Lifestyle Medicine Interventions Research Articles

Impact of Lifestyle Medicine Interventions on the Management of Systemic Hypertension in Primary Care: A Canadian Randomized Controlled Trial

The study aimed to evaluate the feasibility of implementing lifestyle interventions in primary care settings with hypertensive patients and their effect on blood pressure, body composition, cardiometabolic markers, and antihypertensive drug use. Sixty participants diagnosed with stage 1 hypertension were randomly assigned to 4 groups: (1) Standard medical care (control), (2) Physical activity protocol, (3) Dietary Approach to Stop Hypertension (DASH) diet, and (4) Combination of physical activity protocol and DASH diet. Participants received counseling from family physicians, nurses, kinesiologists, and registered dietitians. Various assessments were conducted before (T0) and after (T6) the interventions, including 24-h ambulatory blood pressure monitoring, blood and urine tests, anthropometric measurements, computed tomography to measure adipose tissue, submaximal exercise test to estimate maximal oxygen consumption and health questionnaires. Fifty-one (51) participants (51/57, 89%) completed the program. All interventions reduced blood pressure indices between T0 and T6, except the combined interventions group. Body composition and cardiometabolic parameters were improved in all groups, except for the control group. In total, 28% of participants (7/23) reduced or stopped their antihypertensive medications at T6. The results suggest that structured lifestyle interventions are feasible in primary care and improve blood pressure and cardiometabolic parameters in patients with stage 1 hypertension.

Effectiveness of a combined lifestyle intervention for older people in long-term care: A randomized controlled trial

PurposeLifestyle medicine interventions combining physical, nutritional, and psychological components have been found effective in general older population. However, evidence from the long-term care (LTC) is scarce. MethodsWe conducted a pragmatic, two-arm, parallel group, superiority randomized controlled trial. Residents living in a LTC facility for one or more years, able to discern and to express informed consent, and requiring nursing care were considered eligible. The three-months intervention combined bi-weekly physical exercise groups, a healthy diet, and weekly psychological wellbeing sessions. Patients of the control group were subjected to routine care. At the end of the study participants were assessed using Barthel Index, Katz Activities of Daily Living, and Tinetti scales. ResultsA total of 54 patients with a mean age of 84 years took part to the study. Physical exercise and psychological wellbeing sessions were mostly attended by all the subjects of the intervention group. Both groups took less calories than planned in the diets; in addition, the intervention group showed a lower energy and carbohydrates intake than the control group. At the end of the study, the intervention group showed a significant improvement in the total scores of all the scales. ConclusionsThis intervention was effective in improving functionality in older people living in the LTC setting. Results were achieved in a short timeframe, likely due to synergistic interactions between components. However, a further exploration of underlying factors is needed, to better understand the barriers that hampered a complete intervention delivery in this context.

Efficacy of a lifestyle intervention for elderly in long-term care: a randomized controlled trial

Abstract Background Long term care (LTC) services represent an important element of worldwide health systems, providing medical care and social services to thousands of elderlies. In this setting inadequate food consumption and lack of physical exercise represent major causes of mortality and morbidity due to malnutrition, sarcopenia, osteoporosis, and dehydration. While it has been acknowledged that these conditions are potentially reversible with proper lifestyle medicine interventions, the latter are rarely implemented and evaluated in LTC owing to their intrinsic complexity. Methods A randomized controlled trial was conducted to assess the effectiveness of a three-months combined food-physical exercise lifestyle intervention in elderlies living in an Italian LTC facility. The diet was designed to provide high levels of energy, proteins, leucine, and calcium. The physical exercise treatment was delivered two times per week, with a moderate to high effort requested to subjects. At baseline and at the end of the intervention subjects were evaluated using the Barthel Index, Activities of Daily Living, and Tinetti scales. Results 54 participants took part to the trial. At the end of the study the intervention group showed a significant improvement in all the scales. They burned 287 Kcal/week, significantly more than the control group. In contrast to the study protocol, they introduced 11% less calories than the control group. Conclusions This intervention has been proved effective in increasing functionality, with the beneficial effect that might be primarily attributed to the physical exercise, considering the low adherence to diet in the intervention group. This evidence supports the hypothesis that these interventions, despite the effectiveness, are complex to be powerfully implemented. While our results encourage the efficacy of lifestyle interventions in LTC, more studies are needed to deeply understand barriers and facilitators for an effective implementation. Key messages • This lifestyle intervention proved effective in improving functionality in institutionalized elderlies. • The low adherence to diet highlights challenges and complexities of lifestyle interventions in LTC.

