From the moment I waded into the world of Lifestyle Medicine back in 2022, I have reflected on this question: Which pillar is the most important? As you now know, there are six pillars of Lifestyle Medicine and a strong case can be made for each as the most important. My colleagues, as well as many leaders in Lifestyle Medicine, most often correctly and unequivocally advocate for nutrition as the most important pillar. They are not wrong. At the same time, there is room to consider a different answer. And it all begins with you.

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Nutrition is foundational for healthy, happy living. Particularly from the lens of Lifestyle Medicine, where we are looking to prevent and reverse chronic diseases such as Diabetes and Obesity, nutrition is paramount. We know from decades of research that whole-food, plant-predominant eating achieves better health outcomes, from heart health to neurocognitive function to gut microbiome to even mental health. When it comes to these specific goals and health benefits, nutrition is indeed the most important.

What I would invite you to consider is the practical application of putting healthy nutrition into practice. This is where many of us fall into the typical diet mindset: you make a broad sweeping change in eating habits for the better, that lasts all of 2-12 weeks before life happens and we throw in the towel. What follows is the bigger risk, usually 3-9 months of no “diet” or a reversion to old, less healthy habits. Enter nuance.

Here’s where I disagree with nutrition being the most important pillar. If there are barriers to you successfully implementing and sustaining a healthy eating pattern, then it makes more sense to me to address those first, so that you can actually be successful with your nutrition and health goals. Let us look at a few examples.

If you are sleeping 3-4 hours per night and never feel rested, fall asleep during the day, and have no energy, your decision-making capacity, tolerance for stress and uncertainty, and emotional regulation are all going to suffer. Those factors make it much, much harder to stay steady with nutrition. The most important pillar at that time, for you, may be to improve sleep. Once you are getting restorative rest and your sleep is in a more stable place, you can then move towards working on nutrition.

Alternatively, let’s say a person is using risky substances everyday. They might be consuming 2-3 glasses of wine every night, or using cannabis daily, or habitually trapped in IV drug use. In these cases, while nutrition still matters greatly for their health, helping them manage substance use might be the most important first step (and pillar) for that person.

This is what I mean when I say it all begins with you. When I work with a patient or client 1:1, my goal is to meet them where they are. In the textbook, on paper, in theory, yes, nutrition is the gold standard for health. And the other pillars of movement, sleep, stress management, avoidance of risky substances, and positive social connection all matter too. But the most important pillar is a constantly shifting concept, not a fixed answer. Similar to the concept of nourishment. I believe the most important pillar is whichever one is most meaningful to you, for your current goals for health or life, at any given time. Whatever is best for you.

Meeting people where they are is one of the best ways to provide high-quality clinical care and health coaching to folks. I was recently reminded of how applicable this is in primary care or quite honestly any other specialty in medicine. When someone has high cholesterol and the lifestyle measures they are taking are insufficient, we do support management with medication, such as a statin. However, if that person really does not want to take a statin, and the doctor prescribes one anyway, how much benefit is the person actually receiving from the prescription? Again, in theory, it’s all the right management and follows the evidence and guidelines. But putting it into practice, it’s a totally different story. Supporting the human-being in front of you and meeting them where they are first, enhances the experience for all involved.

So in the end, which pillar is the most important? For me, is comes down to 2 key elements:

  1. Where you are at with your health, life, and goals, at any given moment in time.
  2. Whichever category you feel is best to tackle first, to give you the best shot at that pillar and the others.

How does one go about putting this all into practice? Here is your action plan:

  • Put pen to paper and write the 6 pillars down on the left hand side.
  • Take an honest, reflective look at where you are currently at with each one and write some bullet points to the right of each pillar, for each category.
  • Choose one pillar to tackle first to achieve better health and a better you.
  • For that one pillar, choose one small goal that you can do daily (or most days) for at least a week or a month.
  • Reassess after that time period and repeat the steps.

Take the pressure off. Yes, nutrition is important, but so is meeting yourself where you are and giving yourself grace and self-compassion to choose whatever is best to work on for you. It might look different for others, and that is totally okay. You got this.

As always, chase progress, not perfection.

I believe in you,


Dr. Khimji


This Week’s Challenge

Try going analog for 24 hours. Avoid using digital devices for 24 hours, or at least see how many hours you can last without your smartphone.


The Bottom Line

Many doctors and leaders in Lifestyle Medicine say that Nutrition is the most important pillar. Although I do agree it matters greatly, and is indeed the most important for chronic disease prevention and reversal, I do think there is another answer. The most important pillar is whichever one matters the most to a person at any given point in time. The one that they want to or need to work on most at that moment. For some it may be sleep first, for others perhaps movement. Regardless, it matters most that we meet folks where they are and support them with what they need, rather than what we think they should do (even when objectively accurate). There is a difference between what is most important in theory vs what is most important in reality and in actual practice. When it comes to taking action, the most important pillar is the one you are actually going to work on, has the biggest impact for you, and the best chance of lasting. Put this into practice by figuring out where you are at with each pillar now, then choosing a small goal for one pillar, and doing that most days for at least 1 week or 1 month. Reassess and repeat after that time period.