Transcription:
What is a Healthy Lifestyle Really?

Maggie McKay: We all know the basics of a healthy lifestyle as adults: eat healthy, exercise and get enough sleep. But is that all there is to it? And what is lifestyle medicine? Our guest today is Dr. Claudia Dal Molin, Assistant Professor, Director of Musculoskeletal Ultrasound Education, University of Maryland School of Medicine and sports medicine expert with a passion for lifestyle medicine at University of Maryland Medical Center. She'll talk about what is a healthy lifestyle really.

Welcome to the Live Greater podcast series, information for a Healthier You from the University of Maryland Medical System. Thank you so much for being here today. I am dying to dig in and learn how to improve our healthy lifestyles. I think it's safe to say that everyone wants to be healthy, but it's also probably safe to say that what that means is different for everyone. So how would you define health or how our listeners should think of health to find their own definition and what is really important?

Claudia Dal Molin: Well, I think that maybe the definition of health should be different for everyone. But instead, maybe we work to acknowledge some fundamental truths to health and then try and find our own individual journey to get there. So, there's types of different health that you can think about. There's physical health, mental health, spiritual health, and social health. And the journey and approach that people have towards their health that I find is what can be individualized. So, it's important to find a way that works for your life, your personality, your priorities and beliefs, and even your medical conditions.

Maggie McKay: Where does lifestyle medicine come into play and what is it?

Claudia Dal Molin: Lifestyle medicine is actually a newer medical specialty and it uses lifestyle interventions as a primary way of treating chronic conditions. There are six pillars that are acknowledged in lifestyle medicine, and they are nutrition, which is a whole food plant-based approach; exercise, sleep hygiene, stress management and mental health, social connection and support, and then avoiding risky substances.

Maggie McKay: What does that mean to live a balanced life?

Claudia Dal Molin: So, I think if we look at those pillars, I think balanced really means looking at that in even proportions where no one area gets too far out of hand.

Maggie McKay: And how do you and your patients decide on goals and paths to meet those goals?

Claudia Dal Molin: Well, first, I start with common denominator goals. So, goals that really everyone should have, and believe it or not, when you look at fad diets, there are common themes even through them. So once you establish what common denominator goals really everyone should work on, then it comes to identifying individual goals.

So, these are person-specific challenges that folks may have. That might be knowledge, that might be skills, that might be habits and behavior. So think reprogramming or that could be planning an organization and sort of scheduling your life. My approach is, first, I take a really thorough medical history. I go over your medications, allergies, food intolerances, and even lab work. Once I have a good understanding of that basic starting place, then we get into knowledge. So, it's important to teach people the right things, but also to make sure that they understood that. And then, we work on that application and implementation of that knowledge, making sure that not only is it well understood, but is it being implemented the way that I mean. Past that, then we get into life logistics, so schedules; people's environments, both at home and at work; and even food preferences, cultural preferences. We work on things one at a time, though

Maggie McKay: Is there such a thing as being totally healthy? What should the goal be?

Claudia Dal Molin: I think there is a thing such as being totally healthy, and I think if you look at different metrics of measuring health across different domains, you could see how someone could achieve total health. So that might be lab work that is normal, that might be good vital signs, good blood pressure. That could actually be a healthy weight, especially when it comes to taking care of your joints. That could be your waist circumference. We know that a healthier waist circumference is great for cardiovascular health and reduces cardiovascular risk. There could be musculoskeletal health. So are you experiencing symptoms? Do you move in a way that prevents injuries? And are you strong enough to protect yourself against them? This could also come down to do you have healthy habits? So, how often do you exercise? How often do you pay attention to healthy food, whole foods plant-based? Do you get a good night's sleep and do you sleep on a schedule? How good are you at dealing with stress and what tools do you use to do that? All of that can be considered when you're talking about total health.

Maggie McKay: And what's the difference between a lifestyle approach and some other weight loss approaches like seeing a nutritionist, commercial diets, gastric bypass, pre-op process, et cetera?