S1725 Lifestyle Medicine Interventions Successfully Reduce Typical Symptoms of GERD in a World Trade Center First Responder Cohort

S1725 Lifestyle Medicine Interventions Successfully Reduce Typical Symptoms of GERD in a World Trade Center First Responder Cohort

The Use of Reframing: Increasing the Importance of Lifestyle Medicine.

Lifestyle behavior modification is an essential component to prevention and treatment of non-communicable diseases worldwide. For the last 40years, studies have recognized that there is suboptimal training of physicians in lifestyle medicine and its implementation in clinical settings. The lack of nutrition and exercise counseling occurring in the medical office does not reflect the high level of evidence supporting its use. Lifestyle behavior counseling is complex; as are the individualized needs of patients. Therefore, we suspect that the lack of knowledge in nutrition and exercise prescriptions are not the only barriers to providing optimal care. Reframing lifestyle medicine interventions like nutrition and exercise from adjunctive to central to treatment and reframing the role of the physician therein may be necessary to address important barriers to overall lifestyle behavioral counseling.

Relationship of Chronic Systemic Inflammation to Both Chronic Lifestyle-Related Diseases and Osteoarthritis: The Case for Lifestyle Medicine for Osteoarthritis.

Systemic inflammation is a root cause of lifestyle-related chronic diseases and may also play a role in the development and progression of osteoarthritis (OA). Lifestyle medicine seeks to treat, prevent, and reverse lifestyle-related chronic disease via 6 pillars: nutrition, sleep health, stress management, physical activity, social connections, and risky behavior avoidance/reduction. This article presents a review of the literature in which we assess the connections between the 6 pillars of lifestyle medicine, chronic systemic inflammation, and OA. We also discuss the whole-person approach that lifestyle medicine interventions can provide to reduce chronic systemic inflammation and affect the development or progression of OA.

Lifestyle Medicine Interventions to Manage Hypertension in Brazilian Patients With Type 2 Diabetes

Hypertension and type 2 Diabetes (T2D) are highly associated and can promote an additive risk of mortality and hospitalization, as well as a significant burden on the Brazilian Unified Healthcare System. Despite this, blood pressure and glycemic control are still suboptimal and remain a significant challenge in Brazil. As it will be reviewed in this paper, current evidence supports the effectiveness of various dietary, exercise, and lifestyle interventions for hypertension and T2D. Among dietary interventions, the DASH diet appears to be particularly effective in reducing blood pressure and decreasing the risk of cardiovascular mortality, with a moderate effect on glycemic control. Regular physical activity, including aerobic, resistance, or combined exercise programs, is also recommended to reduce blood pressure, improve glycemic control and also reduce cardiovascular disease risk. Stress reduction programs have also been shown to be effective in reducing blood pressure. However, although numerous lifestyle interventions are effective for hypertension and T2D, factors such as personal preferences, motivation, and cultural background should be considered to ensure the long-term sustainability of these interventions. In addition, there is a need for further research to determine the cost-effectiveness of lifestyle interventions in the Brazilian population to encourage the development of evidence-based health policies.

Patient-Reported Outcomes from a Pilot Plant-Based Lifestyle Medicine Program in a Safety-Net Setting.

