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Transcultural Lifestyle Medicine

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Creating a Lifestyle Medicine Center

Abstract

Cultural factors – language barriers, beliefs, values, education, psychosocial aspects, availability of food, eating patterns, physical activity behaviors, and socioeconomic status, among others – are potent modifiers of the response to lifestyle interventions. Ideally, lifestyle medicine interventions must be based on the best evidence available and culture must be recognized and effectively incorporated in the health system. Transcultural medicine – a component of precision medicine – includes ethno-cultural elements in the dynamic encounter between a healthcare professional and a patient. Effective evidence-based interventions result from the transculturalization of information from one culture to another. This is a stepwise process that involves clinical practice guidelines, transcultural adaptation, implementation, and finally outcomes, which are followed. The transcultural adaptation process applies ecological validity model dimensions. The transcultural Diabetes Nutrition Algorithm (tDNA) – a portable tool developed to facilitate the delivery of lifestyle modifications and nutrition therapy to people with prediabetes and type 2 diabetes in different countries and cultural settings – is an example. Various approaches to lifestyle medicine using the chronic disease model are discussed. The components to prepare a Lifestyle Medical Center to provide transculturalized care are presented. These culturally sensitive elements include staff and communication strategies that consider cultural competence knowledge, attitudes and skills, infrastructure/services, information/software, and important administrative/organizational aspects. A formal survey to capture relevant social determinants of disease is critical for every patient encounter. Clinical examples weave through the discussion: an Arab patient evaluated by a Hispanic doctor in a healthcare center in Miami, a Japanese patient evaluated in Brazil for diabetes risk screening, and an African American female referred to a lifestyle medicine center in the USA. These case studies are platforms to deliver didactic applications of transcultural concepts.

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Change history

  • 19 November 2020

    J. I. Mechanick, R. F. Kushner (eds.), Creating a Lifestyle Medicine Center, https://doi.org/10.1007/978-3-030-48088-2

Abbreviations

BMI:

Body Mass Index

DPP:

Diabetes Prevention Program

EVM:

Ecological Validity Model

FEV1:

Forced Expiratory Volume first second

FINDRISC:

Finland Diabetes Risk Score

FVC:

Forced Vital Capacity

HCP:

Healthcare Professional

MNA:

Mini Nutritional Assessment

NHANES:

National Health and Nutrition Examination Survey

SDOH:

Social Determinants of Health

T2D:

Type 2 Diabetes

tDNA:

transcultural Diabetes Nutrition Algorithm

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Authors and Affiliations

  1. LifeDoc Health, Memphis, TN, USA

    Ramfis Nieto-Martínez

  2. Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA

    Ramfis Nieto-Martínez & Juan P. González-Rivas

  3. Foundation for Clinical, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela

    Ramfis Nieto-Martínez & Juan P. González-Rivas

  4. International Clinical Research Center, St Anne’s University Hospital, Brno, Czech Republic

    Juan P. González-Rivas

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  1. Ramfis Nieto-Martínez
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Editors and Affiliations

  1. The Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, and the Division of Endocrinology, Diabetes and Bone Disease Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Jeffrey I. Mechanick

  2. Departments of Medicine and Medical Education, Northwestern University, Chicago, IL, USA

    Robert F. Kushner

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Nieto-Martínez, R., González-Rivas, J.P. (2020). Transcultural Lifestyle Medicine. In: Mechanick, J.I., Kushner, R.F. (eds) Creating a Lifestyle Medicine Center. Springer, Cham. https://doi.org/10.1007/978-3-030-48088-2_19

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