Presence and agency in lifestyle medicine: A neuropsychobiological framework for sustainable health transformation

In an era dominated by chronic disease, Lifestyle Medicine (LM) offers a profound paradigm shift, yet its efficacy is often tethered to sustained behavioral change. This article proposes a neuropsychobiological framework for LM centered on three interconnected pillars: Presence, Agency, and Connectivity. We argue that cultivating Presence—an attuned awareness of internal bodily states (interoception) and external environments—provides the foundational data for well-being. Agency, the belief in one's capacity to act intentionally and effectively upon this data, translates insight into behavior. Finally, Connectivity, encompassing both neural integration and social belonging, fosters resilience and sustains health transformations. Drawing on interoceptive predictive coding models, active inference, and the neuroscience of social bonding, we illuminate the underlying mechanisms by which these pillars empower individuals to transcend passive health management. Through humanized clinical examples and practical strategies, we illustrate how this framework can transform LM from prescriptive advice to an empowering journey of self-discovery and sustainable health.