Lifestyle medicine interventions that emphasize healthy behavior changes are growing in popularity in U.S. health systems. Safety-net healthcare settings that serve low-income and uninsured populations most at risk for lifestyle-related disease are ideal venues for lifestyle medicine interventions. Patient-reported outcomes are important indicators of the efficacy of lifestyle medicine interventions. Past research on patient-reported outcomes of lifestyle medicine interventions has occurred outside of traditional healthcare care settings. In this study, we aimed to assess patient-reported outcomes on nutrition knowledge, barriers to adopting a plant-based diet, food and beverage consumption, lifestyle behaviors, self-rated health, and quality-of-life of participants in a pilot plant-based lifestyle medicine program in an urban safety-net healthcare system. We surveyed participants at three time points (baseline, 3 months, 6 months) to measure change over time. After 6 months of participation in the program, nutrition knowledge increased by 7.2 percentage points, participants reported an average of 2.4 fewer barriers to adopting a plant-based diet, the score on a modified healthful plant-based diet index increased by 5.3 points, physical activity increased by 0.7 days per week while hours of media consumption declined by 0.7 h per day, and the percentage of participants who reported that their quality of sleep was "good" or "very good" increased by 12.2 percentage points. Our findings demonstrate that a lifestyle medicine intervention in a safety-net healthcare setting can achieve significant improvements in patient-reported outcomes. Key lessons for other lifestyle medicine interventions include using a multidisciplinary team; addressing all pillars of lifestyle medicine; and the ability for patients to improve knowledge, barriers, skills, and behaviors with adequate support.

Review article: Functional dyspepsia and pregnancy-Effects and management in a special population.

Around 10% of Americans meet the Rome IV criteria for functional dyspepsia (FD), with a significantly higher rate in women. FD also has a higher prevalence in women below the age of 50, suggesting that women who are affected are likely to be of reproductive age. Unfortunately, there is a lack of research or evidence-based guidelines on managing FD in pregnancy. To address this issue, we aimed to perform a systematic review of the interactions between FD and pregnancy and managing pre-existing FD in the peripartum and post-partum phases using current lifestyle, pharmacological, non-pharmacological and alternative medicine interventions. Due to the lack of Rome IV FD-specific data in pregnancy, we instead performed a narrative review on how existing FD interventions could be extrapolated to the pregnant population. Where possible we use the highest level of available evidence or official guidelines to answer these questions, which often involves synthesising treatment and safety evidence of these interventions in other diseases during pregnancy. Finally, we highlight current substantial knowledge gaps requiring further research for the safe management of a pregnant patient with pre-existing FD. Overall, despite the paucity of knowledge of treating FD during pregnancy, providers can mitigate this uncertainty by planning ahead with the patient. Patients should ideally minimise treatment until after breastfeeding. However, interdisciplinary resources are available to ensure that minimal-risk interventions are maximised, while interventions with more risks, if necessary, are justifiable by both the patient and the care team. Future investigations should continue to elicit the mechanistic relationship between FD and pregnancy while cautiously expanding prospective research on promising and safe therapies in pregnant patients with pre-existing FD.

Change in cardiometabolic risk factors in a pilot safety-net plant-based lifestyle medicine program.

Interventions emphasizing healthful lifestyle behaviors are proliferating in traditional health care settings, yet there is a paucity of published clinical outcomes, outside of pay-out-of-pocket or employee health programs. We assessed weight, hemoglobin A1c (HbA1c), blood pressure, and cholesterol for 173 patients of the Plant-Based Lifestyle Medicine Program piloted in a New York City safety-net hospital. We used Wilcoxon signed-rank tests to assess changes in means, from baseline to six-months, for the full sample and within baseline diagnoses (i.e., overweight or obesity, type 2 diabetes, prediabetes, hypertension, hyperlipidemia). We calculated the percentage of patients with clinically meaningful changes in outcomes for the full sample and within diagnoses. The full sample had statistically significant improvements in weight, HbA1c, and diastolic blood pressure. Patients with prediabetes or overweight or obesity experienced significant improvements in weight and those with type 2 diabetes had significant improvements in weight and HbA1c. Patients with hypertension had significant reductions in diastolic blood pressure and weight. Data did not show differences in non-high-density lipoprotein cholesterol (non-HDL-C), but differences in low-density lipoprotein cholesterol (LDL-C) were approaching significance for the full sample and those with hyperlipidemia. The majority of patients achieved clinically meaningful improvements on all outcomes besides systolic blood pressure. Our study demonstrates that a lifestyle medicine intervention within a traditional, safety-net clinical setting improved biomarkers of cardiometabolic disease. Our findings are limited by small sample sizes. Additional large-scale, rigorous studies are needed to further establish the effectiveness of lifestyle medicine interventions in similar settings.

