Rani Polak

Physical activity counseling in medical school education: a systematic review

Background Despite a large evidence base to demonstrate the health benefits of regular physical activity (PA), few physicians incorporate PA counseling into office visits. Inadequate medical training has been cited as a cause for this. This review describes curricular components and assesses the effectiveness of programs that have reported outcomes of PA counseling education in medical schools. Methods The authors systematically searched MEDLINE, EMBASE, PsychINFO, and ERIC databases for articles published in English from 2000 through 2012 that met PICOS inclusion criteria of medical school programs with PA counseling skill development and evaluation of outcomes. An initial search yielded 1944 citations, and 11 studies representing 10 unique programs met criteria for this review. These studies were described and analyzed for study quality. Strength of evidence for six measured outcomes shared by multiple studies was also evaluated, that is, students’ awareness of benefits of PA, change in students’ attitudes toward PA, change in personal PA behaviors, improvements in PA counseling knowledge and skills, self-efficacy to conduct PA counseling, and change in attitude toward PA counseling. Results Considerable heterogeneity of teaching methods, duration, and placement within the curriculum was noted. Weak research designs limited an optimal evaluation of effectiveness, that is, few provided pre-/post-intervention assessments, and/or included control comparisons, or met criteria for intervention transparency and control for risk of bias. The programs with the most evidence of improvement indicated positive changes in students’ attitudes toward PA, their PA counseling knowledge and skills, and their self-efficacy to conduct PA counseling. These programs were most likely to follow previous recommendations to include experiential learning, theoretically based frameworks, and students’ personal PA behaviors. Conclusions Current results provide some support for previous recommendations, and current initiatives are underway that build upon these. However, evidence of improvements in physician practices and patient outcomes is lacking. Recommendations include future directions for curriculum development and more rigorous research designs.

Including lifestyle medicine in undergraduate medical curricula

Purpose Currently, there is no model to integrate the discipline of lifestyle medicine (LM) into undergraduate medical education. Furthermore, there are no guidelines, validated assessment tools, or evaluation or implementation plans in place. Background The World Health Organization predicts that by 2020, two-thirds of disease worldwide will be the result of poor lifestyle choices. Fewer than 50% of US primary care physicians routinely provide specific guidance on nutrition, physical activity, or weight control. Methods We are establishing a plan to integrate LM into medical school education in collaboration with the investing stakeholders, including medical school deans and students, medical curriculum developers and researchers, medical societies, governing bodies, and policy institutes. Three planning and strategy meetings are being held to address key areas of focus – with a particular interest in nutrition, physical activity, student self-care, and behavior change – to develop specific implementation guidelines and landmarks. Results After the first two meetings, the proposed areas of focus were determined to be: 1) supporting of deans and key personnel, 2) creation of federal and state policy commitments, 3) use of assessment as a driver of LM, 4) provision of high-quality evidence-based curricular material on an easily navigated site, and 5) engaging student interest. Implementation strategies for each focus area will be addressed in an upcoming planning meeting in early 2015. Conclusion This initiative is expected to have important public health implications by efficiently promoting the prevention and treatment of non-communicable chronic disease with a scalable and sustainable model to educate physicians in training and practice.

Health-related Culinary Education: A Summary of Representative Emerging Programs for Health Professionals and Patients.

Background Beneficial correlations are suggested between food preparation and home food preparation of healthy choices. Therefore, there is an emergence of culinary medicine (CM) programs directed at both patients and medical professionals which deliver education emphasizing skills such as shopping, food storage, and meal preparation. Objective The goal of this article is to provide a description of emerging CM programs and to imagine how this field can mature. Methods During April 2015, 10 CM programs were identified by surveying CM and lifestyle medicine leaders. Program directors completed a narrative describing their programs structure, curricula, educational design, modes of delivery, funding, and cost. Interviews were conducted in an effort to optimize data collection. Results All 10 culinary programs deliver medical education curricula educating 2654 health professionals per year. Educational goals vary within the domains of (1) providers self-behavior, (2) nutritional knowledge and (3) prescribing nutrition. Six programs deliver patients’ curricula, educating 4225 individuals per year. These programs’ content varies and focuses on either specific diets or various culinary behaviors. All the programs’ directors are health professionals who are also either credentialed chefs or have a strong culinary background. Nine of these programs offer culinary training in either a hands-on or visual demonstration within a teaching kitchen setting, while one delivers remote culinary tele-education. Seven programs track outcomes using various questionnaires and biometric data. Conclusions There is currently no consensus about learning objectives, curricular domains, staffing, and facility requirements associated with CM, and there has been little research to explore its impact. A shared strategy is needed to collectively overcome these challenges.

