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Lifestyle Medicine

2nd Edition, March 15, 2013

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ISBN: 978-1-4398-4542-4
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Product Details:

  • Revision: 2nd Edition, March 15, 2013
  • Published Date: March 15, 2013
  • Status: Active, Most Current
  • Document Language: English
  • Published By: CRC Press (CRC)
  • Page Count: 1613
  • ANSI Approved: No
  • DoD Adopted: No

Description / Abstract:


An overwhelming body of scientific and medical literature supports the concept that daily habits and actions exert an enormous influence on short- and long-term health and quality of life. This influence may be either positive or negative. Hundreds, if not thousands, of studies provide evidence that regular physical activity, maintenance of a healthy weight, not smoking cigarettes, and following sound nutritional and other health-promoting practices all profoundly impact health.

Since the publication of the first edition of Lifestyle Medicine (Blackwell Science, 1999), this literature has grown even stronger and more robust. Clearly, the time has come to update and summarize this information in one place and bring it to the attention of physicians and other health care workers with the hope and belief that it will impact on the way they practice medicine. This has been the goal and challenge of the second edition of Lifestyle Medicine.

The strength of the literature supporting the health impact of daily habits and actions is underscored by their incorporation into virtually every evidence-based clinical guideline addressing the prevention and treatment of metabolic diseases. For example, the following guidelines and consensus statements from various prestigious medical organizations all provide significant emphasis on lifestyle medicine principles and practices as key components of the prevention and treatment of disease:
  • JNC VII Guidelines for Hypertension, Prevention and Treatment
  • NCEP (ATP III) Guidelines for Cholesterol Management
  • Institute of Medicine Guidelines for Obesity Management
  • Guidelines from the American Heart Association for the Prevention and Management of Coronary Artery Disease
  • Guidelines from the American Diabetes Association for the Management of Diabetes
  • Dietary Guidelines for Americans 2010 American Heart Association Nutrition Implement- ation Guidelines
  • Guidelines from the American Academy of Pediatrics for the Prevention and Treatment of Childhood Obesity
  • Guidelines from the American Academy of Pediatrics for Heart Disease Risk Factor Reduction in Children Guidelines from the American Heart Association and the American Academy of Pediatrics for the Prevention and Treatment of the Metabolic Syndrome
  • American Heart Association Strategic Plan for 2020
  • Joint Statement from the American Heart Association and American Cancer Society for the Prevention of Heart Disease and Cancer

Despite the widespread recognition in evidence-based guidelines of the important role lifestyle measures and practices play in the prevention and treatment of metabolic diseases, little progress has been made in improving the habits and actions of the American population. In some instances, risk factors for chronic diseases have actually gone in the opposite direction and increased over the last decade. Consider the following:
  • More than 70% of the adult population in the United States does not get enough physical activity to result in health benefits.
  • Over two-thirds of the adult population in the United States are either overweight or obese (a staggering 40% increase over the past 20 years).
  • Less than one-third of the adult population gets adequate servings of fruits and vegetables and follows other simple, evidence-based nutritional principles related to good health.
  • Of the adult population in the United States, 20.6% still smoke cigarettes.
  • The prevalence of diabetes in the United States has doubled in the past 20 years.
  • The metabolic syndrome is now thought to be present in 25% to 35% of the adult population in the United States.
  • Over one-third of the adult population in the United States has high blood pressure.
  • Cardiovascular disease, which remains the leading killer of both men and women in the United States resulting in 37% of all mortality each year, has multiple lifestyle factors as underlying risk factors.
  • The choice of an inactive lifestyle increases an individual's risk of developing heart disease as much as smoking a pack of cigarettes per day.
  • Obesity is the leading cause of osteoarthritis in women and the second leading cause in men.
  • Obesity is the second leading cause of cancer in the United States and is projected to surpass cigarette smoking in the next decade.

Despite these grim statistics, an impressive body of evidence has also emerged regarding how powerful daily practices, when incorporated into a positive lifestyle, can be in lowering risk factors and promoting good health. For example, the Nurses' Health Study demonstrated that 80% of all heart disease and over 91% of all diabetes in women could be eliminated if they would adopt a cluster of positive lifestyle practices, including maintenance of a healthy body weight (BMI of 19–25 kg/m2), regular physical activity (30 min or more on most days), not smoking cigarettes, and following a few simple nutritional practices such as increasing whole grain and consuming more fruits and vegetables. The U.S. Health Professionals Study showed similar dramatic reductions in men from these same positive behaviors. In fact, if individuals adopted only one of these positive behaviors, their risk of developing coronary artery disease would be cut in half.

