AT A GLANCE: Lifestyle medicine applies clinical evidence to everyday habits—diet, physical activity, sleep, social connection, purpose and stress—to prevent and treat chronic disease. Here are key things you will learn about lifestyle medicine from Courtney Pinkham, MD, a family physician and medical director of the Lifestyle Medicine Program at Jefferson Health, in this article:
- The six pillars of lifestyle medicine are a whole-food plant-predominant diet, regular physical activity, high-quality sleep, positive social connections, a sense of purpose, and avoidance of high-risk substances paired with healthy coping mechanisms.
- Lifestyle medicine is grounded in clinical evidence, not the assumption that "natural" is always better.
- Not all stress is harmful. Distinguishing distress from eustress, and having intentional coping strategies in place, is a core part of the approach.
- Small, consistent changes to daily habits matter more than occasional dramatic interventions.
- Talk with your physician if sleep problems, stress or other daily habits are affecting your health, or if you need help making sustainable lifestyle changes.
Lifestyle medicine is a field built on the direct premise that many of the most common and costly chronic conditions—type 2 diabetes, hypertension, heart disease, certain cancers—are significantly shaped by how people live day to day. Diet, movement, sleep, social connection and the way a person manages stress are not peripheral concerns to health. They are central drivers of it.
The evidence base supporting lifestyle interventions has grown substantially. Researchers have documented the relationship between chronic sleep deprivation and elevated dementia risk, identified specific physical activity thresholds that protect against metabolic disease, and demonstrated that behavioral therapy for insomnia can outperform medication in certain cases. These findings have moved lifestyle medicine from the margins of clinical practice toward the mainstream.
What distinguishes the field from general wellness advice, however, is not a particular philosophy, it is a commitment to intellectual curiosity and clinical evidence. Lifestyle medicine is not about dramatic cleanses or the assumption that anything "natural" is automatically beneficial. It is about understanding what the research shows and then finding the most realistic way to apply it to the conditions of a patient's actual life.
The AMA's What Doctors Want Patients to Know™ series gives physicians a platform to share what they want patients to understand about today's healthcare headlines.
In this installment, Courtney Pinkham, MD, a family physician and medical director of the Lifestyle Medicine Program at Jefferson Health, shares what she wants patients to know about lifestyle medicine—from the six pillars that define the field to why a five-minute stretch still counts.
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.
Lifestyle medicine is built on evidence-based pillars
"There are six pillars of lifestyle medicine,” said Dr. Pinkham. To start, one pillar is “a whole food, plant-predominant—plant-based, plant-focused—diet. Whatever is the most relatable way of saying to a patient ‘eat more whole plant foods.’”
Another pillar is around “regular physical activity, and there are particular activity goals,” she said. “To prevent conditions such as type 2 diabetes, hypertension, dyslipidemia and heart attack, we recommend 150 minutes each week in the moderate-intensity physical activity range, which you’ve arrived at if you’re trying to sing and you’re short of breath.
“Or 75 minutes in the high-intensity range. That’s short of breath trying to talk,” Dr. Pinkham added. “Ideally a combination of those per week has the best chance to give the most return on investment for preventing the development of those metabolic conditions.”
Each pillar carries specific, clinically grounded targets—and together they address the full range of habits that shape long-term health.
Other pillars include "high-quality sleep, positive social connections and having a sense of purpose—it's incredibly meaningful,” she said. Then there is “avoidance of high-risk substances: controlled substances, alcohol, smoking, dipping, vaping, to a certain extent marijuana. And healthy coping mechanisms."
Sleep is a clinical issue—and the best treatment is not a pill
Of all six pillars, sleep may be the one where patients most often receive advice that falls short of what the evidence supports.
"Currently all of the medications we have to treat insomnia are a chemical equivalent of knocking someone out, whether it be any prescription sleep aid or the antihistamine sleep aids available over the counter,” Dr. Pinkham said. It is “the equivalent of being knocked out as opposed to getting good quality sleep.”
The first-line treatment recommended by the American Academy of Sleep Medicine is behavioral, not pharmaceutical.
"Cognitive behavioral therapy for insomnia has something like an 80-plus percent decrease or resolution in insomnia in patients who complete the intervention,” she said. “Those numbers are maintained at five years post-intervention. So, you do this for six to 12 weeks and your insomnia is, for many people, effectively cured as opposed to being on a sleep aid every single day.”
"We observe in clinical studies over time that the people who are chronically sleep deprived have an increased risk of developing dementia,” Dr. Pinkham said. “Unfortunately, it doesn't matter if you started with poor sleep, and you add a sleeping pill. We don't see the same reduction in dementia if you are sleeping on a sleeping pill as you do with good quality sleep that is not medication-assisted sleep.
