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Trinity Health Ann Arbor Hospital in Ypsilanti, Michigan, creates groundbreaking programs that connect the medical facility with the community. Nearly 15 years ago, a hospital-based farm was constructed on our campus that received national attention and continues to provide patients and families with life-changing access to fresh produce, community connectedness and education.

Through collaborative planning, our hospital's leadership team then approved the creation of a forward-thinking service line, Lifestyle Medicine, in 2021. The service line provides access to evidence-based education and empowers individuals and communities to improve their health.

A medical subspecialty that has existed for about two decades in the U.S., lifestyle medicine uses information in six key pillars to treat, reverse and prevent chronic illness and promote whole-person health.¹ The six pillars are: a whole-food, plant-predominant diet; physical activity; avoiding risky substances; attaining restorative sleep; positive social connections; and healthy stress management. These pillars are not just foundational for supporting the absence of disease; they are critical for one's mental, physical and emotional flourishing.

TAKING A BROADER APPROACH TO WELL-BEING
Trinity Health Ann Arbor's Lifestyle Medicine service line began during the COVID-19 pandemic when many people were simply trying to hold it together and the ability to thrive seemed unattainable. During this time, we noticed many staff, patients, friends and family struggling with sleep issues, an increase in food and substance consumption to manage stress, feelings of isolation and shifts in routines, which led to more sedentary lifestyles.

As the connection between chronic conditions and poorer COVID-19 outcomes became stronger, people began looking for skills, tools and resources to take charge of their health and prevent or reverse chronic disease. At the same time, many people were looking for a new relationship with health care that took a broader view of health and well-being.

Our Lifestyle Medicine service line was designed to help address these needs. The service line was developed and is currently led by American College of Lifestyle Medicine board-certified practitioners. Our programs empower participants with the knowledge and reproducible skills needed to form sustainable healthy habits in each lifestyle medicine pillar area. When practiced consistently, these skills and habits propel patients on their path toward whole health.

We deliver whole-person care through a variety of programs to staff and community members looking to treat, prevent and reverse chronic disease. These programs have a high satisfaction rate, reach more than 1,600 people per year and have resulted in a positive impact on mental health, consumption of fruits and vegetables, HbA1C (one's average level of blood sugar over the past two to three months) and blood lipid profiles, among other demonstrable successes.

As positive psychology is an underlying theme of lifestyle medicine, these programs compassionately meet participants where they are and provide nonjudgmental care that allows patients to feel comfortable and seen. This approach to care strongly aligns with the Health Care Improvement Quintuple Aim (which defines the role of health care in society)² of better health outcomes, lower cost, improved patient satisfaction, improved provider well-being and advancement of health equity.

PRIORITIZING STAFF WELL-BEING
Health care providers are dedicated to delivering exceptional care to their patients but often do not prioritize their own health and well-being. This was particularly evident during the pandemic, when the need seemed more palpable than ever for evidence-based, easy-to-access resources that provided staff with the knowledge and skills to sleep better, nourish their bodies with healthy foods, connect with each other and find positive ways to manage stress.

To help meet this need, we developed and launched the Lifestyle Medicine Intensive series, a 12-week deep dive into all six pillars of lifestyle medicine that includes not only the "why" behind the evidence-based habits recommended for participants, but also the "how." The series takes sometimes complicated science and distills it down into concrete, achievable actions and provides skill-building opportunities — including culinary medicine sessions — so participants have the confidence and know-how to turn the recommendations into reproducible, everyday habits. As they practice these habits consistently, they actively work toward a state of thriving and flourishing, which is demonstrated in the positive impact on objective measures like weight, lipid panels and HbA1C, as well as behavior change metrics like increased fruit and vegetable intake, number of exercise days and duration of sleep.

Last year, we developed our Lifestyle Medicine Huddle series to make it easy for all hospital leaders and their teams to learn about and practice evidence-based self-care techniques. These take place during teams' previously scheduled huddle times and are led by registered dietitians certified in lifestyle medicine with the goal of providing quick, experiential and evidence-based activities, including opportunities to move, stretch, participate in guided breathing work and practice gratitude. In a survey of participating staff, all agreed that lifestyle medicine huddles increased their knowledge of evidence-based self-care techniques, and nearly 90% of employees have changed or are considering changing their self-care habits due to the huddles.

