ORIGINAL RESEARCH
Michelle S. Rockwell, PhD, RD; Emily A. Cox, MPH, MS, RD; Marissa Meyer, DO; Julia Stelter, DO; Camille Mittendorf, BSPH; Ava Wolsborn; Grace-Anna Chaney, MA; Tonja M. Locklear, PhD; John W. Epling, MD, MSEd; Elizabeth A. Polk, MD, dipABLM
Corresponding Author: Michelle S. Rockwell, PhD, RD; Department of Family & Community Medicine, Carilion Clinic; Department of Family & Community Medicine, Virginia Tech Carilion School of Medicine.
Email: msrock@vt.edu
DOI: 10.3122/jabfm.2026.260049R1
Keywords: Chronic Disease, Health Behavior, Implementation Science, Lifestyle, Nutrition, Patient Engagement, Program Evaluation, Safety-Net Clinics
Dates: Submitted: 1/30/2026; Accepted: 5/4/2026
Status: In Press.
INTRODUCTION: Lifestyle Medicine (LM) focuses on preventing and treating chronic diseases with evidence based interventions for nutrition, physical activity, substance use, recovery (stress/sleep), and connectedness. Despite evidence that LM improves multilevel outcomes, integration remains limited in primary care, particularly in low-resource settings.
METHODS: We used a convergent parallel mixed methods study design to evaluate the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) of a primary care-based LM Clinic (LMC) in the Virginia safety net 2 years after inception. Data were derived from electronic health records (n=661), patient surveys (n=229), and clinician interviews (n=12).
RESULTS: REACH: LMC patients were demographically similar to the overall practice population. EFFECTIVENESS: Most (77%) patients who attended >2 LMC visits improved in 1 or more clinical outcomes (body mass index, blood pressure, hemoglobin A1c, blood lipids). Participants perceived the LMC most effective in improving nutrition (71%) and least effective in improving connectedness (37%). ADOPTION: Clinicians described multiple benefits of the LMC, but highlighted social, logistical and behavioral barriers to patient engagement. IMPLEMENTATION: The median patient experience rating was 7 out of 10 (IQR: 5, 10). Less than 15% of patients attended the recommended >4 LMC visits. MAINTENANCE: The most reported reason for attending LMC visits was “My doctor recommended it.” Appointment availability, scheduling difficulty, and family or work responsibilities were the most common reasons for discontinuing LMC attendance.
CONCLUSIONS: A primary care-based LMC shows potential for improving patient outcomes in this safety net setting; broader impact requires improved access, support, and tailoring to context.