Lifestyle Medicine: Preventing and Treating Chronic Diseases

This article is the first in a series of contributions produced with ELMO

ELMO (European Lifestyle Medicine Organization) was founded at the end of 2016 in Geneva by Stefania Ubaldi and Ioannis Arkadianos. The organization has the merit of bringing to Europe the development of structured training initiatives focused on the method. Since 2019, the European Certificate in Lifestyle Medicine promotes the “eight pillars of Lifestyle Medicine” and emphasizes the importance of the Mediterranean diet. ELMO is governed by its members through a General Assembly that elects a board of directors for a four-year term. The board names a president, a vice-president, and a Secretary General. The organizational structure also includes national representatives and ambassadors spread across several European countries.

Health systems around the world are facing a rapid rise in non-communicable chronic diseases, including obesity, type 2 diabetes, cardiovascular disease, hypertension, fatty liver disease and metabolic syndrome, affecting both older and younger generations. While pharmacological therapies remain essential, they often target disease outcomes rather than the behavioral and environmental determinants that drive them. This highlights the need for a more comprehensive and preventive model of care.

Non-communicable diseases are largely determined by modifiable behavioral risk factors, including poor nutrition, physical inactivity, tobacco use, and harmful alcohol consumption. Recent Eurostat mortality statistics indicate that cardiovascular diseases and cancer account for the majority of deaths in the European Union, while the WHO Europe region identifies non-communicable diseases as the leading cause of premature mortality and disability across the region. The World Health Organization (WHO) estimates that up to 80% of premature heart disease, stroke, and type 2 diabetes could be prevented by modifying these risk factors. Prevention and lifestyle-based interventions therefore represent a fundamental public health priority.

The science of prevention and treatment

ELMO (European Lifestyle Medicine Organization), building on the work of its Scientific Council, defines Lifestyle Medicine as: “A branch of medicine aimed at maintaining optimal health and preventing, treating, and reversing chronic diseases across all stages of life. Healthcare interventions used in Lifestyle Medicine include evidence-based behavioral strategies, taking equity and sustainability into account, to improve self-management capacities to optimize nutrition, sleep hygiene, stress management, social relationships, sexual health and fertility, physical activity, and to minimize substance use and environmental exposure.”

Through structured and evidence-based interventions, patients can improve health outcomes, reduce disease risk, and in some cases achieve remission of chronic conditions. Lifestyle Medicine aims to serve as the foundation of health and healthcare. Its principles are reflected in many other medical approaches:

• Conventional medicine: lifestyle interventions are often included in clinical guidelines as first-line treatments for many chronic diseases.
• Preventive medicine: public health recommendations are closely aligned with the pillars of Lifestyle Medicine, such as physical activity, nutrition, and avoidance of harmful substances.
• Integrative medicine: emphasizes a holistic approach to the person and often incorporates Lifestyle Medicine principles.
• Mental‑body medicine: explores how lifestyle-related factors influence both mental and physical health.
• Functional medicine: utilizes personalized approaches to address the root causes of disease, often through lifestyle interventions.
• Complementary and alternative medicine (CAM): adopts a holistic view of health and often includes lifestyle-based strategies.

From the origins of Lifestyle Medicine to the founding of ELMO

The concept of Lifestyle Medicine originated in the United States. The ACLM (American College of Lifestyle Medicine) was founded in 2004 by a group led by researcher John Kelly at Loma Linda University. In 2010, the landmark article published in JAMA, “Physician Competencies for Prescribing Lifestyle Medicine,” by Liana Lianov and Mark Johnson, first defined the core competencies required for clinical practice in this field. In 2018, the ACLM stated that Lifestyle Medicine emphasizes whole-food, plant-based nutrition, physical activity, sleep, emotional well-being, and avoidance of harmful substances for the prevention, treatment, and reversal of lifestyle-related conditions. Australian researcher Garry Egger further highlighted the integration of medical, behavioral, motivational, and environmental strategies into Lifestyle Medicine, with self-care playing a central role.