Furthermore, proper nutrition has been demonstrated to significantly decrease the likelihood of developing diseases— most prominently, obesity, diabetes, and cancer. Physical activity has been repeatedly shown to lower the risk of heart disease and many cancers. Smoking cessation has been clearly associated with increased risk of cancer and chronic obstructive pulmonary disease. The benefits of smoking cessation are profound and occur rapidly.

Even small amounts of weight loss substantially lower the risk of developing chronic disease. For example, in the Diabetes Prevention Program individuals with baseline glucose intolerance, who increased physical activity and lost 5%–7% of their body weight, reduced their risk of developing diabetes by 58%.

In addition to the adverse health consequences of poor lifestyle decisions, these choices also carry a significant economic burden. Each year, the United States spends more than $6700 for every man, woman, and child on what is essentially "sickness" care. In contrast, virtually every other industrial economy spends considerably less. For example, Greece, which ranks as the 16th largest economy in the world, spends less than $600 annually for every man, woman, and child on health care. Yet, Greece achieves superior outcomes on virtually every recognized international standard of health outcomes than does the United States. Every other industrialized economy also spends less money per capita than the United States and often achieves superior health outcomes.

Poor lifestyle choices such as lack of physical activity, poor nutritional choices, smoking cigarettes, and failure to maintain a healthy body weight all represent significant risk factors for such costly diseases as diabetes, coronary artery disease, and cancer. Clearly, until we can make a positive impact on lifestyle measures and practices in modern medical care, we will not solve this enormous financial drain on the American economy as well as the toll of human lives. These facts have been recognized in the recent health care reform debate in the United States and are incorporated into the Accountable Care Organization guidelines.

As the literature relating lifestyle practices and habits has grown deeper and more complex, the challenge for physicians and other health care professionals has become even more daunting to keep abreast of this ever-expanding field and incorporate the findings into the modern medical practice.

This challenge is all the more complex since the literature relating to lifestyle and health is spread over a wide variety of disciplines, journals, and textbooks. The need to summarize the evidence behind lifestyle and health into one comprehensive textbook that spans the field of lifestyle medicine has become clearer as the evidence has become deeper and more persuasive. This is what we have attempted to accomplish with the second edition of Lifestyle Medicine.

I was proud to serve as the editor of the first edition of Lifestyle Medicine that was published in 1999. With this initial comprehensive volume, we coined the term "lifestyle medicine," summarized key findings across multiple disciplines as they existed in the late 1990s, and launched a new emphasis in medicine related to the links between daily behaviors and outcomes. Subsequently, the field of lifestyle medicine has grown dramatically and has matured significantly. There is now an academic, peer-reviewed journal in lifestyle medicine (the American Journal of Lifestyle Medicine, SAGE Publications). Physician competencies have been published based on the recommendations from major medical groups, including the American Medical Association, the American College of Physicians, the American Academy of Pediatrics, the American College of Sports Medicine, the American College of Preventive Medicine, and others.

In addition, an academic medical society has been established for physicians and other health care workers (the American College of Lifestyle Medicine) and an educational track in lifestyle medicine is now offered at the American College of Preventive Medicine's annual meeting.

While the field of lifestyle medicine is still in its infancy, there is clearly momentum. It is also clear that the academic discipline relating to short- and long-term health consequences of daily habits and actions will be called lifestyle medicine.

A key consideration for incorporating information and counseling concerning lifestyle and health will be broad acceptance of this imperative in the physician community. While most physicians and other health care professionals support the general concept that physical activity, proper nutrition, weight management, not smoking, and other behaviors profoundly impact on health, incorporation of counseling and information in these areas into the daily practice of medicine has lagged. This is extremely unfortunate since multiple surveys have demonstrated that physician recommendation is the leading reason why individuals change actions and habits. Moreover, 75% of the adult population in the United States sees a primary care physician at least once a year. The opportunity to underscore the links between lifestyle habits and practices and health outcomes is, therefore, extremely large.

So what is "lifestyle medicine"? We defined lifestyle medicine in the first edition of this reference book as "the integration of lifestyle practices into the modern practice of medicine both to lower the risk factors for chronic disease and/or, if disease is already present, serve as an adjunct in its therapy. Lifestyle medicine brings together sound, scientific evidence in diverse health related fields to assist the clinician in the process of not only treating disease, but also promoting good health." While this definition was put forth over a decade ago, the connections between daily habits and health outlined in this initial formulation remain the fundamental premise behind the field of lifestyle medicine and the organizing principle behind the second edition of our textbook.

