Lifestyle fundamentals to address with patients

The lifestyle medicine formula is very clear and very discreet, said David Katz, MD, MPH, FACPM, FACLM, during an interview with Integrative Practitioner at the Integrative Healthcare Symposium in New York City last week.

One of the empowering elements for any healthcare professional, and in particular those focused on integrative medicine, is that practitioners can start to improve someone's overall health by nudging them forward  in any of the areas that are most important to well-being—feet, fork, fingers, sleep, stress, and love, as Katz refers to them.

Feet is physical activity. Forks is dietary pattern. Fingers is no toxic substances like tobacco to the lips. Adequate sleep. Stress mitigation. Strong social interactions. "If we think about our patients holistically, we can try to improve their overall health by identifying the weak link in this chain," said Katz. "Where does [the patient] need the most help?"

For example, for someone who is sleep deprived, maybe it's a waste of time to focus on exercise because they don't have the energy to do it, Katz said, and they won't until their provider addresses their sleep. If they have chronic pain, maybe that's keeping them up at night. Or if a patient is not interacting with important people in their lives—family, friends, loved ones—maybe that's producing stress that's denying them sleep, he said.

One of the key takeaways, said Katz, is that there is a practical aspect of thinking holistically. Lifestyle medicine provides a nice template to care for patients. "The core areas that are consistently important for the bounty of years and life in years are what we should focus on," said Katz.

Diet tends to produce the most confusion among both patients and practitioners. The basic theme of healthy eating, the basic care and feeding of homo sapiens, is clear and well-established, said Katz, so we shouldn't waste time arguing with ourselves or one another over the details we don't know. "We should focus on accomplishing the fundamentals that we do know and helping our patients embrace that," he said.

Practitioners should feel both empowered to and obligated to help their patients understand the fundamentals of a healthy diet. There are a number of things providers can do to help patients through this journey, Katz said, including the art and science of effective behavior modification. Behavior change in the clinical setting starts with education and giving patients the resources to make positive lifestyle changes. "We want to provide good guidance to our patients about where they need to go and simply help them avail themselves of all of the new tools available that make it easier to get there from here."

The number one job for integrative practitioners, however, is to convey to patients consistently and emphatically what we know about the fundamentals of a healthy lifestyle. That's where the action is. "Everything else we do is important," said Katz. "But for all of the residual health problems, lifestyle addresses the bulk of it."

Stay tuned for a follow-up feature article and video highlighting Katz's session at the Integrative Healthcare Symposium.