reverse the lifestyle‐related chronic disease that is all too prevalent’. In the 2017 edition of Egger’s textbook, Lifestyle Medicine: Lifestyle, the Environment, and Preventive Medicine in Health and Disease, he defines Lifestyle Medicine as ‘The application of environmental, behavioural (sic), medical, and motivational principles to the management of lifestyle‐related health problems in a clinical and/or public health setting (Rippe 2019, pp. 961–962)’.
2 A Rippe defines Lifestyle Medicine as ‘The integration of lifestyle practices into conventional medicine to lower the risk for chronic disease and, if the disease is already present, to serve as an adjunct to therapy’ (Rippe 2019, pp. 961–962).
3 B There have been several definitions of Lifestyle Medicine by various schools of thought across the global community. The preferred definition may be that authored by Sanger, Katz, Dysinger, and others published in late 2014 in the International Journal of Clinical Practice: ‘Lifestyle Medicine is the evidence‐based practice of helping individuals and communities with comprehensive lifestyle changes (including nutrition, physical activity, stress management, social support, and environmental exposures) to help prevent, treat, and even reverse the progression of chronic diseases by addressing the underlying cause’.
4 C The overall benefits of physical activity on health include higher health‐related fitness, higher control and maintenance of a healthy weight, less risk of disabling medical conditions and less chronic disease rates than people who are inactive. Physical inactivity is the fourth leading risk factor for global mortality. It is the cause of 1 in 10 premature deaths. Ozone therapy is not a component of Lifestyle Medicine. There is no emphasis on the use of supplements in Lifestyle Medicine. Evidence‐based medication use is sometimes used as adjunct to Lifestyle Medicine treatment (Kelly and Shull 2019, pp. 187–191).
5 D A key component of the practice of Lifestyle Medicine is the use of whole food plant‐based nutrition. Several studies have proved that plant‐based nutrition prevents, treats, and oftentimes reverses the course of certain diseases such as hyperlipidaemia, hypertension, coronary artery disease (Ornish et al. 1990), Type 2 Diabetes Mellitus (Barnard et al. 2009), certain cancers (Kelly and Shull 2019, p. 125). A recent EAT‐Lancet Commission series on healthy diets from sustainable food systems, ‘Food in the Anthropocene’ has also highlighted the benefits to the planet of a mainly plant‐based diet (Willett et al. 2019; Tips Box 1.1), which inextricably links health and sustainable development.TIPS BOX 1.1 Key Messages from ‘Food in the Anthropocene’Unhealthy and unsustainably produced food poses a global risk to people and the planet. > 820 million people have insufficient food and many more consume an unhealthy diet that contributes to premature death and morbidity. Global food production is the largest pressure caused by humans on Earth, threatening local ecosystems and the stability of the Earth system.Current dietary trends, combined with projected population growth to about 10 billion by 2050, will exacerbate risks to people and planet.Transformation to healthy diets from sustainable food systems is necessary to achieve both UN Sustainable Development Goals and the Paris Agreement. Scientific targets for healthy diets/sustainable food production are needed to guide a Great Food Transformation.Healthy diets have an appropriate caloric intake and consist of a diversity of plant‐based foods, low amounts of animal source foods, unsaturated > saturated fats, and small amounts (if any) of refined grains, highly processed foods/added sugars.Transformation to healthy diets by 2050 will require substantial dietary shifts, including a greater than 50% reduction in global consumption of unhealthy foods such as red meat and sugar, and a greater than 100% increase in consumption of healthy foods such as nuts, fruits, vegetables, and legumes.Dietary changes from current diets to healthy diets are likely to substantially benefit human health, averting ~10.8–11.6 million deaths/year: a reduction of 19.0–23.6%Sustainable food production needs to operate within the food systems’ safe operating space at all scales on Earth. So, production for ~10 billion people should use no additional land, safeguard existing biodiversity, reduce consumptive water use/manage water responsibly, substantially reduce nitrogen/phosphorus pollution, produce zero CO2 emissions, and no methane/nitrous oxide emission increase.Transformation to sustainable food production by 2050 will require ≥ 75% reduction of yield gaps, global redistribution of nitrogen/phosphorus fertilizer use, phosphorus recycling, radical improvements in efficiency of fertilizer/water use, rapid implementation of agricultural mitigation options to reduce greenhouse‐gas emissions, land management practices shifting agriculture from a carbon source to a sink, and a fundamental shift in production priorities.The scientific targets for healthy diets from sustainable food systems are intertwined with all UN Sustainable Development Goals. For example, achieving these targets will depend on providing high‐quality primary health care that integrates family planning and education on healthy diets. These targets and the Sustainable Development Goals on freshwater, climate, land, oceans, and biodiversity will be achieved through strong commitment to global partnerships and actions.Achieving healthy diets from sustainable food systems for everyone will require substantial shifts towards healthy dietary patterns, large reductions in food losses and waste, and major improvements in food production practices.Source: Willett et al. (2019).
