Course Syllabus - American College of Lifestyle Medicine

 
Course Syllabus - American College of Lifestyle Medicine
Lifestyle Medicine
                  Course Syllabus
                                                                                      Creator:
                                                                         Beth Pegg Frates, MD
                                                                                 Contributors:
                                                                             Jonathan Bonnet
                                                                              Merlica Coriolan
                                                                            Yasamina McBride
                                                                                    Gia Merlo
                                                                              Irena Metanovic
                                                                                 Kate Simeon
                                                                          Shannon Worthman;
 Vision
 A world in which all physicians and allied health professionals have been trained in
 evidence-based lifestyle medicine, integrating healthful behaviors into their own lives
 and incorporating a lifestyle medicine-first approach into clinical practice.

lifestylemedicine.org
This syllabus is based on the foundational work of Beth Pegg Frates, MD who created a lifestyle medicine course
at the Harvard Extension School in 2014, available to undergraduate, master, and other professional students
interested in health and wellness. It has consistently been one of the most popular courses at the Harvard
Extension School and has been attended by physicians, lawyers, engineers, nurses, wellness coordinators,
social workers, business owners, religious leaders, stay at home moms, and retirees. The success of the course
and increasing demand for the information inspired Dr. Frates to partner with the American College of Lifestyle
Medicine to craft a syllabus that could be widely distributed and used in many different health care institutions,
organizations, and schools. This curriculum represents the work of an entire team whose goal is to supply a
foundation for a lifestyle medicine course on which instructors and professors can build and personalize it for
their own individual needs. It is adaptable to a variety of educational environments, including undergraduate
studies, master level courses, nursing school, physical therapy programs, occupational therapy programs,
nutrition education courses, health and wellness coaching, or in the exercise and fitness space. We hope that you
find the material useful and would love to hear your feedback on ways in which we can improve the syllabus for
others.

© 2021 American College of Lifestyle Medicine.
Introduction to Lifestyle Medicine
Syllabus Creator: Beth Pegg Frates, MD, @BethFratesMD
Contributors: Jonathan Bonnet MD; Merlica Coriolan; Yasamina McBride; Gia Merlo MD, MBA, DipABLM;
Irena Metanovic; Kate Simeon; and Shannon Worthman, NBC-HWC
Course Syllabus 4.1.2021

2                                                                                      Lifestyle Medicine Course Syllabus
Author
Beth Pegg Frates, MD, is trained as a physiatrist as         Dr. Frates is currently working on writing her next book.
well as a health and wellness coach. Dr. Frates is a         She is passionate about developing programs focused
Magna Cum Laude graduate of Harvard College where            on lifestyle medicine and wellness.
she majored in psychology and biology. She then              As a member of the Board of Directors of the American
graduated from Stanford Medical School and did her           College of Lifestyle Medicine, Dr. Frates established the
internal medicine internship at Massachusetts General        Donald A. Pegg Student Leadership Award in 2016, in
Hospital, after which she completed her physiatry            honor of her late father, a New York City businessman,
residency at Harvard’s Department of Physical Medicine       Donald Pegg, who suffered a heart attack and a stroke
and Rehabilitation. Dr. Frates has held a faculty            in 1986 when he was 52. In response to this health
appointment at Harvard Medical School (HMS) since            set back, he went on a mission and searched for ways
2000, and she is now an Assistant Professor, Part Time.      to prevent it from happening again. He participated in
She is an award-winning teacher at HMS. In 2008,             residential intensive lifestyle change programs, added
she started the first Lifestyle Medicine Interest Group      fruits, vegetables, more whole grains, and healthy
(LMIG) at HMS and has worked with ACLM to help               protein to his diet as well as started riding a stationary
other institutions develop LMIGs in her role as Board        bike religiously five days a week.
Liaison to the ACLM Trainees. Two years ago, Dr. Frates
developed and taught a college lifestyle medicine            With this regimen and his medical care, Dr. Frates’
curriculum at the Harvard Extension School, which is         father was able to live the best years of his life after his
one of the most popular courses offered at the school.       heart attack and stroke, enjoying 27 additional years
In addition to her academic work, Dr. Frates runs her        with family and friends. Donald served as an inspiration
own private practice, helping people adopt healthy           to many, especially his daughter, Beth who has spent
habits, through Wellness Synergy, LLC. As the Director       the past 30 years researching, studying, teaching, and
of Wellness Programming at the Stroke Institute for          practicing lifestyle medicine.
Research and Recovery at Spaulding Rehabilitation            Dr. Frates and her family believe in the power of lifestyle
Hospital, Dr. Frates has created and implemented a           medicine to transform lives and help individuals be
twelve-month wellness program for stroke survivors           healthier and more productive. She is now dedicated
and their caregivers. Co Author of the book, Life After      to working with young aspiring healthcare students,
Stroke: The Guide to Recovering Your Health and              understanding that our nation and world need a
Preventing Another Stroke, co-author of three chapters       transformed and sustainable system of healthcare
on behavior change in different medical textbooks, and       delivery, built on the foundation of evidence-based
author of multiple journal articles on lifestyle medicine,   lifestyle medicine.

Lifestyle Medicine Course Syllabus                                                                                     3
Founded in 2004, the American College of Lifestyle Medicine (ACLM) is the only medical professional association
  for physicians, allied health professionals, health care executives, medical students and residents, and those in
  professions devoted to advancing the cause of lifestyle medicine.
  ACLM supports its members by educating, equipping and empowering them to provide an evidence-based lifestyle
  medicine-first treatment option for chronic disease, as opposed to prescribing ever-increasing quantities of pills
  and procedures. ACLM provides live and online CME- and CE-accredited events and educational offerings across
  the medical education continuum, Board and professional certification opportunities, clinical practice tools, patient
  education resources, networking opportunities, and advocacy—all designed to manifest the vision of lifestyle
  medicine becoming the foundation of health and all health care.
  ACLM has a rapidly expanding membership base of more than 4,500 across the United States and around the
  globe. Its members represent the broad diversity of the medical profession, reflecting the interdisciplinary “team-
  based” approach of lifestyle medicine clinical practice: primary care physicians, physician assistants, nurses, allied
  health professionals, researchers, educators, students, lifestyle medicine thought leaders, health care executives
  and health coaches.
  Medical students and residents are encouraged to join the American College of Lifestyle Medicine, taking an active
  role in ACLM’s Trainees . In the true spirit of the Hippocratic Oath, Trainee members are committed to ‘first, do no
  harm’ as they immerse themselves in specialized lifestyle medicine training, so they are equipped to be on the
  forefront of an emerging value and outcome-based system of healthcare delivery. As young trainees, they hope to
  develop the skills and knowledge to effectively prevent, treat, and reverse chronic disease using evidence-based
  practices.

      What is Lifestyle Medicine?
      Lifestyle Medicine is the use of evidence-based lifestyle therapeutic intervention—including a
      whole-food, plant-predominant eating pattern, regular physical activity, restorative sleep, stress
      management, avoidance of risky substances, and positive social connection—as a primary modality,
      delivered by clinicians trained and certified in this specialty, to prevent, treat, and often reverse
      chronic disease.

      It is one of the fastest growing specialty career fields in medicine and holds the promise of real
      value-based care and true health reform as it addresses the root-cause of most chronic illness.

