Associate Professor John Anthony Stevens

Human health and the health of our planet are inextricably linked. The accelerating loss of global biodiversity represents one of the most profound health threats of the 21st century. With species extinction rates estimated to be 10-100 times higher than natural baselines, biodiversity decline is no longer solely an environmental concern. This narrative review synthesizes evidence suggesting that biodiversity decline is increasingly relevant as a determinant of human health and survival rather than solely an environmental concern. The six pillars of lifestyle medicine, offer a coherent framework for interventions that can simultaneously prevent and improve lifestyle related illness outcomes while improving planetary health by reducing environmental pressures that drive species extinction and biodegradation. The review examines evidence synthesized from peer-reviewed databases (MEDLINE, PubMed, CINAHL, Joanna Briggs, SCOPUS, ScienceDirect, and GreenFILE), primarily 2010-2025, organized across seven thematic domains: infectious disease ecology, ecosystem services, microbiome dynamics, lifestyle medicine interventions, One Health integration, behavioural change, and clinical/policy implications. The review argues that lifestyle medicine must evolve from individual-focused clinical practice to also explicitly address structural drivers of ecological degradation, including food systems, transport, and urban design, thereby operationalizing planetary health principles in clinical care.

The escalating global burden of chronic disease, increasing health inequities, and provider burnout require innovative care models. Shared medical appointments (SMAs) are group-based interventions with potential to advance the Quintuple Aim framework: patient experience, population health, cost reduction, provider wellbeing, and health equity. This review critically synthesizes evidence regarding SMAs’ capacity to meet the Quintuple Aim in lifestyle and chronic disease care. Peer-reviewed studies, including systematic reviews, RCTs, and observational research, were selected through biomedical database searches including Medline CINHAL Joanna Briggs Institute and PubMed. Criteria: SMAs (and other related terms) addressing one or more Quintuple Aim domains. Strong evidence supports enhanced patient satisfaction, timely access, and communication in SMAs. Population health shows improved outcomes for diabetes, cardiovascular disease, COPD, and prenatal care. Cost-effectiveness is achievable with effective design. Provider wellbeing benefits include reduced burnout and improved teamwork. SMAs advance health equity, providing effective models for Indigenous, rural, and disadvantaged cohorts. SMAs align robustly with the Quintuple Aim and demonstrate multi-domain impacts. Chronic disease and lifestyle medicine practitioners and health services should consider their broad adoption and ongoing local adaptation.

Introduction: This paper presents a secondary analysis of data from a study of 216 people participating in a trial of program shared medical appointments (PSMA) in weight management. The focus of this paper is the Aboriginal women who participated in this translational research project and who were not reported on specifically in the primary analysis and publication. This paper, therefore, examines the use of PSMA as a culturally safe and responsive procedure to facilitate weight management. Method: Twogroups, totalling 25 Aboriginal women, participated in a 6-session 12-week culturally responsive weight management PSMA. Repeated weight and satisfaction measures at 3, 6 and 12 months were collected. Results: 19 of 25 (76%) Aboriginal women completed the MYU. 16 (84%) lost some weight, and 5 (26%) lost clinically significant weight (> 5%), sustained for 1 year. The participants and providers rated the procedure > 4 on 5-point Likert scales for satisfaction. 95% reported that they preferred MYUs for weight management over 1:1 consultations with their general practitioner. Conclusion: The data indicates that programmed shared medical appointments appear to be a culturally safe and responsive procedure to support the Aboriginal women, in this study, to manage their weight.

First Nations women in Australia diagnosed with type 2 diabetes, co-designed and attended a programmed shared medical appointment that included continuous glucose monitors and culturally responsive food appreciation activities over 8 weekly sessions to improve glycaemic control. The project was a single site, longitudinal change from baseline, mixed methods, feasibility study using HbA1c as the primary outcome measure. Secondary outcome measures included, weight, metabolic health-related blood panels, CGM, Blood Glucose Levels (BGL) time-in-range percentage, Patient Activation Measure (PAM) and Problem Areas In Diabetes (PAID) tools and client satisfaction survey and semi focussed interviews. Forty participants commenced and twenty-five participants completed the program (62,5%). Of the completing participants the mean HbA1c had an absolute reduction of 0.7 percentage points ( from baseline to program completion, P = .013). Eighteen (75%) reduced HbA1c and maintained some reduction for 12 months. Seven (28%) achieved remission, HbA1c <6.4% (46 mmol/l) maintained for 12 months. There were statistically significant improvements in weight, systolic blood pressure, liver enzymes, BGL time-in-range, PAM and PAID scores. It is feasible to use programmed shared medical appointments incorporating CGM aiming to improve glycaemic control and other metabolic measures of health among First Nations women in Australia.

Background: Overweight and obesity has a bi-directional association with the growing burden of musculoskeletal (MSk) dysfunction and pain. It seems inevitable that MSk practitioners will see increasing numbers of patients who are overweight and or obese and require this to be addressed as part of their management. Little evidence exists to describe the engagement of patients and their MSk practitioner in weight management as an adjunct or direct component of their intervention or therapy.
Methods: A self-administered electronic survey was constructed with 13 items to collect self-reported data from Australian practitioners who have a focus on MSk management. The target group was from a multidisciplinary MSk network of 350 members.
Results: A total of 204 completed surveys were analysed from respondents working in one of seven MSk- related professions. It was found that 70% of patients/clients seen by respondents were overweight or obese and that <18% of these patients had weight management included as part of their treatment.
Conclusions: Sixty percent of the respondents in this survey indicated that they do not include weight management as part of their practice despite 70% of their patients/clients being overweight and or obese. With the exception of Medical Practitioners and Exercise Physiologists, in this survey, the other therapists including Chiropractors, Osteopaths, Physiotherapists and Occupational Therapists, indicated that they lacked confidence, knowledge and methods to engage a systematic approach to weight management with their patients/clients.

Background and objectives: Programmed shared medical appointments (pSMAs) are an extension of shared medical appointments (SMAs) for managing chronic diseases. Acceptance and outcomes of a trial for weight management are reported here.

Method: Six programmed sessions in weight management were carried out in seven NSW primary healthcare centres.

Results: Seventy-seven per cent of 216 participants (64 male, 102 female) completed at least four of six pSMAs over 16-18 weeks ('adherers'). Eighty-five per cent of adherers approved of pSMAs, and 73% said they would prefer these over a standard clinical consult. Providers also rated the process highly. Overall mean weight loss over 12 months was 3.2% (95% confidence interval [CI]: 2.2, 4.3; P <0.001). For adherers, mean weight loss was 4.3% for males (95% CI: 2.6, 6.1; P <0.001) and 4.2% for females (95% CI: 2.7, 5.7; P <0.001), with 46% of males and 35% of females maintaining clinically significant losses (>5%) after 12 months. pSMAs were calculated to be four times more cost effective and up to seven times more time effective than 1:1 consultations for weight loss.

Discussion: pSMAs are a popular, cost and time-effective adjunct to standard clinical management.