American Journal of Lifestyle Medicine

Burnout syndrome results from unmanaged chronic workplace stress. It is characterized by emotional exhaustion, lack of a sense of personal accomplishment, and depersonalization. Burnout is associated with the development of poor work-related outcomes, mental health disorders, substance abuse, and cardiovascular disease. Burnout in physicians and other health care providers can negatively affect patient care. The prevalence of burnout in anesthesiology is among the highest of all medical specialties, with rates approaching 40%. Unique risk factors for the development of burnout in anesthesiologists may include environmental social isolation, long work hours, lack of control over one’s career, and the presence of certain personality traits that select for a career in anesthesia. System-based interventions targeting workplace contributions to burnout and individual resilience and mindfulness training can be helpful in reducing burnout symptoms. Future research efforts examining both the health care environmental structure and the specific burnout risk factors for anesthesiologists will help produce targeted treatment strategies for members of the anesthesiology community.

Under typical circumstances, up to half of physicians, 31% of nurses who provide direct patient care, and 37% of nurses working in nursing homes experience burnout, and these rates are likely exacerbated following the Coronavirus disease 2019 pandemic. Diet is a mediating and modifiable factor with regard to burnout risk. Chronic stress, such as the stress experienced by individuals suffering from burnout, has been shown to influence the amounts and types of foods individuals eat, contributing both to excessive eating and undereating and the development of chronic diseases. Dietary strategies to mitigate burnout for physicians and health care professionals should be developed based on existing evidence related to nutrition and mental health, incorporate effective behavior change theory, and include systems-level change to promote healthy eating among health care professionals. Evidence supports the application of the Mediterranean diet, cognitive behavioral theory, and mindful eating interventions. Policy and systems approaches should support the availability of healthy foods at employer-sponsored events and eating outlets, worksite wellness, and nutrition education in medical training curriculum.

Health care professionals represent a population at high risk for poor health. Although this may be counterintuitive given their expertise in health, the high stress and long hours of many medical work environments present challenges for health care professionals to engage in healthy lifestyle behaviors. This is extremely problematic for the health and well-being of both health care professionals and the patients they treat. Medical settings are encouraged to implement interventions that intervene at both the enviornmental and personal level to help faciliate behavior change among health care providers.

Primary care physicians have among the highest rates of burnout of any medical specialty in the United States. Team-based care is an organizational approach to meet the increasing demands on the primary care system, including the well-being of its providers. Physicians report that pharmacist-delivered comprehensive medication management improves patient care efficiency, decreases workload and provides additional work-based social support, among other benefits. Physician perspectives as well as resources for implementing physician-pharmacist collaborations are discussed.

The issue of employee productivity has become a major concern for companies. Inefficiency can occur at every stage of production either as poor design, worker limitation, or other factors. It is generally assumed that a healthy worker is more productive than an unhealthy worker. As early as 1776 Adam Smith observed and published in The Wealth of Nations that poor worker health was a detriment to industrial productivity. The objective of this article is to review the literature documenting the gain or loss of productivity related to the health of workers, as well as any lifestyle management strategies that can be used to improve employee health and productivity. The impact of employee obesity, smoking, physical activity, sleep, and behavioral health on productivity will be explored. By identifying and addressing health risks that impair worker performance, lifestyle medicine professionals can demonstrate a significant return on investment by creating a healthier and more productive work force.

Lifestyle medicine domains, despite accounting for more than 78% of chronic disease risk, are infrequently taught as a part of the medical curriculum. Aspects such as nutrition are taught in less than 25% of medical schools, a statistic that continues to decline, and less than 20% of practicing physicians were required to take even a single course in exercise counseling during their medical school training. To combat this lack of training, the American College of Lifestyle Medicine annually awards the Donald A. Pegg scholarship to fund the development of Lifestyle Medicine Interest Groups (LMIGs) across medical schools worldwide. This scholarship was initiated in 2016 and utilizes private funds to support the development and expansion of LMIGs with the aim of increasing awareness of lifestyle medicine among training practitioners. There are four award winners per year. To date there are sixteen Pegg Award winners. This article will showcase the four 2019-2020 Donald A. Pegg award recipients and their impact on the LMIGs at their institutions. Furthermore, it highlights the ingenuity and adaptation of these LMIGs during the COVID-19 pandemic.

