Physician competencies for prescribing lifestyle medicine.

THE LEADING CAUSES OF DEATH FOR ADULTS IN THE United States are related to lifestyle—tobacco use, poor diet, physical inactivity, and excessive alcohol consumption. US residents with these risk factors have plenty of room for improvement—including those who are asymptomatic and those living with chronic disease. Health behaviors could greatly influence future health and well-being, especially among patients with chronic disease. However, only 11% of patients with diabetes follow accepted dietary recommendations for saturated fat intake, and 18% of patients with heart disease continue to smoke, barely better than the general population’s smoking rate. The enormous potential effects of health behavior change on mortality, morbidity, and health care costs provide ample motivation for the concept of lifestyle medicine, ie, evidencebased practice of assisting individuals and families to adopt and sustain behaviors that can improve health and quality of life. Examples of target patient behaviors include, but are not limited to, eliminating tobacco use, improving diet, increasing physical activity, and moderating alcohol consumption. Effectively motivating patients to change behavior can be a frustrating and difficult challenge. Merely encouraging patients at the end of an office visit to attempt such changes yields limited results. Success requires the development of specific healthy lifestyle action plans in partnership with patients and intentional follow-up in subsequent visits. For example, one study showed that when physicians provided structured counseling to sedentary adult patients, followed by a health educator booster call, the total length of the weekly walking exercises increased by 5 times that of patients in the control group who received standard care. Even though the most widely accepted, well-established chronic disease practice guidelines uniformly call for lifestyle change as the first line of therapy, physicians often do not follow these recommendations. For instance, obese patients are advised to lose weight only 36% of the time during regular examinations, a proportion that improves only slightly to 52% if a patient already has obesity-related comorbidities. Furthermore, only 28% of smokers reported that health care professionals had offered them assistance to quit smoking in the past year. Findings such as these reveal 2 important facts: Physicians cannot ascribe the entire responsibility for inadequate lifestyle changes to their patients, and clinicians must accept some responsibility for deficiencies in the quality of health care. Acknowledging the crucial role of environmental and community factors in creating and sustaining inappropriate health behaviors does not eliminate the duty of physicians to assist patients in making health behavior changes. Physicians also have cited inadequate confidence and lack of knowledge and skill as major barriers to counseling patients about lifestyle interventions. Among the 620 respondents in a survey of family physicians, only 49% felt competent prescribing weight loss programs for obese patients. Even though changing unhealthy behaviors is foundational to medical care, disease prevention, and health promotion, a physician’s trusted relationship with the patient must be augmented whenever possible by family support, an interdisciplinary health care team, and community organizations and agencies (BOX). To begin to address the identified gap in physicians’ armamentaria, a group of representatives from primary care medical specialties and other interested medical professional societies met and developed suggested lifestyle medicine competencies for primary care physicians. Further work continues in developing curricula, training materials, evaluation, and system-based practice tools and performance measures to help physicians achieve these goals. Although these suggested competencies were developed largely to guide continuing medical education activities for primary care and preventive care physicians, many of these individual competencies have relevance for all spe-