Early in her career, Cate Collings studied and worked in exercise physiology in a lab, testing Olympic athletes one day and cardiac patients the next. Between the two, the remarkable recovery of cardiac patients through exercise fascinated her the most. At age twenty-eight, she began medical school and eventually specialized in cardiology.
“My day-to-day practice was, of course, prescribing and titrating medications, seeing patients in the hospital, ordering tests, and so forth,” Collings recalls. “I realized at the time that even though I walked the walk and talked the talk and my patients knew me to be an advocate for lifestyle, there was very little I could get across in a clinical encounter in the office. Just providing patients with lifestyle counseling or education was insufficient. There needed to be healthcare system change to provide patients with the resources to be successful, because otherwise they often fail after resorting to fad nonevidence-based programs outside the walls of their healthcare.”
While attending her first American College of Lifestyle Medicine (ACLM) conference, she met health professionals seeking the kind of solutions she was never exposed to in her medical school training or in her primary field of cardiology. “I really felt very optimistic that the people who convened in this membership organization were providing care the right way, and for the right reasons,” she reveals.
Collings’ journey led her to the position of president of ACLM, a medical professional society of some nine thousand healthcare professionals committed to lifestyle medicine as the foundation of a transformed and sustainable healthcare system. And she brings her knowledge and experience to every aspect of her role.
“When I first began engaging in the field in 2015, lifestyle medicine was still an alternative way to manage a patient, but over time, I saw this as misguided,” she says. “Lifestyle medicine needed to be the first and primary way to treat most conditions, with medications and procedures as adjunctive treatment. In other words, lifestyle medicine should be the center of medicine, as opposed to being on the margins of medicine.”
Addressing lifestyle is the first item in most chronic care clinical guidelines. And patient and provider satisfaction often result from a lifestyle medicine approach, which aligns the Quintuple Aim of better health outcomes, lower cost, improved patient satisfaction, improved provider satisfaction and advancement of health equity.
“To get lifestyle medicine into the center of medicine, we need to understand the US healthcare system thoroughly. It’s fractionated into many stakeholders, all interested in their economic slice of the healthcare sector,” she says. “Each stakeholder may be thinking their solution is what will fix a lifestyle-borne medical condition with a pharmaceutical or procedural solution, but bypassing the lifestyle root cause needlessly perpetuates the condition at a substantial cost to the patient and payor alike.”
Cate Collings worked alongside ACLM to establish partnerships on the national level, with such key organizations as the American College of Sports Medicine, the Partnership to Fight Chronic Disease, and Population Health Alliance. ACLM also engaged with seventy healthcare systems to join a Health Systems Council, navigating barriers to integration of substantive lifestyle medicine certified providers and services within systems. “We have to look at multiple paths and to numerous partners to move lifestyle from the margins into the mainstream,” she says. “It’s life or death for both patients and our healthcare resources.”
Cate Collings also applies her knowledge of lifestyle medicine through her role as chief medical officer of HealthFleet, a digital health technology company using coaching as a behavioral change tool, educating people on lifestyle medicine. An important element of her work comprises taking on the challenge of spreading evidence-based information to individuals in a huge population.
“We can’t do this one by one,” she observes. “We can do it in a clinical setting in groups of ten to twelve, but there’s a great need for more than that. So, in the role I have with HealthFleet, I oversee content, bringing the most credible, evidence-based and updated lifestyle medicine content to their platform, which is integrated with expert coaching and behavior change techniques. Then, we provide this solution to employers to meet any number of their goals.”
She continues, “One goal may be helping employees with high-risk health conditions, stress and emotional health, or another goal may be reducing healthcare claim costs. A healthier employee has fewer sick days, out-of-pocket costs, and costs incurred by their employer.”
For example, for an individual with type 2 diabetes, the first course of treatment, in the absence of critical blood levels, shouldn’t be a medication, but an intensive lifestyle program that’s supported by insurance carriers and employers. If the type 2 diabetes condition can be eliminated all together, there is an upside to both the patient and the payor.
Cate Collings remains optimistic about the future of lifestyle medicine. “As the pandemic has waxed and waned, attention has been given to the excess risks of lifestyle-related chronic conditions,” she observes. “We are seeing recognition in health systems. We are seeing it at the national policy level. Patients need this. The nation needs this. The time for lifestyle medicine is now.”