Interviewed by Brandon Barndt, DO
Elizabeth (Beth) Pegg Frates, MD is a pioneer in lifestyle medicine education, is an award-winning teacher at Harvard, and currently works with patients to help them adopt and sustain healthy habits. Since 1996, Dr. Frates has been on faculty at Harvard Medical School and has won multiple teaching awards, and, most recently, she created the first full-semester lifestyle medicine course at Harvard, which was recognized by the University as an example of a successful course offered at the Harvard Extension School. She serves as the Co-Chair of the Pre-Professional Education Committee at the American College of Lifestyle Medicine (ACLM) and was elected to the Board of Directors for the ACLM for a three year term ending October 2019.
She has co-authored two books on Lifestyle Medicine: Life After Stroke: The Guide to Recovering Your Health and Preventing Another Stroke and The Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits.
Currently, Dr. Frates serves as the Director of Wellness Programming at the Stroke Institute for Research and Recovery at Spaulding Rehabilitation Hospital. Dr. Frates sees patients through her private practice, Wellness Synergy, LLC. Merging her training in physical medicine and rehabilitation with her training in lifestyle medicine and coaching, Dr. Frates has developed novel wellness programs for stroke survivors and their caregivers based on lifestyle medicine principles (nutrition, exercise, stress reduction, connection).
She graduated from Harvard College and then then attended Stanford Medical School, interned at Mass General Hospital, and completed her residency in the Department of Physical Medicine and Rehabilitation at Harvard Medical School where she served as Chief Resident.
Q: Lifestyle medicine is a very new field within medicine. Can you tell us a little bit about what Lifestyle medicine is, in your mind, and what your favorite aspect of it is?
Lifestyle Medicine is an evidence based burgeoning area of medicine that uses healthy habits like regular exercise, nutritious eating patterns, sound sleep, stress reduction, and cultivating high quality connections to help prevent, treat, and even reverse medical conditions and diseases like diabetes, heart disease, obesity, and high blood pressure.
My favorite part about lifestyle medicine is the challenge of helping to empower people to not only adopt healthy habits but also to sustain them. Tapping into a person’s motivators for change is key. Using motivational interviewing skills allows the lifestyle medicine physician to encourage the patient to talk about all the reasons that the patient would benefit from change and why that change might be important to that particular person. It is a patient-centered approach. There are guidelines for exercise, diet, and sleep, but not everyone will be able to meet the guidelines right away. So, the lifestyle medicine physician must collaborate with the person to find the best individual approach that will get the patient moving in the right direction. What works for one person may not work for someone else.
Q: You are a physiatrist by training, so how did you come to get involved with Lifestyle Medicine? Do you feel like Physical Medicine & Rehabilitation and Lifestyle Medicine mesh well?
I was very interested in stroke and stroke prevention as a pre-med student. My father had suffered a stroke when he was 52 and I was 18. I watched his recovery and his complete lifestyle change. He often said he lived the best 27 years of his life after his health set back. So, I went into medicine knowing I wanted to help people prevent heart attacks and strokes, but in the 1990s there was really no field that focused on prevention in this way. Preventive Medicine was mostly epidemiology at that time. Physiatry training seemed like a great fit, so that I could focus on stroke and recovery. Rehabilitation uses exercise prescriptions and nutrition prescriptions routinely. However, it was not until I co-authored a book titled Life After Stroke: The Guide to Recovering Your Health and Preventing Another Stroke, that I really took a deep dive into the power of exercise and nutrition in preventing strokes (primary and secondary prevention).
When I was a resident at Spaulding Rehabilitation Hospital, Dr. Eddie Phillips was an attending. He knew about my stroke prevention book and told me that I had written about lifestyle medicine. At that time in 2009, he asked me to join him in creating the Institute of Lifestyle Medicine which offers CME courses twice a year at HMS in lifestyle medicine. I worked with Dr. Philips to put those courses on for almost 10 years. Then, I started to attend the American College of Lifestyle Medicine annual meetings and met lifestyle medicine leaders from across the country including Dr. Dean Ornish and Dr. David Katz. I was voted to the Board of Directors for the American College of Lifestyle Medicine and got very involved in the Education efforts there.
