Group consultations are a form of community-integrated care that involve patients with similar health issues meeting with a clinician in a group setting. This approach enhances self-care and co-production, as patients learn from each other and participate in shared decision making. Group consultations have been shown to improve patient activation and evidence-based outcomes for long-term conditions such as diabetes and COPD, often at lower costs than individual consultations. Group consultations can be delivered in different ways, depending on the needs and preferences of the patients and the clinicians, including virtual sessions that allow for holistic care in the home environment. Case studies from various settings illustrate the effectiveness of group consultations in managing conditions like hypertension and diabetes. Group consultations are therefore a valuable method that combines the best of traditional care with the advantages of peer support and education, leading to better health outcomes in an efficient way.

Person-centred care (PCC) is a healthcare approach that emphasises the importance of individual patient preferences, needs, and values. It involves a shift in the power dynamic of medical consultations, allowing for shared control between the professional and the patient. The UK’s National Health Service has prioritised six processes to enable PCC, which include shared decision making and personalised care planning. Person-centred care aims to enhance patients’ skills and confidence for self-management by focusing on what matters to them rather than solely on their health conditions. The Health Foundation’s model of PCC highlights the need for care to be personalised, coordinated, and respectful of the patient’s dignity. Lifestyle Medicine, which largely focuses on supporting people to change behaviour, greatly depends on PCC as it empowers individuals to manage their health. Care planning and shared decision making are collaborative processes that balance the expertise of both the clinician and the patient. Understanding a patient’s ‘activation level’ can be useful for tailoring support to their ability to make lifestyle changes. Ultimately, PCC enhances the outcomes of Lifestyle Medicine by fostering patient self-management and improving the quality of treatment decisions.

Healthy clinicians are more likely to provide better care for their patients.

However, they often face serious health challenges themselves, which often stem from both personal lifestyle behaviours and work-related factors. Some of the common problems include burnout, stress, fatigue, musculoskeletal disorders, and cardiovascular diseases. To address these issues, interventions need to adopt a comprehensive approach that incorporates Lifestyle Medicine principles, such as nutrition, physical activity, stress management, and social support. These principles can help healthcare workers improve their health behaviours and cope with the demands of their work. However, personal interventions are not enough. There is also a need for organisational support and policy changes that create a healthier work environment for healthcare workers. This includes supportive leadership, flexible work schedules, adequate staffing, and access to wellness programmes. By improving the health of healthcare workers, interventions can also have positive impacts on patient care and healthcare costs.

Self-care is a broad concept that refers to the actions taken to preserve or improve health, which can vary depending on the academic literature. A useful framework to understand self-care is the Self-Care Matrix, which consists of four dimensions: activities, behaviours, context, and environment. Self-care activities are the specific practices that promote health, such as physical activity, healthy eating, hygiene, and rational use of health products. Self-care behaviours are the principles and actions that guide positive health behaviours and lifestyle choices. Self-care context is the degree of dependence or independence from external healthcare resources. Self-care environment is the external factor that influences self-care practices within the community. Self-care is closely related to Lifestyle Medicine, which supports individuals in adopting sustainable health practices and prioritises preventive strategies over reactive measures. Lifestyle Medicine and self-care play a crucial role in both primary and secondary prevention of diseases. The future of self-care envisions a healthcare landscape where technology and personalised approaches enhance self-care and Lifestyle Medicine. However, there are also challenges to address, such as potential inequalities and misconceptions that may arise as health systems pivot towards self-care.

Sleep is a dynamic process that is influenced by our daily behaviours and in turn impacts our waking choices. It’s important to understand that healthy sleep involves not just the duration but also the timing and architecture of sleep, which can affect disease risks and outcomes. The regulation of sleep is driven by the sleep homeostat, also known as Process S, and the circadian system, known as Process C. Sleep itself consists of Non-Rapid Eye Movement (NREM) and Rapid Eye Movement (REM) stages, each with distinct brain wave patterns and physiological functions. The circadian system, which is governed by sunlight and melatonin, synchronises our body’s clocks and regulates physiological rhythms.

There is variability in individual sleep needs, which are influenced by genetics, and these needs change across the lifespan. Poor-quality sleep is linked to mental health issues, cardiovascular disease, diabetes, and other pathologies. Common sleep disorders include insomnia and obstructive sleep apnoea, with lifestyle interventions being key treatments.