ELMO (European Lifestyle Medicine Organization) was founded in late 2016 in Geneva, Switzerland, by Stefania Ubaldi and Ioannis Arkadianos. Stefania Ubaldi served as the organization’s first president, while Ioannis Arkadianos is its current president. Ioan Hanes holds the office of vice-president and is the founder of the European Certificate in Lifestyle Medicine. Ten years ago, Lifestyle Medicine was still relatively unknown in Europe, which led to the development of structured training initiatives. Since 2019, the European Certificate promotes the “eight pillars of Lifestyle Medicine” and the importance of the Mediterranean diet. More than 600 participants have completed the program, including health professionals and individuals interested in lifestyle-based health approaches.

The European Certificate is delivered online through weekly ten‑week interactive sessions, guided by experts, group projects, and guest speakers, and concludes with an online exam that assesses both theoretical knowledge and practical skills. ELMO is governed by its members through a General Assembly that elects a Board of Directors every four years. The board names a president, a vice-president, and a Secretary General. The organization also includes national representatives and ambassadors across Europe and internationally. In addition to its annual congress and certification program, ELMO hosts the podcast “Lifestyle in On Air” and publishes a patient-centered health care and professional education newsletter.

The 7th European Congress of Lifestyle Medicine

From September 10 to 12, 2026, ELMO will host the 7th European Congress of Lifestyle Medicine in Brussels, Belgium. In addition to English-language sessions, the congress features Dutch-language tracks focused on women’s health and French-language sessions dedicated to longevity. The French-language track is coordinated by Michel Poulain, one of the founders of the Blue Zones concept. Together with Gianni Pes, a medical surgeon and associate professor of Applied Dietetic Sciences at the University of Sassari, he identified regions with an exceptionally high number of healthy centenarians, including Ikaria (Greece), Okinawa (Japan), Sardinia (Italy), Nicoya (Costa Rica), Loma Linda (California), and more recently Martinique (France). These “Blue Zones” have become important sources of inspiration for longevity in good health and have earned global recognition thanks to the work of Dan Buettner, a renowned American explorer, bestselling author, and science communicator known worldwide.

The scientific evidence underpinning Lifestyle Medicine

A solid body of evidence supports the association between healthy behaviors and major disease outcomes. Foundational studies such as the Seven Countries Study, the Framingham Heart Study, Interheart, Interstroke, the Nurses’ Health Study, the Adventist Health Study-2, the Lyon Diet Heart Study, and the North Karelia Project consistently demonstrated the profound impact of diet, physical activity, smoking, weight management, and other lifestyle factors on health and longevity. Likewise, numerous intervention studies have shown that lifestyle changes can alter the pathophysiology of disease:

• Diabetes Prevention Program: an intensive lifestyle intervention reduced the incidence of diabetes by 58%.

• DiRECT Trial: structured weight management programs induced type 2 diabetes remission in many patients.

• DASH Trial: dietary modification significantly lowered blood pressure.

• DASH-Sodium Trial: reducing sodium produced additional improvements in blood pressure.

• Ornish Lifestyle Heart study: intensive lifestyle changes led to regression of coronary atherosclerosis.

• PREDIMED study: a Mediterranean diet enriched with olive oil or nuts significantly reduced major cardiovascular events.

• Exercise-based interventions: physical activity was about 3.5 times more effective than standard care in reducing liver fat measured by MRI, independent of weight loss.

• Large cohort studies (2019): cardiovascular risk declines within five years after quitting smoking.

The eight pillars of European Lifestyle Medicine

ELMO identifies eight essential pillars for European Lifestyle Medicine: the six pillars commonly promoted in the United States, plus sexual health and environmental and planetary health.

1) Nutrition

Nutrition is one of the most important determinants of metabolic health. Evidence-based dietary patterns can meaningfully contribute to disease prevention, treatment, and long-term health outcomes.

