Coronado resident Dr. Gina Casian will be opening the doors to Choose Healthy on July 5, 2025. The practice will be open on Saturdays and Sundays by appointment only. Choose Healthy will focus on the benefits of integrative lifestyle medicine with internal medicine. Dr. Gina founded her practice on an approach to wellness that eliminates the deficiencies burdening the current healthcare system. “Patient care should once again become the main priority of the healthcare system, and I intend to provide that with Choose Healthy,” Dr. Gina says.

What led Dr. Gina to pursue the medical field

Dr. Gina was born in Romania and came from a family of medical providers. She describes her childhood as a fairytale. She was the only girl in her family and grew up in a small village, enjoying a simple life with everything she needed. However, when she lost her dad to lung cancer, everything changed.

“When I was fifteen, I lost my father,” Dr. Gina begins. “It was a very shocking experience. Looking back, it was a very important stage in life, especially for a girl. It affected me emotionally very much. I could not understand. I come from a religious family, and I hold certain beliefs. My father was my role model, and it was very hard for me. I asked many questions to the universe at that time. I remember hiding around the house to understand what that disease was and knowing that there is no cure, which opened my interest. I said, ‘No, there has to be a cure.’ This is impossible.”

Dr. Gina let tragedy guide her bright future. She started researching and pursuing her education, eventually enrolling in medical school. She completed her training in Internal Medicine in Michigan and later moved to San Diego.

Dr. Gina’s pregnancy led her to lifestyle medicine

Dr. Gina’s journey to become a mom inspired her focus on lifestyle medicine. “I had a very difficult experience with fertility and becoming a mother,” Dr. Gina says, explaining that she experienced three miscarriages. “Losing my father was one of the most traumatic experiences. I learned a lot about my strengths and weaknesses. But when you really want something and you believe it, you do your best. I am very grateful that I have one son, and he’s happy and healthy.”

Part of Dr. Gina’s effort to have a healthy pregnancy was reviewing her lifestyle. “I was living downtown, I was not exercising. I was eating mostly fast food, not sleeping well, and not prioritizing stress management. I was under pressure to improve my metabolic health and my hormonal health.” Dr. Gina was considered of advanced maternal age as she was close to 40, and so she made changes in her lifestyle. “I was introduced to hot yoga for the first time, and since then, I can’t imagine living without yoga.”

The road was still difficult. “The entire pregnancy was abnormal. I was told many times that abortion was an option, and I just listened to my gut. Sometimes, medicine and science cannot explain things. My mother heart and my gut told me I would have a healthy baby.”

These challenges marked the beginning of her path to lifestyle medicine. “I learned a lot about how to change your lifestyle before you turn to medications. I want to share that with other people.”

Inspiring Those Around Her

After a tough pregnancy, COVID hit. “It was a very stressful situation,” Dr. Gina recalls. “I had a toddler in my house as well as my husband and my mother from Romania. It was a very stressful household. I had to go to work. I was the only one leaving the house. We were essential workers at that time, and I was very stressed. Then, gyms and yoga centers closed. I started running, which I never did before, and from running three miles, I ended up running about eight marathons.” She continues, “It was one of those situations when I said, ‘I can do this. How can I do it?’ And then, when I did it, I asked myself, ‘What else can I do?’ That’s the point I said,

‘I don’t want to live my life and die with my dreams.’

There are some amazing things that I could have done in my life, and I didn’t even give myself a chance to do them. That inspired my husband as well. He started running. Now he’s doing ultramarathons. It was beautiful to see. He would say, ‘I see my wife running, how can I sleep?’ He was inspired. We inspire people around us.”

Lifestyle Medicine

Lifestyle medicine consists of six pillars: nutrition, physical activity, restorative sleep, stress management, toxin avoidance, and cognitive connections. “This is what I am looking to explore with my patients.” Dr. Gina says, “I am getting certifications and qualifications in as many areas as I can. I am doing a course right now on mindfulness meditation, and I’m also doing a dialectical behavior therapy course. It’s for counseling. Then I am doing a couple of nutrition courses as well.”