Lifestyle Medicine Education

The actual causes of premature adult deaths, the preponderance of noncommunicable chronic diseases, and their associated costs are related to unhealthy behaviors, such as poor nutrition, physical inactivity, and tobacco use. Although recommended as the first line of prevention and management, providers often do not provide behavioral change counseling in their care. Medical education in lifestyle medicine is, therefore, proposed as a necessary intervention to allow all health providers to learn how to effectively and efficiently counsel their patients toward adopting and sustaining healthier behaviors. Lifestyle medicine curricula, including exercise, nutrition, behavioral change, and self-care, have recently evolved in all levels of medical education, together with implementation initiatives like Exercise is Medicine and the Lifestyle Medicine Education (LMEd) Collaborative. The goal of this review is to summarize the existing literature and to provide knowledge and tools to deans, administrators, faculty members, and students interested in pursuing lifestyle medicine training or establishing and improving an LMEd program within their institution.

Legumes: Health Benefits and Culinary Approaches to Increase Intake

Much evidence supports the health benefits of consuming a plant-based diet and increasing the intake of legumes. A high intake of fruits, vegetables, whole grains, legumes (beans), nuts, and seeds is linked to significantly lower risks of heart disease, high blood pressure, stroke, and type 2 diabetes (1,2). The American Diabetes Association’s nutrition therapy recommendations for the management of adults with type 2 diabetes note that many eating patterns are acceptable for people with diabetes. Several diets, including the DASH (Dietary Approach to Stop Hypertension) and Mediterranean-style plans, although not strictly vegetarian, still promote increased intake of plant-based foods such as legumes and their associated health benefits (3). Although research supports the benefits of legume consumption, only ∼8% of U.S. adults report eating legumes on any given day (4). The purpose of this article is to highlight the research demonstrating the benefits of increasing legumes in the diet and to offer practical suggestions to aid health care providers in increasing their own legume intake and more confidently discussing such a goal with their patients. Unlike with some other chronic conditions, individuals who have type 2 diabetes are responsible for providing up to 95% of their own care (5). One of the most challenging aspects of type 2 diabetes care is helping patients adopt healthier behaviors. When nutrition therapy is provided by a qualified professional, people can learn how to make better food choices to help improve their glycemic control, blood pressure, cholesterol, and BMI (6). In fact, medical nutrition therapy (MNT), as provided by a registered dietitian, has been shown to improve glycemic control outcomes and reduce health care costs to Medicare (7). Recent literature demonstrates the benefit of augmenting this nutritional information with skills-based culinary education. Robust correlations exist between healthy food preparation skills and improved …

Bridging the gap - planning Lifestyle Medicine fellowship curricula: A cross sectional study

BackgroundThe emerging field, Lifestyle Medicine (LM), is the evidence-based practice of assisting individuals and families to adopt and sustain behaviors that can improve health. While competencies for LM education have been defined, and undergraduate curricula have been published, there are no published reports that address graduate level fellowship in LM. This paper describes the process of planning a LM fellowship curriculum at a major, academic teaching institution.MethodsIn September 2012 Harvard Medical School Department of Physical Medicine and Rehabilitation approved a “Research Fellowship in Lifestyle Medicine”. A Likert scale questionnaire was created and disseminated to forty LM stakeholders worldwide, which measured perceived relative importance of six domains and eight educational experiences to include in a one-year LM fellowship. Statistical procedures included analysis of variance and the Wilcoxon signed-rank test.ResultsThirty-five stakeholders (87.5%) completed the survey. All domains except smoking cessation were graded at 4 or 5 by at least 85% of the respondents. After excluding smoking cessation, nutrition, physical activity, behavioral change techniques, stress resiliency, and personal health behaviors were rated as equally important components of a LM fellowship curriculum (average M = 4.69, SD = 0.15, p = 0.12). All educational experiences, with the exception of completing certification programs, research experience and fund raising, were graded at 4 or 5 by at least 82% of the responders. The remaining educational experiences, i.e. clinical practice, teaching physicians and medical students, teaching other health care providers, developing lifestyle interventions and developing health promotion programs were ranked as equally important in a LM fellowship program (average M = 4.23, SD = 0.11, p = 0.07).ConclusionsLifestyle fellowship curricula components were defined based on LM stakeholders’ input. These domains and educational experiences represent the range of competencies previously noted as important in the practice of LM. As the foundation of an inaugural physician fellowship, they inform the educational objectives and future evaluation of this fellowship.