Empowering People with Diabetes: Role of Continuous Glucose Monitor Systems.

Continuous glucose monitoring in a person with diabetes who is embracing lifestyle changes can be greatly impactful in numerous ways. There are many factors that have been identified to affect blood glucose, and for someone who may be implementing the six pillars of lifestyle medicine, their blood sugar may require closer monitoring. Lifestyle medicine interventions may lead to improved glucose levels or even remission. The continuous glucose monitor allows people to see glucose levels, trends, and how rapidly their glucose levels are rising or dropping, empowering them to make connections with how they feel and how their actions are impacting their blood sugar, as well as giving information about how medications may need to be adjusted or deprescribed. CGM, when appropriately used, can help determine how to best manage diabetes, optimize outcomes, minimize risks, and empower the person and healthcare team.

Implementing an Activity Tracker to Increase Motivation for Physical Activity in Patients With Diabetes in Primary Care: Strengths, Weaknesses, Opportunities and Threats (SWOT) Analysis.

Many projects related to technology implementation in the context of chronic diseases have been developed over the years to better manage lifestyle medicine interventions and improve patient care. However, technology implementation in primary care settings remains challenging. The aim is to carry out a strengths, weaknesses, opportunities, and threats (SWOT) analysis (1) to assess satisfaction among patients with type 2 diabetes using an activity tracker to increase motivation for physical activity (PA) and (2) to explore the research and health care team's perceptions of this technology's implementation in a primary care setting. A 3-month hybrid type 1 study, which included 2 stages, was conducted in an academic primary health center in Quebec City, Quebec, Canada. In stage 1, a total of 30 patients with type 2 diabetes were randomized to the intervention (activity tracker) group or the control group. In stage 2, a SWOT analysis was performed on both patients and health care professionals to determine the components of successful technology implementation. Two questionnaires were used to gather feedback: a satisfaction and acceptability questionnaire concerning an activity tracker (15 patients in the intervention group) and a questionnaire based on the SWOT elements (15 patients in the intervention group and 7 health care professionals). Both questionnaires contained quantitative and qualitative questions. Qualitative variables from open questions were synthesized in a matrix and ranked according to apparition frequency and global importance. A thematic analysis was performed by the first author and validated by 2 coauthors separately. The information gathered was triangulated to propose recommendations that were then approved by the team. Both quantitative (randomized controlled trial participants) and qualitative (randomized controlled trial participants and team) results were combined for recommendations. In total, 86% (12/14) of the participants were satisfied with their activity tracker use and 75% (9/12) felt that it incited them to stick to their PA program. The main strengths of the team members' perspectives were the project initiation and involvement of a patient partner, the study design, the team, and the device. The weaknesses were the budgetary constraints, the turnover, and the technical issues. The opportunities were the primary care setting, the loan of equipment, and common technology. The threats were recruitment issues, administrative challenges, technological difficulties, and a single research site. Patients with type 2 diabetes were satisfied with their activity tracker used to improve motivation for PA. Health care team members agreed that implementation can be done in primary care, but some challenges remain in using this technological tool in clinical practice regularly. ClinicalTrials.gov NCT03709966; https://clinicaltrials.gov/ct2/show/NCT03709966.

