Public Perception of Lifestyle Medicine and the Integration of Behavioral Health: A Nationally Representative Survey of U.S. Adults 18+

Introduction

Lifestyle Medicine (LM) and Behavioral Health (BH) are evidence-based, intersecting disciplines that improve both physical and mental health outcomes when applied in practice. Lifestyle Medicine employs therapeutic lifestyle interventions to prevent, treat, and, in some cases, reverse chronic disease by focusing on six pillars: avoidance of risky substances, connectedness, regular physical activity, restorative sleep, stress management, and a whole food, plant-predominant eating patter ¹ ; whereas Behavioral Health addresses mental health disorders, substance use disorders, psychosocial stressors, crisis states, and stress-related physical manifestations. ² Increasingly, these fields are recognized as complementary, with lifestyle interventions and mental health care capable of working synergistically to improve overall health outcomes. ³

Chronic disease remains the leading cause of morbidity and mortality in the United States, ⁴ with lifestyle-related factors, including poor nutrition, physical inactivity, insufficient sleep, chronic stress, substance misuse, and social isolation, contributing substantially to disease burden.^5,6 In response, Lifestyle Medicine has emerged as a clinically effective and cost-efficient approach to preventing and treating diet- and lifestyle-related disease.^7-9 However, despite growing evidence supporting its effectiveness, LM remains underutilized across many health systems.^10-12 This underutilization is multifactorial and reflects challenges including limited public awareness, restricted access to care, and financial and logistical barriers that impede engagement in lifestyle interventions. ¹³ These barriers are particularly pronounced among lower-income and underserved populations. ¹⁴

Evidence demonstrates that behavioral health symptoms, such as stress and anxiety, contribute significantly to chronic disease and can be positively impacted by lifestyle.^15,16 As a result, integrated Lifestyle Medicine and Behavioral Health (LMBH) models are gaining increasing attention. ³ Nevertheless, national-level insights into public awareness, perceptions, preferences, and barriers remain limited.

Realizing the potential of LMBH integration requires a deeper understanding of the patient perspective, including individuals’ interests, motivations, and the practical barriers they encounter when seeking care. Attention to patients’ lived experiences is essential for effective policy development and the successful integration of care models.

This study examines United States (U.S.) adults’ knowledge of and attitudes toward Lifestyle Medicine, Behavioral Health, and their integration using a nationally representative survey of adults aged 18 years and older. By providing empirical data on public perceptions of these care models, the findings aim to inform patient-centered care design, guide resource allocation, and support strategies that accelerate the transition of these essential, evidence-based services from specialized offerings to broadly covered, accessible, and foundational components of population health.

Methods

Results

Demographics and Health Characteristics of Respondents

Fifty-one percent of the sample was female. Forty-three percent of respondents were between the ages of 18-44, 32% were between 45 and 64, and 25% were 65 and over. Demographics of all survey participants, along with a comparison to a representative sample in the U.S. are shown in Table 1.^18-20

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Table 1.

Demographic Characteristics of Survey Respondents.

Characteristic	Percentage
Age, y
18-44	43
45-64	32
≥65	25
Gender
Male	48
Female	51
Other	1
Health status
Very good/Excellent	31
Good	45
Fair/Poor	24
Race/Ethnicity
White	60
Hispanic	16
Black	11
Asian	6
American Indian/Alaska Native	1
Native Hawaiian/Other Pacific Islander	1
Other	3
Refused	2
Household income
< $25,000	23
$25,000–$49,999	26
$50,000–$74,999	17
$75,000–$99,999	12
$100,000–$149,999	11
$150,000–$149,999	7
> $150,000	4
Education
Did not complete high school	3
High school graduate	30
Associate degree	12
Some college	18
College graduate	23
Postgraduate degree	14

Seventy-one percent of respondents were diagnosed with at least one chronic condition, and 24% rated their health as fair/poor (31% reported their health as very good or excellent). Chronic conditions reported by participants included high blood pressure (35%), anxiety (28%), high cholesterol (27%), overweight/obesity (22%), or diabetes/prediabetes (21%).

Discussion

This is the first nationally representative survey of U.S. adults to explore the perceptions, understandings, and attitudes towards lifestyle medicine and behavioral health. There was clear interest in accessing these services, as 91% of respondents were at least somewhat interested in changing their lifestyle habits to improve their health.

