Beth Frates wears multiple hats. She is a pioneer in lifestyle medicine and education and practises lifestyle medicine via her health and wellness coaching company, Wellness Synergy, LLC. She is an award-winning teacher at Harvard Medical School and an acclaimed author. One of Beth’s earliest literary successes came with her book, The Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Highly recommended by a wide variety of professionals, it is regarded as a practical guide for anyone looking to embrace a better work-life balance. But it has also served to shine a spotlight on the hugely significant role health care workers can and should have in their interactions with their patients by helping them make appropriate choices to support a healthier lifestyle.
Beth ‘walks the walk’ and never misses an opportunity to talk and educate about the six pillars of lifestyle medicine. They include the management of nutrition, exercise, sleep, stress, substance use and personal connections. She is passionate about her capacity to connect on social media. A prolific contributor to Twitter and Instagram, she harnesses the platforms to share affirmations, discuss evidence-based studies and offer health and self-care tips to an audience far beyond the usual reach of the medical profession. Her Twitter account – @BethFratesMD – has ramped up an impressive 132K followers. Her Instagram posts are an eclectic mix of personal experiences interwoven with a wealth of lifestyle medicine knowledge. Her bio lists interests in yoga and running, her beloved dog, and her career accolades. Above all else she maintains that social interactions are everything – especially after the pandemic.
Beth was recently elected president of the American College of Lifestyle Medicine (ACLM), which comes at a time of growing recognition among health leaders and policymakers that lifestyle medicine can deliver high-value care.
It was the faltering health of Beth’s Father that set her on a quest to learn about the profound influence sustainable lifestyle choices can have on health and quality of life. Lived experiences are often a catalyst for new understanding and change. So, when her Dad suffered a heart attack, largely due to poor diet, lack of exercise and extreme stress, Beth (then aged 18) immersed herself in a journey of learning. Lifestyle medicine, she discovered, helps people change the trajectory of their lives. And physicians, she felt, could benefit from adapting their own habits to prevent burnout, which in turn would help their patients make smarter choices.
She recalls: ‘My Father was financial advising and accounting in New York City in a very competitive market. It’s not easy – you have to constantly be upping your game – and, although he was a healthy, athletic person, by 52 he had fallen off his routine exercise, was not eating healthily and was working from 6.00am until 11.00pm. He would go to church with us on a Sunday but leave us to return to work. Then one day, running for the last train home, he had a heart attack – and it changed everything in our world.’
Thanks to an insightful physician, who gathered the family together to work towards improving her father’s work-life balance, he made a recovery – and her family made massive lifestyle changes. Some of his New York friends were ‘quite savvy’, Beth remembers, and recommended the Pritikin Center, which was one of the earliest programs in lifestyle medicine where they helped him establish a safe and successful rehabilitation by embracing healthy habits.
‘I'm not sure what they called it then, but we would now call it an intensive lifestyle medicine programme. He learned how to exercise safely. My Mom learnt about cooking healthy food, and we had our eyes opened to resiliency and stress management.’
Primed to follow her Dad into the family business, she was studying economics when her lightbulb moment came. It was 1988 and having come across an article by Dr Alan Rozansky about mental stress and cardiac patients and how mental stress could affect heart health as much as physical stress, she grew hungry to learn more. Armed with the paper, she presented herself at Westchester Medical Center in Valhalla, New York, and declared, ‘I'm a college student. My Dad had a heart attack and stroke and I would like to work in this area for the summer.’ Luckily for her she met cardiologist Michael Kay who subsequently became her mentor. He appreciated her bold approach and passion for what was to become a deep love affair with lifestyle medicine. She hasn’t looked back.
It feels a tad distasteful to suggest any upside to the recent pandemic. After all, Beth is a member of the 'physician family' – a community heavily impacted by the global catastrophe. But as a lifestyle medicine pioneer, Beth seemingly used the pandemic as a springboard for change when it shone a much-needed spotlight on physician overload and burnout.
With the media focused on the relentless frontline challenges, there came a heightened awareness of the stressful ‘day-to-day ‘– a subject long overdue for discussion.
Quite simply, the effects of Covid-19 led to discussions not previously had about the mental health risks within the medical profession. It’s an uncomfortable truth Beth seems willing to accept.
Those with a passing concern for the welfare of medics might have foreseen a future less rosy. With the pandemic, physicians had their work cut out; circumstances forced them to adapt quickly. They faced hardships and had to make difficult choices. Tasked with safely and effectively navigating care whilst meeting the demands of changing guidelines and standards, many of these unprecedented challenges led to terrible decision-making scenarios. It took its toll. And, for many, the fallout remains.
Beth is unequivocal about the importance of physician wellness in all this melee. For her, the steps to mitigate against the inevitable dangers to health should begin at a student level. Embracing healthy habits sooner rather than later might even stop those burnout statistics in their tracks – or at least prevent them from rising exponentially. And she believes that if physicians embrace wellness, they are more likely to guide their patients in a similar direction.
She goes as far as to suggest that the successful rehabilitation of patients is influenced by the lifestyle behaviours and attitudes toward wellbeing of their treating health professional. What she often finds with lifestyle medicine is that the physicians who are working to improve their own lifestyles and maintain healthy practices are more likely to feel comfortable counselling patients about these topics. Interestingly, when physicians themselves are feeling over-exhausted and signs of burnout, they often explore healthy living and find lifestyle medicine. Many lifestyle medicine clinicians have shared the fact that this new specialty helped them find new meaning and purpose in their work, helping them work through or escape burnout.
This fact places Beth in a hugely influential position.
