriculture accounts for 92% of humanity’s fresh water use. One astounding statistic quoted by Robbins is that producing just one pound of beef requires 1850 gallons of water, enough to stack a pile of one gallon water jugs higher than the Empire State building!

Lifestyle medicine physicians are in a unique position to help the public at large and policy makers understand that there is an urgent need exists to move toward a healthier planet through a plant forward diet in the United States and around the world. This dietary shift will not only improve individual health but also the health of the planet.

The breadth, depth, and clinical relevance of the articles that we are pleased to publish in the annual issue of AJLM devoted to the preceding national conference of ACLM, reflect similar broader trends in the area of lifestyle medicine. Numerous important achievements have occurred in the past 12 months and will continue to occur for the foreseeable future. For example, the significant relationship between ACLM and Blue Zones heralds an expanded clinical footprint emphasizing the core principles of lifestyle medicine. ⁸ The acceptance of ACLM as a member of the House of Delegates of the American Medical Association provides an even deeper clinical footprint and credibility than was achieved in the past. ⁹ The publication of several important supplements to AJLM including the “Clinical Practice Guideline on the prevention and treatment of prediabetes and diabetes” ¹⁰ underscores the unique positioning and power of lifestyle medicine to help patients achieve behavioral change.

ACLM continues to be a powerhouse and a major driving force in moving lifestyle medicine forward. The membership of ACLM has increased to over 13,500 individuals making it the most rapidly growing health care organization in the world. Even more importantly, the members who are drawn to ACLM are filled with passion, commitment, and energy and are determined to make the world a healthier place!

In addition to the magnificent ACLM conference in 2024, the year also witnessed the publication the 4th edition of my Lifestyle Medicine textbook. ¹¹ This academic textbook has over 325 contributors representing leading experts in academic lifestyle medicine related fields throughout the world. In 2024 and 2025, we will be publishing at least 6 soft covered books in the Lifestyle Medicine Series that I edit. These include a book on lifestyle nutrition, ¹² lifestyle medicine and the whole person care, ¹³ lifestyle medicine and geriatrics ¹⁴ lifestyle medicine and occupational health, ¹⁵ lifestyle medicine and pediatrics ¹⁶ and lifestyle medicine health equity. ¹⁷ Another book in the area of lifestyle medicine and personal and planetary health ¹⁸ will follow within the next 12-18 months.

Thus, on multiple fronts and multiple areas the power and scope of lifestyle medicine continues to grow.

The American Journal of Lifestyle Medicine has also kept pace with the expanding opportunities in lifestyle medicine! In the past year, the number of subscribers of AJLM increased to over 25,000. We have experienced over 325,000 downloads of full-text articles. ¹⁹ Article submissions have come from virtually every corner of the world and continue to rapidly increase both in number, quality and relevance!

With all of these occurrences, I am very proud to step back and look at all that we have accomplished together. While numerous important milestones have been achieved, there are many more challenges that must be confronted.

We still have yet to significantly move the needle in helping people actually change their daily habits and actions to improve their health. I am optimistic that we will continue to make headway in this area but it will require the very best efforts of all of us working together with the passion, commitment and hard work that epitomizes members of the lifestyle medicine community! Indeed, we have “miles to go before we sleep.”