Despite this interest in improving lifestyle habits, 50% of respondents had never heard of lifestyle medicine. There also appears to be confusion about what constitutes LM, since participants reported being counseled on multiple LM pillars by clinicians. Potential marketing, outreach, and educational campaigns targeting consumers that describe what lifestyle medicine is, how it might benefit them, and where they can access resources could be useful.

In our survey, younger men with higher incomes were most familiar with LM and its impact on health. This may be due to an inherent interest in healthy aging or longevity among this demographic, ²¹ or a result of clinicians’ bias in discussing these concepts with some individuals and not others. The lack of familiarity with LM among other demographics, as well as misconceptions noted (15% thought it was a medication or supplement), suggest a clear education gap between the specialty of lifestyle medicine and the population at large.

Despite a lack of familiarity with the term LM, 70% reported being counseled on lifestyle and behavior changes and nearly 80% of respondents found LM at least moderately appealing. This is consistent with findings in an Australian survey of 649 adults. In that study ∼75% of adults felt positive about LM and that it aligned with their personal values. Eighty-six percent reported understanding how LM worked, and 70% believed it would be effective. ¹² In this U.S. LM survey, people were most interested in physical activity, nutrition advice, and stress management. These may be ideal areas to focus on first to attract adults and improve engagement with LM services.

Survey participants also strongly supported BH as a component of health care services, with 75% rating it as very or extremely important. The majority (82%) of survey respondents felt that it should be part of routine care provided by their primary care provider. An impressive 41% of respondents were very or extremely confident that they could make behavior changes that support their mental and emotional health. This desire for LM and BH services by adults shows that there is both a recognition about the importance of mental health, stress, and other health-related social needs, as well as an appetite to engage in services that address those issues. However, the high levels of confidence in making behavior changes does not necessarily translate into new behaviors. For example, it is estimated that 47% of individuals who intend to exercise never actually do. This “intention-behavior gap,” is well-recognized and remains a challenge in translating positive intentions into meaningful health changes. ²²

Several barriers were reported that made access to LMBH services difficult. Financial constraints, lack of insurance coverage, scheduling challenges, transportation limitations, and limited service availability emerged as the most commonly cited barriers. This was more common among older adults, those with lower incomes, and those in fair or poor health, the same demographics that often have higher rates of diet-related chronic disease.^23,24 These barriers closely mirror what has been reported in the literature regarding access to BH care. ²⁵ Although these individuals express interest in making lifestyle changes, they were also less confident in their ability to access LM services. Understanding and working to address barriers, particularly among the lower-income demographic, are critical to improving overall care. Recognizing the relevance of the fundamental cause theory will be valuable when implementing lifestyle medicine interventions to avoid inadvertently worsening health equity.^26,27

This survey highlights consumer interest, understanding, knowledge gaps, and barriers to accessing LMBH care. Exploring ways to educate patients, provide appropriate resources, and better integrate LMBH care are needed. Given the critical role LMBH plays in overall health, it is imperative to transition LMBH from specialized services to fundamental, covered, and accessible resources. Leveraging Federally Qualified Health Centers (FQHCs) and empowering primary care sites to deliver LMBH is not merely an option; it is a critical step toward ensuring these vital services are delivered to individuals and families who stand to benefit the most.

Limitations

The cross-sectional survey design elicits reported perceptions about topics and may not reflect true actions or behaviors. The online platforms used to recruit participants invariably created a selection bias toward individuals with access to technology and the time to complete questionnaires. An attempt was made to create a representative sample of U.S. adults, though this artificial recreation may have introduced other unrecognized biases. The surveys were not administered within any specific community, which increased generalizability, though could make the data less relevant to specific health care systems and communities with varying amounts of resources and access to services. Finally, significant testing was not performed, which could have added further credence to the differences observed between subgroups.

Conclusion

U.S. adults perceive LM and BH services positively and value their integration into primary care. Most adults were interested in improving their lifestyle habits and were confident that they could make recommended changes to improve their mental health. However, barriers such as education, access, and financial and logistical obstacles make utilizing LMBH services challenging. These findings should inform patient-centered care design, guide resource allocation, and support strategies that accelerate the transition of these essential, evidence-based services from specialized offerings to broadly covered, accessible, and foundational components of population health.

Supplemental Material

Supplemental Material