  Education Offerings
Bachelor Level    Master’s / Doctorate       Residency         Fellowship         CME/CE/MOC           Certification

             Professional Education                                           Professional Experience
  Learn more about other Lifestyle Medicine educational offerings at lifestylemedicine.org.
  Questions? Contact education@lifestylemedicine.org

  4                                                                                      Lifestyle Medicine Course Syllabus
Table of Contents
                         Week 1:     Understanding Lifestyle Medicine                          6
                         Week 2:     Empowering People to Change                               8
                         Week 3:     Collaborating, Motivating, Goal-Setting, and Tracking     10
                         Week 4:     Improving Health Through Exercise                         12
                         Week 5A:    The Nutrition-Health Connection                           14
                         Week 5B:    Weight Management                                         17
                         Week 6:     Sleep Matters                                             19
                         Week 7:     Stress and Resilience                                     21
                         Week 8:     Peace of Mind With Meditation, Mindfulness, and Relaxation 23
                         Week 9:     The Power of Connection                                   25
                         Week 10:    Positively Positive                                       27
                         Week 11:    Substance Use Disorder                                    29
                         Week 12:    Staying the Course - Self Care                            31
                         Week 13:    Education Reform around Lifestyle Medicine
                                     Current State of Practice for Lifestyle Medicine          33
                         Week 14:    Review Week                                               35

Lifestyle Medicine Course Syllabus                                                                   5
Week 1: Understanding Lifestyle Medicine
The introductory week provides students with a framework from which to build. Starting from Hippocrates and
moving forward, the work and research performed by lifestyle medicine pioneers is highlighted. We explore how the
development of vaccines and antibiotics changed the landscape of medicine, and how the Industrial Revolution
played a part in the spread of lifestyle-related diseases. In addition, the economics of lifestyle medicine are
addressed, looking at the cost and burden of chronic diseases such as diabetes, obesity, cardiac disease, and
metabolic disorder. As lifestyle medicine is an evidenced-based specialty, we review research basics including
the value of randomized, controlled studies, observational studies, longitudinal studies, and prospective and
retrospective studies, as well as case studies.

Weekly Goals for Instructors:
1. Introduce the field of lifestyle medicine.
2. Encourage students to consider their own healthy habits.
3. Provide a road map for the next 13 classes.
4. Take care of housekeeping items for the course (such as reviewing logistics, the grading scheme, and discussing
   the value of section sessions).

Learning Objectives:
By the end of the module, the participant will be able to:
1. Define lifestyle medicine.
2. Explain the concept of evidence-based lifestyle medicine.
3. Summarize the importance of lifestyle medicine for individuals, society, and healthcare.
4. Describe the history, economics, and competencies attendant to lifestyle medicine.

Guiding Questions for Students:
1. What are some of the lifestyle-related problems patients, providers, and healthcare systems are facing today?
2. How is lifestyle medicine meeting the needs of patients, providers, and healthcare systems in the 21st century?
3. How can patients and providers acquire the necessary knowledge, skills, and tools required to treat and prevent
   lifestyle-related chronic diseases such as cancer, diabetes, obesity, cardiac disease, stroke, metabolic syndrome,
   and other chronic diseases?
4. What is the evidence supporting lifestyle medicine (e.g., how do we know it works)?

Lecture Topic: Overview and Introduction to Lifestyle Medicine
Section Information:
Section sessions are run by teaching assistants (TAs). The TAs can use the section time to review logistics for weekly
assignments, quizzes or other requirements for the course. The sections run for an hour, and they provide an
opportunity for students to ask questions and to learn more information on the topic of the week. If there is a recent
article from the medical literature or the popular press related to the weekly topic, the section session is a great
forum for discussing it. In addition, students will be asked to consider how the weekly topic pertains to their own
lives, at times taking self-assessments. These smaller sessions encourage greater student participation and help to
foster connections among students and between student and teaching faculty.

6                                                                                     Lifestyle Medicine Course Syllabus
Section Activities:
Pre-assignment: Lifestyle Evaluation on page 25 of Fahey Chapter 1
Logistics Topic: Discuss overall course logistics and address students’ questions and concerns.
Overall Goal: Define evidence-based practice
Application Goal: Determine how students feel about their own healthy habits and evaluate students’ Fahey Lifestyle
Evaluation results.
Discussion Board Topic(s): General Discussion Board Assignment Instructions (same for each week): This is a group
discussion that should be completed after the lecture. It is graded out of 5 points:
1. Include information from Weekly Lecture, Weekly Section, or Weekly Reading (1p).
2. Supply at least one reference at the end of your discussion (1p). It is strongly recommended that you use APA
   format, but you are not required to do so.
3. Respond to a classmate’s post (1p).
4. Limit your response to a 1-2 paragraphs (5 to 7 sentences, no more) answer (1p).
5. Submit on time (1p).
An online “coffee house” discussion board is available for students who would like to share more than the allocated
1-2 paragraphs to answer the question. The coffee house discussions are lively and invite students to discuss topics
of interest amongst themselves while a teaching assistant monitors the group.
Discussion Board Topic(s):
Prior to the readings and lecture for this week, what did you think lifestyle medicine was? What do you think it is
now? Be sure to cite what influenced your prior thinking on the topic and your current thinking.

Required Readings:                                              Fitness and Wellness. 9th ed. New York: McGraw Hill Higher
                                                                Education;2010: 1-26
1. Frates B, Bonnet JP, Joseph R, Peterson JA. Understanding
lifestyle medicine. In: Frates B, ed. Lifestyle Medicine        8. Diabetes Prevention Research Group. Reduction in
Handbook: An Introduction to the Power of Healthy Habits.       the incidence of type 2 diabetes with lifestyle intervention
Monterey, CA: Healthy Learning; 2021:17-44.                     or Metformin. New England Journal of Medicine.
                                                                2002;346(6):393–403. doi:10.1056/nejmoa012512.
2. Egger G, Binns A, Rossner S. Chapter 1 Introduction to
lifestyle medicine. In: Egger G, Binns A, Rossner S.Lifestyle   9. Subramanyam R. Art of reading a journal article:
Medicine: Managing Diseases of Lifestyle in the 21st Century.   Methodically and effectively. Journal of Oral and
2nd ed. North Ryde, Australia: McGraw-Hill; 2010:1–10.          Maxillofacial Pathology : JOMFP. 2013;17(1):65-70.
                                                                doi:10.4103/0973-029X.110733.
3. DeCourten M, Egger G. Chapter 2 The epidemiology of
chronic disease. In: Egger G, Binns A, Rossner S.Lifestyle      Optional Readings:
Medicine: Managing Diseases of Lifestyle in the 21st Century.
2nd ed. North Ryde, Australia: McGraw-Hill; 2010:11–24.         1. Rippe J, Angelopoulos. Chapter 1 Rationale for
                                                                Intervention to Reduce the Risk of Coronary Artery Disease. In
4. Frates EP. Interview With Award Winners From ACLM            Rippe J Lifestyle Medicine, 2nd Ed. Boca Raton, FL, CRC Press;
2015: Dean Ornish and John Kelly, Nashville, Tennessee. Am J    2013:3-17.
Lifestyle Med. 2016.
                                                                2. Rippe J, Angelopoulos. Chapter 2 Lifestyle Strategies for
5. Dysinger WS. Lifestyle medicine competencies for primary     Risk Factor Reduction, Prevention, and Treatment of Coronary
care physicians. Virtual Mentor. 2013;15(4):306–310.            Artery Disease. In Rippe J Lifestyle Medicine, 2nd Ed. Boca
doi:10.1001/virtualmentor.2013.15.4.medu1-1304.                 Raton, FL, CRC Press; 2013:19-34.
6. Katz D. Lifestyle is medicine. Virtual                       3. How to read a paper. rhttps://ebm.bmj.com/
Mentor. 2013;15(4):286–292. doi:10.1001/ vir                    content/6/5/135. Accessed June 22nd, 2020.
tualmentor.2013.15.4.ecas1-1304.
                                                                4. How to read and understand a scientific paper: A step by
7. Fahey TD, Insel PM, Roth WT. Introduction to Wellness,       step guide for non-scientists by Jennifer Raf for the Huffington
Fitness, and Lifestyle Management In: Fahey TD, Insel PM,       Post http://www.huffingtonpost.com/jennifer-raff/how-to-read-
Roth WT. Fit and Well: Core Concepts and Labs in Physical       and-understand-a-scientific-paper_b_5501628.html