Good sleep health can be promoted through regular schedules, optimal bedroom environments, and managing lifestyle factors. Education and policy changes are needed to address sleep issues.

Lifestyle Medicine is an evidence-based medical discipline that emphasises behaviour change to improve overall health, focusing on mental wellbeing, social connections, healthy eating, physical activity, sleep, and minimising harmful behaviours. The approach bridges clinical practice with public health interventions, targeting both individual and population health. It is effective in preventing, treating, and sometimes reversing chronic diseases through lifestyle modification. Clinicians practising Lifestyle Medicine support actions beyond clinical consultations, advocating for healthy environments and policies. The discipline also addresses the challenges of non-communicable diseases and enhances resilience against infectious diseases. It offers an alternative to over-medicalisation, promoting self-care and lifestyle changes alongside traditional medical treatments. The new medical paradigm recognises the modifiability of gene expression and the importance of lifestyle factors in health outcomes. Lifestyle Medicine is increasingly integrated into medical education and healthcare delivery systems. It aligns with the shift towards person-centred care that focuses on patients’ values and goals, contributing to a more holistic approach to health and wellbeing.

Healthy relationships are interpersonal connections that are mutually beneficial, supportive, and respectful, with an emphasis on open communication and trust. Social isolation and loneliness can negatively impact the development and quality of healthy relationships and are associated with poor physical and mental health outcomes. Social isolation and loneliness are influenced by various risk factors, such as disability, bereavement, family structure, urbanisation, and technology use, and affect different groups of people differently.

Interventions to enhance healthy relationships can include improving social skills, enhancing social support, increasing opportunities for social contact, addressing maladaptive social cognition, and facilitating community engagement and volunteering. The relationship between clinician and patient is also a key factor for health outcomes, and can be improved by continuity of care, empathy, and trust. Clinicians can apply a Lifestyle Medicine approach to identify and address the impact of relationships on health, and support people to develop and maintain healthy relationships.

A person-centred approach is central to effective lifestyle discussions, avoiding stigma and blame that can undermine patient motivation and self-efficacy. This involves shifting from a clinician-led model to collaborative consultations that respect patient values and goals, and fosters a partnership between the clinician and the patient. Compassionate care is essential for this approach. To prepare for consultations, health professionals must consider factors such as language, accessibility, and reception staff attitude that can influence the patient’s perception of person-centred care. Health professionals should use open-ended questions and active listening to gather a comprehensive lifestyle history that aligns with patient values and preferences. They should also understand patient concerns and expectations, and use them to build rapport and develop shared treatment goals. Moreover, health professionals must assess relationships and support systems that can significantly impact health outcomes, and explore positive mental states and life satisfaction to assess mental wellbeing comprehensively. By establishing a therapeutic relationship through compassionate history taking, health professionals can lay the foundations for effective behaviour change interventions.

Harmful substances and behaviours include alcohol, drugs, smoking, gambling, harmful technology use, and risky sexual practices, with a spectrum of harm from minimal to severe. Stigma and discrimination compound the harmful effects of these substances and behaviours. The biopsychosocial model has been historically used to understand, assess, and intervene in problems with such substances and behaviours. Harmful use of substances and behaviours is a growing problem and contributes significantly to the global burden of disease. The rise of technology-driven behaviours, such as gaming and social media use, can lead to addictive or compulsive patterns. Alcohol is a leading risk factor for disease and death, with no safe level of consumption recommended by the World Health Organization. Misuse of illicit and prescription drugs is rising globally, with opioids contributing to the most significant drug-related harm. Tobacco use remains a major modifiable risk factor for disease and mortality. Problem gambling has a high suicide rate and is often accompanied by financial problems. Definitions of problematic use of gaming and other technologies are challenging, with varying cultural and generational views on acceptable levels.

Behaviour change science is a central concept in Lifestyle Medicine. It focuses on modifying lifestyle risk factors through evidence-based interventions. The COM-B model provides a framework that considers Capability, Opportunity, and Motivation as key components influencing health behaviours. In clinical settings, understanding and modifying patient behaviours are crucial for better health outcomes. Identifying internal and external factors that influence behaviour is essential for effective intervention. Various approaches, such as education, persuasion, and enablement, are used to target different aspects of behaviour change. Behaviour Change Techniques (BCTs) play a vital role in creating specific strategies for behaviour modification. Contextual understanding recognises the importance of considering the patient’s environment and circumstances. Additionally, addressing health inequalities acknowledges the role of wider determinants of health and emphasises the need for interventions that do not exacerbate disparities. Using behaviour change science in the practice of Lifestyle Medicine enhances patient-centred care and health outcomes.