She graduated magna cum laude from Harvard College, majoring in psychology and biology. She then attended Stanford Medical School, interned at Massachusetts General Hospital, and completed her residency in the department of physical medicine and rehabilitation at Harvard Medical School, where she served as chief resident.
After residency, Beth focused on stroke and stroke prevention.
And it was in this role that she had something of an epiphany, seeing the possibilities of casting her net wider to guide people to better health with her lifestyle medicine insights.
Joining the dots, she used this background as a starting point to empower a larger spectrum of people, adding behaviour change, coaching and motivational courses to her panoply of skills.
By 2008, Beth had developed the concept of a lifestyle medicine interest group (LMIG).
She has won multiple teaching awards for her work in pre-clinical core courses, including nutrition, musculoskeletal system, central nervous system, endocrine system, and introduction to the professions.
More recently, Beth created a college curriculum on lifestyle medicine for a Harvard Extension School undergraduate and graduate-level course, which many physicians and pre-meds have taken each year.
As director of lifestyle medicine and wellness for the Department of Surgery at Massachusetts General Hospital, she also helped craft an innovative wellness initiative. It is a unique role. With an interest in surgical burnout – notorious for forcing surgeons to rethink their career choice and quit the profession early – her job is to reduce the chances of this happening.
Compassion is Beth’s watchword. She evidently places a high value on self-care and is the embodiment of her health messaging. She exercises regularly – ‘I run a lot – I've always enjoyed that runner's high – and I paddle board, but I like to try new things. I like to be challenged’. She also enjoys yoga, eats healthily and has a dog, Athena, who needs twice daily walking. When we talk over Zoom, her beloved German Shepherd is sat beside her, the perfect close companion and confidante. Her husband and two sons also keep her busy and her desire for a more balanced work-family life set her career pathway.
She considered becoming a surgeon, but she felt that the lifestyle required to practice surgery was not compatible with the family life she envisioned for herself. Even before having her children, she held family time in the highest regard.
‘I enjoy working closely with surgeons and my time with them. I know how demanding their lives can be.’
She loves teaching, coaching and lecturing and has developed a close relationship with the physician community over 30 years. Her focus may be on helping them maintain a healthier perspective, but a strong sense of fun lies at the heart of what she does.
‘Surgeons are driven, competitive people and I can identify with that. But they need to relax, too. It was a surgeon who taught me how to windsurf when I was a medical student at Stanford, so I know they like fun, and I know they like a challenge. I brought my hula hoops to one lecture, and I did some hula hooping and said, “You guys could do this, too. I mean, come on, it's so simple.” One gave it an impressive try, and another did it better than I did! So I added another hoop and double hooped. We had fun, but they also understood that I was serious about lifestyle medicine and that I was there for a reason.’
Her home life inspires her professionally and vice versa. Having overcome a fear of dogs by adopting Reesee, her Goldendoodle who recently passed away, and more latterly Athena the German Shepherd– Beth served as medical editor for the Harvard Special Health Report titled, Get Healthy, Get a Dog [2] that explored the many direct physical and mental health benefits of owning a four-legged friend.
In 2016, she co-wrote The Laughter Prescription [3], a paper that referenced evidence to indicate that laughter is a part of our basic armamentarium that helps prevent diseases and ensure a healthier population. Laugher, she concluded, allows a rush of mood-boosting, pain-alleviating endorphins.
What may have once felt a little left field, these studies serve a serious purpose. Preventative practices reduce the financial burden on the healthcare sectors, makes for healthier physicians who share these best practices with their patients.
Beth has been talking about the transformative effects of healthy habits for more than a decade and is now widely considered an authority on lifestyle medicine.
Her connection with cardiologists goes back a long way from when her father had a heart attack and recently came full circle when she was surprised to receive an email from her original inspiration, the pioneering Dr Alan Rozansky, an advocate of mind and body connections and behavioural cardiology for many years. He wrote to her to tell her he had heard her talk at the Institute of Lifestyle Medicine, had become Board Certified in Lifestyle Medicine, and recently edited an entire journal edition on lifestyle medicine that he was eager to share with the American College of Lifestyle Medicine community. He reached out to Beth as she serves as President of that organization. He had no idea of the fact that his work had had a profound influence on her career. Noting her focus on evidence-based posts, sharing research and even adding a sense of ‘spirituality’ to her feeds, he informed her that he had followed her on Twitter and said, ‘ I love the information you share.’ Beth was delighted – the comments providing a strong sense of validation to her life’s work.
We discuss the power of digital communications, and it is evident that social connections are something she holds dear. Quite possibly, it is the most important in the six lifestyle medicine pillars.
So, just how sustainable are those six pillars in a world beset by constant challenges that includes conflict and crises? There will be times when we lapse, Beth admits, but a sense of purpose, social connections and natural sources of energy help to bolster our resilience. It is not necessarily a quick fix; moreover a long-term commitment.
The relationship between wellness and medicine is not complicated, and Beth is at the forefront of changing attitudes to blend these two areas in everyday lives. That includes those working within the profession who are prone to allowing their focus on self-care to slip. Looking after others can be detrimental to health, which is why Beth argues it is just as important to talk and share stories with colleagues who understand as it is with patients.
When the going gets tough, the co-dependency of physical, economic and social wellbeing is crucial. And if we can implement these habits for such a profound change that it can prevent poor health – without the need for surgical intervention – then what’s not to love, embrace and share forward?
References
- https://www.health.harvard.edu/staying-healthy/get-healthy-get-a-dog
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125057/
Julie Bissett