Lifestyle Medicine Course Syllabus                                                                                             7
Week 2: Empowering People to Change
Behavior change is a critical component of lifestyle medicine. Learning to use the coach approach is important.
There are distinct differences between being a coach and being an expert, which we explore in depth, looking at
both “doing” and “being” skills. Empowering lasting behavior change requires the lifestyle medicine practitioner
to fill up his or her toolbox with effective, research-based tools, skills and theories, including the Transtheoretical
Model of Change, Motivational Interviewing techniques, Appreciative Inquiry, Goal Setting Theory, Acceptance
and Commitment Therapy, and the Social Ecological Model. Equally important are the “being” skills necessary to
partner with patients, support them, collaborate with them, and to co-create goals and plans that are specific to
each patient. The five As of counseling (assess, ask, agree, assist, arrange) and its evolution are reviewed. In this
week, we consider the Coach Approach and the Expert Approach in theory as well as from a patient’s perspective.
In addition, we take a look at the medical literature and review the latest studies on behavior change, coaching, and
Motivational Interviewing.

Weekly Goals for Instructors:
1. Challenge students to think differently about how to empower people to change.
2. Invite students to consider the pros and cons of direct advice vs. negotiation in the area of behavior change
3. Consider the role of education in behavior change.
4. Demonstrate how to be a coach by highlighting the “being” and “doing” characteristics/attributes of a coach
   through patient examples and case studies.
5. Explain the five As of behavior change counseling.
6. Introduce the Transtheoretical Model of Change.
Learning Objectives:
By the end of this module, participants will be able to:
1. Outline health and wellness coaching strategies.
2. Describe the differences in the coach-like approach vs. the expert-like approach.
3. Discuss the essential elements of being a coach.
4. Summarize the five As of behavior change counseling.
5. Recognize the six stages of change in the Transtheoretical Model of Change.
6. Describe the concept of the Frates COACH approach.

Guiding Questions for Students:
1. What are the attributes of an effective health and wellness coach?
2. How does the coach-like approach differ from the expert-like approach?
3. What is the Frates COACH Approach?
4. How could the Transtheoretical Model of Change help both patients and providers?
5. How can a clinical environment be created that facilitates lasting behavior change?
6. What are the key factors involved in behavior change counseling?

8                                                                                      Lifestyle Medicine Course Syllabus
Lecture Topic: Behavior Change as a Critical Component in Lifestyle Medicine
Section Activities:
Logistics Topic: Introduce Case Study assignment and address students’ questions and concerns.
Overall Goal: The Coach Approach helps clients/patients to find their vision, motivation, to determine their goals,
and to work toward those goals in a non-judgmental manner.
Application Goal: Help students learn why and how to use the Coach Approach with themselves or a friend/family
member.
●   The Coach Approach:
    • When have you experienced counseling with the Expert Approach (e.g., doctor’s visit, school education,
      parents giving advice, a sports coach)?
    • When have you experienced the Coach Approach (e.g., collaborating with a friend or colleague, at a yoga
      studio, during a wellness coaching session)?
    • How do you feel when people tell you what to do?
    • How do you feel when people ask you your opinion on different topics?
    • Can one healthcare practitioner work with both hats?
●   Readiness for Change Scale – Review with students what it is and how to use it.
Discussion Board Topic(s):
How could you incorporate the Coach Approach into your practice when working with a client/patient and what are
the benefits for utilizing the Coach Approach vs. the Expert Approach?

Required Readings:                                              Optional Readings:
1. Frates B, Bonnet JP, Joseph R, Peterson JA. Empowering       1. Frates EP, Moore MA, Lopez CN, McMahon GT. Coaching
people to change. In: Frates B, ed. Lifestyle Medicine          for behavior change in physiatry. American Journal of Physical
Handbook: An Introduction to the Power of Healthy Habits.       Medicine & Rehabilitation. 2011;90(12):1074–1082.
Monterey, CA: Healthy Learning; 2021:45-88.                     doi:10.1097/ phm.0b013e31822dea9a.
2. Egger G, Coutts R, Litt J. Chapter 4 Everything You Wanted   2. Ghorob A, Willard-Grace R, Bodenheimer T. State of
to Know About Motivation. In: Egger G, Binns A, Rossner         the art and science: Health coaching. American Medical
S.Lifestyle Medicine: Managing Diseases of Lifestyle in the     Association Journal of Ethics. 2013;15(4):319–326. http://
21st Century. 2nd ed. North Ryde, Australia: McGraw-Hill;       journalofethics.ama-assn.org/2013/04/pdf/stas2-1304.pdf.
2010:33–47.                                                     Accessed June 10, 2020.
3. Boehmer KR, Barakat S, Ahn S, Prockop L, Erwin P,            3. Frates EP, Moore M. Chapter 27 Health and Wellness
Murad MH. Health Coaching Interventions for persons with        Coaching Skills for Lasting Change. In: Rippe JM, ed. Lifestyle
chronic conditions: a systematic review and meta-analysis       Medicine. 2nd ed. Boca Raton, FL CRC Press. 2013: 343-360.
protocol. BioMed Central Systematic Reviews. 2016:5:146.        4. Linke SE, Pekmezi D. Chapter 17 Applying Psychological
https://systematicreviewsjournal.biomedcentral.com/             Theories to Promote Healthy Lifestyles. In Rippe JM Lifestyle
articles/10.1186/s13643-016-0316-3. Accessed June 10,           Medicine, 2nd Ed. Boca Raton, FL, CRC Press; 2013:223-232.
2020.
                                                                5. Stoltzfus T. Coaching questions: A coach’s guide to
4. Frates EP, Bonnet J. Collaboration and negotiation:          powerful asking skills. Virginia Beach, VA: Pegasus Creative
The Key to therapeutic lifestyle change. American               Arts; April 1, 2008.
Journal of Lifestyle Medicine. 2016;10(5):302–312.
doi:10.1177/1559827616638013.                                   6. Kent K, Johnson JD, Simeon K, Frates EP. Case series in
                                                                Lifestyle Medicine: A Team approach to behavior changes.
5. Frates EP, Bonnet J Behavior Change and Nutrition            American Journal of Lifestyle Medicine. 2016;10(6):388–397.
Counseling. In: Rippe JM, ed Nutrition in Lifestyle Medicine.   doi:10.1177/1559827616638288.
Humana Press 2017

