Lifestyle medicine is an increasingly important specialty that helps prevent and manage obesity and other chronic diseases. The foundation of lifestyle medicine is helping patients incorporate sustainable healthy habits into their everyday lives.
Rather than focusing on a single condition or treatment, lifestyle medicine addresses the behaviors that impact a patient’s overall health, including nutrition, physical activity, sleep, stress management, social connection and substance use.
At Jefferson Health, that philosophy is the cornerstone of its new Lifestyle Medicine Program.
“The goal is to empower patients with strategies they can realistically integrate into daily life rather than adding more pressure or unrealistic expectations,” said Nikkira Townsend, a certified registered nurse practitioner (CRNP) at Jefferson Health.
Jefferson Health’s Lifestyle Medicine Program was born out of a $2.4 million grant from the Patient-Centered Outcomes Research Institute (PCORI) to implement evidence-based patient education and coaching to combat obesity.
Jefferson Health leaders made the case to PCORI that the program could expand its impact by supporting patients who have other components of metabolic syndrome, but who technically do not have obesity. After PCORI gave Jefferson Health the green light to pivot, the system developed the Lifestyle Medicine Program with a goal to improve health across a broad patient population.
Today, the program guides patients toward improving their health by focusing on the six pillars of lifestyle medicine. They are:
- Nutrition.
- Physical activity.
- Sleep.
- Stress management.
- Social connectedness.
- Avoiding risky substances.
A multidisciplinary team of clinicians, registered dietitian nutritionists (RDN) and other health professionals at Jefferson Health work together to help patients make long-term, meaningful changes.
“It’s this really beautiful camaraderie,” said Courtney Pinkham, MD, medical director of the Lifestyle Medicine Program at Jefferson Health. “And patients have reported that this is a really great group of clinicians who are very caring, compassionate, knowledgeable and patient.”
Jefferson Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, clinicians and care teams with resources to help drive the future of medicine.
Navigating the program
Patients can self-refer into the Lifestyle Medicine Program, or any clinician at Jefferson Health can refer to it as well. Once patients are referred, they receive a MyChart message to schedule their first one-on-one virtual visit with a nonclinical provider.
Before the first visit, patients complete extensive intake questionnaires that help the care team understand their metabolic health, lifestyle, behaviors, overall well-being and quality of life.
The program uses the Centers for Disease Control and Prevention’s health-related quality of life (HRQOL) survey and the American College of Lifestyle Medicine screener, which includes a depression score assessment, a sleep survey, a diet and nutrition screening, and an activity assessment.
“We try to get a thorough idea of what someone’s life looks like on day zero, when they decide to schedule this appointment,” said Dr. Pinkham. “That gives us a better idea of how we can meet them where they are to help them.”
During the initial appointment, clinicians and other health professionals walk patients through the principles of lifestyle medicine and what to expect in the program.
After the first appointment, patients enroll in one of the program’s group cohorts, which meet one hour a week for 12 weeks. Cohorts are intentionally offered during early morning, lunchtime, and evening hours to minimize disruptions to patients’ work schedules.
Throughout the program, patients work with their care teams to develop SMART goals, which are specific, measurable, realistic, time-bound, and positive. Rather than asking patients to completely overhaul their lifestyle, clinicians and other health professionals help them identify changes they can successfully incorporate into their lives.
Each week, patients learn to develop sustainable habits and strategies around the different pillars, while also building their own confidence in their ability to take control of their health. At the end of each session, patients receive a recipe to help them start integrating healthy nutrition choices into their routines.
“Most people intuitively know they should eat more plants and less ultraprocessed foods, so this is not brand-new novel information,” Dr. Pinkham explained. “But where the rubber meets the road is learning how to do this when they are caretakers, have increasing work demands or are just tired between juggling work and other responsibilities.
“Those are barriers,” she added. “We help them learn how to do this in a way that’s palatable, financially sustainable and efficient.”
After the 12-week program, patients continue working with their lifestyle medicine care team with six-, nine- and 12-month follow-up appointments. During these visits, care teams repeat screenings and assessments, review metabolic testing and bloodwork, revisit SMART goals, and help patients navigate new or existing roadblocks.
Sleep is more important than many realize
While the program teaches patients about the six distinct pillars of health, clinicians and other health professionals emphasize that each pillar is deeply interconnected. Improvements in one area often drive changes in another.
“If people aren’t sleeping well, it makes everything else more difficult to achieve,” said Tim MacConnell, a physician assistant for the program at Jefferson Health. “If you’re not sleeping well, it’s going to affect almost every aspect of your health, including your mental health.”
Because of this clear connection, each patient completes a sleep assessment upon entering the program. If the screening shows a patient has a high risk for sleep apnea, their lifestyle medicine care team will refer them to sleep medicine specialists for additional testing, such as a sleep study.
If a patient is struggling with insomnia, care teams will address sleep hygiene and recommend practical ways to improve sleep habits. If they need additional support, the lifestyle medicine team refers patients to integrated behavioral specialists who offer cognitive behavioral therapy for insomnia (CBTI).
Often, patients are surprised to learn how much sleep affects their lives overall.
“One patient entered the program thinking nutrition was her problem, but when she learned about sleep and addressed that, she recognized that sleep was the biggest lever that made her feel better,” said MacConnell. “Sleep is often underappreciated, but once patients wrap their head around it, they start to notice the big difference it makes.”
Addressing nutrition with small changes
Nutrition is another cornerstone of the program. That’s why registered dietitian nutritionists (RDN) co-teach all group classes alongside the advanced practice clinicians (APC).
“We’re so fortunate to have our RDNs aligned with APCs,” said Dr. Pinkham. “RDNs are invaluable … they have an entire skillset that is very nuanced, in depth and rapidly changing.
