For Extra Protection From COVID's Worst Effects, Look to Lifestyle Medicine | Opinion

One encouraging result of the devastating COVID-19 pandemic is that it has elevated public awareness of the crisis of chronic disease—those underlying conditions so often associated with worse outcomes—and the urgent need to address it.

Six in 10 U.S. adults have a chronic disease and 4 in 10 have two or more, many of them lifestyle related, according to the U.S. Centers for Disease Control and Prevention (CDC). Fortunately, for those looking to make positive lifestyle behavior changes, the growing field of lifestyle medicine can help them achieve their goals and improve their health.

Research has established a relationship between lifestyle-related health conditions and severe illness from COVID-19. One study concluded that lifestyle risk factors in combination such as smoking, physical inactivity and obesity accounted for up to 51 percent of severe COVID-19 cases. An underlying chronic disease can put people at 12 times greater risk of dying from COVID-19.

The American College of Lifestyle Medicine (ACLM) focuses on six pillars of lifestyle—nutrition, physical activity, restorative sleep, stress management, social connections and avoidance of harmful substances—that contribute to chronic diseases. Lifestyle medicine clinicians support patients in making personalized lifestyle behavior changes as a means to treat, prevent and even reverse many diseases such as obesity, diabetes, or heart disease.


Eating patterns exist on a spectrum. At one end is the standard American diet with its ultra-processed, fast- and fried foods. It is associated with increased risk of type 2 diabetes, heart disease, obesity and other lifestyle-related chronic diseases.

On the other end of the spectrum are eating patterns such as a whole-food, plant-predominant diet. This eating pattern is associated with decreased risk of chronic diseases such as type 2 diabetes.

Studies have shown that eating patterns based on intake of whole fruits and vegetables combined, along with substantially lower sodium intake, can reduce blood pressure, sometimes with the same potency of medication.

Physical Activity

Regular physical activity improves cardiovascular fitness, reduces blood pressure and blood glucose, controls weight and prevents obesity and decreases the risk of heart disease, hypertension, depression and even some cancers.

Runners at sunset
Runners at sunset. Nick Wilson/Getty Images

Research suggests regular physical activity such as at least 150 minutes a week of moderate exercise supports immune function. The more physical activity, the more benefit, but any amount of exercise is better than none.


Sleep can play an important role supporting immune system defenses. A National Health and Nutrition Examination Survey study of almost 23,000 patients found that those who slept five hours or less at night reported more colds and infections than those who slept seven to eight hours. Insufficient sleep is also associated with increased risk of hypertension, obesity, type 2 diabetes and anxiety.

Avoidance of Unhealthy Substances

According to the CDC, during the first six months of the pandemic, 13 percent of Americans reported starting or increasing substance use as a way of coping with stress or emotions related to COVID-19. It is known that tobacco use and drinking too much alcohol increases the risk of many chronic diseases.

The American Heart Association recommends that if you don't drink, don't start. If you do drink, the guidelines are one drink for a woman and two drinks for a man in a day.

Stress Management

Some stress is helpful if it motivates or energizes you to accomplish challenging goals. However, distress or negative stress can cause your health to deteriorate, especially if the stress is chronic and you lack healthy coping mechanisms. Research demonstrates that meditation can reduce blood pressure.

Social Connections

The COVID-19 pandemic has shown many of us how much we crave connection. Not being able to celebrate holidays with family and friends was a challenge. Now greeting loved ones with hugs is treasured.

Social connections have long been linked to longevity and relationships affect physical, mental and emotional health. Health-related measures like blood pressure and heart rate improve even with short, positive social interactions.

You don't have to address these lifestyle behaviors alone. The number of lifestyle medicine-certified clinicians is growing rapidly. Since the American Board of Lifestyle Medicine and ACLM launched the first certification exams in 2017, the total number of certified diplomates has grown to nearly 2,800 across North America. Diplomates reflect the entire care team, from physicians, nurses and physician assistants to other clinicians such as registered dietitians, physical therapists, pharmacists, health coaches and more.

By embracing the potential of lifestyle medicine now, we can reduce lifestyle-related chronic disease, protect ourselves from the most severe effects of COVID-19 and be better prepared to withstand pandemics of the future.

Dr. Beth Frates, MD, FACLM, DipABLM, is a faculty member at Harvard Medical School and president-elect of the American College of Lifestyle Medicine.

The views expressed in this article are the writer's own.