In a unified effort to optimize service member readiness, and overall health, before, during and after service, medical leaders across the Military Health System met Feb. 29 to March 1 for the Air Force Medical Service’s inaugural Lifestyle and Performance Medicine summit.

Hosted at the Defense Health Headquarters in Falls Church, Virginia, subject matter experts shared the progression of forming new healthy habits and the lasting positive impact that a change in lifestyle has across physical, mental and emotional well-being of the active duty member, but also the extent of these effects on their families and communities.

The role L&PM on Great Power Competition

Brig. Gen. James Parry, Medical Operations acting director for the Air Force Surgeon General, opened the three-day summit, which was held in-person and virtually for about 400 attendees.

“When we think about great power competition, we want our Airmen and Guardians to be spiritually, mentally and physically ready,” Parry said.

Lifestyle medicine is a medical specialty that focuses on lifestyle interventions within six areas: nutrition, physical activity, stress management, sleep quality, social connections, and avoidance of risky substance use.

“When we optimize this hexagon, we optimize for posture and readiness,” Dr. Regan Stiegmann, L&PM physician and former Air Force flight surgeon, said.

Stiegmann emphasized the evidence-based success of lifestyle and performance medicine on current human optimization goals to target prevention, treatment, and in some cases, reversal of chronic diseases.

The first day’s keynote speaker, father of Aerobics and former Air Force lieutenant colonel, Dr. Kenneth Cooper, supported the recognition of lifestyle choices as a significant factor in achieving a holistic approach to an individual’s health.

“The most underappreciated risk factor for physical and mental health known to man is lifestyle. No drug can replicate the benefits of an active lifestyle,” Cooper said.

Subject matter experts throughout the summit cited case studies in which a combination of providing lifestyle counseling, whole food plant-based dietary choices, regular aerobic exercise and improving access to nutritional and health resources have led to an overall optimized quality of life among service members.

According to lifestyle medicine practitioners, including Maj. Valerie Bedsole, 480th Intelligence, Surveillance and Reconnaissance Wing Group Surgeon, Joint Base Langley-Eustis, Virginia, and Col. Mary Anne Kiel, Chair, Air Force Lifestyle & Performance Medicine Working Group, other like-minded medical personnel are vying for this approach to be at the forefront of patient care.

Since the endorsement of Lifestyle and Performance Medicine by the Air Force Medical Service in 2021, it has provided a pathway for individuals to cultivate self-interest in their personal health, and become proactive with forming and sustaining preventive lifestyle choices that will greatly contribute to optimized health.

“There is a need to understand human behavior, what people value so we can better communicate, encourage them to aspire for change, set goals, and eventually form healthier habits over time,” Lt. Col. Dan Cassidy, Interim Commander, 37th Human Performance Squadron, Lackland Air Force Base, Texas, said during his presentation on how to shift military health culture starting from behavioral change at the individual level.

Despite family history that may suggest greater susceptibility to certain chronic conditions or risky substance use, much can be mitigated through early lifestyle prevention with nutrition, exercise and, most importantly, creating a built environment in which healthy lifestyle is supported.

Overcoming patient barriers as lifestyle practitioners

During the second day of the summit, guest speakers highlighted the significance of recognizing patient barriers to achieving health-related goals and how medical practitioners can equip themselves in providing holistic, long-term solutions.

With growing support from medical leaders and practitioners, the implementation of L&PM within the Military Health System is seen as a strategic opportunity to optimize for medical readiness by equipping medical personnel with the appropriate training and establishing a culture of holistic approach to health.

Keynote speaker and director of the Lifestyle Medicine Program at George Washington University, Dr. Brad Moore, spoke of embracing lifestyle medicine as medical practitioners to better support patients and exemplify its benefits. Within his role at George Washington University Hospital, he shared how the new Lifestyle Medicine curriculum that he helped establish in September 2022 has led to the elective gaining popularity among medical residents, many of whom have opted to become board certified.

Moore, along with guest speakers Dr. Michael Jarka and Megan Amadeo who represented Defense Health Agency partnerships in primary care and Armed Forces Wellness Centers, shared the viewpoint that a lifestyle-oriented mindset is vital to becoming more patient-centered and focusing on quality of care within the Military Health System.

Across AFWCs in the country, monthly health assessment risks with self-reported goals, habits, stress management, and nutrition, paired with personalized health counseling for clients – all of which exemplify a lifestyle-oriented approach, have seen drastic improvements in client health.

“What we’re really looking for is to optimize their health, improve their health literacy, and sustain behavioral change,” Amadeo said.

With more military health practitioners incorporating lifestyle medicine in their patient care, the more traction they hope to gain from senior leadership in standardizing these practices.

The future of Lifestyle & Performance Medicine

Day three opened with Dr. Michael Malanoski, deputy director of the Defense Health Agency, who gave a preview of future health care delivery for the services.

“What we want to be as a health care system is to be patient-centric focused on health and treatment of the individual,” Malanoski said.

Currently, the Military Health System is based on a fee for service model. The first phase of change began with five pilot primary care sites where patient-centric focus is being rolled out, in which patients are given a pre-deployment health assessment that is then monitored and updated on a monthly basis throughout their active duty service.

The second phase is to create a digital mobile app that will allow patients to engage with scheduling visits, obtaining medical information, viewing lab tests, and eventually having access to various health coaches. The third phase involves establishing separate IT and data platforms that support personalized care for each service.

“It is a fundamental change in culture.” Malanoski said. “For this to succeed, we need the entire enterprise to sense when they fall back on old practices that do not support tailored care.”

Throughout the last day of the summit, attendees heard from speakers who shared successes of their practical applications of L&PM at their Air Force installations.

At Travis Air Force Base, Lt. Col. Joseph Sky, Chief, Preventive Cardiology, David Grant Medical Center at Travis Air Force Base, California, had pitched the integration of L&PM in 2001, and eventually incorporated this approach into his behavioral medicine practice. Now, L&PM is an elective for medical residents at the base and exists as a pathway for board certification.

“About 50% of family physicians across the tri-services were reporting less than very confident in delivering lifestyle medicine,” he said. “The future direction is developing and formulating a tri-service curriculum similar to lifestyle medicine established at Travis Air Force Base.”

Air Force Surgeon General, Lt. Gen. Robert Miller and Chief Master Sgt. Dawn M. Kolczynski, Chief, Medical Enlisted Force, concluded the summit by recognizing the urgent need for L&PM practices.

“I understand that this is about great power competition, but it’s about the future after the military as well,” Kolczynski said. “If we can be prevention-focused, we can help people form good habits. Though everything doesn’t have to be perfect, and we recognize that.”

Miller spoke on collaborating with the DHA on health care delivery with a focus on readiness, and emphasizing the need for medical practitioners to keep bringing attention to L&PM to garner traction.

“The way we start is by best using resources we have today and then standardizing as much as possible. And let the results speak for themselves,” Miller said. “Our message is getting out there when commanders are noticing these changes.”