Lifestyle Medicine Core Competencies 2025: What Healthcare Professionals Need to Know

At first glance, the 2025 update to the Lifestyle Medicine Core Competencies looks modest. One new competency was added and two existing competencies were revised, taking the total from 88 to 89. The significance of the update, however, is not really about the number of changes. Together, they reflect several important developments in the field: greater attention to social determinants of health, a clearer recognition of the relationship between human and planetary health, and a more nuanced approach to food processing and nutrition.

For healthcare professionals, the competencies are more than a list of subjects to study. They describe knowledge and skills relevant to evidence-based Lifestyle Medicine across different healthcare disciplines and help inform professional education, clinical practice, and certification. At the same time, an international competency framework does not determine professional licensure or scope of practice within an individual country. Those remain subject to applicable laws, regulations, professional standards, and local clinical guidance.

What are the Lifestyle Medicine Core Competencies?

The competencies have developed over more than 15 years. The first physician competencies for prescribing Lifestyle Medicine were published in JAMA in 2010. The framework was expanded in 2015 to include competencies relevant to physicians and a broader range of healthcare professionals, followed by a major update in 2022. In 2020, oversight of the competencies had transitioned from the American Board of Lifestyle Medicine to the Lifestyle Medicine Global Alliance, an affiliate of the International Board of Lifestyle Medicine. The 2025 review was subsequently commissioned by the Lifestyle Medicine Global Alliance and undertaken by its Scientific Advisory Committee as the field became increasingly international and new priorities emerged.

The current framework contains 89 competencies across ten broad areas. These cover the foundations of Lifestyle Medicine; practitioner health, leadership, and community advocacy; nutrition; physical activity; sleep; tobacco use and other harmful exposures; key clinical processes; health behavior change; emotional and mental health; and connectedness and positive psychology.

That breadth is worth noting. Competency in Lifestyle Medicine is not simply knowing the six pillars. It also involves understanding evidence, assessing patients appropriately, supporting behavior change, working with interprofessional teams, knowing when referral is needed, using clinical information, measuring outcomes, and improving how care is delivered.

The published 2025 framework marks seven of the 89 competencies with an asterisk because, using the authors' terminology, they may be outside the scope of practice of some non-provider healthcare practitioners. This distinction matters. Lifestyle Medicine is multidisciplinary, but multidisciplinary care does not mean that every professional performs every clinical task. Each practitioner remains responsible for working within their education, competence, licensure, and legal scope of practice.

The new competency: social determinants of health

The most visible addition in the 2025 update is the formal inclusion of social determinants of health. The new competency asks professionals to apply Lifestyle Medicine interventions in the context of social determinants of health to improve health outcomes and health equity.

On paper, that may look like a small change. In practice, it asks healthcare professionals to think more carefully about how lifestyle recommendations are made.

Advice to “eat healthier,” for example, can mean very different things for a person who has sufficient income, time, cooking facilities, food knowledge, and easy access to appropriate foods compared with someone working long hours with limited resources and fewer realistic food choices. The same is true for physical activity, sleep, stress management, and social connection. Housing, employment, education, transportation, caregiving responsibilities, neighborhood conditions, and access to healthcare can all affect what a person is realistically able to change.

The competency therefore moves Lifestyle Medicine further away from an overly individualistic view of health. Knowing which behavior might theoretically improve health is not enough. Healthcare professionals also need to understand the circumstances in which that behavior has to occur.

This does not mean clinicians are expected to solve every social problem affecting their patients. It means that recommendations should be realistic, person-centered, culturally relevant, and sensitive to barriers that may influence implementation. It also strengthens the case for interprofessional care, community resources, and collaboration beyond the consultation room.

For healthcare professionals in Viet Nam, this is particularly relevant. Urban and rural environments, household resources, food availability, long working hours, family responsibilities, transportation, access to safe spaces for physical activity, and access to healthcare can all influence whether a recommendation is practical. Applying international Lifestyle Medicine evidence responsibly therefore requires more than translating it into Vietnamese. It requires understanding how that evidence fits Vietnamese lives.

Planetary health is now framed as a two-way relationship

The planetary health competency was also revised. In 2022, the competency asked professionals to explain the impact of lifestyle choices on planetary health and sustainable living. The 2025 wording asks them to examine the relationship between Lifestyle Medicine, planetary health, and sustainable living.

The change is meaningful. The earlier wording focused mainly on how human choices may affect the environment. The updated competency more clearly reflects a bidirectional relationship: human behavior can affect environmental systems, while environmental conditions can also influence human health.

Air pollution, extreme heat, climate-related events, environmental exposures, food systems, and access to green space can interact with respiratory, cardiovascular, metabolic, mental, and other health outcomes. The 2025 paper specifically explains that the competency was revised to emphasize the two-way relationship between human and planetary health and the health consequences associated with that relationship.

This does not mean every Lifestyle Medicine consultation needs to become a climate-health consultation. It does mean that health behaviors cannot always be separated neatly from the environments in which people live.

That perspective has obvious relevance to Viet Nam, where rapid urbanization, air quality, extreme heat, flooding, changing food environments, and other environmental pressures increasingly intersect with health. The competency provides a stronger conceptual basis for recognizing these connections without turning Lifestyle Medicine into environmental medicine or public health.

