Gia Merlo's additional information
Gia Merlo, MD, MBA, Med, DipABLM, FACLM is a clinical professor of nursing and Senior Advisor on Wellness, a clinical professor of psychiatry at the NYU Grossman School of Medicine, and a fellow of the American College of Lifestyle Medicine. Merlo recently published a textbook Lifestyle Nursing (Taylor & Francis/CRC Press, August 2022) that expands Lifestyle Medicine (an evidence-based approach in preventing, treating, and oftentimes, reversing chronic diseases) to Nursing. Her first book, Principles of Medical Professionalism (Oxford University Press, 2021), stresses the importance of physician wellness, the need to address the social determinants of health, as well as the need to address chronic diseases with prevention. Merlo is the Associate Editor of the American Journal of Lifestyle Medicine. She is a contributing author of the American College of Lifestyle Medicine (ACLM) curriculum Lifestyle Medicine 101 and of the board review course, Foundations to Lifestyle Medicine.
Merlo's current book projects include Medical Professionalism: Theory, Education, and Practice (Oxford University Press, expected 2023), Lifestyle Psychiatry: Through the Lens of Behavioral Medicine (Taylor & Francis/CRC Press, expected 2023), A Handbook of Lifestyle Nursing (expected 2023).
Merlo is a part of the Psychiatry Faculty Group Practice at NYU Grossman School of Medicine and sees patients at NYULangone Health Psychiatry, 1 Park Avenue, New York, NY. She completed her Master of Education in Health Professions at Johns Hopkins University School of Education in August 2022 and is currently an Adjunct Faculty at Johns Hopkins helping students in the program complete their capstone projects.
Merlo has served on the board of directors of many nonprofits over the years and is currently on the board of directors of Plant-Powered Metro of New York (PPMNY) and the advisory board of the Global Positive Health Institute (GPHI). She is chair of the Mental and Behavioral Health Member Interest Group of the ACLM. She has been involved in clinician care and medical education for nearly 30 years in professional development and mental health, particularly for healthcare professionals.
Before joining NYU, Merlo was an associate dean of health professions at Rice University. She also taught medical students, residents, and fellows at Baylor College of Medicine, where she was a 2017-19 Master Teacher Fellow. She has served on the faculty at the University of Pennsylvania School of Medicine, Baylor College of Medicine, Rice University, Texas Children’s Hospital, and Children’s Hospital of Philadelphia.
MD - Nagarjuna UniversityMBA - Temple UniversityMEd - John Hopkins University
Academy of Professionalism in Health CareAmerican Academy of Child and Adolescent PsychiatryAmerican College of Lifestyle MedicineAmerican Medical AssociationAmerican Psychiatric Association
Faculty Honors AwardsMaster Teacher Fellowship, Baylor College of Medicine (2019)Houston’s 50 Most Influential Women, Houston Women’s Magazine (2018)Favorite Professor Award, Rice University Scholar Athletes (2017)Fellowship, American Psychoanalytic Association (1997)
Primary Care at the Intersection of Lifestyle Interventions and Unhealthy Substance UseAbstractAbstractPrimary care physicians are well-positioned to integrate lifestyle interventions into the management of patients with unhealthy substance use, who may also have mental and physical chronic health comorbidities. However, the COVID-19 pandemic exacerbated the U.S.’s poor state of health, revealing that its current approach to chronic disease management is neither effective nor sustainable. Today’s full spectrum comprehensive care model requires an expanded toolkit. Lifestyle interventions broaden current treatment approaches and may enhance Addiction Medicine care. Primary care providers have the potential to have the greatest impact on unhealthy substance use care because they are experts in chronic disease management and their frontline accessibility minimizes healthcare barriers. Individuals with unhealthy substance use are at an increased risk of chronic physical conditions. Incorporating lifestyle interventions with unhealthy substance use care at every level of medicine, from medical school through practice, normalizes both as part of the standard care of medicine and will drive evidence-based best practices to support patients through prevention, treatment, and reversal of chronic diseases.
