Introduction to Lifestyle Medicine
4%of exam
Health Behavior Change
10%of exam
Motivational InterviewingChange StagesSelf-EfficacyAction Plans
Key Clinical Processes
8%of exam
Lifestyle AssessmentMedication SafetyFollow-UpTeam Care
Practitioner Health and Community Advocacy
4%of exam
Practitioner HealthBuilt EnvironmentHealth EquityCommunity Resources
Nutrition Science and Prescription
26%of exam
Dietary PatternPlant FoodsFat SubstitutionDPP TrialVitamin B12
Physical Activity Prescription
14%of exam
Adult Activity TargetsFITTTalk TestSafety Screen
Emotional Well-Being
10%of exam
Stress AssessmentMindfulnessDepression ScreenReferral
Sleep Health
8%of exam
Sleep DurationCBT-ISleep ApneaCircadian Timing
Tobacco and Toxic Exposures
8%of exam
Five AsCessation TreatmentAlcohol ScreenE-Cigarettes
Connectedness and Positive Psychology
8%of exam
Social ConnectionLonelinessMeaningPositive Practices
Quick Facts
- Credential
- Physician DipABLM
- Exam
- 150 multiple-choice questions
- Time
- Four hours maximum
- Domains
- Ten weighted areas
- Largest domain
- Nutrition: 26%
- Pass score
- Numeric cutoff not published
- Delivery
- Prometric testing center
- Scope
- Licensed physician pathway
Six Pillars Memory
Food, move, sleep, cope, abstain, connect
NutritionActivitySleepStressSubstancesConnection
Six Pillars
- Nutrition
- Healthful dietary pattern
- Activity
- Regular, adapted movement
- Sleep
- Restorative sleep
- Stress
- Adaptive coping
- Substances
- Avoid risky use
- Connection
- Supportive relationships
- Clinical role
- Treatment alongside indicated medicines
MI OARS
OARS invites patient-led change
Open questionsAffirmationsReflectionsSummaries
Lapse vs Relapse
Lapse
- Brief plan interruption
- Use restart cue
Relapse
- Sustained return to prior behavior
- Reassess barriers and support
Neither warrants blame
Choose the Counseling Move
- Change not considered→Explore perspective(Offer information with permission)
- Patient voices ambivalence→Reflect both sides(Elicit change talk)
- Patient preparing action→Agree specific plan(Name context and start)
- Patient succeeded briefly→Highlight mastery(Build next achievable step)
- Plan interrupted→Create restart cue(Reduce first step)
- Barrier is access→Connect community resource(Adapt to feasibility)
Behavior Change Tools
- Open question
- Invites patient perspective
- Reflection
- Restates understood meaning
- Change talk
- Patient voices change reasons
- Precontemplation
- Change not yet considered
- Preparation
- Planning near-term action
- Self-efficacy
- Confidence from achievable success
- Lapse
- Temporary interruption; restart plan
- Action plan
- Specific behavior, context, follow-up
Choose the Clinical Next Step
- Inactive but asymptomatic→Begin achievable movement(Progress toward guidance)
- Chest pressure with activity→Stop and assess urgently(Emergency care if concerning)
- Chronic insomnia→Offer CBT-I(Assess other sleep disorders)
- Snoring plus witnessed pauses→Evaluate possible apnea(Refer when appropriate)
- Positive depression screen→Assess symptoms and safety(Screen alone is no diagnosis)
- Nonpregnant smoker ready→Counsel plus pharmacotherapy(Check suitability and preference)
Clinical Process
- Lifestyle assessment
- Assess all six pillars
- Shared goal
- Patient-valued, feasible behavior
- Follow-up
- Measure response and barriers
- Insulin risk
- Intake changes may cause hypoglycemia
- Sulfonylurea risk
- Monitor glucose during lifestyle change
- Medication review
- Prescriber adjusts when clinically indicated
- Team care
- Refer beyond clinician expertise
Practitioner and Community
- Practitioner health
- Sustainable habits and boundaries
- Built environment
- Activity access depends on place
- Food access
- Cost and availability shape choices
- Health equity
- Tailor plans to constraints
- Community referral
- Connect to accessible resources
Pattern vs Single Food
Dietary pattern
- Usual intake across time
- Guides clinical substitution
Single food
- One meal proves little
- No isolated cure
Treat the full pattern
Choose the Nutrition Response
- High sodium concern→Compare actual portions(Favor lower-sodium pattern)
- Elevated LDL→Replace saturated fats(Add soluble-fiber foods)
- Fully vegan diet→Secure reliable B12(Fortified foods or supplement)
- Diabetes prevention risk→Offer structured lifestyle program(DPP paired diet and activity)
- Complex renal nutrition→Refer registered dietitian(Individualize medical nutrition therapy)
- Insulin with intake change→Monitor glucose(Prescriber reviews dose)
Nutrition Patterns
- Dietary pattern
- Usual intake matters most