Claudia Dal Molin: So I think you're starting to see with lifestyle medicine, it is a much more comprehensive approach as we work through those domains or those pillars, those different areas of health. One of the biggest pieces here with working in lifestyle medicine is incorporating disease management and medical care into the process. So it's really holistic to be able to also look at labs, medicines, and even make referrals when it needs to be made. That makes it a very multidisciplinary approach if and when it needs to be. My approach is usually more intensive. I meet weekly or biweekly with my patients, and this is more supervision, more accountability, but also a way of helping people correct mistakes if they're having trouble along the way.

With a nutritionist as an example, my understanding is that patients see them less frequently, usually on a monthly basis or even every other month. Other domains aren't always addressed and there's limited disease management. And I have also found that there isn't always an emphasis on whole food plant-based approach to food. I've seen a lot of supplemental shakes being recommended for patients.

In terms of commercial diets, many of them are not very comprehensive, and they certainly don't take any chronic diseases or medical practice into account. Also, the level of change all at once that they typically ask you to do is a lot, and it doesn't usually occur with a lot of coaching or handholding.

Then, if we look at the bariatric approach, that definitely is typically multidisciplinary. You usually have a lot of different types of experts and doctors working in a team to help the patient. That approach though doesn't always give people behavioral skills to have long-term success. There is a certain percentage of people that do experience regaining of their weight, and it usually has to do with not nipping behaviors and other challenges in the bud before surgery. Also, the emphasis is not always whole foods or plant-based and, obviously, that approach comes with surgery.

Maggie McKay: What's the difference between seeing a lifestyle medicine physician and a lifestyle coach?

Claudia Dal Molin: So a lifestyle medicine physician is a doctor, and like I mentioned before, can provide comprehensive lifestyle coaching and care, but also medical care. So, they have four years of college, four years of medical school, three years of residency usually and, depending on the type of fellowship or specialty, one to three years of that. So there's a lot of education that goes into it.

With a health coach, they're allowed to provide people general wellness advice and nutritional info, but they are not allowed to diagnose disease states or advise on how to treat disease states, and they certainly aren't allowed to chime in in terms of medical treatment there. There's no license requirement for being a health coach, but there are certifications that exist and it can take as little as three months or up to a year to get that certification depending on where it comes.

Maggie McKay: And what are the advantages of this approach compared to other approaches?

Claudia Dal Molin: I think a comprehensive approach is fundamentally a great one. I'm certainly passionate about a comprehensive approach because my own priority and intention with my patients is to give them skills that they can take with them for the rest of their life. I like the ability of integrating medical care with extensive training into the process, so not only being able to identify diseases that the patient didn't even know they had, but to also identify maybe some psychiatric factors that are at play that might be better addressed formally instead of ignoring or pushing through them. And as a doctor, I have the power to direct that care and get help when we need it and help my patient navigate that process too.

Then, depending on someone's background and training, there's additional knowledge of nutrition that comes with that fellowship training. So usually, there's an opportunity to do that in sports medicine, obesity medicine, and lifestyle medicine. Personally, with the background in sports medicine that I have, I also find it helpful to be able to identify injuries, direct rehabilitation of those injuries and then be able to transition to functional athletic activity. That is something that is bread and butter for a sports medicine physician, and certainly very similar to what we do with athletes all the time.

Maggie McKay: What things can people do on their own, books to read, apps, websites to visit?

Claudia Dal Molin: There's a lot of information out there, and that's almost part of the problem. I think a lot of people struggle with sorting information out on their own. There's just so much information on the internet and not all of it is true. So, a great example of that is diets or even people that believe in demonizing carbohydrates or demonizing gluten and dairy across the board. Those certainly are not hard and fast rules. While they might be important for certain patients, isn't true across the board.

Maggie McKay: And what would you like people to take away from this conversation?

Claudia Dal Molin: Everyone's journey is different. We all live different lives and have different needs. There are some fundamental truths that can't be avoided, but the approach can be tailored to work for you.

Maggie McKay: Thank you so much. You've given us a lot to think about and so many good ideas to start integrating into our daily lives. It's been a pleasure.

Claudia Dal Molin: Likewise. Thanks so much for having me.

Maggie McKay: Find more shows just like this one at umms.org/podcast. Thank you for listening to Live Greater, a health and Wellness podcast, brought to you by the University of Maryland Medical System. We look forward to you joining us again. And if you found this podcast helpful, please share it on your socials and check out our entire podcast library for topics of interest to you.