Ifeoma Monye - Lifestyle Medicine

25 A The scientific foundation of the Erica Frank et al.’s ‘Healthy Doctor = Healthy Patient’ principle includes the following and more:North American physicians tend to live longer than their peersPhysicians live longer because they have healthier habits (including as medical students) than their contemporariesPhysicians and medical students with the healthiest habits are more likely to advise their patients about related preventive habitsCounselling patients makes a difference in patients’ habits and in their health(Rippe 2019, p. 1039)

1 Barnard, N.D., Cohen, J., Jenkins, D.J. et al. (2009). A low‐fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74‐wk clinical trial. American Journal of Clinical Nutrition 89 (5): 1588S–1596S. https://doi.org/10.3945/ajcn.2009.26736H.

2 Egger, G., Dixon, J., Meldrum, H., et al. (2015) Patients’ and providers satisfaction with shared medical appointments. Australian Family Physician 44(9): 674–679. PMID: 26488050.

3 Egger, G., Binns, A., Rossner, S. et al. (2017). Lifestyle Medicine: Lifestyle, the Environment and Preventive Medicine in Health and Disease, 3e. Academic Press.

4 Frank, E. (2004) STUDENTJAMA. Physician health and patient care. JAMA 291(5):637. https://doi.org/10.1001/jama.291.5.637. PMID: 14762049.

5 Kelly, J. and Shull, J. (2019). The Lifestyle Medicine Board Review Manual, 2ee. American College of Lifestyle Medicine.

6 Lianov, L. and Johnson, M. (2012). Physician competencies for prescribing lifestyle medicine. JAMA 304(2):202‐203. https://doi.org/10.1001/jama.2010.903. PMID: 20628134.

7 Noffsinger E.B. (2012). The ABCs of group visits: an implementation manual for your practice, 1e. Springer.

8 Ornish, D., Brown, S.E., Scherwitz, L.W. et al. (1990). Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 336 (8708): 129–133. https://doi.org/10.1016/0140‐6736(90)91656‐u. PMID: 1973470.

9 Rippe, J.M. (2019). Lifestyle Medicine, 3ee. CRC Press, Taylor & Francis Group.

10 Willett, W., Rockström, J., Loken, B. et al. (2019). Food in the Anthropocene: the EAT‐Lancet Commission on healthy diets from sustainable food systems. Lancet 393 (10170): 447–492. https://doi.org/10.1016/S0140‐6736(18)31788‐4. Epub 2019 Jan 16. Erratum in: Lancet. 2019 Feb 9;393(10171):530. Erratum in: Lancet. 2019 Jun 29;393(10191):2590. Erratum in: Lancet. 2020 Feb 1;395(10221):338. Erratum in: Lancet. 2020 Oct 3;396(10256):e56. PMID: 30660336.

Behaviour change is the mainstay in the delivery of lifestyle medicine interventions. It is important that clinicians are familiar with behaviour change techniques that foster self‐efficacy and cultivate a therapeutic relationship to empower the change process. Knowledge of different theories is essential. Practising the different techniques with patients will enable clinicians to become proficient in them. The emphasis is on listening rather than informing the patient, motivating rather than convincing the patient, and collaborating with the patient rather than directing the patient.

This chapter tests the candidate’s knowledge of health behaviour, change theories, and how they can be applied in practice to help patients maintain healthy behaviour. It tests the candidate’s ability to apply motivational interviewing, cognitive behaviour therapy, and positive psychology techniques to the behaviour change process.

1 Which of the following best describes the ‘action’ stage of the Transtheoretical Model of health behaviour?The patient has been making changes within the last six monthsThe doctor assists with plans on specific changesThe patient intends to make changes within six monthsThe patient intends to make some changes within one month

2 Which of the following options best describes the Health Belief Model (HBM) of behaviour change theory?Different interventions should be used at different stages of behaviour changeGovernmental policies lead to health behaviour changeSelf‐efficacy and perceived susceptibility to health threat leads to behavior changeSocial reinforcement leads to a patient maintaining a healthy behaviour

3 Which of the following most appropriately describes the levels of influence on health behavior change?Community factors and social networkIntrapersonal, interpersonal, and institutional factorsIntrospective factors, beliefs, and personalityPublic rules, regulations, and policies

4 A 48‐year‐old woman attends for a review of her asthma and when you mention her BMI of 40 kg/m2, she informs you that she has been thinking of buying an exercise bike for her birthday in two months’ time and becoming more active. What stage of health behaviour change does this best describe?Action stageContemplation stagePrecontemplation stagePreparation stage

5 Which of the following management options will be most appropriate for a person on the precontemplation stage?Discuss health risks and benefits of a healthy lifestyleDiscuss mindfulness‐based stress reductionPersonalize their health risk based on medical historyReferral to a dietician for meal planning

6 The action stage of health behaviour change is best characterized by which of the following?The doctor gives a personalized analysis of risk based on the patient’s historyThe doctor maps out an action plan for the patient to endorseThe patient has been making specific health modifications within the past six monthsThe patient is encouraged to list out all the possible barriers to making progress

7 Which of the following would be the best practice in facilitating health behaviour changes?Aim to document a behaviour change plan in every patient’s health records every yearEnsure that every patient leaves with a clear relapse plan Making available a readiness assessment for patients to complete in advance in the waiting roomReview the patient’s completed readiness assessment form to prioritize lifestyle areas you want the patient to change

8 A health behaviour change theory that best explains the reciprocal influence of personal factors, environmental factors, and the health behaviour on the individual is:Health Review ModelSocial Learning (Cognitive) TheoryTheory of Reasonable BehaviourTheory of Socially Accepted Behaviour

9 Key behaviour theories have several similarities. Which of these options best describes the common features?Environmental influence, e.g. socially accepted norms guarantee behavioursMotivation and beliefs about risk and benefits of the health behaviour underpin changeOne’s confidence in ability to complete the behaviour change is keyRegular self‐criticism and reflection aids in behaviour

10 Which of these options is the most appropriate skill in facilitating sustainable behaviour changes at the early stages?Cognitive behaviour techniquesMotivational interviewingPositive psychologyReframing non‐productive thinking

11 Which of these options best represents the precontemplation stage of behaviour change?I am not thinking about making a change at allI have started a change within the last six monthsI am thinking of making a change within the next six monthsI have been making a change for more than six months

12 Which of the following is the most appropriate management in stage‐matched interventions?Offer an intervention that is acceptable to majority of patientsOffer an intervention that is tailored to the patient’s readiness for a specific actionOffer an intervention that is used by all patientsOffer an intervention that the patient has failed before so he can perfect it

13 Which of these options best represents the process in Stage‐Matched Interventions?Family support should not be solicited as this encourages dependenceIt is important that the patient completes every item at each stageThe degree of readiness is not an important factorThe doctor aims to help the patient move from one stage of readiness to the next