Physician burnout, as described in North America, is a multidimensional work-related syndrome that includes emotional exhaustion, depersonalization, and a low sense of accomplishment from work. More than 50% of physicians were reporting symptoms of burnout prior to the COVID-19 pandemic. This silent epidemic of burnout is bound to become less silent as the pandemic continues. Lifestyle medicine is an evidence-based discipline that describes how daily habits and health practices can affect overall health and well-being of individuals. Lifestyle Medicine can potentially play a significant role in preventing and ameliorating physician burnout. This article explores the burnout process, including the historical context, international definitions, symptoms, and imprecision of the clinical diagnosis. The systemic etiological issues are discussed, and the psychological underpinnings are explored, including physicians’ personal vulnerabilities contributing to burnout. The stress response and lifestyle medicine’s role in healthy coping are described. A prevention model for risk factor reduction is proposed, focusing on primordial, primary, secondary, and tertiary prevention. Lifestyle medicine clinicians’ role in prevention, treatment, and advocacy to ameliorate the potential for burnout is discussed along with specific recommendations.

Along with proper diet and avoidance of tobacco use, physical activity is extremely important to maintain and improve overall health of the individual and population. Despite evidence for the cost-effectiveness of physical activity counseling in primary care, only one-third of patients report that they received physical activity counseling by their primary care physician (PCP). Both PCPs and patients face numerous barriers to addressing insufficient physical activity. To assist patients in overcoming their barriers to regular physical activity, the PCP should assess and address the patient’s specific barriers to physical activity and counsel patients about the most common general barriers, such as lack of time, knowledge, and motivation. Numerous benefits and barriers are present, and the PCP should understand them and use the information to better counsel patients regarding the benefit of and need for regular physical activity. Brief counseling is an efficient, effective, and cost-effective means to increase physical activity and to bring considerable clinical benefits to various patient populations.

The effect of diet on blood cholesterol concentrations has become controversial. We assessed whether industry-funded studies were more likely than non–industry-funded studies to report conclusions that were not supported by their objective findings. PubMed and Cochrane Central Register of Controlled Trials searches through March 8, 2019, yielded 211 relevant articles. The percentage of industry-funded studies increased from 0% in the 1950s to 60% for 2010 tp 2019 (P < .001). Of 94 non–industry-funded intervention studies for which the effect of egg ingestion on cholesterol concentrations could be determined, net cholesterol increases were reported in 88 (93%) studies (51% statistically significant, 21% not significant, 21% significance not reported). Among 59 industry-funded intervention studies, net cholesterol increases were reported in 51 (86%) studies (34% statistically significant, 39% not significant, and 14% significance not reported). No studies reported significant cholesterol decreases. Nonsignificant net cholesterol decreases were reported by 6 (6%) non–industry-funded and 8 (14%) industry-funded studies. However, 49% of industry-funded intervention studies reported conclusions that were discordant with study results (ie, net cholesterol increases were described as favorable in the articles’ stated conclusions), compared with 13% of non–industry-funded studies. Readers, editors, and the public should remain alert to funding sources in interpreting study findings and conclusions.

Introduction: Reviewing gaps in self-monitoring during weight loss interventions may help identify individuals demonstrating signs of disengagement in behaviors, including moderate to vigorous physical activity (MVPA), associated with weight loss maintenance. This study examined the associations of different aspects of self-monitoring during a weight loss intervention with 24-month MVPA and weight. Methods: Secondary data analysis from the Tracking Study, a trial comparing weight-tracking frequency during a lifestyle weight loss program, was conducted. Self-monitoring logs from n =339 participants were used to define 4 characteristics and 4 specific gap lengths: short (1-4 weeks), medium (5-8 weeks), long (9-12 weeks), and extra long (>12 weeks). Self-reported MVPA and staff-measured weight were measured at baseline, 6, 12, 18, and 24 months. Generalized estimating equation modeling examined the association between self-monitoring characteristics and reported MVPA and weight. Results: Participants with gaps in self-monitoring as early as the second week of the intervention reported less MVPA and weighed more at 24 months. Furthermore, consistent tracking of MVPA was associated with higher reported MVPA and lower weight. Conclusions: Behavior tracking provides important information about behavioral disengagement early in the intervention process. Future work should test intervention augmentations to improve behavior change when disengagement is detected.

