A Journey to Lifestyle Medicine, by Tom Rifai, MD, FACP

As for many of you, lifestyle medicine is far more than just a profession to me as I not only treat people with major metabolic health issues, maladaptive eating patterns and behavioral health issues, I myself am also “one of them.”

Among other issues, I have been battling binge eating disorder for decades and still today. It is one of my major motivations to be the most compassionate lifestyle medicine physician possible. Before delving into the beginnings of my journey to lifestyle medicine, one “teaching moment” in establishing my “absolutely no judgment of patients…EVER” approach was a brutal early morning awakening of choking on my own vomit after a night of binge eating almost two large pizzas in rapid fashion. For a very critical moment, I truly thought I was going to die. In less than 5 seconds of awakening (but which felt much longer) I was “running” backwards into a wall in my apartment in an effort to dislodge my (not so comfortable) comfort food mix of refined flour, fatty cheese and salt. I don’t remember seeing my life flash before my eyes. Rather, I saw visions of a newspaper article: “Detroit Nutrition Doc Dies Choking on Pizza!”

I have had the benefit (and yes, burden – but I try to look at the bright side) to have been educated by an emotionally traumatic and at times violent childhood blended with a family history of very bad eating habits, much driven by emotional eating. Then there were the two years on anti-depressant therapy (one of those years on two medications combined) and a full continuous year of CBT and psychotherapy at 14-15 years of age.

But no, there really is no full “recovery” from bingeing nor end to “the journey of a lifestyle” in my personal, and professional opinion. At the end of the day I view all of what I have gone through and “suffered” (quotations because suffering = opportunity to learn) as a glorious and worthy battle! And this is the same spirit in which I coach our lifestyle program patients.

I didn’t exactly “get lucky” with a counterbalance of great family genes for metabolic health. Elevated lipoprotein (a), a genetic tendency towards low HDL and insulin resistance are all part of my genetic make-up. Sadly, my beloved youngest brother passed away in January, much driven by frank binge eating tendencies. These have been motivations to be the best lifestyle medicine physician I can be, both professionally and personally.

My father was probably the first strong influence on my journey to lifestyle medicine. Formerly a world class urologist, he currently suffers from self driven type 2 diabetes, dementia, depression and a long history of over and binge eating. While he taught me great things in ethics, value of dedication in education, and the importance of world history, his teaching in lifestyle was the most valuable. I’ll never forget one “sentinel event” around 10 years of age. On a Saturday around 11:30 am, after rounding on his patients (skipping breakfast, of course), I watched him, almost literally, inhale his McDonald’s bag of french fries before our hamburgers even hit the tray at the counter! And then, to shocked audience of me, dad ordered another bag of fries as soon as our burgers hit the tray. It was certainly an indelible, and influential, moment for me. Even as a youngster I knew what he did was not healthy and for whatever (or very good) reason, I can see the image and moment in my mind now as if it happened yesterday. And thanks to that experience, one of my life missions is “breaking the chain” of my family history of bad eating behaviors not only for me but, just as importantly, my two children. I’m proud to say that, almost assuredly due to lifestyle my recent carotid artery intima-media thickness (CIMT) ultrasound was consistent with a vascular age more than a decade younger than my biological age (mid 30’s vs almost 50). Yes, a binge eater with a far less than stellar family history was literally saved by lifestyle (as) medicine. For me, the right attitude is “progress IS perfection”!

My path to lifestyle medicine wasn’t driven by a single “magic moment in time.” I thought would be practicing lifestyle medicine via primary care. However I realized that lifestyle medicine could (and needs to be) a specialty in and of itself. The time required with patients for the highest odds for successful lifestyle change cannot, sadly (at least as our current “health” care system is set up), be effectuated in the current fast paced primary care culture. Hopefully that will change. And while I couldn’t respect primary care docs more (some of my best teachers), I decided to go straight into multidisciplinary care lifestyle and metabolic medicine right from residency. The rest is lifestyle medicine history!

Dr. Tom Rifai, Founder and CEO of health coaching, consulting and education company Reality Meets Science®, is board certified by the American Board of Internal Medicine, a Diplomate of the American Board of Lifestyle Medicine, and Speakers Bureau member for the American College of Lifestyle Medicine. He is expert in areas of metabolic health and behavior modification-based management of insulin resistance, including but not limited to pre and type 2 diabetes, dyslipidemia, hypertension as well as compassionate weight control. Dr. Rifai’s personal history of severe binge eating disorder uniquely drives his compassion and understanding of those with he is honored to coach and guide to improved health and healing. While he is well-versed in pharmaceutical management to reduce metabolic risk, his dynamic lifestyle-driven “Keys to Optimal Wellness” (https://www.consultant360.com/articles/wellness-weight-loss-and-disease-prevention-5-keys-healthy-lifestyle-change) is at the core of his therapy model, with carefully selected pharmaceutical medicines recommended only if necessary. Dr. Rifai’s 5 Keys healing lifestyle based model and RMS (for Reality Meets Science, but for which many RMS devotees say actually stands for ‘Rifai Makes Sense!’) brand is rooted in a unique blend of professional, evidence-based training as well as personal experiences with trauma, depression, anxiety and aforementioned binge eating disorder.

Dr. Rifai is the primary author and online course director of Harvard’s Lifestyle Medicine CME, ‘Nutrition and the Metabolic Syndrome’, which integrates his 5 Keys to Optimal Wellness. It is one of the most popular Harvard online Lifestyle Medicine offerings with over 4000 doctors and other healthcare providers worldwide having taken his course over the last decade, which was updated in 2019 and upgraded to Harvard’s new digital Lifestyle Medicine platform in 2020. Plans for his Flexitarian lifestyle based book on the 5 Keys are currently underway!

Dr. Rifai served two terms on the Board of Directors for the National Board of Physician Nutrition Specialists and was unanimously elected its president during his final term. He is part of the True Health Initiative (THI) Council of Advisors, Media Response Committee (serving with Drs Dean Ornish and Walter Willett) as well recently being named THI’s ‘News Of The Day’ editor, helping debunk commonly found exaggeration, hyperbole and misinformation regarding nutrition and lifestyle in the general media (http://www.truehealthinitiative.org/councils/tom-rifai/).

Prior to going full-time CEO for RMS and providing world class health coaching (via group digital platform as well as highly curated one on one), corporate consulting and keynote speakingDr. Rifai served as Regional Medical Director of Metabolic Health and Weight Management for the world-renowned Henry Ford Health System (an active 5 Keys to Optimal Wellness RMS licensee) in Metro Detroit, Michigan as well as Associate Medical Director of the Pritikin Longevity Center in Miami, Florida. Dr. Rifai continues to serve as a Medicare-approved Pritikin ICR (Intensive Cardiac Rehabilitation) educator (on the topics of dietary fats and weight control) and advisor.

Tom Rifai MD FACP
CEO, Reality Meets Science® LLC