Lifestyle Medicine Course Syllabus                                                                                             9
Week 3: Collaborating, Motivating, Goal-Setting, and Tracking
To practice lifestyle medicine, one must practice setting goals that are appropriate for the patient and that patient’s
stage of change for that particular behavior. Patients can be in different stages of change for different behaviors,
and thus the goals they set for the behavior will be different. Building self-efficacy—the feeling of confidence that a
person can complete a task—is critical in lifestyle medicine. Co-creating SMART goals is essential. SMART stands for
Specific, Measureable, Action-oriented, Realistic, and Time-sensitive. It is important to practice setting SMART goals
so that patients can enjoy small successes and feel motivated to continue with their lifestyle changes. The best goal
is the one that the patient feels is important, the one the patient feels confident that he or she can complete, and
the one that is SMART. The provider or the patient’s caregiver might feel that the patient should complete a goal
that the provider or caregiver feels is very important, but if the patient does not view that particular goal as worthy or
interesting, then the patient is not going to work towards that goal with any sustained effort. Setting the goal is one
piece of the puzzle and keeping the patient accountable for the goal is another. If no one is checking on the patient,
then the patient might forget or just ignore the goal. We explore effective strategies for holding people accountable
for their goals. Motivational Interviewing techniques, Appreciative Inquiry, Goal Setting Theory, Acceptance and
Commitment Therapy, and the Social Ecological Model are covered in detail this week.

Weekly Goals for Instructors:
1. Introduce techniques that practitioners can use to empower patients, including change talk with motivational
   interviewing and finding the positive with appreciative inquiry.
2. Provide a history of goal setting with relation to organizational behavior.
3. Review the 5-Step Model for creating a collaborative relationship.

Learning Objectives:
By the end of the module, the participant will be able to:
1. Describe goal-setting theory.
2. Integrate motivational interviewing, appreciative inquiry, and the social-ecological model of change into practice.
3. Describe SMART goals.
4. Discuss the 5-step model for collaboration and coaching conversations.
5. Demonstrate collaboration as the key piece of goal-setting.
6. Acknowledge the importance of respecting autonomy when setting goals.
7. Outline strategies for accountability and monitoring.

Guiding Questions for Module:
1. Why is it important for a health care provider to set goals with patients?
2. What is the difference between a healthcare provider setting a goal for a patient and a healthcare provider co-
   creating a goal with a patient?
3. What types of goals motivate people?
4. What is the difference between setting a goal and holding a person responsible for a goal?
5. How does tracking progress add value to the behavior change process?

10                                                                                       Lifestyle Medicine Course Syllabus
Lecture Topic: Goal Setting, Accountability, and Tracking for Lifestyle Medicine
Section Activities:
Logistics Topic: Introduce the Personal Change Project. Address students’ questions and concerns
Overall Goal: Review goal setting for different stages of change, motivational interviewing, appreciative inquiry, and
ACT therapy.
Application Goal: Practice setting SMART goals. (Show students how to effectively use Goal Setting Worksheet)
Discussion Board Topic(s):
Imagine yourself speaking to another healthcare professional/colleague. How would you explain to your colleague
the importance of goal setting in the practice of lifestyle medicine? And what does empathy have to do with it
anyway?!

Required Readings:                                                 Optional Readings:
1. Frates B, Bonnet JP, Joseph R, Peterson JA. Collaborating,      1. Frates EP. The Five step collaboration cycle: A tool for the
Motivating, Goal-Setting and Tracking. In: Frates B, ed.           doctor’s office. International Journal of School and Cognitive
Lifestyle Medicine Handbook: An Introduction to the Power of       Psychology. 2015;2(3). doi:10.4172/2469-9837.1000144.
Healthy Habits. Monterey, CA: Healthy Learning; 2021:89-118.
2. Battersby M, Egger G, Litt J. Chapter 5 Self-Management
in Lifestyle Medicine. In: Egger G, Binns A, Rossner S.Lifestyle
Medicine: Managing Diseases of Lifestyle in the 21st Century.
2nd ed. North Ryde, Australia: McGraw-Hill; 2010:48–58.
3. Newton P, Bristoll H. Effective Goal Setting: Productivity
Skills. Team FME: Free Management ebooks; 2013:8:29
http://www.free-management-ebooks.com/dldebk-pdf/fme-
effective-goal-setting.pdf Accessed June 10, 2020.
4. Donnachie C, Wyke S, Mutrie N, Hunt K. “It's like a
personal motivator that you carried around wi’ you’: utilising
self-determination theory to understand men’s experiences
of using pedometers to increase physical activity in a
weight management programme. The International Journal
of Behavioral Nutrition and Physical Activity. 2017;14:61.
doi:10.1186/s12966-017- 0505-z.
5. Samdal GB, Eide GE, Barth T, Williams G, Meland E.
Effective behaviour change techniques for physical activity
and healthy eating in overweight and obese adults; systematic
review and meta-regression analyses. The International
Journal of Behavioral Nutrition and Physical Activity.
2017;14:42. doi:10.1186/s12966-017-0494-y.

Lifestyle Medicine Course Syllabus                                                                                               11
Week 4: Improving Health Through Exercise
Starting from suggestions provided by Hippocrates about walking, we examine physical activity recommendations
over the years. The most recent government guidelines provided by the Department of Health and Human Services
in 2008 are reviewed. Understanding the definitions and differences between types of physical activity is stressed
with a special appreciation for lifestyle exercise. The four parts of the exercise prescription (FITT= frequency,
intensity, time, and type) are introduced as a framework for exercise counseling, to be used along with the Coach
Approach for behavior change. Lastly, the risks of exercise are discussed with a focus on the American College
of Sports Medicine’s algorithm for risk stratification, which categorizes patients as high, moderate, or low risk
for exercise. Updated recommendations for pre- screening patients are included. We examine specific exercise
prescriptions for diseases and conditions including heart disease, diabetes, obesity, arthritis, osteoporosis, and
multiple sclerosis.

Weekly Goals for Instructors:
1. Emphasize the health benefits of physical activity to the body and the brain.
2. Review the evidence-based guidelines for physical activity levels.
3. Consider ways to present physical activity as doable and enjoyable.

Learning Objectives:
By the end of this module, participants will be able to:
1. List the definitions of exercise.
2. Recall the physical activity guidelines.
3. Utilize a framework to make exercise prescriptions.
4. Discuss the benefits and risks of exercise and review the risk stratification system developed by the American
   College of Sports Medicine.

Guiding Questions for Students:
1. What are the primary benefits of exercise?
2. What are some less commonly known benefits of exercise?
3. How does exercise affect the 11 systems of the body?
4. What are the risks of exercise?
5. Why don’t people exercise?
6. How can physical activity become part of daily life in the twenty-first century?
7. What is the evidence that physical activity affects health?

Lecture Topic: Value of Physical Activity and Physical Activity Guidelines
Section Activities:
Pre-assignment: Physical Activity Readiness Questionnaire – PAR-Q
Logistics Topic: Discuss a Personal Behavioral Change assignment – monitoring behavior without change. Address
students’ questions and concerns.
Overall Goal: Provide an overview of benefits of physical activities and different forms it can take. Introduce students
to different physical activity-promoting initiatives (government and NGO)
Application Goal: Practice with students how to make an Exercise Prescription and review PAR-Q with them.

12                                                                                      Lifestyle Medicine Course Syllabus
Discussion Board Topic(s):
Why is physical activity promotion important to the health of individuals and what steps can we take to change our
culture around physical activity?

