24/08/2025
Should Lifestyle Medicine be a separate specialty?
I have just read this opinion piece in the BMJ and I agree with much of it.
BMJ link: https://www.bmj.com/content/390/bmj.r1690
Lifestyle Medicine at its broadest is about good public health. On an individual level it is about good personalised care, often using the wider team, certainly in primary care. This includes clinicians, health coaches and social prescribers.
I myself actually do not like the term Lifestyle Medicine but there isn't a close enough substitute. It is hard to make time and space for it in busy modern medical practices without running groups or long appointments.
It’s also quite common for practitioners to have focused interest areas within LM. Some are interested in the whole lot, some love aetiology, others nutrition, exercise, sleep, mindfulness or breathwork. These are sadly absolutely not a part of standard medical practice however much people might infer that they are. And if non-medics or non-clinicians suggest interventions it is suddenly deemed at risk of “not being evidence-based”. Have heard this far too many times, despite much of a medics work being best-guess.
We doctors in particular seem to find it hard not having expertise in areas that encroach into “medicine” via patients needs, yet simultaneously lack trust in others that have that experience and expertise. Ergo lifestyle medicine exists to fill some of these gaps.
The map is not the territory.
A related key point is that advice that has been given historically by clinicians over the years on 'lifestyle' to patients has frankly been a bit 'finger in the air' and quite hit and miss. It's often an after-thought and yes, we all use “Bayesian thinking” when the evidence base doesn’t work or just isn’t there.
Undergraduate and postgraduate medical education also had very little about it in the curriculum until recent years. Imperial Medicine have been running LMAP for their students for some years now which is great to see.
Perhaps Lifestyle Medicine shouldn't be a separate specialty, (although we live in times where everything is increasingly sub-specialised), but it is absolutely a skill, knowledge and attitude set that can be learned and taught.
It is also sometimes absent in many aspects of healthcare. It can be poorly understood, ignored and maligned for various reasons. Some humility would be welcome and the acceptance that we are all continuously learning.
And sometimes we see the opposite with a fair bit of bandwagoning, often in the private sector by some of the big health insurance companies who screen for basic bloods and then expect the patient's NHS GP to sort any abnormalities out.
In any case, most practitioners and patients I have had conversations with over the years find a Lifestyle Medicine approach enriching, satisfying and enabling.
Would love to hear your thoughts.
