AMWA member Beth Frates, MD
• Clinical Assistant Professor, Harvard Medical School
• Director of Lifestyle Medicine and Wellness, Department of Surgery, Massachusetts General Hospital
• Director of Wellness Programming, Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital
• President, American College of Lifestyle Medicine
What are you currently doing professionally?
As Director of Wellness Programming at the Stroke Institute for Research and Recovery at Spaulding Rehabilitation Hospital, a Harvard Medical School affiliate, I have created and implemented a 12-Step wellness program, PAVING the Path to Wellness™ for patients and providers. Most recently, I co-authored the book PAVING the Path to Wellness Workbook: A Guide to Thriving with a Healthy Body, Peaceful Mind and Joyful Heart. As of the fall of 2020, I serve as the Director of Lifestyle Medicine and Wellness for the Department of Surgery at Mass General Hospital. In addition, I have my own lifestyle medicine consulting practice where I see patients 1:1 and in groups. I was elected President of the American College of Lifestyle Medicine for 2023-24.
Tell Us About Your Career Path
I was originally an undergrad economics major at Harvard, but my father suffered a heart attack and stroke my freshman year. He was only 52. That challenging experience for my family made me determined to figure out how to prevent heart attacks and strokes. With this goal in mind, my senior thesis studied the impact of mental stress on the heart, finding that mental stress can have a significant impact on the EKG and Thallium scans showing ischemia and wall motion abnormalities similar to those found during physical stress with the stress test in coronary artery disease patients.
After graduation, I went to Stanford Medical School where I studied the impact of nutrition on endothelial cells. One study I participated in examined the effect of a diet high in saturated fat versus one high in L-arginine, which is found in walnuts and promotes high nitric oxide (NO) levels. Individuals with diets high in nitric oxide had healthier endothelial cells. I found it fascinating that the foods we eat affect our bodies down to the cellular level. At the time, the primary focus of cardiology was on treating heart disease with medications and stents. And the primary focus on preventive medicine was epidemiology and public health. Because heart attacks and strokes were of great interest to me, I saw that rehabilitation medicine allowed me the time to create close connection with patients and prolonged exposure to them allowing for time to counsel and teach about healthy living to help them prevent a second event. At that time patients spent about four weeks in rehabilitation. After medical school, I interned at Mass General Hospital and did my residency in the Department of Physical Medicine and Rehabilitation at Harvard Medical School, where I was chief resident.
I pursued some really interesting research while I was at Spaulding. One study I participated in surveyed family physicians and asked about exercise habits and counseling practices. We asked physicians if they exercised, if they counseled on exercise, if they practiced aerobic exercise, if they counseled on aerobic exercise, if they engaged in strength training and if they counseled on strength training. Our results show that physicians preach what they practice. If they exercised, they counseled on it. If they did not do strength training, they did not counsel on it. This study was published in 2000 and has been replicated by others a number of times with the same result. Also, during my time at Spaulding, I conducted research on stroke survivors and their caregivers, testing their knowledge and expectations after stroke. We discovered that only about half of patients recovering from stroke or heart attack could accurately answer questions about how and why their strokes occurred. I found this knowledge gap extremely concerning. In 2006, I decided to co-author a book with colleagues to educate patients on what they need to know to prevent a second cardiac event. The book is called “Life After Stroke: The Guide to Recovering your Health and Preventing Another Stroke.” A colleague read it and informed me that I was promoting the practice of “lifestyle medicine,” which at the time was a relatively obscure and that I was unaware of. But I was interested and immediately set out to learn more. Lifestyle medicine has been my passion ever since.
Lifestyle medicine is a medical specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions including, but not limited to, cardiovascular diseases, type 2 diabetes, and obesity. Lifestyle medicine certified clinicians are trained to apply evidence-based, whole-person, prescriptive lifestyle change to treat and, when used intensively, often reverse such conditions. Applying the six pillars of lifestyle medicine—a whole-food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connections—also provides effective prevention for these conditions.
Can you cite any particular instance (s) or individuals that influenced your choices?
There are so many people who have influenced me, it is hard to name them all. Dr. Eddie Phillips, who was an attending physician at Spaulding Rehabilitation Hospital, encouraged me to help him direct the first CME courses at Harvard Medical School on the topic of lifestyle medicine. I joined him to create the Institute of Lifestyle Medicine at Harvard Medical School in 2006. In 2008, I started the first Lifestyle Medicine Interest Group (LMIG) at Harvard Medical School. During these LMIG meetings, I was teaching exercise, nutrition, and stress resiliency to medical students. Lifestyle Medical Interest Groups are student-led organizations that address the growing need for lifestyle medicine education and activities at academic and health institutions. Today, 123 LMIGs are established on academic and health system campuses. Of those, 81 LMIGs are at medical schools across the US.