Rather than imposing rigid diets, RDNs focus on helping patients implement behavioral changes when it comes to food.
“[We] focus on balance, satiety and energy levels rather than imposing strict limits on things like calories or food groups,” said Karenna Genzlinger, RDN. “We pursue smaller, realistic changes that can be made consistently over the long term.”
Patients also learn practical skills like meal planning, interpreting nutrition labels, and mindful eating to build confidence in making healthier food choices.
Increasing physical activity supports long-term health
Physical activity is a cornerstone of lifestyle medicine because regular movement helps prevent and manage many chronic diseases while improving physical function, mental health and overall well-being. Whether it is walking, strength training, cycling or simply moving more throughout the day, finding enjoyable ways to stay active can boost energy, support long-term health and improve quality of life.
“We really try to have patients rethink what physical activity looks like for them,” said Sarah Skobeloff, a registered dietitian. “Ultimately, one of the most important factors is finding activities that you’re going to do and do it consistently. If that’s doing dance class three days a week, do it.”
Additionally, a key tip for patients to remember is that “no time is too little to move your body,” Skobeloff said. “If you only have 10 to 15 minutes, that’s greater than zero.”
When patients first start, it may not be easy at first. But as they start incorporating more physical activity into their lives, it does become easier and it helps build their confidence.
That is why “starting where you are is incredibly important,” she emphasized.
Patients also should make their “movement menu. It’s not just one activity, but can you find a bunch of different forms of movement that you enjoy?” Skobeloff explained. It’s about “meeting your energy levels, your time and your mental state at the moment—meeting yourself where you are.”
Managing stress leads to physical and emotional changes
Stress management follows a similar philosophy as the five other pillars of the program.
“When patients begin managing stress more intentionally, the changes are often both physical and emotional,” said Townsend. “Many report improvements in sleep quality, energy levels, mood, focus and overall sense of control. Some patients notice fewer stress-related symptoms such as headaches, gastrointestinal discomfort, elevated blood pressure or emotional eating behaviors.”
Beyond symptom improvement, patients often describe feeling more present and confident in handling challenges and better able to engage in other healthy lifestyle behaviors.
“When they feel regulated and supported, they are often more successful with nutrition, exercise, relationships and long-term health goals,” Townsend explained. “One of the most meaningful outcomes is seeing patients recognize that caring for their mental and emotional well-being is not separate from physical health; it is a foundational part of it.”
Building community through social connection
Social connection is another foundational pillar of lifestyle medicine. In fact, social isolation and loneliness are associated with an increased risk of cardiovascular disease, poor immune function, increased inflammation, poor sleep, and an increased mortality risk, according to Kathleen Hill, CRNP.
The group cohort itself creates opportunities for patients to learn from one another, while building a supportive community. Patients participate in group discussions and support each other through similar challenges and roadblocks.
“Patients interact with each other … and often share that they too feel a certain way or offer suggestions to participants who are struggling to find an answer that someone else has had success in tackling,” Hill said. “These things help to build community.”
The program extends those relationships beyond weekly cohort sessions by hosting monthly virtual or in-person events centered around the six pillars.
For example, this spring, the program’s lead RDN hosted a cooking demonstration at Reading Terminal Market in Philadelphia.
“The patients had a really good time and felt like they learned something new,” said Dr. Pinkham.
This summer, the program also held an event with a physical therapist who discussed how to make physical activity accessible when facing chronic pain.
“The physical therapist discussed how to preserve the ability to move when dealing with chronic pain,” Dr. Pinkham said. “Each pillar is going to be talked through twice during the 12-month year.”
A multidisciplinary team approach
Although the Lifestyle Medicine Program is not designed specifically around individual chronic diseases such as diabetes, kidney disease or heart failure, its emphasis on healthier nutrition, movement, sleep and stress management is particularly valuable for these patient populations.
“We know that one night of poor sleep increases insulin resistance,” Dr. Pinkham explained. “That applies to everyone, but if you have prediabetes or type 2 diabetes, that information is going to be more compelling and meaningful for you … because if you increase your insulin resistance that will make your prediabetes more likely to become type 2 diabetes or it will make your type 2 diabetes harder to control.”
Patients with complex medical conditions continue following recommendations from their specialty care teams, while also integrating lifestyle medicine strategies into their care plans.
The same collaborative approach applies to substance use. Clinicians educate patients about how risky substances affect both physical and mental health, while using validated screening tools to assess substance use patterns and readiness for change.
“The lifestyle medicine approach supports patients in reducing or eliminating the use of risky substances through evidence-based assessment and treatment strategies that promote risk/benefit awareness and sustainable behavior change,” said Jacqueline Zipay, CRNP for the program.
When needed, clinicians and care teams connect patients to dedicated smoking cessation or addiction treatment programs.
Early results
The program’s inaugural cohort completed its 12-week program this summer. And care teams are already seeing anecdotal evidence that these behavioral shifts are positively impacting patients’ health and quality of life.
For example, one patient in the program wanted to become more physically active, but assumed cost would be a barrier. Rather than accepting that obstacle, their care team encouraged them to contact their insurance company to find out if fitness benefits were included in their plan.
By the following week, the patient had called the insurance company, enrolled in the activity, and started participating. Dr. Pinkham noted that the patient immediately felt mentally stronger, more confident and excited about being active simply by taking those first steps.
For the Lifestyle Medicine Program team, those small victories are what define success. Their goal is not simply helping patients lose weight or improve their lab work. They also want to help patients gain a sense of control and build the confidence they need to continue making positive changes long after they complete the program.
“Those types of wins matter,” said Dr. Pinkham. “It’s not all about the number on the scale; it’s about how we can improve patients’ quality of life.”