Applying Psychiatry and Psychology Principles to Lifestyle Approaches for Mental and Behavioral HealthAbstractAbstractResearch suggests that mental health symptoms and disorders are historically underdiagnosed and undertreated, in part due to the siloed nature of medicine. Yet, approximately 50 million American adults experience a mental health disorder. As the field of lifestyle medicine continues to emerge and grow, there is an important opportunity to address mental health from a lifestyle medicine perspective, as well as to ensure that lifestyle medicine can be utilized for all patients, including those with mental health conditions. To effectively address mental health, the field of lifestyle medicine would benefit from understanding and leveraging the decades of science and practice from the fields of psychiatry and psychology, as well as the expertise of psychiatrists and psychologists who are familiar with the science and trained in lifestyle medicine. Incorporating empirical literature from other areas, utilizing well-established conceptual frameworks, and addressing the overlap between lifestyle medicine and mental health early in, and throughout, training and education, are important steps to move toward addressing mental and behavioral health with a lifestyle medicine approach.
Incorporating Mental Health Into Lifestyle MedicineAbstractAbstractThe evidence-based interconnection between mental health with lifestyle medicine practice is discussed. The extent to which physical health, and mental and behavioral health overlap are significant, and their interaction is seen in many ways. These bidirectional influences form a continuous thread through all lifestyle medicine pillars. The intersection of mental health and lifestyle should be considered and applied to provide optimal evidence-based lifestyle medicine for all patient populations who will benefit from the specific attention to diet, physical activity, relationships, stress, sleep, and substance use. Lifestyle medicine can be utilized to directly address and treat a range of mental health symptoms and disorders, and physical illnesses. In addition, behavior change skills and addressing the psychological factors contributing to barriers are crucial to helping patients reach their lifestyle medicine goals. Approaches to practice that attend to, and address, mental and behavioral health are relevant to and necessary for all types of providers who work within the lifestyle medicine framework.
Mental Health in Lifestyle Medicine: A Call to ActionAbstractAbstractMental health symptoms are pervasive, with 1 in 5 American adults experiencing a mental disorder. Poor mental health is associated with a significant global cost burden, from disability to economic impacts. The field of lifestyle medicine, which emphasizes the role of lifestyle factors in the onset and treatment of disease and well-being, is well suited to address mental health. More recently, there has been attention to the need to incorporate mental health into the field of lifestyle medicine and to attend to the bidirectional role of mental health and lifestyle. Thus, there is a critical opportunity for the field of lifestyle medicine to incorporate mental health into each of the foundational pillars (diet, exercise, substance use, psychological well-being/stress, relationships, sleep) while also specifically targeting lifestyle interventions for populations with mental disorders. The current article provides a framework for the role of mental health within lifestyle medicine by addressing the scope of the problem, clarification regarding mental health, and areas of practice (ie, psychiatry), and providing an overview of the relevant mental health literature for each pillar. This article serves as a call to action to explicitly address and include mental health within all aspects of lifestyle medicine research and practice.
The Aging PhysicianAbstractAbstractAfter decades of working in the medical field, physicians have gathered an extensive knowledge of human pathology as well as effective courses of treatment for illnesses. However, aging may also bring about cognitive deterioration, which may compromise the quality of care physicians provide to their patients. In 2015, 23 percent of physicians were above the age of 65. An estimated 25,000 to 50,000 active physicians are expected to suffer from mild cognitive impairment and up to 25,000 from dementia. Currently, physicians are not held to a mandatory retirement age and are not subject to oversight of their cognitive abilities and physical health as they age. However, the current system of self-regulation for cognitive impairment is insufficient for protecting patient safety; on the other hand, mandatory retirement or screening of aging physicians may be ethically or legally problematic. An optimal solution would balance the safety of patients and the dignity of aging physicians. It is likely to be multipronged and multifactorial, involving multiple screening steps and continued development to assess the quality of validation. Adoption of healthy lifestyle practices and financial literacy, as well as providing opportunities for retired physicians to stay involved with the medical profession, may encourage successful aging among physicians and ease the transition to retirement.
