Column
Lewiss on Lifestyle Medicine
Lewiss on Lifestyle Medicine
Key takeaways:
- PCPs are uniquely positioned to help patients achieve healthier lives through lifestyle medicine.
- Lifestyle medicine does not require perfection. It starts with partnering with patients to design healthier lives.
The “primary” care physician — as suggested by the word — is designed and meant to be a first-contact health care professional.
This person should provide care that is continuous, comprehensive and coordinated with specialists. Primary care improves population health, contains health care costs and reduces health disparities.
PCPs focus on prevention, as well as the early detection, diagnosis and treatment of acute and chronic diseases.
The primary care and lifestyle medicine connection is easy to see. This is ground zero for doctors and patients to co-design a health plan focused on the science-based specialty and its principal pillars: food is medicine, movement and exercise, stress reduction, restorative sleep, being in community, and avoiding harmful substances.
When I speak with physicians, the two pillars they find the most challenging for themselves are restorative sleep and decreasing baseline stress. The reason is multifactorial: perfectionism, a culture of always saying yes to every opportunity, the taboo of seeking support and treatment for mental health, the shift work design of many specialties, the sleep deprivation required in residency, and the sleep deprivation pattern that continues afterward.
I recently caught up with Lucy McBride, MD, a PCP who has spent 25 years in primary care, first in Baltimore, where she completed training at Johns Hopkins, and is now in Washington, DC. She has been practicing there for over 20 years.
Lucy incorporates lifestyle medicine science into her patient care. In speaking with her, I realized the extent to which she truly partners with her patients to design healthier lives based on their unique medical issues and goals. Before talking about her office practice, I asked Lucy about her personal lifestyle medicine habits.
Lewiss: On which pillars do you focus for you and your health?
McBride: I love this question, partly because the honest answer is humbling. I’ve practiced medicine for 25 years, and I still don’t do any of this perfectly — nor do I try to. Perfectionism is its own kind of harm.
The pillar I lean on hardest is community. Being in relationship — with my family, my friends, my patients — regulates my nervous system more than any supplement or tracker ever could. When my younger brother died suddenly and unexpectedly in July 2024, it was my community that made me feel whole.
Movement is my second nonnegotiable, but not the way optimizing culture means it. I don’t move to hit a number. I move because it’s the most reliable tool I have for my own mood and anxiety. Walking outside with friends is my go-to, but I also walk alone because walking is when I get my best thinking done. Yoga is an essential part of my life, too, for the breathwork and stretching myself out.
Lewiss: Which pillars do you find most challenging?
McBride: The pillar I have to actually work at, because my own wiring makes it hard, is getting enough rest and sleep. I’m someone who lives with a noisy brain and the constant push to do more, so this is lifelong maintenance, not a box I’ve checked.
The place I give myself the most grace is food. I’ve been open about my history with disordered eating in college, which is exactly why I hold “food as medicine” loosely. The goal for me isn’t a “perfect” diet; it’s listening to what my body needs and enjoying the pleasure of feeding it well.
The point, for me, isn’t to nail all six pillars. It’s noticing which pillar needs support at any given time and meeting those needs without perfectionism.
Lewiss: You describe anxiety as something dynamic and something we all have. Say more about your take on anxiety and the human condition?
McBride: The No. 1 risk factor for anxiety is being human. It’s built into our DNA for a reason — it kept our ancestors alert to genuine danger, and it still reminds us to pay our taxes and look both ways when we cross the street. A little adrenaline is adaptive. The trouble starts when anxiety takes on a life of its own and causes emotional, physical or behavioral problems.
Anxiety lives on a continuum. Each of us has a baseline — are you generally a 3 out of 10, where things that rattle other people roll off you? Or a 9, where your alarm fires louder than the actual threat? We all travel up and down that scale depending on what life throws at us.
Lewiss: It is kind and refreshing the extent to which you normalize anxiety. What is your approach with patients in the office?
McBride: So, the question I ask patients isn’t “Do you have anxiety?” It’s “Where’s your baseline?” and then “How far up do you climb under stress? How much does it interfere with your sleep, your relationships, your ability to function? And what brings you back home?”
Two patients capture the range. One came to me certain that her stomach symptoms were “all in her head,” because seven specialists had told her so — and it turned out she had Crohn’s disease. Her anxiety wasn’t irrational; it was appropriate, flagging something real that had been missed. Another patient cycled through seven specialists for headaches, palpitations and tremors that were, in fact, anxiety wearing physical disguises. A screening questionnaire would’ve missed both of them.
That’s why I don’t aim to stamp anxiety out. The work — and it’s lifelong — is calibrating your vigilance to your actual risk and building a coping kit you can reach for when you climb the scale. The goal isn’t an anxiety-free existence. It’s “right-sized” anxiety.
I believe in the role primary care plays in your health span and in your lifespan. A PCP will ensure you get life-saving vaccinations, screening examinations for cancer, referrals to specialists and education on lifestyle medicine behaviors you can implement.
*Editor’s note: In next month ’ s column, Lewiss and McBride focus on GLP-1 medications .
For more information:
Resa E. Lewiss, MD, DipABLM, is a lifestyle medicine and emergency medicine physician. She is an adjunct professor of emergency medicine at the Warren Alpert Medical School of Brown University. She produces and hosts The Visible Voices Podcast and is the coauthor of the leadership book MicroSkills: Small Actions, Big Impact. She can be reached via her website resaelewissmd.com.
Lucy McBride, MD, is a Harvard and Johns Hopkins trained PCP. She is the author of Beyond the Prescription: A Doctor’s Guide to Taking Charge of Your Health. She can be reached at info@lucymcbride.com.
Lewiss on Lifestyle Medicine
Sources/Disclosures
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Disclosures:
Lewiss and McBride report no relevant financial disclosures.
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