Introduction to lifestyle medicine practice questions for the lifestyle medicine boards
The introduction domain checks that you can define lifestyle medicine, place it among other fields and summarize the evidence behind it.
ABLM exam domain: Introduction to Lifestyle Medicine
4%of the ABLM exam
~6of 150 physician questions
~5of 120 health professional questions
64questions on this domain in the bank
What the exam expects you to know
ABLM builds the exam on the lifestyle medicine core competencies. For this domain they include:
What lifestyle medicine is and its role in health care
The core competencies identified by a national consensus panel
How lifestyle medicine compares with other fields of health and medicine
Evidence that health behaviors drive key outcomes and change disease pathophysiology
The prevalence and cost of lifestyle-related chronic disease
Lifestyle choices and planetary health
High-yield areas
The six pillars: eating pattern, physical activity, restorative sleep, stress management, avoiding risky substances and positive social connection
Lifestyle medicine as treatment, not only prevention
Interpreting landmark prevention studies and their limits
The burden and cost of diabetes, cardiovascular disease and obesity
Diet, food systems and environmental sustainability
How to study it
These are mostly recall and interpretation questions. They are worth a few points, so review them briefly and spend most of your time on nutrition and activity.
Free practice questions: Introduction to lifestyle medicine
4 questions from the bank, with the full rationale and source. Pick your answer, then open the rationale.
Question 1 of 4 · easyIntroduction to Lifestyle Medicine
A 50-year-old woman with overweight, elevated fasting glucose, and impaired glucose tolerance asks why a structured lifestyle program is being offered alongside discussion of metformin. Her physician cites the original 2002 Diabetes Prevention Program. Which statement accurately compares the trial’s interventions over an average 2.8 years?
Metformin reduced diabetes incidence more than the lifestyle program
The interventions produced similar reductions in cardiovascular mortality
The lifestyle program improved weight without reducing diabetes incidence
Metformin reduced incidence only after participants developed diabetes
Lifestyle reduced diabetes incidence more than metformin versus placebo
Show answer and rationale
Answer: E. Lifestyle reduced diabetes incidence more than metformin versus placebo
A (incorrect): The reported relative reductions versus placebo were larger with lifestyle than with metformin.
B (incorrect): The cited result concerns incident diabetes, not a demonstrated cardiovascular mortality comparison.
C (incorrect): The trial measured and demonstrated a reduction in diabetes incidence, not merely weight change.
D (incorrect): Participants did not have diabetes at enrollment; metformin was tested to prevent or delay its development.
E (correct): Lifestyle reduced incidence by 58% and metformin by 31% relative to placebo. This supports structured prevention in a comparable high-risk population, not a promise that either intervention prevents every case.
Source: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. (2002); DOI 10.1056/nejmoa012512. https://europepmc.org/article/MED/11832527. Locator: Abstract, Results, incidence reductions of 58% and 31% versus placebo and comparative effectiveness.
Question 2 of 4 · easyIntroduction to Lifestyle Medicine
A state health department is planning a campaign and asks a lifestyle medicine physician how many adults actually eat enough fruits and vegetables and which groups fall shortest. She cites the 2022 MMWR report by Lee and colleagues using 2019 Behavioral Risk Factor Surveillance System data from 49 states and the District of Columbia. Which finding was reported?
About half met fruit recommendations and a third met vegetable recommendations
Meeting fruit recommendations was most common among men
Meeting vegetable recommendations was most common among lower-income adults
About 12% met fruit and 10% met vegetable recommendations
About a third met vegetable recommendations, lowest in adults over 50
Show answer and rationale
Answer: D. About 12% met fruit and 10% met vegetable recommendations
A (incorrect): Incorrect. Just 12.3% of adults met fruit recommendations and 10.0% met vegetable recommendations.
B (incorrect): Incorrect. Meeting fruit recommendations was lowest among males (10.1%) and highest among Hispanic adults (16.4%).
C (incorrect): Incorrect. Meeting vegetable recommendations was lowest among adults living below or close to the poverty level (6.8%).
D (correct): Correct. In 2019, 12.3% of adults met fruit intake recommendations and 10.0% met vegetable recommendations, with state ranges of 8.4% to 16.1% for fruit and 5.6% to 16.0% for vegetables. The report suggests targeting men, young adults and lower-income adults.