Food processing: more nuance than “processed is bad”

The third change is within nutrition. The 2022 competency asked practitioners to describe how the level of food processing affects health and discuss the evidence. The 2025 version asks them to appraise the evidence relating to how both the level and type of food processing affect health outcomes.

That distinction matters because “processed food” is not a single nutritional category. The 2025 paper points out that minimal processing such as flash-freezing fruits and vegetables, grinding intact whole grains, or shelling nuts does not necessarily reduce nutritional value and can sometimes improve access to healthy foods. By contrast, other types and levels of processing may be associated with very different nutritional profiles and health outcomes.

The authors also acknowledge that several food-processing classification systems exist, each with strengths and limitations, although the NOVA classification is the system most widely used in current research. That alone is a useful reminder that healthcare professionals should be cautious about reducing a complex area of nutrition science to a single label.

The distinction becomes particularly useful when communicating with patients or the public. Advice such as “avoid all processed foods” may sound simple, but it is scientifically imprecise and can be impractical. A more useful assessment considers the type and degree of processing, nutritional composition, overall dietary pattern, frequency of consumption, what the food may replace in the diet, and the quality of evidence linking it with health outcomes.

This nuance is especially relevant in Viet Nam, where traditional foods, minimally processed staples, packaged foods, convenience products, street foods, and increasingly globalized food products now coexist within a rapidly changing food environment.

What did not change is just as important

The attention given to the three new or revised competencies should not obscure the larger framework. Most of the 89 competencies remained unchanged. Behavior change, clinical assessment, nutrition, physical activity, sleep, substance use, mental and emotional health, social connection, and key clinical processes remain central components of Lifestyle Medicine.

This matters because public discussions of Lifestyle Medicine can sometimes stop at the six pillars themselves. Knowing that healthy eating, physical activity, sleep, stress management, avoidance of risky substances, and social connection matter is only the beginning. Healthcare professionals also need to know how to help people make and sustain change.

The competency framework therefore includes areas such as motivational interviewing, health coaching approaches, cognitive behavioral strategies, positive psychology, therapeutic alliance, patient-centered action planning, self-efficacy, relapse prevention, and family and social support. It also extends into interprofessional teamwork, group visits, telehealth, electronic health records, outcome measurement, quality improvement, and evidence-based clinical decision-making.

In practice, Lifestyle Medicine is not simply about what a patient might change. It is also about how healthcare professionals and healthcare systems can support meaningful, appropriate, and sustainable change.

Evidence appraisal remains a core professional responsibility

One competency that deserves particular attention is the requirement to understand and apply the principles of evidence-based medicine.

Lifestyle interventions should not be held to a lower scientific standard simply because they appear “natural” or intuitively healthy. Healthcare professionals still need to ask familiar questions. How strong is the evidence? Who was studied? What outcome was measured? How large was the benefit? Were potential harms assessed? Is the intervention feasible? Does the evidence apply to the patient or population in front of us?

That responsibility becomes even more important as public interest in Lifestyle Medicine grows. Healthcare professionals are increasingly likely to encounter adjacent commercial claims involving wellness programs, digital health tools, supplements, personalized nutrition, wearables, microbiome testing, and other rapidly developing areas. Some may ultimately prove useful. Others may have limited evidence, or may be promoted ahead of the science.

Being competent therefore includes knowing not only what current evidence supports, but also where evidence remains uncertain.

That distinction is essential if Lifestyle Medicine is to remain firmly within evidence-based healthcare.

What do the competencies mean for different healthcare professionals?

The competencies were developed for use across multiple healthcare disciplines, but they should not be interpreted as giving identical responsibilities to everyone.

A physician may diagnose disease, manage medical treatment, and prescribe within the physician's professional scope. A dietitian may provide detailed nutrition assessment and intervention. A psychologist or other appropriately qualified mental health professional may contribute specialized behavioral or psychological care. Nurses, physiotherapists, pharmacists, exercise professionals, and other members of the healthcare team can contribute different expertise according to their education, competence, and applicable professional regulations.

The competency framework itself recognizes this distinction through the seven competencies identified as potentially outside the scope of practice of some non-provider healthcare practitioners.

For Viet Nam, this point deserves particular attention. International competencies can provide useful reference points for education and professional development, but they do not override Vietnamese requirements concerning professional licensing, medical examination and treatment, or the permitted scope of individual healthcare professions.

Lifestyle Medicine should strengthen interprofessional practice, not blur professional accountability.

What does this mean for healthcare professionals in Viet Nam?

The 2025 competencies are timely for Viet Nam because noncommunicable diseases remain the country's leading cause of death. According to the World Health Organization, noncommunicable diseases, including cardiovascular disease, cancer, chronic respiratory disease, and diabetes, account for about 80% of deaths in Viet Nam, many of them premature.

The National Survey on the Risk Factors of Noncommunicable Diseases in Viet Nam, 2021, published by the World Health Organization Regional Office for the Western Pacific in 2025, provides further context. It examines major behavioral and metabolic risk factors including tobacco use, alcohol use, physical inactivity, dietary risks, overweight and obesity, raised blood pressure, elevated blood glucose, and abnormal blood lipids.

