Lifestyle Medicine: Of Pillars and Pistons, Constructs and Connotations

Lifestyle Medicine espouses a framework dividing the field among 6 “pillars:” optimal nutrition, physical activity, restorative sleep, stress management, connectedness, and risky substance avoidance. Pillars, however, though lending support to a common structure, do not interact—they stand apart. Repair to one damaged pillar does nothing to fill the cracks in another. The domains of lifestyle medicine do interact, however, in ways of practical importance to clinician and patient alike. The mismatch between the verbal imagery of a pillar and operational reality of a self-propagating chain reaction has implications for medical practice and personal behavior that make this a matter of more than semantic importance. We make the case that a framework evincing the interactions among the lifestyle medicine domains has the potential to facilitate uptake of relevant practices by showcasing a generally overlooked auto-catalysis and economy of scale. We contend that “pillars” do not reliably and fully convey the value proposition of lifestyle medicine, and suggest some suitable alternatives.