Suboptimal diet is a major risk factor for health issues and early mortality globally. Diets like the Mediterranean, DASH, and whole-food plant-based are associated with improved health and disease prevention. It’s crucial to assess dietary quality and nutritional status during clinical consultations using brief validated tools. Dietary habit improvements can be achieved through medical consultations with time and follow-up. The most effective way to promote healthy eating at a population level is through Public Health policies. Nutrition research has advanced from focusing on calories to understanding food quality, processing, and the role of phytoactive substances. Large-scale studies have established associations between diet and health outcomes, despite challenges in proving causality. High-quality trials such as DASH and Lyon Diet Heart Study have shown the benefits of specific dietary patterns on health. Tailoring dietary advice to individual characteristics can motivate healthier eating habits. Discussing dietary habits in clinical consultations should be sensitive to cultural, social, and financial determinants.

Mental health disorders are highly prevalent and costly in high-income countries, driven by multiple social, economic, environmental and lifestyle factors. Lifestyle Medicine strategies can prevent and treat mental health disorders by addressing their biopsychosocial determinants and enhancing positive psychology- focusing on preserving developing what works well, rather than the traditional medical model of fixing what has broken. A number of tools and techniques to assess and prescribe lifestyle interventions for mental wellbeing are available. Mental health is intimately connected with other aspects of Lifestyle Medicine, such as physical activity, relationships, and the natural environment. Applying the evidence base from Lifestyle Medicine offers possibilities to avoid over-prescribing and promote non-pharmacological and holistic approaches that empower individuals and communities.

Traditional clinical training has often lacked the leadership and management skills necessary for practitioners to effectively drive change. Despite facing systemic pressures and resource limitations, clinicians can be agents of change by innovating within their work environments. Practising self-care and understanding the benefits of Lifestyle Medicine are essential for healthcare practitioners to sustain their wellbeing and energy for these changes. The transformation of healthcare environments to encourage healthier choices can profoundly affect the wellbeing of both staff and patients. Large-scale change can be fostered by engaging with the community and connecting patients to local groups and activities. The UK has seen examples of successful Lifestyle Medicine projects and we explore some examples of success in this chapter. To innovate in healthcare, one must be clear about their motivation, be prepared to initiate projects without initial funding, plan for their evaluation, and ensure that the projects are enjoyable for all participants involved.

Western medicine has undergone significant changes over time. Initially rooted in mysticism, it has evolved into what we experience today as an empirical, scientific discipline. Modern medicine is increasingly associated in the public consciousness with advanced technologies and miracle drugs. However, critiques by intellectuals such as Ivan Illich highlight issues such as medical expansionism and iatrogenesis – the harm caused by medical intervention. Socialised medicine systems across the world face huge challenges, including financing and workforce. Commercial determinants are increasingly recognised as influencing adverse health outcomes, alongside the role of the pharmaceutical and wider health technology sectors. Lifestyle Medicine emerges as a paradigm shift, emphasising preventive measures and lifestyle changes alongside more technologically driven treatments. Balancing evidence-based interventions with holistic care is crucial for overall wellbeing and the sustainability of healthcare and population overall.

Deprescribing is the practice of stopping or reducing the dose of medicines that may be causing more harm than benefit to patients. Deprescribing can help prevent overprescribing, which can lead to adverse effects, unnecessary costs, or lack of efficacy. By deprescribing, patients can avoid medication-related problems, simplify their medication regimen, and enhance their wellbeing with non-pharmacological interventions. However, deprescribing is not without risks. Patients may experience withdrawal symptoms or recurrence of their original condition, which require careful monitoring and support. Deprescribing also faces several barriers, such as limited time and resources for clinicians, lack of clear guidelines, and patient reluctance or attachment to their medicines. To overcome these challenges, deprescribing should be based on a strong clinician–patient relationship, a gradual and individualised process, a multidisciplinary team approach, and a shared decision making model. Deprescribing can also be guided by various frameworks that help clinicians review, assess, prioritise, and follow-up on patients’ medications. There are tools that help identify potentially inappropriate or unnecessary medications and provide recommendations for deprescribing.