Investigating self-reported efficacy of lifestyle medicine approaches to tackle erectile dysfunction: a cross-sectional eSurvey based study

BackgroundErectile dysfunction (ED) is the most common sexual dysfunction in men. Some types of ED are amenable to treatment using lifestyle medicine approaches with or without pharmacotherapy.AimInvestigate self-reported efficacy of lifestyle medicine approaches to tackle ED.MethodsA cross-sectional online survey of 1177 community dwelling adults explored the prevalence and methods used to tackle ED in the community setting. We examined differences between participants with and without ED. Variables associated with ED in univariable analyses were included in a multivariable logistic regression to identify variables independently associated with the condition.OutcomesSelf-reported measure: perceived effectiveness of lifestyle medicine interventions to tackle ED.ResultsMost respondents (76.5%) had experienced ED, and this was associated with having a long-term condition, taking anti-hypertensive medication, hypercholesterolaemia and obesity. Medication was the most common management strategy overall (65.9%), followed by stress management (43.5%) and weight loss (40.4%). Over half (53.9%) did not use any lifestyle modification strategies to tackle ED. Only 7.0% of ED sufferers received a mental health assessment and 29.2% received other tests (e.g., blood test, medical imaging) by GPs. Cardiovascular training was identified as the best rated strategy by its users (37.8%). Supplements (35.1%) and weight training/physical activity (32.6%) were also positively rated.Clinical implicationsStructured education to general practitioners and community dwelling adults about the impact of lifestyle behaviour modification and how this could influence the appearance or trajectory of ED could help improve personal choice when tackling ED.Strengths and limitationsTo our knowledge, this is the first study to collect eSurvey responses from community dwelling adults to gauge their reliance and perceived effectiveness of lifestyle medicine approaches to tackle ED. The principal limitation was the lack of follow-up, and not recording other information including lifestyle factors such as nutrition, smoking, and the use of alcohol and recreational drugs, which may have enabled a fuller exploration of the factors that could influence the primary outcome measures examined.ConclusionDespite the high prevalence of ED, there is not enough awareness in the community setting about effective and low-cost lifestyle medicine strategies, including cardiovascular training and the use of supplements and weight training, to help tackle this common condition.

Implications of lifestyle medicine in medical practice.

Globally, we are seeing a rise in non-communicable diseases such as obesity, hypertension, diabetes, metabolic syndrome, chronic respiratory diseases, cancer, etc., due to stressful lifestyle in this competitive world. Most of the non-communicable diseases are associated with lifestyle behavior. Presently, the role of lifestyle medicine is very critical and important in the management of chronic lifestyle-associated disorders. Considering the above facts, we decided to review the literature to gain a deeper insight into the implications of lifestyle medicine in medical practice. A literature search was conducted on PubMed, Scopus and Google Scholar databases. We observed that lifestyle medicine intervention is a growing and newer discipline and is being employed along with conventional management of non-communicable diseases by medical practitioners today, as they are strongly associated with lifestyle behaviors and practices. Motivation for change in lifestyle is challenging because it depends on the patient's determination and eagerness to adapt and accommodate to the newer lifestyle pattern. The medical practitioners should spend time in coaching patients on lifestyle-related health education. Guidance and coaching by medical practitioners will help patients adapt to practices of maintaining regular physical activity, a balanced diet, good sleep hygiene, and avoid addictions of tobacco and alcohol as part of life. Introducing real and progressive evidence-based behavioral changes to reduce the risks of lifestyle-related acute and chronic diseases in medical practice will reduce the burden of non-communicable disease.

Back to Basics: Lifestyle Interventions for Adolescent Depression.