Improving patients’ home cooking – A case series of participation in a remote culinary coaching program

This case series describes and examines the outcomes of a remote culinary coaching program aimed at improving nutrition through home cooking. Participants (n = 4) improved attitudes about the perceived ease of home cooking (p < 0.01) and self-efficacy to perform various culinary skills (p = 0.02); and also improved in confidence to continue online learning of culinary skills and consume healthier food. We believe this program might be a viable response to the need for effective and scalable health-related culinary interventions.

Family physicians prescribing lifestyle medicine: feasibility of a national training programme

Background The actual causes of the preponderance of non-communicable chronic diseases are related to unhealthy behaviours, such as poor nutrition, physical inactivity and tobacco use. Our goal was to evaluate the feasibility of training in lifestyle medicine (LM) for family physicians, which could be included in ‘Healthy Israel 2020’, a national initiative created to enhance the health of Israelis. Methods Twenty-six providers participated in a 1-year certificate of completion in LM. A control group included 21 providers who participated in a similar musculoskeletal training programme. Pre/post data were collected in both groups of participants’ attitudes and self-efficacy to prescribe LM and personal health behaviours. Mid/post feedback was collected in the study group participants. Results Physicians in the LM training represented a nationwide distribution and attended >80% of the programmes’ meetings. They reported positive outcomes in most areas after the intervention compared with baseline. Five variables reached statistical significance: potential to motivate patients to improve exercise behaviours (p<0.05), confidence in ones knowledge about LM (p=0.01) and counselling (p<0.01), particularly related to exercise (p=0.02) and smoking cessation (p<0.05). The control group demonstrated one significant change: potential to motivate patients to change behaviours to lose weight (p<0.05). Conclusions A training programme in LM appears feasible and could have a positive impact on interested family physicians’ attitudes and confidence in prescribing LM. Thus, ‘Healthy Israel 2020’ and other programmes worldwide, which aim to improve health behaviours and decrease the impact of chronic diseases, might consider including family physicians training.

Public Health Nurses Promoting Healthy Lifestyles (PHeeL-PHiNe): methodology and feasibility.

Mother and Child Health Clinics have provided preventive health services in Israel for nearly a century. The Public Health Nurses Promote Healthy Lifestyles Program was developed to assist families in adopting healthy behaviors. The program ran in the Jerusalem District from 2009 to 2011. After piloting, 175 public health nurses received training and interventions took place in 45 clinics serving parents of 167 213 infant and toddlers per year. When evaluation is completed, our hope is to incorporate the program into Mother and Child Health Clinic services regularly provided nationwide, thereby becoming an integral part of the initiative, Healthy Israel 2020.

Credentialed Chefs as Certified Wellness Coaches: Call for Action.

Beneficial relationships exist between food preparation skills and improved dietary quality, and between times spent preparing food and mortality. Food shopping, meal planning, preparation and cooking skills are valuable in supporting good health. Thus experts are proposing nutritional counseling be expanded to include these beneficial behavioral skills. Educational programs delivered by chefs have recently emerged as a way to improve engagement with nutritional guidelines. It is reasonable to assume that a chef with behavior change knowledge and skills, such as coaching, may be more effective in facilitating behavior change. We encourage chefs who wish to be involved in promoting health-related behavior change to consider continuing education in coaching knowledge and skills. We also recommend culinary schools to consider offering these courses, to aspiring chefs. Such programming will not only benefit future clients but also offers a career- enriching professional opportunity to chefs. Credentialed chefs can make a positive health impact and should be included as professionals who are eligible for the impending national certification of health and wellness coaches.