"But we don't have enough people trained in cognitive behavioral therapy for insomnia in the United States. One of the really amazing parts of our program is that the psychology and behavioral health team at Jefferson is being trained on it,” she added. “It's going to be one of the biggest impacts we will have in general, because so many people just don't get enough sleep and don't realize all of the ramifications that sleep deprivation can have."
Build social connection
"We talk in the program about how just being in the program is a social connection, because you know that this group of people is supporting you,” Dr. Pinkham said. “But we also plan on having some of our social connection groups be about how do you find your village.
“What does your village look like? What does it mean to show up for our village, and how do we support each other?" she added.
Find healthy ways to cope with stress
"In the program, we talk about the difference between distress and eustress,” Dr. Pinkham noted, sharing that “I was a competitive gymnast growing up. I remember doing a small, excited dance before the judges presented, so I could get on the equipment sooner, because I was amped up. I was excited to perform.
“That is a type of stress. I loved that because I loved competing," she added. "Certainly, healthcare scares for loved ones as one example, financial uncertainty being another, there are truly stressors that are terrible. But a lot of times when I'm working with patients, I work through that patient’s relationship to that stress first and foremost. If stress is the price we pay for a meaningful life, it is not all bad."
Having intentional coping strategies in place changes what patients reach for when that discomfort arrives.
"We all do something to cope with stress because we, by nature of being human, are going to do something to deal with that discomfort,” she said. “And if we aren't intentional … then we are more likely to doom scroll on our phones, impulse buy things or even gamble. We are more likely to do the maladaptive coping that can actually make the pressures on us worse long term.”
Lifestyle medicine is different than a wellness culture
"The point of the program in lifestyle medicine in general is that we are intellectually curious, and the things that we are recommending come from an evidence base,” Dr. Pinkham said. “Dr. Dean Ornish has done a ton of research on various lifestyle medicine interventions and how they impact coronary artery disease and prostate cancer, and he just pivoted and is doing some work on dementia. We have these multitudes of articles that say these changes in this way are consistent with this outcome.”
“There’s some overlap between wellness culture and lifestyle medicine. A lot of people in a wellness culture approach would value sleep and positive social connection,” she said. "The difference is the way that lifestyle medicine approaches it is ‘hey, here's what happens when people get good, productive, regular sleep,’ and we look at that group of people as compared to people who routinely are sleep deprived.
“We observe in clinical studies over time that the people who are chronically sleep deprived have an increased risk of developing dementia,” Dr. Pinkham added. “So, there's one reason why you might consider working on a better approach to improving your sleep.”
Wellness culture, by contrast, often leans on a particular form of reasoning that lifestyle medicine explicitly rejects.
"One of the things I've observed in the more pop culture wellness definition is a real appeal to nature fallacy—the idea that something 'natural' is always superior,” she explained. “Arsenic is natural. Carbon monoxide is natural. Opium is natural. The difference between medicine and poison is dose.”
“There are some chemical substances that we find in nature that even at minuscule doses can have horrific health outcomes,” Dr. Pinkham said. "Just because you don't know the names of something doesn't impact what your body does with it.
“All it means is that you haven't yet spent years learning how to read chemical names,” she added. “It doesn't have any impact on whether your body is going to benefit from it or not."
Small changes matter, but be consistent
A lifestyle medicine program does not ask patients to overhaul everything at once. Its power comes from finding what is sustainable within the real conditions of a patient's life.
"If you do not have the time to go to the gym for an hour every day, can you do 10-minute exercise stacks throughout the day?” Dr. Pinkham said. “Maybe you do squats for 10 minutes in between meetings, or maybe you make it a point that you get to work 10 minutes early and you walk around the building before you go in.”
“Can we figure out how to do something meaningful and consistent with your values for your life in the most ridiculously unambitious way and do that consistently?” she said. “Because it is more important to consistently take care of your body than to spend a week where all of your foods are raw vegan and you're meditating for two hours a day. That one week is not going to be as valuable as making a point to eat a cup of leafy green vegetables every day.”
The threshold for what matters is lower than many patients assume.
"If you're lifting at all, that's way better than not lifting weights ever, because strength training is also really important to long-term health outcomes,” Dr. Pinkham said. Think about “what is the least ambitious thing you can do that makes you just a little bit healthier and just keep doing that until it's a routine.
"As the oldest firstborn female gymnast perfectionist, it's taken me a long time to recognize that I actually still benefit from a 15-minute workout, even if it's not an hour at the gym,” she said. “There's still value in that and I should still feel proud of myself.”
“Some days when it's really hard for me to figure out the exercise, I have finally gotten to a point where I feel good about even five minutes of stretching or balance activity as a component of increasing my physical fitness, because it's more than nothing,” Dr. Pinkham said. "That's really what lifestyle medicine is hoping to get across to people: here's the evidence base, here's the practical application, and here is the thing that will make your quality of life improve the most for years to come."