After completing this activity, practitioners will be better able to:• Discuss and better understand the recently adopted screening standards for adolescents with depression and the potential advantages of using "lifestyle medicine"• Set up a process for providing effective interventions for the increased number of patients with adolescent depression• Design or update their toolbox of treatment options for adolescents with depression based on the new literature and increased demand. Recently adopted quality standards recommend that pediatricians screen adolescents for depression and that they document follow-up plans for those who screen positive. As a result of these new recommendations, pediatricians and other pediatric providers, as well as psychiatrists and other mental health professionals, may face an increasing number of referrals and a growing need for effective interventions for adolescent depression. Given the widely acknowledged scarcity of traditional mental health resources, the current study reviewed the rapidly expanding array of evidence-based, but nontraditional, interventions applicable to outpatient pediatric and mental health care settings. Many of these interventions come from a lifestyle medicine framework. Lifestyle medicine interventions are congruent with the cultures of pediatrics and outpatient psychiatry, and offer additional evidence-based tools for providers managing adolescent depression. These interventions can be implemented individually or within group or community settings, and may be used in conjunction with more common interventions such as psychotherapy or psychotropic medications.

Teaching and learning lifestyle medicine during COVID-19: how has living during a pandemic influenced students’ understanding and attitudes to self-care and population health? A qualitative analysis

BackgroundIn 2019 a new Lifestyle Medicine (LM) module was introduced to the undergraduate medical curriculum at Imperial College London. Lifestyle Medicine is an emergent discipline which aims to tackle the increasing burden of non-communicable disease. Previous work has suggested that students value clinical teaching over traditional Public Health topics. Taking a constructivist view of learning, this paper assesses changes in medical students’ attitudes towards Public Health and LM in response to living through a pandemic. We then make suggestions as to how this lived experience might be useful in teaching LM, and discuss the interaction between teaching, behaviour, and experience with consideration of self-determination theories in learning.MethodsFirst-year medical students were surveyed at the end of their first year of teaching and asked if living during the COVID-19 pandemic had changed the value they place on LM and if so, how. Thematic analysis was conducted on responses representing 71% (n = 216) of the year group.ResultsFour themes were defined in the data: acknowledging importance; impact on behaviour; health inequalities and the wider determinants; and promoting Public Health and prevention. These themes highlight the distinct levels through which the pandemic has had an impact: from personal behaviour to population health.ConclusionsThis is the first study to look at the impact of living through a pandemic on attitudes to LM. Our results suggest that the pandemic has led to increased reflection on health behaviours. The lived-experience of COVID-19 may facilitate a better understanding of health inequalities and their impact, alongside the opportunities presented by effective LM interventions.

Do Medical Students Appreciate Lifestyle Medicine and Are They Confident in Their Skills?

As the prevalence of chronic diseases increases worldwide, there is a need for educating future physicians in the use of lifestyle medicine to treat and prevent diseases. Any addition to the undergraduate medical curriculum requires a strategic educational approach with consideration for efficiency. This study aims to identify priorities for lifestyle medicine interventions in the undergraduate medical curriculum. Third-year medical students (N=115) were surveyed on their beliefs about lifestyle medicine and their confidence in lifestyle medicine skills. The survey consisted of seven items to which students responded with how closely they agreed via a 5-point Likert scale. Descriptive statistics were reported. Most medical students entering their clinical years understand the value of lifestyle medicine in patient care (100%) and want to learn the skills and knowledge involved (98.2%). The value of lifestyle medicine counseling skills during the limited patient-doctor time was least universally acknowledged among third-year medical students (93.9%). Third-year medical students are most confident in being able to obtain a comprehensive lifestyle history (3.6±0.8) and least confident in setting clear, personalized, lifestyle change goals (3.1±0.9). Future interventions to increase confidence in lifestyle medicine skills should focus on educating students on setting lifestyle change goals, personalizing prescriptions, and motivational interviewing for use in clinical care.

The Time is Now For Lifestyle Medicine: Lesson From Lifestyle Medicine Leaders.