6 C Health coaching in Lifestyle Medicine assesses the readiness for change, collaboratively establishing client goals, evaluating successful steps and self‐limiting patterns, reassessing and modifying goals, articulating insights gained, and formulating post‐coaching plan to sustain changes that promote health and wellness. Research has shown that patients who received coaching services demonstrated significant improvements in both physical as well as mental health, with reduction in chronic disease markers (HbA1c, blood pressure, and LDL cholesterol) that persisted one year after completion of the health coaching intervention.Health coaching is an essential component of the practice of Lifestyle Medicine. It has been found to be effective in the treatment of mild‐moderate depression. The coach does not prescribe a management plan for the client. Health coaching can be used to improve personal lifestyle choices regarding weight management and physical activity or sleep (Rippe 2019, p. 236).
7 D The main pillars of Lifestyle Medicine include Nutrition, Physical Activity, Sleep, Stress Management, Avoidance of Tobacco, Alcohol, and other harmful substances’ Use, Social Connectedness, and Positive Psychology. Behavioural change is the mainstay of management. Nutrition needs to be plant‐based and does not need to follow any particular named diet such as Mediterranean, Atkins, Paleo’s, etc. Emotional wellness is a key component in the practice of Lifestyle Medicine (Rippe 2019, p. 964).
8 A Lifestyle Medicine places emphasis on behavioural change. This is the most distinctive aspect of the principles and practice of Lifestyle Medicine.Behaviour change is the foundational activity through which Lifestyle Medicine works. Lifestyle Medicine often needs a multi‐professional team, but behavioural change is the distinction from other specialities. All team members are equally important in the management of the patient (Rippe 2019, p. 193).
9 B A typical setting for a Lifestyle Medicine Clinic could be in a Primary, Secondary, or Tertiary clinic that incorporates the typical one‐to‐one consultation and group consultations in the management of patients. The practice of Lifestyle Medicine does not require a super‐specialist diagnostic centre, nor is it typically a tertiary consultant‐delivered service. Lifestyle Medicine involves significant evidence‐based changes in behaviours that affect health by a multidisciplinary team whose members have themselves adopted healthy lifestyles (Rippe 2019, p. 967).
10 C According to Noffsinger, 2012, shared medical appointments are ‘conservative individual medical visits in a supportive group setting where all can listen, interact, and learn’. These have been used as an adjunct clinical approach in several countries (Noffsinger 2012; Egger et al. 2015). They provide more time with the doctor, faster access to care, increased peer support, and greater opportunity for self‐management (Egger et al. 2017, p. 58).
11 B The strongest and most compelling evidence is effectiveness of intensive therapeutic lifestyle change treatment (ITLC) because it produces the most dramatic treatment effects, just as higher dosing of pharmacological agents does. Conversely, few studies have been carried out on non‐intensive lifestyle change programs. Their effectiveness is presumed based on published intensive therapeutic lifestyle