Dear colleagues and friends,

The Russian novelist Fyodor Dostoevsky said once, “There is only one thing that I dread: not to be worthy of my sufferings”. 2020 was a challenging year and I think 2021 will be too. But if we support each other then I think we can turn this darkness into something worthy of that suffering. More than ever we need to come together, support each other, revitalise our spirits, and work energetically towards fundamental change. ASLM is the fertile ground where we can do exactly that.

Fortunately, despite the massive challenges, ASLM has grown from strength to strength in 2020. We had more new Fellows and Board Certified practitioners in 2020 than all previous years combined. We created our first foundational course in Lifestyle Medicine, aptly titled Lifestyle Medicine First Aid, as part of a suite of online courses to come. And membership continues to grow rapidly despite the disruption.

We have also partnered with multiple major universities, research institutes and healthcare organisations on some very significant initiatives to bring Lifestyle Medicine into modern clinical practice. Furthermore, we look forward to soon announcing a range of new projects and task forces that will continue to advance our mission.

For 2021, I am particularly excited about our Lifestyle Medicine in Practice and Lifestyle Medicine Locals initiatives, where our members will work with local communities to bring Lifestyle Medicine genuinely and proactively “to life” in a myriad of innovative and fun ways.

I suspect our growth is because we are reaching a crossroads; a point where the health profession is beginning to notice Lifestyle Medicine (though we are still in our infancy in my opinion), and then quickly realise that Lifestyle Medicine is a solution to multiple problems, including improving patient outcomes and practitioner burnout.

The demand and need from the public is so great, and the practice of Lifestyle Medicine so rewarding and rejuvenating for both therapist and patient. The economic benefits are also becoming more clear, the need on a social and planetary scale even more obvious, and the hope and renewed energy provided by such solutions is outweighing the counterforces. Now is a perfect time to join or become an even more active member.

For you as individuals, now is more important than ever to practice what we preach. Eat whole foods, move often and in a way you love or that makes you feel great, dance to music, sing to songs, love those around you and accept the love towards you, sleep regularly and well, connect with nature, listen to your intuition, meditate and relax, and ideally, use less social media.

Part of this process, at least for me, is to review how I spend my time and what I truly, deeply care about. It may take hours of reflection, talking and writing. Then, remove what is not in line with your deeper values, and add what is. Life will always be just a series of moments – what do you want the result of those moments to be? A risk of this process is going too far, stressing out too much about “I need to make a difference” (a problem I have struggled with for many years!) such that it degrades your own body-mind-spirit. Buddha once said, “an instrument string too tight will break, a string too loose will produce no sound”. So, finding that balance is what 2020/21 is about. Make your song, make it beautiful, but feel a healing in the process.

As far as “the system” goes, what fundamental change do we need to see? It would take me many hours to summarise and reference all I think about this topic, so I will have to give you the ultra-brief version. We are now entering an era where we have two choices. The first choice is to sit back and continue “business as usual” and assume it will get better, aka denial. Denial is both effective for mental therapy to relieve internal despair, but also the main reason we are in this mess in the first place. For too long we have watched the growing wealth-power gap going unchecked, the degradation of the natural world continuing unacceptably, the emptiness and competing interests of our leaders going unchallenged. The second choice is to “step up”, to dedicate free time and energy towards a fundamental confrontation and evolution in our health care system and the other systems that impact health, such as the social, environmental, economic and political systems. My genuine hope is that ASLM provides a ground for the birth and nurturing of the next generation of change-makers in health and society that are more than desperately needed.

Frustratingly the divide between certain groups persists, but I think may be starting to dissolve, at least within the society. The most common divides I experience as president of ASLM are between vegan and low-carb advocates, between traditional medical folk who, without any real knowledge of Lifestyle Medicine, assume that there is little practical role for it, or assume that it must be complementary or alternative, and finally the idea that Lifestyle Medicine is only focussed on the individual’s behaviour. I am tired of these, I really am. To answer these points so briefly as to be risky:

• Diet wars: Whether vegan or low-carb, what does the ‘plate’ actually look like? Most of the time they are near identical: all whole and fresh as possible food; about 50%+ above-ground and varied plants and the remaining 50% a combination of whole food and healthy forms of plant or animal protein, fat and/or whole-grains, preferably sourced if possible from regenerative farming practices, local farms etc. I think the debate is literally about less than 25% of the plate and really needs to be culturally inclusive. Obviously, healthy dietary patterns and dietary prescriptions (to restore health) are different things. Dietary prescriptions may need to be very specific to achieve the desired effect, but ideally, like dietary patterns, should take into account biopsychosocial-cultural and spiritual requirements. Done. Can we please move on? As far as I am concerned, we should all be working together, supporting each other against the far greater powers such as “big food” and bad science. If you are vegan, get involved with ASLM, if you are low carb, get involved with ASLM. And the same goes for everyone in-between.

• Traditional pharmaceutical and procedural medicine and Lifestyle Medicine: In almost all clinical guidelines, the first intervention recommended is ‘lifestyle advice’. Lifestyle Medicine teaches how to do this in efficient and effective ways, which is important because this is not taught in standard medical education. Yet failing to deliver on effective lifestyle advice is borderline negligence, especially when the weight of evidence for lifestyle intervention across a wide range of conditions is profound. Further, the loss of trust in medications and health professionals is part of a wider problem – a crisis of confidence in the health system. One in which attitudes from some sections of medicine like “it’s all nonsense if it isn’t drugs or surgery” ironically pushes more people towards online pseudoscience in search of answers outside of what their doctors tell them. I too am frustrated by the rise of pseudoscience and online gurus but it is a symptom of a problem, for which Lifestyle Medicine is a solution. I am seeing more and more patients present to my clinic deeply angry at health professionals for not offering anything more than medications to their problems. I can recount many cases of patients who have put their metabolic, cardiac, autoimmune, mental health disorders into remission through Lifestyle Medicine, sadly often with no assistance from their healthcare professional. What an embarrassment.

• The scope of Lifestyle Medicine: The Lifestyle Medicine model of health and disease considers proximal (lifestyle factors) and distal determinants (social, ecological, economic, political) as per below. It has since the beginning. How could we possibly look at changing health behaviour without considering the drivers of that behaviour – the social, environmental, economic and political determinants, they are so vitally important to address.