Choosing Coronado

Choosing Coronado for her practice was an easy decision. “I have a family: my husband and my son. We’ve lived in Coronado for the last five, six years. This is home for us. We love being here. I call it ‘the island of harmony.’ I used to live in downtown and it was a different environment. [In Coronado], I feel like we have a bit more privacy and more substance. It’s sunny all year long, even in the days when it is raining and there are clouds, I tell my son, there is still summer. You just have to see it.”

Looking Back

From a village in Romania to Coronado island, Dr. Gina’s heart is full. “I had only two hours a day with a black and white television. So, from where I started, to where I am right now, I’m very grateful. I can’t say it enough. I am thankful for living in this country. If my parents gave me the most precious gift, which is my life, America gave me the second precious gift, which is my family.”

She continues, “I have a career, and I appreciate my blessings right now. My life has been a continuous uphill battle. Looking back, I see the little village back in my childhood, but I’m still looking up at the mountain. I know it’s a good view. I listen to my heart, and now, as I get older, I think I do listen to my gut as well. It’s just from living and having life experience. It directs me on the right path. I’m taking it one day at a time, and I’m looking for growth.”

The Patient Experience at Choose Healthy

With twenty years of experience in internal medicine, Dr. Gina has an interesting perspective. “I believe that before we get ill, we are healthy. We need to protect our health. I tell my patients that they are all little universes in one big universe.”

At Choose Healthy, patients will start with a 20-minute complimentary visit. Dr. Gina will use this time to establish a relationship and see what issues the patient is looking to address and what their medical concerns are.

The next step is a two-hour comprehensive evaluation. Dr. Gina feels confident that opening up the time frame will help her and her patients.

Health Advice

Dr. Gina has a few important health advisories that she finds herself giving. “The most common advice I give to my patients is that sleep is non-negotiable. Your day starts the day before. It starts at 9 pm. That’s from my own experience. As we get older, we see the effects and the impact of a lack of sleep on how we function.” She says, “Some people say, ‘I sleep good,’ but do they actually get quality sleep? Sleep is very important because it comes with all the hormonal balances in our body. It also helps regulate our appetite, mood, and how we interact with other people.”

Another tip is to stop eating ultra-processed food like hot dogs and candy with food dyes and coloring.

Her last tip is to take care of yourself first. “I had complications [during pregnancy], and there were some nights I was on a hospital bed waiting for some important test results. I would question if I would be able to see my son graduating from high school. That’s when all these ideas of changing my lifestyle and taking important measures in my life began. It shouldn’t be like that. We should be more health-conscious and responsible before we become parents. But when you have a child, it’s something so natural you want to enjoy that little human being that pushes you.”

Personal Values

Dr. Gina shares that she has a set of personal values that guide her. “My health is my number one priority, and my family comes second. Not because I’m selfish and I put myself first, but it’s because if I’m not healthy, I cannot take care of my family. My third value is growth — professional and personal.”

Lastly, the idea of home. “Then I have another value that I cherish so much, and that’s the idea of home being all over the world. In my 50 years, there were many times when I said, ‘What is home?’ It is really in your heart. It doesn’t have to be a place. It’s where you feel comfortable. It has to do with the loved ones. If you have your child, your husband, those few people that you love, with you at home, it can be anywhere. Coronado enhances that emotion of being where I’m supposed to be.”

Get Started at Choose Healthy

Choose Healthy will open on July 5, 2025. The website is ginacasianmd.com. Dr. Gina has also started Walk with a Doc, Coronado Chapter, which takes place every other Saturday. These ongoing events allow participants to safely walk (or roll), learn about current health topics, and meet new people.

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Should physicians use conventional medicine or lifestyle medicine to treat their patients? Those treatment protocols go hand-in-hand, so the best doctors will combine elements of both. School of Medicine Greenville Professor Jennifer L. Trilk, PhD, FACSM, DipACLM, explains why it is not a question of either-or.

Trilk is a co-author of “Proposed Nutrition Competencies for Medical Students and Physician Trainees: A Consensus Statement,” published in JAMA Network Open. The authors’ goal was to recommend nutrition competencies in medical education to improve patient and population health. She is the co-founder of the Lifestyle Medicine Education Collaborative, which has published free medical education curriculum materials on lifestyle medicine.

