Chronic disease places an enormous economic burden on both individuals and the healthcare system, and existing fee-for-service models of healthcare prioritize symptom management, medications, and procedures over treating the root causes of disease through changing health behaviors. Value-based care is gaining traction, and there is a need for value-based care models that achieve the quadruple aim of (1) improved population health, (2) enhanced patient experience, (3) reduced healthcare costs, and (4) improved work life and decreased burnout of healthcare providers. Lifestyle medicine (LM) has the potential to achieve these four aims, including promoting health and wellness and reducing healthcare costs; however, the economic outcomes of LM approaches need to be better quantified in research. This paper demonstrates proof of concept by detailing four cases that utilized an intensive, therapeutic lifestyle intervention change (ITLC) to dramatically reverse disease and reduce healthcare costs. In addition, priorities for lifestyle medicine economic research related to the components of quadruple aim are proposed, including conducting rigorously designed research studies to adequately measure the effects of ITLC interventions, modeling the potential economic cost savings enabled by health improvements following lifestyle interventions as compared to usual disease progression and management, and examining the effects of lifestyle medicine implementation upon different payment models.

Most Western chronic diseases are closely tied to lifestyle behaviors, and many are preventable. Despite the well-distributed knowledge of these detrimental behaviors, effective efforts in disease prevention have been lacking. Many of these chronic diseases are related to obesity and type 2 diabetes, which have doubled in incidence during the last 35 years. The Complete Health Improvement Program (CHIP) is a community-based, comprehensive lifestyle modification approach to health that has shown success in addressing this problem. This pilot study demonstrates the effectiveness of CHIP in an underserved, rural, and vulnerable Appalachian population. Two hundred fourteen participants in CHIP collectively demonstrated significant reductions in body mass index, systolic and diastolic blood pressure, and fasting blood levels of total cholesterol, low-density lipoprotein, and glucose. If these results can be repeated in other at-risk populations, CHIP has the potential to help reduce the burden of preventable and treatable chronic diseases efficiently and cost-effectively.

Preventable and reversible chronic diseases affect millions of Americans, costing the United States billions of dollars annually for treatments that slow the trajectory but fail to address the root cause of illness. Lifestyle medicine is efficacious, and research has shown that this medical approach garners a significant return on investment in the treatment of many chronic diseases. To obtain an overview of successful reimbursement and practice models used by practitioners, American College of Lifestyle Medicine members were invited to participate in an online survey regarding their experience with lifestyle medicine services and reimbursement models. Three hundred and fifty-one respondents with diverse practice structures, geographical locations, and educational backgrounds completed the survey. The results demonstrate that practitioners are utilizing a variety of lifestyle medicine programs and reimbursement and practice models. Seventy-four percent of respondents are currently providing lifestyle medicine, though the majority do not receive reimbursement for their services. This study provides examples of successful lifestyle medicine reimbursement and practice models, as well as demonstrates the need for continued advocacy for sustainable reimbursement of lifestyle medicine services.

Context: Previous studies of the Complete Health Improvement Program (CHIP) have demonstrated short-term improvements in select metabolic and cardiovascular biomarkers in community-based programs. However, less is known about the benefits of an employer-funded lifestyle intervention program. Objectives: To determine if participation in employer-provided CHIP would result in improvements in short-term metabolic and cardiovascular biomarkers, and to compare the results of the current study to a larger national study. Methods: This observational study evaluated metabolic and cardiovascular biomarker changes in employer health insurance beneficiaries enrolled in CHIP between August 2012 and November 2014. Body mass index; blood pressure (systolic and diastolic); total cholesterol, low-density lipoprotein, high-density lipoprotein, fasting plasma glucose, and triglyceride levels; and weight were measured at baseline and after CHIP. Results: Of 160 employees enrolled in CHIP, 115 women and 45 men agreed to participate in the study. Overall, the participants demonstrated significant reductions in body mass index, from a baseline average of 31.5 to a post-CHIP average of 30.5 (P<.001), systolic blood pressure from 124.5 to 119.4 mm Hg (P=.017), diastolic blood pressure from 77.3 to 74.5 mm Hg (P=.046), total cholesterol from 186.0 to 168.8 mg/dL (P<.001), low-density lipoprotein from 112.9 to 99.3 mg/dL (P<.001), high-density lipoprotein from 48.8 to 46.4 mg/dL (P<.001), and fasting plasma glucose from 100.8 to 96.5 mg/dL (P<.001). Conclusion: When funded by an employer, CHIP demonstrated short-term improvements in select metabolic and cardiovascular biomarkers. Future studies will analyze these data to determine whether these findings translate into subsequent decreased employee absenteeism and reduced beneficiary health claims.

The initial benefits of lifestyle modification programs such as reduction in chronic and cardiovascular diseases (CVD) risk factors have been well documented. However, such positive effects may deteriorate over time following relapse into inactivity. Timely detection of weight regain leading to the deterioration of the accrued benefits could trigger early resumption of intensive lifestyle intervention. To date, no known cost-effective, noninvasive approach for monitoring long-term outcomes has yet been established. The purpose of this study was to determine if body mass index (BMI) change predicted changes in other CVD biometric markers during an intensive lifestyle modification program. This study was an observational, retrospective review of records of participants from the Complete Health Improvement Program (CHIP). Biomarker changes of participants in this community-based Intensive Therapeutic Lifestyle Modification Program (ITLMP) offered in Athens, Ohio, a rural Appalachian college town, between April 2011 and June 2017 were reviewed retrospectively. BMI, heart rate (Pulse), systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting blood levels of total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), and glucose (FBS) were monitored before and after program completion. Data were analyzed using a multivariate general linear model. The sample analyzed consisted of 620 participants (mean age of 52.3±13.0 years, 74.5% female). Controlling for age and gender, BMI change significantly predicted 5 out of the 8 biomarker changes measured [Wilk’s λ = 0.939, F(8,526) = 4.29, p <.0001]. Specifically, a 1-point BMI decrease was associated with 4.4 units decrease in TC, 3.2 units in LDL, 5.3 units in TG, 2 units in SBP, and 1 unit in DBP (all p values < .05). These results suggest that change in BMI may be a useful predictor of change in other CVD biomarkers’ outcomes during and after an ITLMP participation. Tracking BMI, therefore, could serve as a proxy measure for identifying regressing biomarker changes following participation in an ITLMP leading to a timelier reassessment and intervention. Future studies evaluating the value of BMI as a surrogate for highlighting overall cardiovascular health are warranted.

Student-led Lifestyle Medicine Interest Groups (LMIGs) empower the next generation of healthcare professionals to tackle the pandemic of lifestyle-related chronic diseases and provide important pathways to increasing the visibility of Lifestyle Medicine (LM) in health professions schools. Each year, the Donald A. Pegg Student Leadership Award offers four allied health students a seed grant to start or support LMIGs at their schools as well as financial assistance to attend the annual American College of Lifestyle Medicine (ACLM) conference. The 2017 student winners were Paresh Jaini, Albert Barrera, Alyssa Greenwell, and Alicja Baska. With the support of the Pegg Award, the awardees and their faculty advisors have made great strides in LM at their institutions in the areas of research, community outreach, student education, and global networking. Their LMIG activities have included students presenting research at national conferences, initiating a chapter of the national organization Walk with a Doc, hosting educational lectures on LM principles, sponsoring plant-based cooking sessions, facilitating stress management workshops, and hosting a national-level LM congress in Europe. Through the ACLM, the Pegg Award generates an atmosphere of growth for LMIGs, fostering the expansion, vision, and integration of LM into the education of health professions students worldwide.