Required Readings:                                               2. Stetson BA, Cooper JM, Dubbert PM. Chapter 18
                                                                 Cognitive and Behavioral Approaches to Enhancing Exercise
1. Frates B, Bonnet JP, Joseph R, Peterson JA. Improving
                                                                 Prescription. In Rippe JM Lifestyle Medicine, 2nd Ed. Boca
health through exercise. In: Frates B, ed. Lifestyle Medicine
                                                                 Raton, FL, CRC Press; 2013:233-243.
Handbook: An Introduction to the Power of Healthy Habits.
Monterey, CA: Healthy Learning; 2021:119-175.                    3. Kokkinos PF, Myers J. Chapter 15 Physical Fitness
                                                                 Evaluation. In Rippe JM Lifestyle Medicine, 2nd Ed. Boca
2. Egger G, Climstein M. Chapter 8 Physical Activity:
                                                                 Raton, FL, CRC Press; 2013:199-208.
Generic Prescription for Health. In: Egger G, Binns A, Rossner
S.Lifestyle Medicine: Managing Diseases of Lifestyle in the      4. David PG. Chapter 16 Exercise Prescription for Apparently
21st Century. 2nd ed. North Ryde, Australia: McGraw-Hill;        Healthy Individuals and for Special Populations. In Rippe
2010:91–110.                                                     JM Lifestyle Medicine, 2nd Ed. Boca Raton, FL, CRC Press;
                                                                 2013:209-222.
3. Egger G, Climstein M. Chapter 9 Physical Activity:Specific
Prescriptions for Disease Management and Rehabilitation.         5. Dunstan DW, Barr ELM, Healy GN, et al. Television viewing
In: Egger G, Binns A, Rossner S.Lifestyle Medicine: Managing     time and mortality: The Australian diabetes, obesity and
Diseases of Lifestyle in the 21st Century. 2nd ed. North Ryde,   lifestyle study (AusDiab). Circulation. 2010;121(3):384–391.
Australia: McGraw-Hill; 2010:111–126.                            doi:10.1161/circulationaha.109.894824.
4. 2008 Physical Activity Guidelines. Office of Disease          6. van der Ploeg HP, Chey T, Korda RJ, Banks E, Bauman
Prevention and Health Promotion. http://www.health.gov/          A. Sitting Time and All-Cause Mortality Risk in 222 497
paguidelines/guidelines/. Accessed June 10, 2020.                Australian Adults. Arch Intern Med. 2012;172(6):494-500.
                                                                 doi:10.1001/ archinternmed.2011.2174.
5. The Executive Summary of the Advisory Report and
selected passages of interest to the student-- for the student   7. Segar M, Guerin E, Phillips E, Fortier M. From a Vital Sign
to decide.                                                       to Vitality: Selling Exercise So Patients Want to Buy It. Current
                                                                 Sports Medicine Reports. 2016;15(4):276–281. doi:DOI:
6. Naci H, Ioannidis JPA. Comparative effectiveness of
                                                                 10.1249/ JSR.0000000000000284.
exercise and drug interventions on mortality outcomes:
Metaepidemiological study. BMJ. 2013;347(oct01 1):f5577.         8. Reynolds G. The scientific 7-Minute workout. Well. http://
doi:10.1136/bmj.f5577.                                           well.blogs.nytimes.com/2013/05/09/the-scientific-7-minute-
                                                                 workout/?_r=0. Published May 2013. Updated October
7. Hallowell E, Frates EP. Mini Distraction #20: Why
                                                                 24, 2014. Accessed June 10, 2020. The New York Times
walking is powerful medicine. 2016. Distraction. Available
                                                                 Magazine.
at: http://www.distractionpodcast.com/2016/08/03/mini-
distraction-20- why-walking-is-powerful-medicine/ Published      9. Riebe D, Franklin B, Thompson P, et al. Updating
August 3, 2016.                                                  ACSM’s recommendations for exercise Preparticipation
                                                                 health screening. Medicine & Science in Sports &
8. Frates E, McBride Y, Bonnet J. It’s fun: A Practical
                                                                 Exercise. 2015;47(11):2473– 2479. doi:10.1249/
algorithm for counseling on the exercise prescriptions: A
                                                                 mss.0000000000000664.
method to mitigate the symptoms of depression, anxiety, and
stress- related illness. Clinical and Experimental Psychology.   10. Ratey JJ, Hagerman E. Spark: The revolutionary new
2016;02(116). doi:10.4172/2471- 2701.1000116.                    science of exercise and the brain. New York, NY: Little Brown
                                                                 and Company; 2013.
9. Riebe D, Franklin BA, Thompson PD, et al. Updating
ACSM's recommendations for exercise preparticipation health      11. American College of Sports Medicine. ACSM’s guidelines
screening. 2015. https://www.acsm.org/docs/default-source/       for exercise testing and prescription. 9th ed. Pescatello L,
files-for-resource-library/updating_acsm_s_recommendations_      Arena R, Riebe D, Thompson P, eds. Philadelphia: Wolters
for_exercise-28-(1).pdf?sfvrsn=3aa47c01_4. Accessed July 6,      Kluwer/ Lippincott Williams & Wilkins Health; February 1,
2020.                                                            2013.
10. DocMikeEvans. 23 and 1/2 hours: What is the single best      12. American College of Sports Medicine. ACSM’s exercise
thing we can do for our health? [Video]. Youtube. https://www.   management for persons with chronic diseases and
youtube.com/watch?v=aUaInS6HIGo Published December 2,            disabilities. 4th ed. Moore G, Durstine J, Painter P, eds. United
2011. Accessed June 10, 2020.                                    States: Human Kinetics; May 3, 2016.
                                                                 13. Office of Disease Prevention and Health Promotion. 2008
Optional Readings:                                               Physical Activity Guidelines for Americans Summary. https://
1. Frates EP, Crane ME. Lifestyle medicine consulting walking    health.gov/paguidelines/guidelines/summary.aspx. Accessed
meetings for sustained weight loss. BMJ Case Reports.            June 10, 2020.
February 2016. doi:10.1136/bcr-2015-213218.
Lifestyle Medicine Course Syllabus                                                                                              13
Week 5A: The Nutrition-Health Connection
Eating patterns and guidelines have changed over the years, and with new research, comes new evidence based
recommendations. We explore the history and evolution of the dietary guidelines in order to better understand
how we have arrived at the current dietary recommendations. We review the spectrum of diets and common
eating patterns from the Standard American Diet (SAD), to the American Heart Association Diet, the DASH Diet, the
Mediterranean Diet, the vegan diet, and the raw food diet. The concept of a whole foods, plant-based diet (WFPB)
is highlighted. The issue of how our food choices affect not just our bodies but also the planet are considered as
well. Individual nutrients, vitamins, and minerals are addressed, but the focus is on consuming healthful meals
and snacks on a regular basis as part of an overall healthy eating pattern. Research on how a healthy WFPB diet
can prevent, treat, and reverse disease is emphasized. The notion that more intensive dietary changes (specifically,
following WFPB diet) can potentially offer superior health outcomes (i.e., disease reversal) is discussed.

Weekly Goals for Instructors:
1. Challenge students to evaluate different diets.
2. Invite students to consider the pros and cons of eating plants.
3. Consider the why, what, and how of a healthy diet.
4. Consider the role of digestion, metabolism and energy balance.
5. Review basic strategies for effective weight management.
6. Consider the role of digestion, metabolism and energy balance.

