Empowering Future Physicians: Why Lifestyle Medicine is Crucial to Undergraduate Medical Education

Congratulations to Ryan Arboleda, OMS-III; Benjamin Pfeiffer, OMS-III; and Regan Stiegman, DO, first place winners of the 2025 Namey/Burnett Award. Sponsored by the ACOFP Foundation, with winners selected by the ACOFP Health & Wellness Committee, the Namey/Burnett Preventive Medicine Writing Award honors the memory of Joseph J. Namey, DO, FACOFP, and John H. Burnett, DO, FACOFP—dedicated advocates for osteopathic medicine—and recognizes the best preventive medicine blog posts submitted by osteopathic family medicine students and residents.

Introduction 

There has been a steady shift from a communicable disease burden to a non-communicable disease burden over several decades. In the United States, studies have estimated that over 50 percent of the population has been diagnosed with at least one chronic disease, such as hypertension, type II diabetes, coronary artery disease, or other non-communicable diseases.​¹ Other studies have estimated that seven out of ten deaths can be attributed to chronic diseases in developing countries​.² This shift in disease burden is not limited to civilian populations. Similar trends have also been noticed among active-duty servicemembers. The prevalence of type II diabetes, obesity, and other chronic diseases has been on the rise, and it has been demonstrated that despite being some of the healthiest individuals upon entering the military, veterans have some of the worst long-term health outcomes compared to other demographics.​^3​,​4 Many of these pathologies are manageable and preventable with a combination of pharmacological, lifestyle, and behavioral interventions. Traditionally, the medical model in the United States has focused on treating chronic disease primarily through pharmacotherapy. However, a field of medicine that has been rapidly growing to address this issue is lifestyle medicine.  

Lifestyle medicine (LM) is a specialty that focuses on evidence-based lifestyle and behavioral interventions for the prevention, treatment, and reversal, of chronic disease​.^5​ To help guide these interventions the American College of Lifestyle Medicine (ACLM) utilizes the six pillars of lifestyle medicine: a whole-food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connections​.^6​

Overwhelming evidence has shown that lifestyle interventions can successfully prevent, treat, and reverse chronic conditions such as type II diabetes, hypertension, and obesity. Aerobic exercise, dietary modifications, and weight management can successfully reduce blood pressure and improve biomarkers associated with cardiovascular risk,^​7 and focused lifestyle intervention has also been shown to lead to type II diabetes remission and can have similar outcomes to pharmacological and bariatric therapies​.^8​ Despite this, the healthcare model in the United States continues to favor a treatment-focused approach revolving around pharmacological therapies rather than a preventative model based on lifestyle intervention. 

For many individuals, their family physician or primary care provider (PCP) is the first point of contact, and many patients have their chronic diseases managed by their PCP rather than a specialist.​⁹ In some cases, their PCP is the sole provider managing their conditions​.¹⁰ Many of these conditions can be managed successfully with focused therapeutic lifestyle interventions. However, many providers are not confident in their abilities to provide comprehensive counseling despite recognizing how crucial these interventions can be in promoting long-term health.​¹¹ Given these gaps in clinical care, this review seeks to address the current state of LM education, certification, and training pathways. This review also seeks to identify current efforts to incorporate a more comprehensive LM curriculum in undergraduate medical education (UME). 

Methods 

For this narrative review, a search of open-access articles in PubMed Central and Google Scholar was conducted using the keywords “lifestyle medicine”, “curriculum”, “undergraduate medical education," and “medical school.” Articles included in this review discussed LM curriculums in medical school and graduate medical education (GME) certification pathways. Articles discussing medical student’s perceptions and knowledge of the specialty were also included. Articles outside the scope of lifestyle medicine education or certification pathways were excluded. Data from an unpublished manuscript regarding perceptions and knowledge of LM among health profession scholarship program (HPSP) students was also included to capture demand for LM in the military setting.  

Results 

Physicians who obtain certifications or specializations in LM are more confident in discussing lifestyle domains such as sleep, relationships, and substance use, and discuss the importance of these topics with patients more frequently​.¹² However, the training pathway to become certified in LM is not fully standardized, and there are limited opportunities to pursue training at the UME level. Current certification pathways involve pursuing certification after completing a primary residency or participating in a residency with an LM certification pathway built into the curriculum. There are academic pathways during medical school that result in LM certification upon graduation, but these opportunities are few and can only be provided at ACLM-approved education programs​.^13​  

However, there is a high interest in LM training and education, especially at the UME level. A survey conducted among allopathic and osteopathic medical students found that only 39.2 percent of students were familiar with the specialty of LM. Many students indicated that it is important to discuss lifestyle and behavioral habits with patients as they strongly benefit overall health. However, 90.5% of allopathic students and 78.7% of osteopathic students considered their knowledge of LM as inadequate or poor. Furthermore, it was found that 92% of students would like to learn more about LM in medical school​.¹⁴ Similar trends were noticed among students planning on pursuing careers in the Armed Forces. Data from a survey of 107 military medical students across 26 medical institutions indicated that 95.4% of respondents felt LM was important to their future careers, and 78.5% of respondents agreed they would benefit from more dedicated time to LM in their core curriculum (R. Arboleda et al., unpublished report, 2024). 

