Chronic diseases are the leading cause of death and disability in the United States, and much of this burden can be attributed to lifestyle and behavioral risk factors. Lifestyle medicine is an approach to preventing and treating lifestyle-related chronic disease using evidence-based lifestyle modification as a primary modality. NYC Health + Hospitals, the largest municipal public health care system in the United States, is a national pioneer in incorporating lifestyle medicine systemwide. In 2019, a pilot lifestyle medicine program was launched at NYC Health + Hospitals/Bellevue to improve cardiometabolic health in high-risk patients through intensive support for evidence-based lifestyle changes. Analyses of program data collected from January 29, 2019 to February 26, 2020 demonstrated feasibility, high demand for services, high patient satisfaction, and clinically and statistically significant improvements in cardiometabolic risk factors. This pilot is being expanded to 6 new NYC Health + Hospitals sites spanning all 5 NYC boroughs. As part of the expansion, many changes have been implemented to enhance the original pilot model, scale services effectively, and generate more interest and incentives in lifestyle medicine for staff and patients across the health care system, including a plant-based default meal program for inpatients. This narrative review describes the pilot model and outcomes, the expansion process, and lessons learned to serve as a guide for other health systems.

Climate change is a threat affecting public health and healthcare systems, and the health sector accounts for nearly 10% of greenhouse gas emissions (GHGEs) in the United States, including through food services. Reducing meat consumption in healthcare institutions presents solutions to reduce food-related GHGEs and provide health benefits to patients. However, challenges in quantifying these benefits present barriers for implementation. We aimed to use publicly available tools to quantify the magnitude of climate, economic, and health benefits associated with integrating a plant-based protein “swap” of current menu options at one hospital institution. On average, modeled plant-based protein swaps cost $0.159/ounce less, reduce trans fats (0.102 g/ounce) and cholesterol (19.0 mg/ounce), and decrease 721 g of CO₂/ounce compared to meat-based counterparts. However, the swap analysis yielded variable results on meal protein content and caloric intake that require additional consideration. If plant-based alternatives were implemented across half of the inpatient dining service at this institution, equivalent to 206,000 meals annually, there could be a potential annual value of $920,240 in food cost savings and $973,028 in avoided GHGEs. Healthcare decision-makers can leverage publicly available tools to implement evidence-based climate change mitigation solutions, helping hospitals battle climate change and reduce the burden of chronic disease.