Learning Objectives:
By the end of this module, participants will be able to:
1. Identify the role that nutrition plays in lifestyle medicine.
2. Describe the key factors associated with a healthy eating pattern.
3. Evaluate the diet spectrum, ranging from the standard American diet (SAD) to the whole food, plant-based
   (WFPB) diet.
4. Compute the power of plants.
5. Discuss the need to focus on behavior change, with regard to weight management.

Guiding Questions for Students:
1. Why is it important to consume a nutritious diet?
2. What can people do to adopt and maintain healthy eating habits?
3. What is the role of energy balance in body weight maintenance?
4. How can food be medicine?
5. What would it take to change the Standard American diet (S.A.D.) to a more healthful one?
6. What are the roles of government, workplace, healthcare system, and food industry in creating, changing, and
   maintaining the diet of a society?
7. What is the evidence that diet affects health?
8. What is the evidence that our eating patterns influence the health of the planet?

14                                                                                     Lifestyle Medicine Course Syllabus
Lecture Topic: Value of Healthy Nutrition and Overview of Nutritional Guidelines
Patient Testimonials are available through the following programs: Dean Ornish, John McDougall, and Pritikin. May
be helpful in actualizing the change required and the benefits achieved with a plant based diet.
Section Activities:
Logistics Topic: Discuss a second Personal Behavioral Change assignment – submitting a behavior change goal for
approval and developing a SMART goal. Address students’ questions and concerns.
Overall Goal: Review with students what the healthy nutritional guidelines are and the key recommendations to
consider when evaluating different diets. Discuss the question, “What is a healthy eating pattern?”
Application Goal: Review with students some of the current diet trends and fads and discuss why they might or might
not be healthy. Discuss the idea of how to make healthful nutrition a lifestyle rather than just a diet.
Discussion Board Topic(s):
What patterns and similarities do you see among the USDA MyPlate, Harvard’s Healthy plate, the USDA and USHHS
Dietary Guidelines, the American Heart Association and American Diabetes Association guidelines, and a whole
foods, plant-based diet? What foods are stressed and what conclusions do you make from these patterns?

Required Readings:                                               8. Martindale W. Is a vegetarian diet really more
                                                                 environmentally friendly than eating meat? CNN The
1. Frates B, Bonnet JP, Joseph R, Peterson JA. The nutrition-
                                                                 Conversation on February 6, 2017. http://www.cnn.
health connection. In: Frates B, ed. Lifestyle Medicine
                                                                 com/2017/02/06/health/vegetarian- diet-conversation/.
Handbook: An Introduction to the Power of Healthy Habits.
Monterey, CA: Healthy Learning; 2021:173-228.                    9. How Not To Die: The Role of Diet in Preventing, Arresting
                                                                 and Reversing our Top 15 Killers NutritionFacts.Org https://
2. Price JM, Egger G. Chapter 10 Nutrition for the Non-
                                                                 nutritionfacts.org/video/how-not-to-die/. Accessed June 10,
Dietitian. In: Egger G, Binns A, Rossner S.Lifestyle Medicine:
                                                                 2020.
Managing Diseases of Lifestyle in the 21st Century. 2nd ed.
North Ryde, Australia: McGraw-Hill; 2010:127–139.                Optional Readings:
3. Egger G, Pearson S. Chapter 11 Fluid, Fitness, and            1. Dwyer J. Chapter 8 Nutrition 101: The Concept of
Fatness. In: Egger G, Binns A, Rossner S.Lifestyle Medicine:     Nutritional Status and Guides for Nutrient Intakes, Eating
Managing Diseases of Lifestyle in the 21st Century. 2nd ed.      Patterns, and Nutrition. In Rippe JM Lifestyle Medicine, 2nd
North Ryde, Australia: McGraw-Hill; 2010:140–150.                Ed. Boca Raton, FL, CRC Press; 2013:103-118.
4. King N, Egger G. Chapter 12 Behavioral Aspects of             2. Starke-Reed P, McDade-Ngutter C. Hubbard VS. Chapter
Nutrition. In: Egger G, Binns A, Rossner S.Lifestyle Medicine:   9 Healthy People 2020: Highlights in the Nutrition and Weight
Managing Diseases of Lifestyle in the 21st Century. 2nd ed.      Status Focus Area. In Rippe JM Lifestyle Medicine, 2nd Ed.
North Ryde, Australia: McGraw-Hill; 2010:151–164.                Boca Raton, FL, CRC Press; 2013:119-130.
5. U.S. Departments of Health and Human Services, U.S.           3. U.S. Department of Health and Human Services, U.S.
Departments of Agriculture. Dietary Guidelines for Americans     Department of Agriculture. 2015 – 2020 Dietary Guidelines
2015-2020, Executive Summary, (2015). https://health.gov/        for Americans. 8th ed. December 2015. http://health.gov/
dietaryguidelines/2015/guidelines/executive-summary/.            dietaryguidelines/2015/guidelines/. Accessed June 10, 2020.
Accessed June 10, 2020.
                                                                 4. Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence
6. Katz DL, Meller S. Can we say what diet is best for           to Mediterranean diet and health status: Meta-analysis. BMJ.
health? Annual Review of Public Health. 2014;35(1):83–103.       2008;337:a1344. doi:10.1136/bmj.a1344.
doi:10.1146/annurev-publhealth-032013-182351.
                                                                 5. Frates EP. Interview with award winners from ACLM
7. Herrero M, Havlík P, Valin H, et al. Biomass use,            2015, Nashville, Tennessee - Dean Ornish. American
production, feed efficiencies, and greenhouse gas                Journal of Lifestyle Medicine. 2016;10(5):341–344.
emissions from global livestock systems. Proceedings of          doi:10.1177/1559827616642399.
the National Academy of Sciences of the United States
                                                                 6. Public Broadcasting Service. How the sugar industry paid
of America. 2013;110(52):20888-20893. doi:10.1073/
                                                                 experts to downplay health risks [PBS Video]. http://www.pbs.
pnas.1308149110.
                                                                 org/video/2365841210/: PBS; 2016.