Jennifer L. Trilk, PhD, FACSM, DipACLM: I always say to the medical students, it’s not an either-or. It’s not either you put a patient on medication or you utilize lifestyle — they go very much hand in hand. So we don’t want to demonize one or the other. You really want to use them as partners, as adjunct. If a patient comes in and has uncontrolled hypertension, you need to utilize the pharmaceuticals and the medications to bring that high blood pressure down so that the high blood pressure doesn’t cause a stroke or myocardial infarction, which is called a heart attack, and yes, absolutely utilize those medications to help the patient. And then over time, because we know that lifestyle behaviors take time, over time, use the lifestyle modifications with the patient talking with them, so that they can eventually reduce the dosage of the medication, or maybe even reduce medication altogether. So we want to make sure that we utilize those hand-in-hand. But if a patient is newly diagnosed with Type 2 diabetes, and, you know, has a has an A1c that’s maybe in that 6.5 to 7.5 range to where they just have started that, we highly recommend, hey, let’s talk with your patient about the changes that they may be able to make to not need to get on medication in the first place and put Type 2 diabetes in remission. Because there’s evidence around that Type 2 diabetes absolutely can go into remission without medications if proper lifestyle is managed. There’s definitely a place for both. The one thing I say with this, with our students and our future doctors, is, if you’re going to utilize a medication, be a very responsible physician, and don’t just send out a medication or prescribe a medication with your with your patient, without talking to them about their lifestyle and how they got that disease in the first place. That is being a responsible doctor. So utilizing both and making sure you’re being responsible in your management of your patient.

“We realize the health system cannot survive with what we’re doing to ourselves. With over 80% of people in the US living with overweight or obesity, it’s just not sustainable.”

As medical specialties go, lifestyle medicine is on the young side, Richard Rosenfeld, MD, MPH, MBA, told Patient Care© during a recent interview. In fact, the discipline is just a little over 20 years old, he said, but its growth lately has been exponential. Membership in the American College of Lifestyle Medicine has grown to more than 13,000, three-quarters of whom are physicians. The first board exam for certification in lifestyle medicine was offered in 2017 and the certification has been awarded to 4000 individuals in the US and another 4000 worldwide, Rosenfeld explained.

Rosenfeld is well versed in the tenets of lifestyle medicine; he follows a plant-based whole foods diet, is a regular runner and New York Marathon finisher, and is the developer and lead author of new guidelines titled Lifestyle interventions for treatment and remission of type 2 diabetes and prediabetes in adults: a clinical practice guideline from the American College of Lifestyle Medicine.

The guidelines incorporate the 6 pillars of lifestyle medicine into practical, action-based recommendations that place sustained behavior change ahead of medication, when feasible, to prevent and manage chronic disease.

1. Healthy nutrition 2. Regular physical activity 3. Restorative sleep 4. Stress management

5. Positive social connections 6. Avoidance of risky substances

“We’re at a real tipping point with lifestyle medicine in this country,” Rosenberg cautioned, indicating that the time is right for the wholistic approach to disease prevention and management. “We realize the health system cannot survive with what we’re doing to ourselves. With over 80% of people in the US living with overweight or obesity, it’s just not sustainable.”

Rosenberg offers more details in the short video above.

The following transcript has been edited for style and flow.

Patient Care: Would you talk about the importance of the impact the ACLM guideline on lifestyle intervention as medicine can have?

Richard Rosenfeld, MD, MPH, MBA: Well, I, in my completely unbiased view as the lead author and developer of the guideline, I’d say I think the impact is extremely optimistic. Having done a lot of guideline work in the past, there tend to be some people that come out kicking and screaming at the end [of the process] about something. So far, I’ve seen nothing but very positive, laudatory feedback on this document from many different sides.

And it’s just [been released], so a lot of people aren’t even aware of it yet. I think as [the guideline] gains traction, it’s going to make a big impact, in operationalizing and empowering people to do these things. We don’t want them to just think about, “Gee, I need more sleep,” or “Gee, I’ve got to eat better and get a little exercise.” Those things never lead to sustained or even meaningful change.

So, as tools in the toolbox, I think the recommendations are great. We’re also at a real tipping point with lifestyle medicine in this country. The discipline is only a little over 20 years old, and it’s had exponential growth recently, now at a little over 13,000 members of the American College of Lifestyle Medicine, about three-quarters of whom are physicians. The remaining members are other health professionals.

