American Journal of Lifestyle Medicine

Despite spending more per capita on health care than any other country, health outcomes in the United States rank low. In 2001, in an attempt to improve the situation, The Institute of Medicine defined ideal health care as safe, timely, effective, efficient, equitable, and patient centered. In 2008, to more clearly define the goals of health care, Berwick, Nolan, and Whittington of the Institute for Healthcare Improvement (IHI) introduced the concept of the Triple Aim—the simultaneous improvement of population health and patient experience while controlling costs. In 2011, the 3 goals of the IHI Triple Aim were adopted by the US National Quality Strategy. Whereas the IHI Triple Aim represents a powerful innovation in health care, population health extends far beyond the care delivery system. To increase the potential impact of efforts that promote the Triple Aim, we offer a model that includes the addition of lifestyle medicine and social policy initiatives to provide a bridge from the clinic to the community and address nonmedical determinants of health. Addressing lifestyle and social policy will require the engagement of nonmedical sectors of the community in new partnerships with health care. The power of these partnerships could result in large and sustainable improvements in health, economic status, and well-being.

The dietary behaviors of underserved populations contribute to diet-related health disparities. Behavior change is affected by many factors that may be grouped in four main categories; individual, interpersonal, institutional, and community and public factors.6However, underserved populations experience additional stressors that create greater barriers to achieving dietary behavior change. Researchers and health professionals are encouraged to work with and within underserved communities to provide appropriate and acceptable programming. This article highlights other stressors that make behavior change more challenging for underserved populations. Additionally, guidance to developing and implementing successful interventions to improve dietary behavior change in underserved populations is included.

Physical inactivity is a serious public health issue. Physical activity promotion messages are part of a comprehensive approach to creating a society in which physical activity is the norm. Although public health messages can be influential, they face tough competition from other sources of physical activity information that offer conflicting advice about being active and thus may undermine public health efforts. It is therefore necessary to consider the multiple sources of messages (eg, commercial, public health) that can cause confusion for consumers. This article reviews research on sources of physical activity information, where such information is sought and by whom, and how messages are processed at both automatic (ie, with little thought) and reasoned (ie, deliberate) levels. Having outlined the challenges, suggestions are made regarding how public health messages can be heard in an environment dominated by commercial advertising. These suggestions include tailoring theory-based messages, ensuring the benefits of being active are highlighted, branding, and forging collaborative partnerships within the physical activity sector. By enacting these strategies, public health messages may be more effective at attracting attention and being subsequently read and recalled by consumers, and thus contribute to an active society.

Policy changes play an important role in shaping the environment to promote healthy choices in physical activity and nutrition. However, additional support is required for these policies to have an increased impact. This article discusses the roles professionals trained in a lifestyle approach can have in promoting policy.

The current US health care system is focused on treating the medical determinants of health. However, research shows that approximately 80% of the variance in a population’s health is determined by the nonmedical determinants of health. The care, health outcomes, and cost of an individual or population may be improved if the focus of the health care system were modified to place a greater emphasis on the non-determinants of health. Employee health has been identified as an area that may be able to improve individual health and the health of the community. Reviewed in this article are the outcomes of a pharmacist-run employee health program that focuses on the nondeterminants of health to improve the care, health outcomes, and costs of health care for one employer.

The passage of Title IX in 1972 resulted in a tremendous increase in the number of females participating in high school and collegiate athletics. This rise in female athletes sparked new focus areas of research in sports medicine related to woman with an important area emerging in 1980, the female athlete triad. This triad consisting of low energy availability, menstrual irregularities, and bone health disruption spans a spectrum of severity and has evolved both in diagnosis and in management throughout the years. Many health questions arise for female athletes and their health care providers, often concerning the most effective management and treatment strategies for this triad. This review examines the research and latest advancements in recognizing and understanding the female athlete triad and explores the most current recommendations for treatment and prevention.

The utility of lifestyle-based health promotion interventions is directly affected by participant adherence to prescribed behavior changes. Unfortunately, poor adherence to behaviors recommended in lifestyle interventions is widespread, particularly over the long term; thus, the “adherence problem” represents a significant challenge to the effectiveness of these interventions. The current review provides an overview of the adherence problem and describes a theoretical framework through which the factors that affect adherence can be understood. To further understand the difficulties individuals face when adhering to health behavior changes, we focus our discussion on the challenges associated with adherence to lifestyle behaviors recommended for weight loss and healthy weight management (ie, reductions in dietary intake and increases in physical activity). We describe strategies that improve long-term adherence to health behaviors related to healthy weight management, including the provision of extended care, skills training, improving social support, and strategies specific to maintaining changes in dietary intake and physical activity. Finally, we discuss difficulties involved in implementing long-term weight management programs and suggest practical solutions for providers.

The importance of optimal bone growth in childhood and adolescence has been recognized as one of the key strategies in osteoporotic fracture prevention. Low birth size, poor childhood growth, and low peak bone mass at the cessation of growth have been linked to the later risk of osteoporosis and hip fracture. Formerly, the focus was merely on maximizing bone mineral accrual because a high peak bone mineral mass may prevent attainment of a critical “fracture threshold” associated with age-related bone loss and osteoporosis. More recently, the focus has shifted away from bone mineral accrual—as measured by dual-energy X-ray absorptiometry (DXA)—toward the optimization of bone strength. This is partly because of the advances in bone imaging that have enabled estimation of bone strength beyond bone mass. In this review, we briefly describe long-bone growth and structural development and our abilities to assess bone properties by medical imaging tools. In addition, we summarize the evidence of factors contributing to skeletal growth, bone fragility, and the development of strong, healthy bones.

Chronic low back pain (cLBP) is common and has a tremendous economic impact. With the prevalence and incidence of low back pain (LBP) on the rise, individuals often seek alternative treatments. Yoga is a widely used complementary and alternative medicine treatment for LBP. However, its efficacy as an intervention for LBP has not been thoroughly investigated. Therefore the purpose of this study was to systematically review the current literature for randomized controlled trials that assess the outcomes of Yoga as an intervention for individuals with cLBP. An electronic database search was performed for studies related to the efficacy of yoga in treatment for cLBP. Studies included were randomized control trials, published in English, from a peer-reviewed journal that identified yoga as the primary treatment focus for LBP in at least one group and included participants with at least a 12-week (3-month) history of symptoms. Our search revealed 185 articles. Of these, 10 met the inclusion criteria. We concluded Yoga intervention appears to be an efficacious intervention in alleviating cLBP. Yoga was demonstrated to significantly improve quality of life and reduce disability, stress, depression, and medication usage associated with cLBP in 8 of the 10 analyzed trials when compared with usual care, self-care book, or exercises. However, more research is necessary before recommendations can be made.