2) Physical activity

Regular physical activity improves cardiovascular fitness, insulin sensitivity, musculoskeletal health, mental well-being, and longevity. Exercise is increasingly recognized as a true therapeutic intervention.

3) Sleep health

Sleep plays a fundamental role in metabolic regulation, immune function, cognitive performance, and emotional well-being. Poor sleep quality is associated with an increased risk of chronic disease.

4) Stress management

Chronic stress contributes to inflammation, hormonal dysregulation, hypertension, anxiety, and unhealthy coping behaviors. Effective stress management strategies are therefore an essential component of Lifestyle Medicine.

5) Avoiding harmful substances

Cigarette smoke, excessive alcohol use, and substance abuse remain among the leading modifiable factors contributing to preventable disease and mortality worldwide.

6) Social connections

Social support and meaningful relationships are increasingly recognized as important determinants of both physical and mental health. Fostering and maintaining positive relationships contributes to well-being, psychological resilience, and quality of life.

7) Sexual health

Sexual health is a pillar introduced into European Lifestyle Medicine, inspired by the WHO recognition of sexuality as both a component of human health and a fundamental human right. The research increasingly shows that chronic diseases can be both a cause and a consequence of sexual dysfunction, which can serve as an early indicator of an underlying lifestyle-related disease. Additionally, sexual health needs of minority populations remain inadequately addressed, not only in routine visits but also in the management of chronic diseases. Infertility issues, increasingly common among younger couples without obvious organic pathology, are being linked more often to lifestyle factors. Lifestyle interventions can thus play a significant role not only in prevention but also in the treatment of infertility.

8) Environmental and planetary health

Environmental health is one of the two areas uniquely integrated into the European approach to Lifestyle Medicine. This pioneering perspective reflects the growing recognition of environmental factors (pollution, climate change, biodiversity loss, etc.) that influence the development of many chronic diseases. It also aligns with the broader concept of “One Health,” which emphasizes the interdependence of human, animal, and environmental health.

A patient‑centered approach

One of the defining features of Lifestyle Medicine is its patient-centered philosophy. Rather than focusing solely on disease management, Lifestyle Medicine seeks to understand the person behind the diagnosis and to support sustainable behavioral change through collaboration, empathy, and empowerment.

– Motivational Interviewing

One of the most valuable concepts in Lifestyle Medicine training is Motivational Interviewing (MI), a communication method developed by clinical psychologists Stephen Rollnick and William Miller. Initially used in substance use treatment, MI is increasingly applied to the care of patients with chronic diseases. It presents a challenge for healthcare professionals because it teaches them that patients themselves are the true experts in their own lives. Behavioral change therefore requires a different communication style, based on open-ended questions, active listening, and a nonjudgmental stance.

The healthcare professional becomes a facilitator of change, helping patients uncover and strengthen their internal motivation. This approach is reinforced by a compassionate and nonjudgmental attitude, which recognizes that behavioral change is influenced by socioeconomic, cultural, psychological, and environmental factors, including stress, trauma, and structural barriers to health.

Practical tools

A common misconception is that Lifestyle Medicine simply involves generic recommendations like “eat better” or “get more exercise.” In reality, it is built on structured, measurable, evidence-based clinical tools that help translate scientific knowledge into practical, personalized interventions that can be applied in daily life.

The 5A model

A widely used approach is the 5A model:

1. Assess the patient’s readiness to change and current health status.
2. Advise with clear, evidence-based recommendations.
3. Agree on collaboratively developed goals based on the patient’s preferences, priorities, and readiness to change.
4. Assist patients in setting goals and overcoming barriers.
5. Arrange follow-up and provide ongoing support.

This model provides healthcare professionals with a practical framework for behavioral counseling during clinical visits.

Lifestyle assessment tools

Lifestyle Medicine also employs validated assessment tools (dietary questionnaires, stress and mental health scales, etc.) to evaluate nutrition, physical activity, sleep quality, stress levels, smoking habits, and cardiometabolic risk. These assessments help turn general lifestyle discussions into objective, clinically relevant measurements.