Modern Lifestyle Medicine can trace its roots from ancient practices to modern applications. Ancient systems, including Ayurveda and traditional Chinese medicine emphasised nutrition, sleep, and stress management, while Greco-Roman and Middle Eastern traditions also recognised the importance of lifestyle in health. The term ‘Lifestyle Medicine’ emerged in the late twentieth century, reflecting a shift towards addressing long-term conditions through lifestyle changes rather than pharmaceuticals. There are challenges on multiple fronts. Firstly, the question of whether research bias is favouring pharmaceutical and surgical interventions over lifestyle changes. Secondly, socio-economic factors exacerbate health inequities, impacting the effectiveness of Lifestyle Medicine. Thirdly, there are education gaps, with healthcare workers lacking knowledge and skills for lifestyle interventions. Fourthly, providers face time constraints and financial incentives that prioritise medications or surgery. Lastly, regulatory issues arise, necessitating quality education and evidence-based practices to distinguish Lifestyle Medicine from alternative approaches.

Health inequalities refer to unfair and avoidable differences in health across populations, influenced by factors such as socio-economic status and societal inequality. These disparities are evident in various health and social outcomes, including child mortality, obesity, and life expectancy. Lifestyle Medicine, which focuses on individual behaviours, acknowledges the need for multi-level action to address health inequalities effectively. Strategies to improve health equity must consider individual circumstances, providing support according to specific needs. For instance, addressing food insecurity, promoting physical activity, and ensuring good quality sleep are Public Health targets that can benefit both individuals and society. Interventions must be tailored to overcome barriers such as cost, availability of resources, and safe environments for positive health behaviours. Ultimately, tackling lifestyle-related health inequality requires a collaborative effort between Lifestyle Medicine and Public Health, aiming for upstream changes to social determinants and advocating for a more equal society

The rapid development of information and communication technologies since the 1990s has had far-reaching impacts on health behaviours and healthcare. There are many opportunities for Lifestyle Medicine. The Gartner Hype Cycle offers a useful model to understand the adoption stages of technologies such as wearable activity trackers and telemedicine in Lifestyle Medicine. Technology can enhance mental wellbeing, social connections, physical activity, healthy eating, sleep quality, and harm reduction.

However, technology use also poses risks, such as encouraging sedentary behaviours, social isolation, and digital exclusion. Data analysis in technology can be challenging, and ensuring cybersecurity and commercial surveillance protection is essential. Technology can help deliver personalised interventions that match patient needs. Technology can also provide holistic health support to patients beyond traditional consultations.

Physical inactivity is recognised as a global risk factor for premature mortality and morbidity. Engaging in physical activity and reducing sedentary behaviour significantly improves both mental and physical health at all ages. Lifestyle Medicine emphasises the importance of a person-centred approach to encourage physical activity during consultations. Physical activity guidelines in the UK recommend adults to engage in at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity weekly for health benefits. Sedentary behaviour is defined as low-energy expenditure activities while awake and is an independent risk factor for ill health. Clinical and community-based interventions, including brief advice and referral to physical activity programmes, are cost-effective and improve physical activity levels. Various tools exist to assess physical activity levels and fitness in clinical settings, aiding personalised healthcare. Personalised support and health coaching techniques, such as motivational interviewing, effectively promote physical activity. Physical activity reduces the risk of long-term conditions, improves weight management, and has positive effects on metabolism and immune pathways. Supporting increased physical activity as part of Lifestyle Medicine can prevent, treat, and potentially reverse chronic health conditions.

Lifestyle Medicine is a practice grounded in evidence-based approaches, distinguishing it from unverified commercial wellness trends. It requires practitioners to critically interpret the evolving evidence base and communicate risks effectively to support shared decision making. While clinical trials for Lifestyle Medicine are less common than for pharmaceuticals, its interventions are nonetheless impactful and often preferred by patients. Epidemiology plays a crucial role in identifying associations between exposures and outcomes, although it cannot always establish causality. Understanding and communicating risk is vital, with absolute and relative risks offering different insights into the potential effects of interventions. The interpretation of evidence must consider both statistical and clinical significance, with confidence intervals providing a more nuanced understanding than p-values alone. Scepticism is necessary when interpreting clinical research to account for potential biases and confounding factors. Ultimately, consensus-driven approaches and trusted institutions guide practitioners in integrating Lifestyle Medicine into broader treatment guidelines.