The policy environment is also giving greater attention to prevention and health promotion. Politburo Resolution No. 72-NQ/TW, dated 9 September 2025, calls for a shift from a treatment-centered approach toward more proactive disease prevention and comprehensive health promotion. The World Health Organization has highlighted the same direction in discussing Viet Nam's response to noncommunicable diseases.

That prevention agenda should not be conflated with formal recognition of Lifestyle Medicine. Resolution No. 72-NQ/TW does not establish Lifestyle Medicine as a medical specialty, certification pathway, or national model of care. It does, however, make many of the underlying capabilities addressed in the competencies increasingly relevant, including prevention, health behavior support, chronic disease management, person-centered care, interprofessional collaboration, and systematic attention to modifiable risk factors.

The practical opportunity for Viet Nam is therefore not to copy an international competency framework word for word. A more useful question is which competencies are most relevant to Vietnamese healthcare professionals, how they should be taught in the local context, how they fit within existing professional roles and regulations, and what evidence is needed to support their implementation in Vietnamese healthcare settings.

The framework itself will continue to evolve

The 2025 publication did more than update three competencies. It also established a longer-term schedule for future revisions. Major competency updates are planned every six years beginning in 2027, with minor updates staggered between them beginning in 2030. The authors also note that changes to curricula, review courses, translations, and certification examinations will take additional time to implement after each competency update.

A subsequent publication in 2026 formalized the governance process further. Under the new model, the International Board of Lifestyle Medicine Scientific Advisory Committee oversees a globally representative process that includes input from affiliated national Lifestyle Medicine societies, regional synthesis, Scientific Advisory Committee consensus, public comment, final ratification, and peer-reviewed publication.

The governance paper describes a recurring 12-month update cycle, with national society feedback during the early stages, regional synthesis, a Delphi consensus process, public comment, final review, and submission for publication. The first scheduled updates under this formalized process are planned for completion in the first quarter of 2027.

As of September 2026, the Lifestyle Medicine Core Competencies: 2025 Update remains the latest published set of competencies. The 2026 governance publication does not replace those 89 competencies. Instead, it establishes the process through which the competencies, the core definition of Lifestyle Medicine, and the definitions of the core pillars will be maintained and updated in the future.

That is a useful reminder that competencies should not be treated as fixed doctrine. Like other areas of healthcare, Lifestyle Medicine needs to evolve as scientific evidence, clinical practice, healthcare systems, and population needs change.

The main message for healthcare professionals

The 2025 update does not redefine Lifestyle Medicine from the ground up. Its importance lies in where the field is placing greater emphasis.

Lifestyle Medicine remains grounded in therapeutic lifestyle interventions, behavior change, person-centered care, critical appraisal of evidence, and integration with clinical practice. But the updated competencies make three ideas harder to overlook: people do not make health choices outside their social circumstances; human health cannot be completely separated from planetary health; and nutrition science requires more nuance than simple labels such as “processed” or “unprocessed.”

For healthcare professionals, the message is therefore broader than learning another list of 89 competencies. The more useful question is how those competencies can help us provide care that is evidence-based, clinically responsible, realistic for the people we serve, and appropriate to the healthcare systems in which we work.

For Viet Nam, that process is only beginning.

Professional education notice

This resource is intended for professional education and knowledge exchange. It does not constitute individualized medical advice, confer professional certification or scope of practice, or replace applicable clinical guidelines, professional judgment, licensing requirements, or Vietnamese laws and regulations.

References

1. Rea BL, Cheema S, Lanza S, Makinde MT, Matthews S, Palma M, et al. Lifestyle Medicine Core Competencies: 2025 Update. Am J Lifestyle Med. 2026;20(3):443-451. doi:10.1177/15598276251379821.

2. Rea BL, Cheema S, Lanza S, Makinde MT, Matthews S, Palma M, et al. Governance and Update Process for Lifestyle Medicine Core Competencies and Definitions. Am J Lifestyle Med. 2026;20(7):1116-1123. doi:10.1177/15598276261424740.

3. Lianov LS, Adamson K, Kelly JH, Matthews S, Palma M, Rea BL. Lifestyle Medicine Core Competencies: 2022 Update. Am J Lifestyle Med. 2022;16(6):734-739. doi:10.1177/15598276221121580.

4. Lianov L, Johnson M. Physician competencies for prescribing lifestyle medicine. JAMA. 2010;304(2):202-203. doi:10.1001/jama.2010.903.

5. World Health Organization Regional Office for the Western Pacific. National survey on the risk factors of noncommunicable diseases in Viet Nam, 2021. Manila: World Health Organization Regional Office for the Western Pacific; 2025.

6. World Health Organization. Viet Nam unites to tackle top causes of disease and death. 15 December 2025.

7. Bộ Chính trị. Nghị quyết số 72-NQ/TW ngày 9 tháng 9 năm 2025 về một số giải pháp đột phá, tăng cường bảo vệ, chăm sóc và nâng cao sức khỏe nhân dân.

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