Lifestyle Medicine Performance Measures: An Expert Consensus Statement Defining Metrics to Identify Remission or Long-Term Progress Following Lifestyle Medicine Treatment

John H Kelly; Liana Lianov; Dexter Shurney; Sley Tanigawa Guimarães; Mechelle Palma; Caldwell Esselstyn; Scott Stoll; Padmaja Patel; Brenda Rea; Koushik Reddy; George Guthrie; Michelle Reiss; Micaela C Karlsen

doi:10.1177/15598276241230237

Lifestyle Medicine Performance Measures: An Expert Consensus Statement Defining Metrics to Identify Remission or Long-Term Progress Following Lifestyle Medicine Treatment

Am J Lifestyle Med. 2024 Feb 20;18(4):567-573. doi: 10.1177/15598276241230237. eCollection 2024 Jul-Aug.

Authors

John H Kelly^{1

2}, Liana Lianov³, Dexter Shurney⁴, Sley Tanigawa Guimarães⁵, Mechelle Palma⁶, Caldwell Esselstyn⁷, Scott Stoll⁸, Padmaja Patel⁹, Brenda Rea^{2

10}, Koushik Reddy^{11

12}, George Guthrie^{2

13}, Michelle Reiss^{14

15}, Micaela C Karlsen¹

Affiliations

¹ American College of Lifestyle Medicine, Chesterfield, MO, USA (JHK, BR, MCK).
² School of Medicine, Loma Linda University, Loma Linda, CA, USA (JHK, BR, GG).
³ Global Positive Health Institute, Inc, Sacramento, CA, USA (LL).
⁴ Blue Zones Well Being Institute, CA, USA (DS).
⁵ Rua Doutor Jesuino Maciel, Sao Paulo, Brasil (STG).
⁶ Philippine College of Lifestyle Medicine, Iloilo, Philippines (MP).
⁷ The Cleveland Clinic Center of Wellness and Preventive Medicine, Lyndhurst, OH, USA (CE).
⁸ The Plantrician Project, St Louis, MO, USA (SS).
⁹ Wellvana Health, Nashville, TN, USA (PP).
¹⁰ Department of Preventive Medicine, Loma Linda University, Loma Linda, CA, USA (BR).
¹¹ James A. Haley Veteran's Hospital, Tampa, FL, USA (KR).
¹² USF Health Morsani College of Medicine, Tampa, FL, USA (KR).
¹³ Department of Graduate Medical Education, AdventHealth Allopathic Family Medicine Residency, Winter Park, FL, USA (GG).
¹⁴ Australian Society of Lifestyle Medicine, Northcote, VIC, Australia (MR).
¹⁵ Life Medical Centre, Erina, NSW, Australia (MR).

PMID: 39262894
PMCID: PMC11384852 (available on 2025-02-20)
DOI: 10.1177/15598276241230237

Abstract

Objective: The objective of this expert consensus process was to define performance measures that can be used to document remission or long-term progress following lifestyle medicine (LM) treatment.

Methods: Expert panel members with experience in intensive, therapeutic lifestyle change (ITLC) developed a list of performance measures for key disease states, using an established process for developing consensus statements adapted for the topic. Proposed performance measures were assessed for consensus using a modified Delphi process.

Results: After a series of meetings and an iterative Delphi process of voting and revision, a final set of 32 performance measures achieved consensus. These were grouped in 10 domains of diseases, conditions, or risk factors, including (1) Cardiac function, (2) Cardiac risk factors, (3) Cardiac medications and procedures, (4) Patient-centered cardiac health, (5) Hypertension, (6) Type 2 diabetes and prediabetes, (7) Metabolic syndrome, (8) Inflammatory conditions, (9) Inflammatory condition patient-centered measures, and (10) Chronic kidney disease.

Conclusion: These measures compose a set of performance standards that can be used to evaluate the effectiveness of LM treatment for these conditions.

Keywords: intensive therapeutic lifestyle change; intensivist; lifestyle medicine; metric; modified Delphi process; performance measure.