The time is NOW for Lifestyle Medicine. In this review based on a presentation at the American College of Lifestyle Medicine (ACLM) 2021 annual conference, ACLM Current President Cate Collings, MD, Immediate Past-President Dexter Shurney, MD, and President Elect Beth Frates, MD, share insights on the current state of lifestyle medicine (LM). Interest in LM has greatly advanced in the face of disruptions from the COVID-19 pandemic, expanded educational opportunities in the field, and a rapidly changing healthcare landscape. With growing access to virtual care, advancing technologies, growing emphasis on home-based chronic care, continuing corporate healthcare mergers and acquisitions, and widening adoption of personalized, patient-empowered treatments, the time is ripe for LM interventions to move to the mainstream. As health investments and costs skyrocket, and new players enter the scene, traditional models of payments, reimbursements, and incentives are slowly being upended. Companies and healthcare systems are finally recognizing the scientific evidence and powerful but undervalued potential of LM to accelerate healthy outcomes while controlling costs. Taken together, the lessons from the COVID-19 pandemic, the growth in LM educational opportunities, and the evolving "business of medicine landscape" signal that the time for lifestyle medicine is NOW.

Lifestyle Medicine Interventions for Personal and Planetary Health: The Urgent Need for Action.

The deterioration of planetary health-from threats such as climate change, environmental pollution, biodiversity loss, and ocean acidification-are a growing hazard to the foundation of health and the "healthspan." For those with chronic conditions-a large and growing subset of the global population-the health dangers are even greater. Climate change is a threat to the very pillars of lifestyle medicine that we rely on to prevent and manage chronic disease. Already, the planetary crisis is limiting our ability to prescribe healthy nutrition, safe outdoor physical activity, stress management strategies, social connection, restorative sleep, and toxic substance avoidance. In this article, we discuss the proceedings of our workshop at the American College of Lifestyle Medicine (ACLM) annual conference LM2021, "Lifestyle Medicine for Personal and Planetary Health." We examine how lifestyle medicine (LM) interventions are a prescription for individual, community, and planetary health. Our prescriptions work to not only restore the health of individuals and families, but also to bolster health equity while allowing us to mitigate and adapt to the health impacts of the planetary crises.

Diabetes remission after a lifestyle-medicine intervention on type 2 diabetes in lean and obese Chinese subjects: a prospective study.

Whether diabetes remission still happened among non-obese type 2 diabetes (T2DM) patients with a body mass index (BMI) <25 kg/m2 following lifestyle-medicine interventions was quite necessary to be reported because many diabetes happened with normal or low BMI in China. The criteria for subject inclusion: <20 years after T2DM diagnosis, ≥6 months treatment with oral anti-diabetic drugs, without serious complications, and no history of insulin use. They were divided into two groups: the obesity group (BMI ≥25 kg/m2) and the lean group (BMI <25 kg/m2). All subjects received the following lifestyle-medicine interventions: stopping oral anti-diabetic therapy, initiating a low-carbohydrate (contributing by 35-40% to calorie intake) diet for the first month (gradual transition to a normal diet for the next 5 months), participating in resistance and aerobic exercise, and receiving strengthen management. Diabetes remission was defined as glycosylated hemoglobin (A1C) level <6.5% (<48 mmol/mol) after 6 months of not taking any anti-diabetic medications during the lifestyle-medicine intervention. Finally, 125 individuals completed the lifestyle-medicine intervention in the prospective study. The efficacy and safety of lifestyle-medicine intervention were assessed and compared between lean and obese Chinese subjects with T2DM. We found that 64.52% of the T2DM subjects in the obese group and 60.64% of T2DM subjects in the lean group achieved diabetes remission [i.e., an A1C level <6.5% (48 mmol/mol)] without any anti-diabetic medications after the 6-month lifestyle-medicine intervention. Our multiple linear regression analysis showed that decreases in the fasting plasma glucose (FPG) level had the most powerful effect on decreases in the A1C level after the intervention (R2=0.3072). Lifestyle-medicine interventions may have increased effectiveness in controlling mild T2DM as compared with the oral antidiabetic-based treatment; unexpectedly, there seems no further improvement in lean relative to obese patients. Three in five subjects could achieve diabetes remission though the lifestyle-medicine intervention regardless of whether their BMI was below or above 25 kg/m2.