Lifestyle Medicine Course Syllabus                                                                                              15
7. Nestle M. Corporate funding of food and nutrition               [Video]. https://youtu. be/8mF0U546084: YouTube;
research. JAMA Internal Medicine. 2016;176(1):13–14.               November 2009.
doi:10.1001/jamainternmed.2015.6667.                               23. The Endocrine Society. Cooking for pleasure, healthy for
8. American College of Lifestyle Medicine, Turn the Tide           life: Type 2 diabetes cooking demonstration[Video]. https://
Foundation. True Health Initiative. A global consensus on          youtu.be/oSBX2HLzIH8: YouTube; September 21, 2012.
lifestyle as medicine. http://TrueHealthInitiative.org. Accessed   24. The Aspen Institute. Foods for protecting the body & mind:
June 10, 2020.                                                     Dr. Neal Barnard [Video]. https:// youtu.be/BnHYHjchn6w:
9. Willett WC, Stampfer MJ. Current evidence of healthy            YouTube; August 19, 2015.
eating. Annual Review of Public Health. 2013;34(1):77–95.          25. Fulkerson L. Forks Over Knives. [DVD]. New York, NY: Virgil
doi:10.1146/annurev-publhealth-031811-124646.                      Films & Entertainment; 2011.
10. Campbell TC, Campbell TM. The China Study: The most            26. Ornish D, Brown SE, Billings J, et al. Can lifestyle changes
comprehensive study of nutrition ever conducted and the            reverse coronary heart disease?: The Lifestyle Heart Trial. The
startling implications for diet, weight loss, and long-term        Lancet. 1990;336:129-33.
health. Revised ed. United States: BenBella Books; December
27, 2016.                                                          27. Ornish D, Lin J, Daubenmier J, et al. Increased telomerase
                                                                   activity and comprehensive lifestyle changes: a pilot study. The
11. Ornish D, Smith A. The spectrum: A scientifically proven       lancet oncology. 2008;9:1048-57.
program to feel better, live longer, lose weight, and gain
health. New York: Random House Publishing Group; December          28. Ornish D, Scherwitz LW, Billings JH, et al. Intensive
2008.                                                              lifestyle changes for reversal of coronary heart disease. JAMA.
                                                                   1998;280:2001-7.
12. Katz DL, Colino S. Disease-proof: Slash your risk of heart
disease, cancer, diabetes, and more - by 80 percent. United        29. McDougall J, Litzau K, Haver E, Saunders V, Spiller G.
States: Plume; September 18, 2014.                                 Rapid reduction of serum cholesterol and blood pressure by a
                                                                   twelve-day, very low fat, strictly vegetarian diet. J Am Coll Nutr.
13. Barnard ND, Grogan BC. Dr. Neal Barnard’s program              1995;14:491-6.
for reversing diabetes: The scientifically proven system for
reversing diabetes without drugs. 1st ed. New York: Rodale         30. Esposito K, Giugliano F, Di Palo C, et al. Effect of lifestyle
Books; April 1, 2008.                                              changes on erectile dysfunction in obese men: a randomized
                                                                   controlled trial. JAMA. 2004;291:2978-84.
14. Harvard Health Publications, Naidoo U. Learn about
hidden sugar in foods [Video].https://youtu. be/fVAEgzXXLVs        31. Jenkins DJ, Kendall CW, Marchie A, et al. Effects of a
YouTube; May 23, 2016.                                             dietary portfolio of cholesterol-lowering foods vs lovastatin on
                                                                   serum lipids and C-reactive protein. JAMA. 2003;290:502-10.
15. BBC Productions. The Truth about sugar. [Video].https://
youtu.be/K4LzSH9qU_QYouTube; October 16, 2015.                     32. Barnard RJ, DiLauro SC, Inkeles SB. Effects of intensive
                                                                   diet and exercise intervention in patients taking cholesterol-
16. NWO BBC Horizon. The truth about vitamins supplements          lowering drugs. Am J Cardiol. 1997;79:1112-4.
[Video]. https://youtu. be/7i7gPyDZZv4: YouTube; May 13,
2013.                                                              33. Esselstyn CB, Jr. Resolving the Coronary Artery Disease
                                                                   Epidemic Through Plant-Based Nutrition. Prev Cardiol.
17. Killoran E. Healthy grocery shopping scavenger hunt.           2001;4:171-7.
Pritikin Longevity Center + Spa. https://www.pritikin.com/
learn-healthy-grocery-shopping-skills. Accessed June 10,           34. Barnard ND, Cohen J, Jenkins DJ, et al. A low-fat vegan
2020.                                                              diet and a conventional diabetes diet in the treatment of type
                                                                   2 diabetes: a randomized, controlled, 74-wk clinical trial. Am J
18. Whole Foods Market. Healthy Cooking Techniques Videos          Clin Nutr. 2009:ajcn. 26736H.
[Video]. http://www.wholefoodsmarket.com/healthy-eating/
healthy-cooking-videos: Whole Foods Market; December 2015.         35. Trapp CB, Barnard ND. Usefulness of vegetarian and
                                                                   vegan diets for treating type 2 diabetes. Current diabetes
19. U.S. Department of Health and Human Services and U.S.          reports. 2010;10:152-8.
Department of Agriculture. 2015–2020 Dietary Guidelines for
Americans. 8th Edition. December 2015. Available at http://        36. Barnard RJ, Hong Gonzalez J, Liva ME, Ngo TH. Effects
health.gov/dietaryguidelines/2015/guidelines/.                     of a low-fat, high-fiber diet and exercise program on breast
                                                                   cancer risk factors in vivo and tumor cell growth and apoptosis
20. U.S. Department of Agriculture and U.S. Department of          in vitro. Nutrition and Cancer. 2006;55:28-34.
Health and Human Services. Dietary Guidelines for Americans,
2010. 7th Edition, Washington, DC: U.S. Government Printing        37. Kahleova H, Matoulek M, Malinska H, et al. Vegetarian
Office, December 2010.                                             diet improves insulin resistance and oxidative stress markers
                                                                   more than conventional diet in subjects with Type 2 diabetes.
21. Dietary Guidelines Advisory Committee. Dietary guidelines      Diabetic Medicine 2011;28:549-59.
for Americans 2015-2020. Government Printing Office; 2015.
                                                                   38. Frattaroli J, Weidner G, Dnistrian AM, et al. Clinical events
22. LifespanHealth. Healthy recipes cooking demonstration          in prostate cancer lifestyle trial: results from two years of
                                                                   follow-up. Urology. 2008;72:1319-23.
16                                                                                               Lifestyle Medicine Course Syllabus
Week 5B: Weight Management
Discuss that weight is a sensitive topic and that many factors come into play beyond simply calories in and calories
out. Encourage sensitive dialogue, the important nature of this topic, and that over 2/3 of American adults are
outside of the healthy BMI.

Weekly Goals for Instructors:
1. Review the essential factors involved in weight management.
2. Develop an understanding of why it can be difficult for a person to lose weight and maintain that loss.
3. Explore the role that diet plays in weight management.
4. Examine the strategies for modifying a person’s behavior with regard to their efforts to manage their weight.
5. Detail the benefits of adhering to a healthy eating pattern for weight management.
6. Review basic strategies for effective weight management.
7. Consider the role of metabolism and energy balance.

Learning Objectives:
By the end of this module, participants will be able to:
1. Understand the key factors involved in weight management.
2. Be aware of the impact of a healthy eating pattern and physical activity/exercise on weight management.
3. Grasp the advantages and disadvantages of various diets.
4. Identify the factors that affect how much a person weighs.
5. Recognize the need for behavioral change in achieving weight management goals.
6. Discuss the need to focus on behavior change, with regard to weight management.

Guiding Questions for Students:
1. How much should a person weigh?
2. How do psychological factors affect a person’s ability to manage their weight?
3. What are the two most important factors in keeping an individual’s weight at a desired level?
4. What factors should a person consider when selecting an eating plan?
5. How should a lifestyle medicine professional assess an individual’s weight status?
6. What is the role of energy balance in body weight maintenance?

17                                                                                    Lifestyle Medicine Course Syllabus
Lecture Topic: Importance of Healthy Weight Management
Section Activities:
Pre-assignment: Have students research the strengths and limitations of BMI. Why is it an important tool? What
limitations does it have? Also have them reflect upon their personal views of weight and what shaped these views.
Weight is more than a number on a scale. It is also about how comfortable you feel moving around day to day and
your functional abilities. How can you convey these concepts to others?
Logistics Topic: Discuss how they can talk about healthy weight to potential patients or clients, in a way that does
not shame them if they do have an unhealthy body weight, but that motivates them to work toward achieving a
healthy weight. Discuss how they can use the COACH approach when discussing weight with a patient.
Overall Goal: Students should understand the complex nature of weight, factors that influence it, society’s
perceptions, and the health benefits of a healthy BMI.
Application Goal: Students should be able to talk with others about the importance of healthy weight and why it
matters, while supporting people who struggle with being underweight, overweight or obese.