From a certification standpoint, board certification in lifestyle medicine is offered through an independent board. I believe the first exam was in 2017, and now there are about 4,000 certified individuals in the U.S. and another 4,000 around the world.

I think we’ve seen a bit of a tipping point. We realize the health system cannot survive with what we’re doing to ourselves. With over 80% of people in the U.S. living with overweight or obesity, it’s just not sustainable.

So, we’ll see. We’re still, in the words of Jim Collins from Good to Great, pushing that massive flywheel, waiting for it to take off. But my hope is that we’re close to the flywheel getting its momentum and spinning around. We’ll see.

Richard Rosenfeld, MD, MPH, MBA, is the distinguished professor of otolaryngology, SUNY Downstate Health Sciences University and senior advisor for quality and guidelines for the American Academy of Otolaryngology – Head and Neck Surgery. Rosenfeld is board certified in otolaryngology – head and neck surgery and in lifestyle medicine.

For an at-a-glance preview of the 14 lifestyle interventions recommended in the American College of Lifestyle Medicine’s guideline, see Guideline Topline: 14 Key Lifestyle Interventions to Treat, Prevent Type 2 Diabetes

How AI is opening doors for lifestyle medicine

As a board-certified lifestyle medicine physician, one of the greatest challenges I face is time — time to listen deeply, educate, help patients create personalized care plans, monitor progress and document thoroughly.

Successful and sustainable lifestyle interventions require more conversation and coaching than the average 15-minute appointment can provide.

Integrating emerging AI technologies into my practice is helping bridge the gap between clinical efficiency and the kind of individualized care that this growing specialty of lifestyle medicine demands. AI and other digital tools, such as wearables and virtual health coaching platforms, can open new and more efficient paths to treat the root cause of lifestyle-related chronic diseases in ways I encourage other clinicians to explore.

These new possibilities are important because the majority of chronic diseases are linked to lifestyle behaviors. Chronic disease clinical practice guidelines routinely list lifestyle behavior change as an optimal, first-line treatment, but lifestyle interventions remain underutilized. There are many reasons, including the lack of nutrition and physical activity education in medical school, and misaligned payment incentives. But many clinicians understandably cite time constraints as an obstacle to addressing lifestyle factors such as optimal nutrition, physical activity, sleep, stress management, connectedness and avoidance of harmful substances.

How AI changed my practice

My adoption of AI tools started fairly simply in 2020, helping patients record visits on their phones to replay key information later. Technology advanced quickly, and today I use an AI-enabled app that transcribes patient encounters in real-time, structures the visit into a comprehensive clinical note, documents the history of present illness, and even helps generate SMART (specific, measurable, achievable, relevant, time-bound) goals in plain language.

After appointments, patients receive clear, accessible summaries of our discussion through our clinic’s open notes system. They can revisit details, follow up on action items, alert us to mistakes and feel empowered as participants in their own care. When patients understand their treatment plans — in language that feels approachable rather than clinical — they’re more likely to follow through. Knowledge is power, and AI helps deliver that power in a format patients can use.

The software has also changed my behavior in the exam room. I spend far less time typing and more time being fully present — making eye contact, listening and connecting on a human level — and better prepared to truly understand my patient’s lifestyle. Instead of worrying about charting, I’m able to help my patients feel more seen and heard. With these tools, I save about 2 hours every day that I would otherwise spend transcribing and documenting. I can devote that time to self-care, such as yoga or time with my family. I feel healthier and more in control of my schedule — no small thing considering our high rate of burnout.

A better learning environment

This technology is also reshaping how I teach. I frequently have medical students and residents in the room, and rather than furiously scribbling notes, they can engage in the clinical conversation, knowing the AI will generate a cohesive summary of our discussion. It blends multiple voices — from patient, clinician and learner — into a seamless narrative. It’s particularly well-suited to lifestyle medicine, automatically organizing content around the lifestyle medicine pillars, reinforcing what we are teaching and providing patients a roadmap they can follow.