Background: The underlying causes of gestational diabetes mellitus (GDM) are important because they are effective for the diagnosis and prevention of this condition. The aim of this study was to identify the risk factors for GDM and the possible etiological agents. Materials and Methods: This case-control study was conducted with 100 women with GDM and 100 healthy pregnant women at a tertiary care hospital, affiliated to Babol University. GDM was identified by impaired oral glucose tolerance test based on the Carpenter and Coustan criteria. Healthy women were randomly selected from the prenatal health care clinic of the same center and were matched to gestational age of 24 to 28 weeks. Descriptive and inferential statistics were used for data analysis via the SPSS software. Results: After adjusting variables, multivariate analysis identified 4 significant risk factors of GDM, including prepregnancy low physical activity (odds ratio [OR] = 2.85, 95% confidence interval [CI]= 0.97-8.34), advanced maternal age (OR = 1.24, 95% CI = 1.13-1.35), body mass index ⩾ 30 kg/m² (OR = 1.10, 95% CI = 1.02-1.20), and family history of diabetes mellitus (OR = 5.62, 95% CI = 2.26-13.96). Conclusion: We observed significant associations between low prepregnancy physical activity and obesity with GDM risk. Thus the finding of this study can help devise strategies for the prevention of GDM.

Aim: Investigating the relationship between health promoting behaviors and quality of life in patients with hypertension. Methods: In this cross-sectional study, health-promoting behaviors and quality of life in patients with hypertension were assessed in a cardiology clinic of a university hospital in an urban area of Iran. The sample consisted of 93 patients with hypertension who were recruited using a convenience sampling method. Demographic data, Health Promoting Lifestyle Behaviors Profile (HPLP II) and World Health Organization Quality of Life–BREF (WHOQOL-BREF) questionnaires were used to gather data. Data were analyzed using SPSS software version 21. Results: The mean score of health promoting behaviors was moderate (2.51 ± 0.47) with highest and lowest scores in nutritional (2.80 ± 0.52) and physical activity (1.78 ± 0.62) dimension, respectively. There was a statistically significant relationship between health-promoting behaviors and quality of life. The relationship between health-promoting behaviors and quality of life had the highest power in psychological health dimension (β = 5.353, P < .001) and lowest power in the environmental dimension (β = 0.365, P < .001). Conclusion: Improving quality of life of patients requires paying attention to educational interventions for creating changes in the lifestyle to improve all aspects of quality of life.

The current study aimed to determine the effect of fasting during Ramadan on the metabolic profile, anthropometry, and serum leptin and adiponectin concentrations. Anthropometry and blood samples were examined at 2 phases: baseline (within 3 days of the start of the Ramadan fast) and end-line (in the last 3 days before the end of the Ramadan fast) in 27 healthy Muslim male participants who completed Ramadan fasting. Results demonstrate reductions in body weight (P < .001), body mass index (P < .001), fat mass (P = .003), muscle mass (P = .004), and waist circumference (P < .001) following reductions in energy intake (P = .003). Insulin sensitivity was improved. Serum insulin concentration and homeostatic model assessment of insulin resistance decreased significantly (P = .005 and P = .009). No significant change in fasting plasma glucose was observed. Correlation coefficients showed a significant correlation between the percentage changes in body weight and percentage changes in serum leptin concentration (r = 0.412; P = .037). These results demonstrate that intermittent fasting during Ramadan leads to beneficial effects by improving insulin sensitivity. It also resulted in a beneficial effect on weight and fat loss.