There is a strong demand for LM and ongoing efforts continue to provide more comprehensive LM education at GME and UME levels. The ACLM has made continual standardization efforts to make LM competencies clearer and more accessible for programs looking to incorporate LM into their curriculum. These educational materials are designed to be more streamlined so that they may be easily incorporated into residency programs so physicians can become LM certified or LM specialists​.¹⁵ Efforts have also gone toward developing dedicated LM fellowships for physicians who are already board-certified in a primary specialty and wish to pursue further sub-specialization through a dedicated fellowship program.​¹⁵  

Similar efforts have also been taking place at the UME level. In 2017 the ACLM established the UME task force to help promote LM education among medical students​16​. While some institutions have adopted LM into their curriculum, the degree to which students are exposed to the field varies greatly. Some institutions implement LM in the core curriculum throughout all four years or have tracks students can participate in. Other programs may only have an interest group or elective courses for students, while some institutions have no LM component at all​.^15​,​17   

Several factors have been identified as barriers to LM education in UME. One common factor cited in the literature is a lack of LM curriculum standardization.​^15​,​18 The ACLM UME Task Force has developed LM core competencies and curriculum specifically designed for medical students. This proposed curriculum would entail 100 hours of educational material that covers all the LM UME competencies. These 100 hours are divided into 40 didactic and 60 application hours. Upon graduation, students would be eligible to sit for board certification through the American Board of Lifestyle Medicine (ABLM).​¹⁶ However, no national requirements have been set by the Commission on Osteopathic College Accreditation (COCA) or Liaison Committee on Medical Education (LCME) requiring a specified number of LM hours in the core curriculum. Thus, many institutions have been slow to adopt the competencies set by the ACLM UME Task Force.  Additional barriers identified were a limited number of LM-trained physicians to teach medical students, a lack of awareness of the specialty, and limited time in a tightly packed medical curriculum​.^{13​,​15​,​18​}  

Discussion 

The findings of this review strongly highlight the urgent need for a more comprehensive approach to LM education in UME Integrating LM into the UME curriculum is essential to empowering future physicians, enabling them to deliver more effective counseling and health optimization strategies. This, in turn, will better equip students to prevent, treat, and reverse chronic diseases, particularly in an era where non-communicable diseases are more prevalent than ever before. 

For students pursuing careers within the Armed Forces, this education is even more critical. The ability to enhance health maintenance and prevention directly supports force readiness and deployment preparedness—key pillars of military effectiveness. Ensuring that medical students in this field are trained in LM will have a tangible, long-term impact on the health and operational capacity of our armed forces. 

While this review acknowledges certain limitations—such as potential bias inherent in narrative reviews and the limited published data on LM among military medical students—it still provides valuable insights. To address these gaps, further research should explore pilot LM programs in UME, assess their effectiveness, and determine how well these programs translate into clinical practice. 

Conclusion 

There is a clear and pressing demand from civilian and military medical students for robust LM education within UME. In a time when chronic and non-communicable diseases are on the rise, the best way to equip tomorrow’s physicians is by giving them the knowledge and skills to prevent these conditions through evidence-based lifestyle interventions. Advocacy efforts aimed at standardizing LM education in UME are not just important—they are crucial. By doing so, we ensure that future doctors are fully prepared to provide high-quality, comprehensive care, ultimately improving the health outcomes of individuals and communities alike.  

References 

​​1. Boersma P, Black LI, Ward BW. Prevalence of Multiple Chronic Conditions Among US Adults, 2018. Prev Chronic Dis. 2020;17:200130. doi:10.5888/pcd17.200130 

​2. Jakovljevic M, Sharma T, Kumagai N, Ogura S. Editorial: NCDs – Core Challenge of Modern Day Health Care Establishments. Front Public Health. 2021;9. doi:10.3389/fpubh.2021.692926 

​3. Stiegmann RA, Payne CB, Kiel MA, Stahlman SL. Increased Prevalence of Overweight and Obesity and Incidence of Prediabetes and Type 2 Diabetes During the COVID-19 Pandemic, Active Component Service Members, U.S. Armed Forces, 2018 to 2021. MSMR. 2023;30(1):11-18.