Lifestyle medicine: A tool for health creation and equity

In 2025, only 46% of adults in Canada met the recommended 150 minutes of moderate to vigorous physical activity per week. Although physical activity is a leading modifiable risk factor for many chronic diseases and all-cause mortality,[1] physicians do not regularly prescribe exercise to patients.[2] Doctors of BC’s Council on Health Promotion has long supported exercise as medicine,[3] but this can be expanded to include a more holistic approach of lifestyle medicine.

Lifestyle medicine is an evidence-based clinical discipline guided by six pillars to prevent, treat, and reverse chronic conditions: whole-food plant-predominant nutrition, physical activity, restorative sleep, stress management, positive social connection, and substance use avoidance.[4] When implemented with sufficient intensity and support, lifestyle medicine can support meaningful reductions in cardiovascular disease, type 2 diabetes, obesity, and other noncommunicable diseases. Many of the pillars can be adapted to different cultural contexts. Social connection is foundational in many cultural worldviews, including for Indigenous Peoples, who consider belonging and kinship to be integral to health.[5]

In Canada, lifestyle medicine is situated in a population health framework that recognizes the interaction between individual agency and structural determinants. Lifestyle medicine is most powerful when its influence shifts from helping individuals make better choices to informing the design of systems that make healthy choices possible: accessible, affordable, and culturally meaningful. Despite Canada’s comparative wealth, federal and provincial data consistently show that income, housing stability, food security, geography, racism, and access to primary care are social determinants from which chronic disease risk increases.[6]

Although it is easy to mention the six pillars to patients, patients must feel empowered to make behavioral changes that are sustainable and life-lasting, increasing their health span rather than merely prolonging the years lived. In addition, without attention to health inequities, lifestyle medicine can inadvertently reinforce stigma or “lifestyle blame,” particularly among communities facing systemic barriers.

Lifestyle medicine is not just for the wealthy; everyone deserves access to it.[7] The pillars of lifestyle medicine must be equitable.[8] Reimagining the pillars as a bridge between health-based clinical care and community well-being is a tool for creating healthy communities.

Rather than assuming that patients affected by adverse social determinants of health are neither willing nor able to attempt behavior modifications, clinicians should have conversations with patients about the powerful outcomes of even small lifestyle changes, meeting them where they are, identifying solutions together, and providing referrals to community-based organizations with resources to help.[9] This requires community engagement, cultural competency, and the application of multilevel and intersectoral approaches.[8] All physicians, regardless of our field, should be advising patients on essential health practices and, most importantly, taking this good advice ourselves.
—Eileen M. Wong, MD, CCFP, FCFP
Council on Health Promotion Member
—Katharine McKeen, MD, MBA, FCFP
Council on Health Promotion Chair

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This article is the opinion of the authors and not necessarily the Council on Health Promotion or Doctors of BC. This article has not been peer reviewed by the BCMJ Editorial Board.

References

1.    ParticipACTION. Key statistics. Accessed 16 February 2026. www.participaction.com/the-science/key-facts-and-stats.

2.    Laberge S, Gosselin V, Lestage K, et al. Promotion of physical activity by Québec primary care physicians: What has changed in the last decade? J Phys Act Health 2024;21:508-518. https://doi.org/10.1123/jpah.2023-0379.

3.    Solmundson K. Is current medical training preparing physicians to prescribe exercise to their patients? BCMJ 2018;60:170-171.

4.    American College of Lifestyle Medicine. What is lifestyle medicine? Accessed 5 March 2026. https://lifestylemedicine.org/about-lifestyle-medicine.

5.    Indigenous Primary Health Care Council. A wholistic and strength-based approach for measuring health and wellness: Considerations for public health indicators. March 2025. Accessed 5 March 2026. https://iphcc.ca/wp-content/uploads/2025/03/Public-Health-Indigenous-Indicator-Framework.pdf.

6.    Public Health Agency of Canada. Social determinants of health and health inequalities. Modified 18 July 2024. Accessed 5 March 2026. www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html.

7.    Collings C. Lifestyle medicine: Not just for the wealthy. MDedge. 7 October 2024. Accessed 5 March 2026. www.mdedge.com/content/lifestyle-medicine-not-just-wealthy.

8.    Duplantier SC, Barach R, St. John S, et al. Equitable access to lifestyle medicine: FQHCs, YMCAs, trauma-informed health coaching, and “community as medicine.” Am J Lifestyle Med 2025;19:1092-1100. https://doi.org/10.1177/15598276251325799.

9.    Krishnaswami J, Sardana J, Daxini A. Community-engaged lifestyle medicine as a framework for health equity: Principles for lifestyle medicine in low-resource settings. Am J Lifestyle Med 2019;13:443-450.