• SMART goals

Behavioral change becomes more effective when goals are specific and realistic. Lifestyle Medicine frequently applies the SMART framework, whereby goals should be:

• Specific → Specific
• Measurable → Measurable
• Action Oriented → Action oriented
• Realistic → Realistic
• Time-based → Time-bound

Rather than telling a patient to “exercise more,” a SMART goal might read: “Walk 30 minutes, five days a week, for the next month.”

This approach improves adherence, clarity, and long-term sustainability

• Exercise prescription

In Lifestyle Medicine, physical activity is approached similarly to prescribing medications. Clinicians can structure recommendations around: frequency

• intensity
• time/duration
• type of exercise
• progression over time

For example, a sedentary patient with hypertension might begin with moderate-intensity walking sessions several times a week, gradually increasing intensity and duration based on tolerance and clinical response.

• Multidisciplinary collaboration

Lifestyle Medicine often requires interdisciplinary teamwork. Physicians can work alongside a range of health professionals (e.g., dietitians, psychologists, physical therapists, exercise specialists, etc.) to provide comprehensive care. This collaborative model reflects the need for chronic disease management to extend beyond isolated medical visits and require coordinated support across multiple dimensions of health.

The future of healthcare begins with lifestyle

Lifestyle Medicine represents both a return to the core principles of medicine and a modern, evidence-based clinical discipline. By integrating nutrition, physical activity, sleep health, stress management, behavioral support, social relationships, sexual health, and environmental awareness into care pathways, it aims to address the root causes of many chronic diseases rather than merely managing their consequences. ELMO was founded on this vision: to promote a scientifically rigorous, compassionate, patient-centered model of care that can improve individual health outcomes while contributing to the long-term sustainability of health systems. As the global burden of chronic disease continues to rise, Lifestyle Medicine offers healthcare professionals and patients a practical, evidence-based framework to create healthier lives, healthier communities, and more sustainable health systems.

Ioan Hanes’s personal experience, Vice-President of ELMO

The conversation took place one afternoon in a university clinic with a patient who was alone in her room. She presented with all the medical diagnoses we most commonly associate with lifestyle-related illnesses: obesity, type 2 diabetes, hypertension, and hyperlipidemia. The discussion began with the history and the physical examination, but at a certain point the patient’s main problem clearly emerged. She was in her fifties, and her greatest challenge was weight gain and the vicious cycle into which she had fallen. She felt ashamed of the episodes when she could not control her appetite and of not knowing how to adopt a healthy lifestyle. At the same time, clinicians often scolded her because they believed she wasn’t doing anything to change her situation. The cycle was simple: the more she felt unwell, the more she ate. At one point in our conversation, she burst into tears, and I watched powerless as she cried. I didn’t know what to say because, deep down, I had been blaming her as well. Why wasn’t she doing anything to lose weight and thus prevent obesity-related complications? Yet, when she asked me, “Doctor, what should I do? How should I eat differently? What kind of exercise should I do? What else can I do to lose weight?” I could only offer a few platitudes. I didn’t know how to respond because, beyond diagnosing and prescribing medications, I had learned very little else in medical school. Of course, I knew prevention mattered, especially through diet and activity. However, like many newly minted physicians, I didn’t have a real understanding of how to prescribe dietary interventions, what type of physical activity to recommend, how much, at what intensity, or whether there were other evidence-based recommendations for a healthy lifestyle. I didn’t know that lifestyle interventions could be a standalone treatment, or an essential part of treating chronic diseases linked to habits. This experience goes back ten years. Later, thanks to an introductory course at Harvard University, I discovered the concept of Lifestyle Medicine and learned that lifestyle interventions have a scientific basis. Ioan Hanes, Vice President of ELMO and Director of the ELMO Certificate, shares how the encounter with the patient changed his perspective.