Beyond the clinic walls

Emerging AI-driven technologies can help extend the reach of lifestyle medicine beyond the clinic walls, enabling deeper engagement and continuous support. Lifestyle medicine clinicians could leverage AI-powered health coaching platforms to deliver tailored recommendations, changing how patients receive guidance between visits through real-time feedback. Smartwatches, continuous glucose monitors and other biometric devices collect a steady stream of health data — heart rate variability, sleep quality, glucose levels, activity patterns — that AI algorithms can analyze. AI-enabled telehealth platforms can support shared medical appointments, where patients with similar conditions can learn together and share experiences, and clinicians can scale their reach and impact.

The future is bright

AI will never replace the human connection with patients. Clinicians must still build trust, listen deeply and guide patients through the nuances of lifestyle change with empathy and expertise. Foundational training remains essential — resources like the American College of Lifestyle Medicine’s complimentary 5.5 CME/CE “Lifestyle Medicine and Food as Medicine Essentials” course can help build that foundation. The course is available until September.

But AI can be a powerful partner. My advice: Don’t be intimidated. Start small. Use a transcription tool, test it in one appointment and build from there.

These new technologies will continue to help us identify effective interventions, personalize care and reach patients who might otherwise feel overwhelmed by the complexity of lifestyle change. You might be surprised by how seamlessly AI can enhance your practice, improving health and happiness for all.

References:

American College of Lifestyle Medicine. Lifestyle medicine & food as medicine essentials. Available at: portal.lifestylemedicine.org/Portal/ACLM/Education/Campaigns/White-House/WHconference-SignIn.aspx. Accessed May 30, 2025.

AMA. Measuring and addressing physician burnout. Available at: www.ama-assn.org/practice-management/physician-health/measuring-and-addressing-physician-burnout. Published May 15, 2025. Accessed May 30, 2025.

CDC. Preventing chronic diseases: What you can do now. Available at: www.cdc.gov/chronic-disease/prevention/index.html. Published May 15, 2024. Accessed May 30, 2025.

For more information:

Michelle Thompson, DO, AOBFP, ABOIM, DipABLM, FACLM, is the medical director of Lifestyle Medicine at the University of Pittsburgh Medical Center. She can be reached at: thommx5@UPMC.EDU. She can also be found on Instagram and Facebook at @mtyogidoc, and more information is available on YouTube and WholeHeartedMedicine.org.

Q&A: First set of lifestyle medicine tools integrated into Epic EHR

Key takeaways:

Tools integrated into Epic’s EHR include ACLM’s lifestyle medicine assessment survey and diet screener.

Implementing these into clinics can be seamless and complementary to current care, an expert told Healio.

The American College of Lifestyle Medicine, or ACLM, announced the integration of the first set of lifestyle medicine assessment tools into Epic’s electronic health record software.

According to a press release, these tools include:

ACLM’s lifestyle medicine short form assessment tool, a clinical survey that captures patient readiness to change and lifestyle behaviors;

ACLM’s Diet Screener, which can capture a picture of a patient’s diet during routine health checkups;

Physical Activity Vital Sign (PAVS) tool, which is recommended by the Physical Activity Alliance for assessing physical activity in adults; and

additional tools that capture lifestyle behaviors and opportunities for change.

ACLM said lifestyle behaviors are the leading drivers of chronic disease nationally — with 80% of chronic conditions contributed to lifestyle behaviors — while therapeutic and intensive therapeutic lifestyle interventions are underutilized because of factors such as systemic barriers and educational gaps.

“Assessing for lifestyle change opportunities is the first step toward addressing their role in the treatment, remission and prevention of chronic disease,” the release said.

ACLM added that health care organizations can work with their Epic analysts to access these tools.

David Michael, MD, DipABLM, medical director of East Carolina University’s Health Lifestyle Medicine Clinic, spoke with Healio to discuss the feasibility of bringing these tools into primary care practices, their potential impacts on patient outcomes and more.

Healio: What has your experience been like with ACLM’s lifestyle medicine assessment tools? How much of an impact have they had on you and your patients?

Michael: Integrating lifestyle medicine assessment tools into our workflow has significantly benefited our practice. Over the past 2 and a half years, approximately 1,000 new patients have completed ACLM’s lifestyle medicine short form assessment tool during their initial appointments via the patient portal. This tool captures baseline behaviors across the six pillars of lifestyle medicine: optimal nutrition, physical activity, stress management, sleep, connectedness and avoidance of risky substances.

