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Legitimacy, trust and readiness for implementing lifestyle medicine in England: a cross-sectional study

Austen El-Osta¹, Sunil Kumar², Sami Altalib³

¹Self-Care Academic Research Unit, Imperial College London, London, UK a.el-osta@imperial.ac.uk.

|June 28, 2026

Abstract

Objectives:

This study examines awareness, perceived legitimacy, trust and readiness for the implementation of lifestyle medicine within National Health Service (NHS) prevention pathways among community-dwelling adults and healthcare professionals (HCPs) in England. A secondary objective was to assess how professional training and system factors relate to the provision and intended use of lifestyle medicine services within the NHS.

Design:

Cross-sectional, self-administered online survey.

Setting:

UK; online survey administered in January 2026.

Participants:

Adults aged ≥18 years living in the UK, recruited via a closed online panel using quota sampling to approximate national distributions by age, gender and ethnicity. A subgroup of respondents self-identified as HCPs.

Main Outcome Measures:

Primary outcomes were perceived legitimacy of lifestyle medicine as a healthcare approach and intention to use an NHS lifestyle medicine service if available. Secondary outcomes included awareness and familiarity with the term 'lifestyle medicine', trust in different providers of lifestyle advice, perceived self-efficacy across lifestyle domains and-among HCPs-training, confidence, barriers and current provision of lifestyle-related advice.

Results:

A total of 733 participants completed the survey including 58 HCPs. Awareness of the term 'lifestyle medicine' was limited in the general population (26.3%) but substantially higher among HCPs (62.1%). Despite this, there was broad agreement across groups regarding core lifestyle medicine domains; particularly nutrition, physical activity, sleep and stress management. Higher perceived legitimacy of lifestyle medicine was strongly associated with stated intention to use an NHS service. Trust in lifestyle advice was highest when delivered by clinicians with formal lifestyle medicine training and lower for non-medical professionals, even when formally trained. Among HCPs, formal training and greater confidence were strongly associated with provision of lifestyle-related advice, whereas perceptions of NHS support for lifestyle-based approaches were consistently low regardless of training status.

Conclusions:

Lifestyle medicine is widely viewed as legitimate and potentially valuable when anchored within professional training and NHS delivery but its implementation is constrained by limited public familiarity, variable workforce capability and low perceived system readiness. Strengthening training pathways, clarifying professional standards and enhancing institutional support may be critical to embedding lifestyle medicine within NHS prevention and long-term condition strategies.

Keywords:

PUBLIC HEALTH Primary Care Primary Prevention Self Care Self-Management

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