These huddles also provide an opportunity to promote the staff's whole health and well-being by connecting them to additional Trinity Health and local well-being resources, which complements Trinity's Live Your Whole Life integrated well-being strategy. The six pillars of lifestyle medicine also align with the Live Your Whole Life strategy, and many of our programs have been approved for the initiative's points that colleagues can accumulate to keep their insurance costs down.

Nearly 90% of participants say the classes have improved their confidence in the kitchen and have encouraged them to try new plant-based foods.

WHOLE HEALTH FOR THE WHOLE COMMUNITY
The community programs of Trinity Health Ann Arbor Hospital's Lifestyle Medicine service line align with Trinity Health's mission to be a "transforming healing presence within our communities" and serve vulnerable populations who are experiencing poverty. Programs are developed and refined based on community needs, and creative solutions are implemented to ensure they are accessible to everyone, regardless of income and insurance coverage.

The service line's flagship community program is the six-week Foundations of Lifestyle Medicine series, which recently became available quarterly. Participants learn the evidence-based "why" behind each of the six pillars of lifestyle medicine and how to translate this information into skills they can easily adopt in their daily lives.

To reduce barriers to participation, the program is fully virtual. Lifestyle Medicine-certified registered dietitians lead the class, and it is billed through medical nutrition therapy. While this billing structure supports the program's sustainability, it also presents a barrier to participation for underinsured patients and those on Medicare or Medicaid. To address this, we are advocating for better state and federal reimbursement policies and are working to establish a scholarship so all patients can access this information.

The most popular of our community programs is the free, monthly Cooking with Plants culinary series.³ Initiated last year, the series broadly shares approachable, budget-friendly strategies for turning whole, plant-based ingredients into delicious meals. The fully virtual series is open to anyone, anywhere, at no cost and imparts viewers with the skills, strategies and confidence to add more health-promoting foods to their daily meals. Nearly 90% of participants say the classes have improved their confidence in the kitchen and have encouraged them to try new plant-based foods. Physicians regularly refer patients to these classes, and the series is used to meet community education requirements for accreditation of several hospital programs.

For youth ages 5–18 and their families, we have Healthy Families, an evidence-based program that takes a multidisciplinary, whole-family approach to addressing childhood obesity. Participants join in one-on-one appointments and eight weeks of group classes, held once a week, which are taught by a team of dietitians, a behavioral health specialist and an exercise physiologist. Classes are offered in-person and virtually to families across southeast Michigan, and scholarships are available so no family is turned away.

Healthy Families is in high demand due to its impactful results. Youth participants reduce their screen time, increase their fruit and vegetable intake and daily exercise, and develop better communication skills and stronger self-esteem. The curriculum is currently being refined to expand the program to other Trinity Health locations.

In its fifth year, our Nutrition Buddies program pairs food-insecure middle schoolers with medical resident physicians for four weeks of culinary nutrition education, a week of camp and social support. Residents provide participating youth with mentorship, social connection and the modeling of positive health behaviors. This contact also offers residents social connections and a deeper understanding of the social determinants of health.

All participants of Nutrition Buddies receive a weekly box of produce from the Farm at Trinity Health Ann Arbor and the ingredients to prepare weekly recipes. Roughly 25,000 pounds of food have been distributed through the program. Each young participant also receives their own culinary kit with all the needed supplies to prepare home-cooked meals. After participating in this program, residents and their young partners see an improvement in their mental health scores and dietary intake. The program is offered twice a year and is free for all participants.

BETTER TOGETHER
Collaboration is foundational to the success of the Lifestyle Medicine service line. Strong referral partnerships exist with our oncology and gastrointestinal surgery departments, and the lifestyle medicine board-certified dietitians work closely with the program's physician partners, hospitalists Dr. Rebecca Daniel, chief of staff, and Dr. Eugene Liu, CME director and the director of the Lifestyle Medicine residency curriculum, to develop new lifestyle medicine opportunities.