Artificial Intelligence in MedicineAbstractAbstractDisruptive forces are challenging the future of medicine. One of the key forces bringing change is the development of artificial intelligence (AI). AI is a technological system designed to perform tasks that are commonly associated with human intelligence and ability. Machine learning is a subset of AI, and deep learning is an aspect of machine learning. AI can be categorized as either applied or generalized. Machine learning is key to applied AI; it is dynamic and can become more accurate through processing different results. Other new technologies include blockchain, which allows for the storage of all of patients’ records to create a connected health ecosystem. Medical professionals ought to be willing to accept new technology, while also developing the skills that technology will not be able to replicate.
Communication, Empathy, and CompassionAbstractAbstractThe state of modern healthcare is often not conducive to empathy or effective communication because physicians are pressured to see as many patients as they possibly can, sometimes forcing them to forsake emotional connection. However, empathy and communication are among the most vital skills for providing excellent care to patients. Incorporation of empathy and communication have been found to result in fewer malpractice suits, better adherence to treatment plans, fewer errors, and improved outcomes. The components of effective communication include active listening, offering feedback, and being able to apologize for past errors or miscommunication. The challenges associated with patients that are labelled “difficult” are discussed. The neurological processes of empathy are highlighted including the regions of the brain that are implicated. The chapter also frames empathy as a broad concept with emotive, moral, cognitive, and behavioral components, and that compassion is an empathic response that may facilitate feelings of engagement and protect against burnout. Increasingly, medical schools are incorporating training in building empathy and compassion into their curricula.
Depression, Anxiety, and Physician SuicideAbstractAbstractPhysicians suffer from mental health issues, particularly depression, at higher rates than the general population, due to many of the same factors that contribute to burnout. However, there is a stigma within the profession that prevents them from getting help. This stigma can be based on feedback from self, colleagues, hospitals/medical systems, and licensing boards. Self-criticism by physicians may lead to self-stigmatization. Colleagues may be afraid to broach the topic of mental health and fail to refer their peers to professional help. Hospitals/medical systems often label physicians suffering from mental health issues as ”unprofessional.” Lastly, licensing boards may discriminate against physicians who disclose prior psychiatric history. Major depressive disorder is the most common diagnosis among physicians. Anxiety disorders have been less well-studied but are likely also to be a major problem. Approximately 300 to 400 physicians are estimated to die from suicide each year, and untreated mental health conditions are a significant risk factor. Action at individual, institutional, and organizational levels is necessary to combat the stigma of mental illness.
Developing Cultural PraxisAbstractAbstractThe ever-evolving composition of the U.S. population prompts healthcare systems to adapt in order to provide care to diverse populations. Health disparities exist, and it is part of our responsibility as medical professionals to reflect on how the sociocultural determinants of health affect outcomes and uncover our unconscious or implicit biases to work towards health equity. The author defines this process as cultural praxis, drawing from Freire’s theory on developing a critical consciousness and understanding cultural humility. Physicians must also understand the systematic problems that lead to inequities in healthcare; the author defines this as structural competence. As in professional identity formation, development of a critical consciousness is an ongoing process that requires reflection, and cultural praxis is more than a set of competencies to be satisfied. This discusses strategies for developing cultural praxis, and provide reflective opportunities in scenarios in which cultural praxis is particularly important, such as in end-of-life care.
Emotional Wellness and Stress ResilienceAbstractAbstractWhen physical and mental stress becomes overwhelming and prolonged, the risk for both medical and psychiatric illnesses increases. There are limitations to the pharmacological approach for treating psychiatric illness, as many major classes of psychiatric drugs create neurotransmitter imbalances, physical and psychological dependence, and undesirable side effects. While medications are necessary or helpful in many cases, there are also non-drug lifestyle strategies and mental health techniques that can help to manage stress. This chapter explores the concept of stress and how it relates to wellness, and provides practical strategies, both physiological and psychological, to manage stress and optimize long-term emotional wellness and happiness.