Community-Engaged Lifestyle Medicine as a Framework for Health Equity: Principles for Lifestyle Medicine in Low-Resource Settings

Lifestyle risk factors, including tobacco and alcohol use, poor nutrition, and inactivity, comprise the leading actual causes of death and disproportionately affect diverse, lower-income and vulnerable populations. Fundamentally influenced by social determinants of health (including poverty, social linkages, food access, and built environment), these "unhealthy lifestyle" exposures perpetuate and sustain disparities in health outcomes, stealing years of healthy and productive life for minority, vulnerable groups. The authors call for implementation of a health equity framework within lifestyle medicine (LM). Community-engaged lifestyle medicine (CELM) is an evidence-based, participatory framework capable of addressing health disparities through LM, targeting health equity in addition to better health. CELM was developed in 2015 by the University of Texas Rio Grande Valley (UTRGV) Preventive Medicine Residency program to address lifestyle-related health disparities within marginalized border communities. The framework includes the following evidence-based principles: community engagement, cultural competency, and application of multilevel and intersectoral approaches. The rationale for each of these components and the growth of CELM within the American College of Lifestyle Medicine is described. Finally, illustrative examples are provided for how CELM can be instituted at micro and macro levels by LM practitioners.