After starting the interest group, Dr. Stephanie Peabody invited me to create a course on lifestyle medicine for Harvard Extension School bachelor’s and master’s students in psychology programs. I taught that for about two years before I attended my first American College of Lifestyle Medicine (ACLM) national meeting. There, I met Susan Benigas who is Executive Director of ACLM and an inspirational woman who has supported and helped open up opportunities for me in lifestyle medicine. ACLM is the medical professional society that educates, equips, and supports certification of physicians and other clinicians in lifestyle medicine. ACLM has grown in membership from 380 in 2014 to more than 9,000 today. Interest among physicians and other clinicians has exploded. Susan’s passion and energy for lifestyle medicine is irrepressible and, after hearing about my work at Harvard, she inspired me to partner with ACLM and to amplify my work more broadly in medical education. This resulted in the creation of the Lifestyle Medicine 101 Curriculum that has been utilized in bachelor’s and master’s programs, medical schools, physical therapy and physician assistant programs to educate students on the six pillars of lifestyle medicine. It is so gratifying to see how many students who have been exposed to the curriculum.
Are you active in any AMWA initiatives and/or do you hold a leadership role in AMWA? How has this shaped your view of medicine?
I was delighted to become a new member of AMWA this spring and look forward to becoming active. I have long advocated for women in health care and medical education and know firsthand the experiences of many women in their careers. I was the first female Chief Resident at Harvard Medical School and, not only that, became pregnant while filling that role. So we created a new pathway for women to do that. I was also one of the first women to become a Fellow of the American College of Lifestyle Medicine (FACLM).
I love working with strong, intelligent and talented women. The American College of Lifestyle Medicine has uniquely strong female leadership. Susan Benigas, ACLM’s Executive Director, is a powerful force for change in health care. ACLM Immediate Past President is Dr. Cate Collings and the President-Elect is Dr. Padmaja Patel, Medical Director of the Lifestyle Medicine Center at Midland Health in west Texas. That’s four women in top leadership roles. I don’t know how many other medical professional organizations can say that. Women are truly trailblazing the path to making lifestyle medicine the foundation of health and all health care.
Are There Challenges that Have Influenced Your Medical Career?
As an early believer in the potential of lifestyle medicine, it was very challenging back in 2008 to convince people in the medical community that it was an evidence-based specialty. Medical school curricula are filled to the brim with important areas such as anatomy, pharmacology, microbiology and pathology. Those are all areas that student doctors must master. But only 29 percent of medical schools in the U.S. report meeting the minimum hours of nutrition education recommended by the National Academy of Science. That’s a problem. If physician do not feel sufficiently educated to provide evidence-based dietary guidance – to explain how what we eat and do not eat impacts our health – then patients are going to seek it from faux Internet experts or fad diets. Patients deserve to know it is possible, for example, to achieve remission for type 2 diabetes through diet alone.
I am fortunate that Harvard Medical School has embraced the opportunity to integrate lifestyle medicine into the curriculum without sacrificing any core topics. Today there is a lifestyle medicine theme throughout all four years of medical education at Harvard and lifestyle medicine-related electives on nutrition and culinary medicine were accepted in recent years. I now have many dedicated and passionate colleagues at Harvard Medical School advocating for and teaching lifestyle medicine, some of whom are board certified in lifestyle medicine.
Given your lived experiences, do you have any advice for women in medicine?
The role for women in medicine has come a long way in the past 20 years. There may be fewer “firsts” but there are glass ceilings that remain, and we must continue to break them. My advice for women in medicine is to be confident that, no matter what anyone else may say, we are leaders – leaders with integrity, dedication, compassion and emotional intelligence. Don’t doubt yourself. And if having a successful career in medicine and starting a family are among your goals then there are paths for you to achieve both. In fact, the role of lifestyle medicine in improving clinician satisfaction is sometimes overlooked. The COVID pandemic exacerbated burnout in medicine. I have countless colleagues who transformed their health and job satisfaction by applying the pillars of lifestyle medicine to their own lives. We worry so much about our patients’ health that we so easily neglect our own. So perhaps my most important advice for women in medicine is to prioritize your own health and well-being first. We can’t truly heal others if we cannot first heal ourselves.
Is there anything else that has impacted your career trajectory or work within or outside medicine that has been a significant influence?
Mentoring – both having one and becoming one– has impacted myself and my career in so many ways. No one ever actually told me how important a mentor would be when I started out in the medicine but I found one, Dr. Walter Frontera, when I was a resident doctor. He was my department chair who supported me and encouraged me to pursue my dreams and passions in medicine and education. He later left Harvard, but we still stay in touch. It is important to realize that you can find mentors any age. In fact, I found a new mentor last year, Dr. Stefanos Kales, in the Harvard T.H. Chan School of Public Health. His guidance has been critical my academic and research opportunities.
I also make a point to mentor others. In the last 23 years, I have mentored about 50 students and physicians. A few I have mentored for over a decade. Mentoring is so gratifying and fulfilling, and those relationships are my most positive social connections – one of the six pillars of lifestyle medicine. Mentoring continues to motivate and inspire me.