Since I had created an entire 14-week course titled, “Introduction to Lifestyle Medicine” for the Harvard Extension for the undergraduate and graduate level courses in the Psychology Department there, I had developed a framework for teaching the materials. There are 6 pillars in lifestyle medicine: exercise, nutrition, sleep, stress resiliency, social connections, and substance use moderation or elimination. The Harvard Extension School course covered all these pillars and more. Behavior change is an important aspect of lifestyle medicine, and in the course there are two weeks devoted to empowering people to change. Other topics included are mindfulness, meditation, and mindfulness-based stress reduction, positive psychology, and the importance of self-care.
Thinking about the 6 pillars of lifestyle medicine and the other topics I teach in the Lifestyle Medicine course at the Harvard Extension school, one can identify significant over-laps and synergy with rehabilitation medicine. Lifestyle medicine is usually practiced in a team much like physiatry. A lifestyle medicine team includes a nurse, a doctor, an exercise specialist, a nutrition specialist, a behavior change specialist, and sometimes a social worker or other allied health professionals. Physiatrists are accustomed to working in teams and holding team meetings. Lifestyle Medicine physicians need to be able to do the same.
Q: So, it sounds like Lifestyle Medicine is quite the exciting field and has grown quickly! How has the field evolved over the last 10 years?
The field has evolved a great deal over the years. In terms of research, the number of papers about exercise, diet, sleep, and stress resiliency techniques has grown at a rapid rate and continues to do so. Dr. Dean Ornish has performed important studies demonstrating that a lifestyle medicine approach including exercise, healthy food, yoga, and social connection can help to reverse cardiac disease. His research is so robust that now in 2019, his UnDo It Program is covered by insurance. This is good news because hopefully more and more lifestyle medicine programs will be covered.
Three years ago, the American Board of Lifestyle Medicine was created. And, now there is a certification process for physicians and other healthcare providers to become certified in lifestyle medicine. This is a big step forward as it allows the field to have a scope of practice and some uniformity with regards to clinicians’ knowledge and treatments.
More and more medical schools are starting to incorporate lifestyle medicine into their curriculum. Most programs are reviewing the existing curriculum and looking for ways to add lifestyle medicine cases, research, and guidelines into subjects that are routinely covered like physiology, endocrinology, and cardiology. This is happening right now at Harvard Medical School. Some schools are offering electives in lifestyle medicine. Harvard offered their first elective last spring, and it was a great success.
In 2009, I started the first lifestyle medicine interest group (LMIG) at Harvard Medical School. This is an opportunity to offer a parallel curriculum to students during lunch time. With this approach, the core curriculum does not need to be altered and administration does not need to be involved with making any changes. An LMIG meets during the week usually at lunch. Professors with an interest and expertise in exercise, nutrition, sleep, and behavior change give presentations while students eat lunch. The Harvard group has been running for 10 years and serves as a model for other schools. I worked with the American College of Lifestyle Medicine and their Professionals In-Training group 4 years ago to help create programming that would enable medical school faculty from across the country to start these groups. I shared 4 PowerPoints that are free and easy to download off the ACLM website. In addition, there are 4 Donald A Pegg Awards given at the ACLM annual meeting. These awards are $1,000 monetary value each to help medical students and faculty to start LMIGs and to help students attend the national meeting.
The American Journal of Lifestyle Medicine has also grown and evolved. It is now featured in PubMed.
Q: You are a very active and prominent member of the Lifestyle Medicine community. Do you mind sharing some details about any projects that you are currently working on or are soon to be released?
I have been actively involved in the education committee at ACLM. In 2018, I co-authored The Handbook of Lifestyle Medicine: An Introduction to the Power of Healthy Habits in collaboration with ACLM. This handbook can be used as the textbook for courses in college or graduate schools. In addition, patients enjoy reading it as it has “Live and Learn” cases in each chapter that describe a patient’s story. Each chapter has the guidelines, research and benefits to the 11 systems of the body for each of the 6 pillars in lifestyle medicine. In 2017, I shared my syllabus from the Harvard Extension School course with ACLM. And that is freely available and downloadable from the ACLM website. Most recently, over the past year, I collaborated with colleagues at ACLM to formalize and standardize a set of 12 PowerPoint decks (120-200 slides per deck) so that college professors, and graduate school professors, as well as community educators could use the set of PPTs as a course on lifestyle medicine. This should be available for release the fall of 2019.