The Diet Screener, available in nine- and 27-item formats, offers a quick snapshot of a patient’s eating patterns and water intake. Meanwhile, the PAVS assesses whether a patient meets minimal physical activity recommendations.

These tools provide a structured understanding of a patient’s lifestyle factors and highlight initial focus areas. They support our ability to individualize care plans and engage patients more deeply in their health journeys. When patients see that we consider the full picture of their health — not just lab values or diagnoses — they feel heard, which builds trust. Additionally, baseline data allows us to track progress over time and identify opportunities for targeted interventions.

Healio: How feasible is it for PCPs to implement these tools in their own practice?

Michael: I believe a PCP will find it feasible, but “care flow” is crucial. Data collection should not occur during valuable face-to-face time and must augment the PCP’s workflow. Clinicians often struggle to address lifestyle factors within the average 15-minute appointment, making it difficult to understand a patient’s behaviors and create a sustainable intervention plan. One significant benefit of these tools is that they can be administered before the clinical appointment.

Having patients complete the assessment through a patient portal, such as Epic’s MyChart, on their own time and at their own pace is key. The PCP walks into the exam room already equipped with relevant insights into the patient’s lifestyle behaviors. Incorporating it into the treatment plan for that day can be seamless. Lifestyle changes can be complementary to the current care plans.

Healio: Can you discuss the significance of having these tools available through Epic?

Michael: The integration into Epic is a potential game changer. Epic is the most widely used EHR system in the U.S. Embedding these tools in the Epic EHR means that many clinicians now have streamlined access to standardized, evidence-based lifestyle assessments. It also means that utilization of these tools should require minimal workflow disruption. The information is captured as data into the EHR and can be easily pulled into clinical notes. As value-based care models continue to evolve, these tools can help PCPs meet quality and patient engagement goals without significantly increasing administrative burden.

Prior to this integration, clinicians who wanted to implement similar assessments often had to rely on external tools, paper forms or work with the EHR build team to try and build their own version of lifestyle assessment — methods that were inefficient, fragmented and hard to track over time. Now, data is centralized, actionable and compatible with emerging technologies like AI, which can summarize and analyze the information to support clinical decision-making. The standardized questions also allow for field-level capture of this data to support research and quality improvement efforts over time.

Healio: Anything else to add?

Michael: Lifestyle factors account for the majority of modifiable risks when it comes to chronic disease. Yet, we have historically under-asked and under-documented these critical elements in clinical care. These lifestyle assessment tools not only normalize asking about lifestyle — they also operationalize it. They help move lifestyle from an abstract concept to a measurable, trackable component of standard care.

This is also an opportunity to align clinical practice with what patients already expect. Patients trust their health care providers for information about nutrition and lifestyle. But lifestyle topics, such as nutrition and physical activity, have not been covered in medical school adequately. Now is a great time for clinicians to seek education and training in lifestyle medicine. ACLM is offering a complimentary 5.5 CME/CEW Lifestyle Medicine and Food as Medicine Essentials course available through September. It’s a good step toward establishing an educational foundation. By educating ourselves and utilizing these assessment tools, we’re not just collecting data — we’re making a statement that these aspects of health truly matter.

References:

American College of Lifestyle Medicine announces integration of first set of lifestyle behavior assessment tools into Epic electronic health records. Available at: https://www.prnewswire.com/news-releases/american-college-of-lifestyle-medicine-announces-integration-of-first-set-of-lifestyle-behavior-assessment-tools-into-epic-electronic-health-records-302454020.html?tc=eml_cleartime. Published May 13, 2025. Accessed May 21, 2025.

Lifestyle Medicine & Food as Medicine Essentials. Available at: https://portal.lifestylemedicine.org/ACLM/Education/Campaigns/White-House/WHconference-SignIn.aspx?WebsiteKey=5caa7854-d0e3-44fc-a359-ef6857e8d551. Accessed May 21, 2025.

For more information:

David Michael, MD, DipABLM, can be reached through Alex Branch at abranch@lifestylemedicine.org.