The partnership with Drs. Daniel and Liu was critical for the successful launch of the Nutrition Buddies program and is also responsible for our new Lifestyle Medicine residency curriculum. The curriculum further extends our collaborative efforts by preparing residents for lifestyle medicine board certification through experiences across the hospital in a variety of departments that take a lifestyle medicine approach to disease treatment and reversal.

In addition to clinical partnerships, we have developed a strong relationship with Trinity Health Ann Arbor's Food and Nutrition Services team to elevate the pillars of lifestyle medicine and highlight the delicious, nutritious meals they bring to life each week. Recently, this collaboration resulted in the permanent installation of an educational lifestyle medicine display in a highly trafficked area outside the hospital's cafe. We are also partnering to develop a labeling system that will easily identify the whole, plant-forward meals available across the hospital campus.

THE FUTURE OF LIFESTYLE MEDICINE
Lifestyle medicine is a growing field that is gaining popularity as health care continues to move toward a values-based, patient-centered care model. We continually receive requests to expand services to provide disease-specific education and support to other service lines. For example, the Oncology Department would like us to expand access to education aimed at preventing cancer recurrence, and senior health advocates would like us to add programs to help prevent cognitive decline and support caregivers.⁴

Additionally, we regularly adapt programs and services based on community needs. Trinity Health Ann Arbor Hospital's most recent community health needs assessment revealed mental health and maternal and infant health as community priorities. As such, all lifestyle medicine programs will be assessed to determine how they can best support these community concerns.

The registered dietitian lifestyle medicine practitioners who lead this service line are committed to reaching as many people as possible. Accomplishing this goal requires creative solutions to current barriers of limited space and technology and poor reimbursement. We are quickly outgrowing our current office and education space, and the process has begun to identify a new teaching kitchen and classroom location. A new location will allow us to reach more patients, staff and community members, improve the physical and virtual accessibility of programs, and create more opportunities for collaboration across the hospital.

In addition, many insurance companies do not cover disease prevention, treatment and reversal program costs. The current reimbursement model still favors procedures, medications and even hospitalization. To address these barriers, we are actively advocating for improved state and federal policies.

Recently, we provided a continuing medical education series to registered dietitians across Trinity Health, and we continue to serve as a resource for the system's other regional health ministries planning to begin or scale lifestyle medicine programs. The team is committed to finding a way to bring these topics and best practices to Trinity Health's regional health ministries across the nation, which will result in healthier communities empowered by knowledge and improved agency to make better lifestyle choices.

For more information about the Trinity Health Ann Arbor Lifestyle Medicine program, visit trinityhealthmi.org/thaalifestylemedicine or email the team at [email protected].

At Trinity Health Ann Arbor Hospital in Ypsilanti, Michigan, ABIGAIL McCLEERY is colleague lifestyle medicine and wellness coordinator. LISA McDOWELL is director of preventative nutrition and wellness. KELLY WILSON is lifestyle and culinary medicine program coordinator.

NOTES

1. "Six Ways to Take Control of Your Health," American College of Lifestyle Medicine, https://lifestylemedicine.org/wp-content/uploads/2023/06/Pillar-Booklet.pdf.
2. "The Quintuple Aim: What Is It and Why Does It Matter?," CHESS Health Solutions, https://www.chesshealthsolutions.com/2023/08/01/the-quintuple-aim-what-is-it-and-why-does-it-matter/.
3. "2024: Cooking with Plants Registration," Trinity Health, https://forms.office.com/Pages/ResponsePage.aspx?id=GeaRDSxKgEy5WY_fUY5S6FNQPNMw309EnG6-1FcoIt5UNUc3RTdNQ1laMDhOTDZFTTlQRUVLOUo5SSQlQCN0PWcu.
4. "Lifestyle Medicine for Older Adults," Vimeo, https://vimeo.com/showcase/10989456.