E (incorrect): Incorrect. Vegetable recommendations were met by 10.0% of adults and were met most often by adults aged 51 or older (12.5%).
Source: Lee SH, Moore LV, Park S, Harris DM, Blanck HM. Adults meeting fruit and vegetable intake recommendations, United States, 2019. MMWR Morb Mortal Wkly Rep. 2022;71(1):1-9. Summary box and Results (2019 BRFSS; 12.3% met fruit and 10.0% met vegetable recommendations; fruit highest among Hispanic adults 16.4%, lowest among males 10.1%; vegetables highest among adults aged >=51 years 12.5%, lowest among adults with low income 6.8%). https://pmc.ncbi.nlm.nih.gov/articles/PMC8735562/
Question 3 of 4 · moderateIntroduction to Lifestyle Medicine
A 48-year-old woman learns that her polygenic score for coronary artery disease is in the top quintile. She asks whether lifestyle can matter if her genes are unfavourable. In the analysis by Khera and colleagues of three prospective cohorts (ARIC, WGHS and MDCS) and a cross-sectional imaging study (BioImage), which finding was reported?
At high genetic risk, favourable lifestyle was linked to 46% lower risk
Lifestyle lowered risk at low genetic risk but not at high genetic risk
High genetic risk raised coronary risk about tenfold versus low risk
A favourable lifestyle required all four healthy factors
Coronary calcification did not differ by lifestyle within genetic groups
Show answer and rationale
Answer: A. At high genetic risk, favourable lifestyle was linked to 46% lower risk
A (correct): Correct. Among participants at high genetic risk, a favourable lifestyle (at least three of four healthy factors) was associated with a 46% lower relative risk of coronary events than an unfavourable lifestyle (hazard ratio 0.54).
B (incorrect): Incorrect. A favourable lifestyle was associated with substantially lower risk regardless of genetic risk category.
C (incorrect): Incorrect. Coronary risk was 91% higher in the top versus bottom polygenic quintile (hazard ratio 1.91).
D (incorrect): Incorrect. A favourable lifestyle was defined as at least three of the four factors: no current smoking, no obesity, regular physical activity and a healthy diet.
E (incorrect): Incorrect. In the BioImage Study, a favourable lifestyle was associated with significantly less coronary artery calcification within each genetic risk category.
Source: Khera AV, Emdin CA, Drake I, et al. Genetic risk, adherence to a healthy lifestyle, and coronary disease. N Engl J Med. 2016;375(24):2349-2358. Abstract Methods (polygenic score; four lifestyle factors) and Results (top vs bottom genetic quintile HR 1.91; favourable lifestyle lower risk regardless of genetic category; high genetic risk favourable vs unfavourable HR 0.54, 46% lower; 10-year incidence 10.7% to 5.1% in ARIC; less coronary calcification in BioImage). https://pmc.ncbi.nlm.nih.gov/articles/PMC5338864/
Question 4 of 4 · moderateIntroduction to Lifestyle Medicine
An administrator reads the ADA’s 2022 economic analysis: people with diagnosed diabetes averaged $19,736 in annual medical expenditures, of which approximately $12,022 was attributable to diabetes. She proposes labeling the entire $19,736 as spending caused by diabetes. Which correction best reflects the study?
The attributable amount includes productivity losses in addition to medical spending
The attributable amount is limited to drugs and glucose-monitoring supplies
The total amount excludes care for conditions other than diabetes
The attributable amount estimates excess spending due to diabetes
The total amount is a lifetime rather than annual estimate
Show answer and rationale
Answer: D. The attributable amount estimates excess spending due to diabetes
A (incorrect): The $12,022 figure is attributable medical expenditure, not a total that adds indirect losses.
B (incorrect): The analysis includes other medical spending attributable to diabetes, including relevant services and hospital care.
C (incorrect): The distinction exists because people with diabetes also incur spending that would be expected without diabetes.
D (correct): Total expenditures in people who have diabetes are not identical to expenditures attributable to diabetes. The reported attributable amount estimates the excess relative to expected spending without it.
E (incorrect): Both figures in this comparison are average annual medical expenditures, not lifetime totals.
Source: Economic Costs of Diabetes in the U.S. in 2022. (2024); DOI 10.2337/dci23-0085. https://europepmc.org/article/MED/37909353. Locator: Abstract, Results, sentence beginning "On average people with diabetes incur annual medical expenditures".
For exam preparation only, not clinical advice.
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