Session Spotlight: Diet, Nutrition, and Exercise—for Patients and Psychiatrists

Diet, nutrition and exercise are crucial tools in promoting recovery for patients—and that means mental health professionals need to adopt a healthy lifestyle too.

“For physicians, practicing a healthful behavior oneself is the most consistent and powerful predictor of physicians counseling patients about related prevention issues,” Jonathan Burgess, M.D., M.P.H., clinical assistant professor of psychiatry at Stanford University, said during an Annual Meeting session on “Lifestyle of Well-Being: Getting Smart About Physical Activity and Healthy Diet for Both Psychiatrists and Their Patients.”

“Whatever you do will likely be what you talk to your patients about,” Burgess said.

Burgess described “culinary medicine,” which uses diet as a foundational treatment in cardiometabolic diseases and psychiatric disorders. Culinary Medicine Teams often include a registered dietitian, a chef, and a medical provider. “Psychiatrists may provide psychoeducation on the mechanism and efficacy of dietary interventions for psychiatric disorders,” he said.

He noted that the Teaching Kitchen Collaborative is an organization of international participants of culinary medicine at major academic hospitals and businesses.

Michael Compton, M.D., M.P.H., a professor of psychiatry at Columbia University who owns a farm in upstate New York, discussed food insecurity, which is common among low-income psychiatric patients. “Imagine you are a single mom, it’s Tuesday night, you have two kids, payday is Friday, it’s time to put dinner on the table—but you have an empty fridge,” Compton said.

He noted that the U.S. Department of Agriculture conducts a large-scale, nationally representative survey every year that has found that 11 to 12% of U.S. households are food insecure. The rate varies across states and is more common in households headed by Black non-Hispanics and Hispanics and among those with income levels near or below the poverty level.

“It starts as a financial problem but ends up as a health care problem related to obesity and diabetes,” Compton said. “We know also that food insecurity likely worsens course, treatment response, and outcomes among those with existing mental illnesses.”

He shared a one-question screening tool: “In the past month, was there any day when you or anyone in your family went hungry because you did not have enough money for food?” For patients who answer yes, he responds with a series of follow-up questions, including:

• How many meals do you eat per day?
• Do you have variety in your diet (different fruits, vegetables, grains, and proteins daily)?
• How often do you eat fast food? How often do you eat chips, cookies, sweets, or candy? How often do you drink soft drinks, sodas, or sweetened tea?

Douglas Noordsy, M.D., director of the Lifestyle and Sports Psychiatry Initiative at Stanford University School of Medicine, emphasized the neurobiological effects of physical exercise. These include upregulation of neurotrophic factors, neuroprotection, neuroplasticity and neurogenesis, increased blood flow to the brain, and formation of new capillaries.

Noorsday referenced a 2017 meta-analysis in Schizophrenia Bulletin that showed that exercise significantly improved global cognition, with greater amounts of exercise being associated with larger improvements in global cognition. Exercise significantly improved the cognitive domains of working memory, social cognition, and attention/vigilance.

Finally, Stanford’s Ruth Case, M.D., described the American College of Lifestyle Medicine’s Lifestyle Medicine Residency Curriculum (LMRC), a virtual curriculum that prepares residents to become certified lifestyle medicine diplomates. The LMRC consists of both educational and practicum components. Its educational component includes 40 hours of interactive virtual didactic material along with 60 hours of application activities designed to be completed over one to three years. The practicum component includes 400 lifestyle medicine–related patient encounters, 10 hours of intensive therapeutic lifestyle change program experience, and 10 hours of group facilitation experience.

Upon completion of the curriculum, residents qualify to sit for the American Board of Lifestyle Medicine certification exam. ■

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