With this definition providing the intellectual framework for the textbook, the second edition of Lifestyle Medicine is divided into 23 parts based on key disciplines related to lifestyle medicine. The second edition is approximately 20% longer than the first edition. All chapters have been fundamentally rewritten or substantially revised and brought up to date with current understandings and references. Many new chapters and several new parts have been added to reflect the modern understandings and enormous changes that have occurred in lifestyle medicine since the publication of the first edition.

The second edition of Lifestyle Medicine opens with Part I on "Lifestyle Management and Prevention of Cardiovascular Disease." We chose to open the second edition with an indepth exploration concerning lifestyle and cardiovascular disease for several reasons. First, I am a cardiologist, and as such, my initial interest in lifestyle practices and health related specifically to measures designed to lower the risk of cardiovascular disease. Second, the area of cardiovascular medicine has been a leader in identifying linkages between lifestyle-related risk factors and risk of heart disease. Third, despite very significant progress in multiple areas of cardiovascular disease, it remains the leading killer of both men and women in the United States. Finally, it seemed appropriate to open the second edition of Lifestyle Medicine with issues in cardiovascular disease, since the American Heart Association has clearly articulated the central role of lifestyle practices and cardiovascular health as a key component in its strategic plan for the year 2020.

Part II on "Nutritional Aspects of Lifestyle Medicine," underscores the key role that nutrition plays in multiple aspects of health and disease. This part contains in-depth analyses of the clinical implications of the Dietary Guidelines for Americans 2010 as well as an extensive discussion of how to evaluate nutritional status and nutrient intakes. Special populations are the focus of several chapters, including nutrition for the active adolescent, nutrition for elite athletes, and nutrition for older adults. An important new chapter relates to how nutrition principles and behaviors can be communicated to patients to help them achieve healthy lifestyles. Part III on "Physical Activity and Fitness" provides clinically important information on how to evaluate physical fitness and prescribe exercise. In addition, since physical activity and exercise are so key to positive lifestyle measures and health, there are individual chapters on these behaviors scattered throughout the book in disease- or condition-specific sections.

Part IV on "Behavioral Psychology" starts from the premise that most of the issues related to lifestyle medicine involve approaches to changing behavior. This part provides an outstanding, clinically relevant framework for how to apply psychological theories to the promotion of healthy lifestyles. These theories have been applied in subsequent chapters within this part to approaches for enhancing adherence to exercise prescription, smoking cessation, and weight loss and maintenance.

art V on "Women's Health" has been expanded and updated to cover important emerging data in this key area. Chapters on breast health, osteoporosis, and physical activity are complemented by new chapters on menopause, osteoporosis, and wellness coaching for women's lifestyle choices. Part VI on "Men's Health" is an entirely new part that addresses key considerations for this medically underserved population. Mental health issues, nutrition for men's health, and management and prevention of urological diseases as well as health promotion and risk reduction specifically geared toward men are welcome, new, and timely contributions to this important area of the book.

A new part on "Endocrinology and Metabolism" (Part VII) provides in-depth discussions of diabetes, glucose intolerance, and the metabolic syndrome as well as the use of lifestyle measures in their prevention and treatment. Part VIII on "Lifestyle Issues in the Prevention and Treatment of Cancer" is another new part that will be highly relevant to every practicing clinician. Such topics as obesity, physical activity, and nutrition and their role in cancer prevention and treatment are discussed in depth as well as their role in cancer survivorship.

Part IX on "Obesity and Weight Management" remains a key part in our textbook. In a sense, obesity represents the quintessential lifestyle disease since nutrition, exercise, pharmacologic management, and surgery all play significant roles. The linkage between the immune system and infectious disease is also an important and often underappreciated area of both research and clinical application. The role of exercise both in immune function, infections, and aging is ably discussed with current understandings from the research literature in Part X on "Immunology and Infectious Disease."

Part XI on "Pulmonary Medicine" has been totally reworked with updated chapters on asthma and pulmonary rehabilitation and new chapters on indoor air quality and influenza among others. This expanded part will be of great interest to all clinicians.

"Sports Medicine and Orthopedics" (Part XII) occupy prominent places in lifestyle medicine. The greatly expanded part in these areas focuses not only on injury prevention and treatment, but also on rehabilitation and sports supplements. The new chapter on concussions in sports is particularly timely given the recent emphasis on this underdiagnosed condition both in professional and amateur sports.