- Plant-predominant
- Plants emphasized; veganism not required
- Whole grains
- Prefer over refined grains
- Legumes
- Fiber-rich protein source
- Soluble fiber
- Oats, beans may lower LDL
- Fat substitution
- Unsaturated replaces saturated sources
- DASH
- Plant-rich; limits sodium
- Vitamin B12
- Fortified food or supplement if vegan
Vegan vs Plant-Predominant
Vegan
- Excludes animal foods
- Needs reliable B12 source
Plant-predominant
- Emphasizes plant foods
- Animal foods may remain
Do not equate labels
Nutrition Decisions
- Packaged foods
- Compare sodium per actual portion
- Processed label
- Also inspect ingredients, pattern
- DPP target
- Original trial: 7% weight loss
- DPP movement
- Original trial: 150 minutes weekly
- DPP ~3yr relative result
- 58% lower diabetes incidence vs placebo
- Complex nutrition
- Dietitian for individualized therapy
- Food swap
- Replace; avoid merely adding calories
FITT Prescription
FITT turns movement into a plan
FrequencyIntensityTimeType
Moderate vs Vigorous
Moderate
- Talk, not sing
- 150–300 minutes weekly
Vigorous
- Only few words
- 75–150 minutes weekly
Use ability and clinical context
Activity Prescription
- Moderate aerobic
- 150–300 minutes weekly for adults
- Vigorous aerobic
- 75–150 minutes weekly alternative
- Strengthening
- At least two days weekly
- FITT
- Frequency, intensity, time, type
- Moderate talk test
- Talk possible; singing difficult
- Vigorous talk test
- Few words before breath pause
- Inactive start
- Short bouts; progress gradually
- Older adult
- Add balance within safe activity
Screen vs Diagnosis
Screen
- Flags possible symptoms
- Needs clinical follow-up
Diagnosis
- Assesses duration and impairment
- Includes safety and context
Positive screen does not diagnose
Emotional Well-Being
- Stress assessment
- Ask impact and coping
- Mindfulness
- Nonjudgmental present awareness
- Depression screen
- Positive result needs assessment
- Safety concern
- Prompt mental-health evaluation
- Trauma-informed
- Permission, safety, no forced disclosure
- Cognitive reframing
- Examine all-or-nothing thought
Insomnia vs Apnea
Chronic insomnia
- Sleep initiation or maintenance difficulty
- CBT-I initial treatment
Possible apnea
- Snoring or witnessed pauses
- Needs diagnostic evaluation
Do not assume one cause
Sleep Assessment
- Adult sleep
- Age 18–60: at least seven hours
- Sleep quality
- Check daytime function too
- Chronic insomnia
- CBT-I initial treatment
- Sleep hygiene
- Alone often insufficient for insomnia
- Possible apnea
- Snoring, pauses, daytime sleepiness
- Circadian anchor
- Consistent wake time; timed light
Tobacco Five As
Ask, Advise, Assess, Assist, Arrange
UseRecommendationReadinessTreatmentFollow-up
Substance and Tobacco Care
- Ask
- Document tobacco use
- Advise
- Recommend cessation respectfully
- Assess
- Explore readiness
- Assist
- Offer counseling and treatment
- Arrange
- Schedule follow-up
- Nonpregnant smoker
- Counseling plus appropriate pharmacotherapy
- E-cigarettes
- Cessation evidence insufficient per USPSTF
- Positive alcohol screen
- Assess pattern and harms
Isolation vs Loneliness
Isolation
- Objectively limited contacts
- Assess available support
Loneliness
- Subjective unwanted disconnection
- Ask how connection feels
Ask about both dimensions
Common Traps
Lifestyle vs medication
Lifestyle can complement drugs ≠ Do not stop drugs automatically
DPP original vs adapted
Original target: 7% loss ≠ Programs may use different targets
Activity target vs starting point
Guideline states weekly range ≠ Inactive adults start smaller
Mindfulness vs treatment
Mindfulness may support coping ≠ Severe symptoms need assessment
Sleep hygiene vs CBT-I
Sleep hygiene supports habits ≠ CBT-I treats chronic insomnia
Tobacco medication vs e-cigarettes
Approved cessation medicines have evidence ≠ USPSTF: e-cigarette evidence insufficient
Connection vs contact count
Loneliness reflects perceived connection ≠ Isolation reflects contact scarcity
Last Minute
- 1.Physician exam: 150 questions; four hours
- 2.Nutrition 26%; activity 14%; behavior 10%
- 3.Lifestyle treatment complements indicated medicines
- 4.MI: ask, reflect, elicit change talk
- 5.DPP trial: 7% loss; 150min weekly
- 6.Adults: 150–300 moderate minutes weekly
- 7.Strengthening: at least two days weekly
- 8.Vegan diet requires reliable B12
- 9.Chronic insomnia: CBT-I first
- 10.Tobacco: counseling plus suitable medication
- 11.Chest pressure during exercise: assess urgently
- 12.Positive depression screen requires assessment
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