A discipline of ‘Lifestyle Medicine’ has developed in several countries to manage lifestyle (and environmentally) related chronic diseases. However to date, the contribution of such a discipline remains unclear. There are two main components: the content, or epidemiology (science), which involves an understanding of the determinants of chronic diseases, and the processes (art), which include the clinical actions required to modify these. The former (ie. ‘causality’) is often multi-factorial but relatively well known. Processes however, have been largely overlooked, with the default being those used in conventional consultations. Yet such processes, developed in an acute disease era, are often unsuited to the more extensive requirements of chronic disease. The 1:1 consultation situation for example has limitations for both patient and provider. Shared Medical Appointments (SMAs) utilizing the advantages of peer support as well as multi-disciplinary input in an extended, non-repetitive consultation, provide one option for the delivery of lifestyle related prescription that is currently lacking in chronic disease management.