Part XIII on "Obstetrics and Gynecology" remains a great strength in this textbook with several new chapters and a complete rewriting and updating of all previous chapters. This part adds further depth and clinical relevance to the expanded commitment to women's health issues found in this edition of Lifestyle Medicine. Part XIV on Dermatology" is greatly expanded based on new understandings from research with an emphasis on clinical applications. Particularly important are completely revised chapters on sun and the skin, exercise and the skin, and overall approaches to skin care for the active individual.

Part XV on "Cardiovascular Rehabilitation and Secondary Prevention" complements the opening part on "Lifestyle Management and Prevention of Cardiovascular Disease." Important advances have occurred both in cardiovascular rehabilitation and the secondary prevention of cardiovascular disease. These topics are admirably discussed with modern evidence-based understandings emphasized.

The power of a positive lifestyle clearly extends into the pediatric population. The modern epidemic of pediatric obesity in the United States and the accompanying dramatic increases in both diabetes and metabolic syndrome in the pediatric population are discussed in detail in the Part XVI on "Lifestyle Components of Pediatric Medicine" as are specific guidelines and recommendations for prescribing pediatric exercise and prevention of osteoporosis. An important new chapter on prenatal influences on future health summarizes modern understandings of an emerging area about how the earliest influences on risk factors may occur in utero. The chapter on cholesterol management in children provides an evidence-based discussion to what has become a controversial topic.

The greatly expanded Part XVII on "Family Practice" provides a comprehensive approach to how busy family practitioners can integrate lifestyle measures and counseling into their daily practice of medicine. Practical advice and recent evidence concerning exercise and nutritional counseling as well as ehealth resources are all discussed in detail. Part XVIII is a new part on "Lifestyle Medicine and Geriatrics" that corrects a significant omission from the first edition of our textbook. The concept of "successful aging" that has gained considerable momentum in the last decade is discussed in detail as are practical strategies for increasing physical activity in the older population.

The greatly expanded Part XIX on "Epidemiology of Lifestyle-Related Diseases" provides a useful framework for the application of epidemiologic principles to both identify and potentially help ameliorate multiple lifestyle-related problems. Part XX on "Health Promotion" has been greatly expanded to include modern understandings of health promotion in the workplace and managed care. This field has grown exponentially in the last 15 years. This part concludes with a provocative chapter on the future of health promotion, taking the reader from current successes in health promotion to an expanded role for corporate health promotion in the future of medicine.

The greatly expanded Part XXI on "Exercise Psychology" moves beyond the part on "Exercise and Sport Psychology," which was contained in the first edition of Lifestyle Medicine. New tools and new approaches to understanding mind–body interactions as well as the genetic influences on behavior are discussed in detail. Physical activity and its relationship to anxiety and depression are also thoroughly discussed. A new and important chapter on the impact of physical activity on brain aging and cognitive function is a highlight of this part. A new chapter on how psychological issues help determine the level of physical activity provides new insights for how research can impact on practical application.

Part XXII is a new part on "Injury Prevention" that represents another highlight of the second edition. Injuries are a very significant component of lifestyle medicine and also often underappreciated by practicing clinicians. This part, with an internationally prominent group of contributors, organized by the Division of Unintentional Injury Prevention at the Centers for Disease Control and Prevention, provides a broad approach to research in injury prevention and how it is impacting on the practice of lifestyle medicine.

The final part on "Public Policy and Environmental Supports for Lifestyle Medicine" (Part XXIII) reminds us that we do not practice medicine in a vacuum. Public policy issues concerning health care reform and public and environmental supports for physical activity, healthy eating, and obesity prevention all play important roles in the modern practice of medicine.

The work of generating this comprehensive volume in Lifestyle Medicine involved the talent of 25 outstanding part editors who have devoted great energy and talent to the difficult task of organizing and editing parts to be not only scientifically accurate but clinically useful. What has emerged from their efforts and those of the over 200 distinguished contributors is a textbook that I hope and believe will be clinically useful to the practicing health care professional while providing state-of-the-art summaries and practical applications of modern scientific and medical understandings related to the interaction between lifestyle practices, modern medicine, and good health. This dual emphasis can only help all of our patients lead happier, healthier, and more productive lives while lowering their risk of developing the chronic diseases that are so endemic in our society.

Over the last 14 years since the publication of the first edition of Lifestyle Medicine, important new information has emerged to provide the scientific links between daily habits and actions and their impact on short- and long-term health and quality of life. The key consideration now will be for those of us in the health care community to apply these understandings to the modern practice of medicine. This is, in my view, the single greatest opportunity that we have to improve health outcomes and lower costs. This is crucial to bringing additional value to the practice of medicine. It is, in essence, both the challenge and opportunity for the future of lifestyle medicine.