Required Readings:
1. Frates B, Bonnet JP, Joseph R, Peterson JA. Weight Management. In: Frates B, ed. Lifestyle Medicine Handbook: An
Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2021:229-260.

18                                                                                         Lifestyle Medicine Course Syllabus
Week 6: Sleep Matters
Sleep is often ignored and taken for granted. While people boast about how they only need 3 hours of sleep a night,
researchers are demonstrating that sleep is connected to satiety hormones, mood, productivity, learning, memory,
and weight. We review the basics of sleep and sleep cycles, how poor sleep affects the human body, and how
proper sleep enhances the functioning of the human body. We identify the factors that promote healthy sleep and
those factors that steal sleep. After stressing the importance of sleep for a healthy body, we explore possible sleep
prescriptions and strategies.

Weekly Goals for Instructors:
1. Invite students to consider the importance of sleep and the dangers of the lack of sleep.
2. Teach the updated stages of sleep.
3. Discuss healthy sleep habits.
4. Challenge students to identify the connection between sleep and health.
5. Share tips for falling asleep.

Learning Objectives:
By the end of this module, participants will be able to:
1. Describe the basics of sleep.
2. Identify the key factors that inhibit sleep.
3. Recognize the importance of evidence-based information concerning sleep.
4. Demonstrate the connection between sleep and health.
5. Recognize how to improve sleep through behavior change.

Guiding Questions for Students:
1. How can people get more sleep?
2. How much sleep do people need?
3. What are healthy sleep habits?
4. What are the stages of sleep?
5. How does a lack of sleep affect the body?

Lecture Topic: Benefits of Healthy Sleep and How to Achieve It
Section Activities:
Pre-assignment: Sleep Questionnaire available at http://internalmedicine.med.sc.edu/forms/Sleep%20
questionnaire2.pdf
Logistics Topic: Review Case Studies and Behavior Change Project progress. Address students’ questions and
concerns.
Overall Goal: Review with students healthy sleeping recommendations and discuss solutions for possible sleep
disruptors.
Application Goal: Discuss with students their results on the sleep questionnaire. Practice with students the Coach
Approach way of addressing some of their sleep disruption issues, and utilize the Epworth Sleepiness scale
(available at: http://healthysleep.med.harvard.edu/narcolepsy/diagnosing- narcolepsy/epworth-sleepiness-scale) as
a tool.

19                                                                                    Lifestyle Medicine Course Syllabus
Discussion Board Topic(s):
Your friend is driving you home from the library late one evening. You both live 30 minutes from school and need to
take the highway. It is midterm time, and you are both exhausted. Although you begin the drive talking about organic
chemistry, soon things quiet down and you fall asleep. You wake up after your friend swerves and hits the brakes.
She then continues driving. What do you do next? How could you help to inform your friend about the dangers of
sleep deprivation and, specifically, driving while drowsy?

Required Readings:                                                 3. Division of Sleep Medicine at Harvard Medical School,
                                                                   WGBH Educational Foundation. Finding your sleep/wake
1. Frates B, Bonnet JP, Joseph R, Peterson JA. Sleep
                                                                   rhythm. Healthy Sleep. http://healthysleep.med.harvard.edu/
Matters. In: Frates B, ed. Lifestyle Medicine Handbook: An
                                                                   interactive/circadian. Accessed June 10, 2020.
Introduction to the Power of Healthy Habits. Monterey, CA:
Healthy Learning; 2021:261-272.                                    4. University of South Carolina School of Medicine. Sleep
                                                                   Questionaire, Department of Internal Medicine, (2006).
2. West C, Egger G. Chapter 18 To Sleep Perchance...To Get
                                                                   http://internalmedicine.med.sc.edu/forms/Sleep%20
Everything Else Right. In: Egger G, Binns A, Rossner S.Lifestyle
                                                                   questionnaire2.pdf. Accessed June 10, 2020.
Medicine: Managing Diseases of Lifestyle in the 21st Century.
2nd ed. North Ryde, Australia: McGraw-Hill; 2010:226–241.          5. Stevenson S. Sleep smarter: 21 essential strategies to
                                                                   sleep your way to a better body, better health, and bigger
3. Division of Sleep Medicine at Harvard Medical School,
                                                                   success. United States: Rodale Books; March 15, 2016.
WGBH Educational Foundation. Assess your sleep needs. Get
Sleep. http://healthysleep.med.harvard.edu/need-sleep/             6. Foster RG, Lockley SW. Sleep: A very short introduction.
what-can-you-do/assess-needs. Updated December 15, 2008.           Oxford: Oxford University Press; March 22, 2012.
Accessed June 10, 2020.                                            7. Lewis PA. The secret world of sleep: The surprising
4. Buysse DJ. Sleep Health: Can We Define It? Does It              science of the mind at rest. New York, NY, United States:
Matter? Sleep. 2014;37(1):9-17. doi:10.5665/sleep.3298.            Palgrave MacMillan Trade; November 11, 2014.
5. Havekes R, Park AJ, Tudor JC, et al. Sleep deprivation          8. Dement WC, Vaughan C, Vaughn C. The promise of sleep:
causes memory deficits by negatively impacting neuronal            A pioneer in sleep medicine explores the vital connection
connectivity in hippocampal area CA1. Takahashi JS, ed. eLife.     between health, happiness, and a good night’s sleep. New
2016;5:e13424. doi:10.7554/eLife.13424.                            York: Random House Publishing Group; March 7, 2000.
5. Touitou Y, Reinberg A, Touitou D. Association between           9. Rath T. Eat move sleep: How small choices lead to big
light at night, melatonin secretion, sleep deprivation, and the    changes-. New York: Missionday; May 14, 2014.
internal clock: Health Impacts and mechanisms of circadian         10. Cappuccio FP, Cooper D, D’Elia L, Strazzullo P, Miller MA.
disruption. Life Sciences 2017: 173: 94-106.                       Sleep duration predicts cardiovascular outcomes: A systematic
6. Kahn MS, Aouad R. The effects of insomnia and sleep             review and meta-analysis of prospective studies. European
loss on cardiovascular disease. Sleep Medicine Clinics.            Heart Journal. 2011;32(12):1484–1492. doi:10.1093/
2017:12(2): 167-177.                                               eurheartj/ehr007.
                                                                   11. Asarnow LD, McGlinchey E, Harvey AG. The effects of
Optional Readings:                                                 bedtime and sleep duration on academic and emotional
1. Division of Sleep Medicine at Harvard Medical School.           outcomes in a nationally representative sample of
Epworth Sleepiness scale. Narcolepsy. http://healthysleep.         adolescents. Journal of Adolescent Health. 2014;54(3):350–
med.harvard.edu/narcolepsy/diagnosing-narcolepsy/epworth-          356. doi:10.1016/j.jadohealth.2013.09.004.
sleepiness-scale. Published 1997. Updated October 16, 2013.
                                                                   12. Araghi MH, Chen Y-F, Jagielski A, et al. Effectiveness
Accessed June 10, 2020.
                                                                   of lifestyle interventions on obstructive sleep Apnea
2. National Sleep Foundation. National sleep foundation            (OSA): Systematic review and Meta-Analysis. Sleep.
Sleepiness test. https://sleepfoundation.org/quiz/national-        2013;36(10):1553–1562. doi:10.5665/sleep.3056.
sleep-foundation-sleepiness-test. Accessed June 10, 2020.

20                                                                                              Lifestyle Medicine Course Syllabus
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