Research Paper By Sarah Hurst
(Health and Wellness Coaching, UNITED STATES)
In the UK, levels of obesity are on the rise. A recent study1 reported that since 1993 the number of men classified as obese has risen from 13.2% to 24.4% and for women it has risen from 16.4% to 25.1%.
For those who are overweight or obese and wish to seek help to lose weight there are three main traditional options available:
- Referral to a Dietician – this usually takes place following a visit to the client’s Doctor who would make a referral to a dietician within the National Health Service (NHS).
- Consultation with a Nutritionist or Nutritional Therapist – this is usually a service sought privately by the client.
- Numerous national and international companies offering diets and weight loss programmes either online, via books, weight loss groups or food package deliveries.
In addition, there are other alternative therapies for weight loss and also many personal trainers might offer nutritional advice as part of their fitness packages.
The first two options listed above will generally provide the client with factual nutrition information, tailored to their personal health history, regarding what to eat and which lifestyle changes to make. The amount of ongoing one to one support will vary by service and practitioner.
The third option, dieting, would appear to be the most popular. The diet industry in the UK is estimated to be worth £2bn but, given that obesity levels continue to rise, this would suggest that diets do not work in the long term.
For those who have high levels of motivation and self-discipline all these options can work well, however for those who need help and support it can be a struggle to go it alone. For those who do require support Health Coaching could be the key to their long-term success.
Self-Motivation
Health Coaching could be an appropriate option for supporting clients with any health related issue, however those trying to lose weight can struggle particularly with self-motivation and this is where coaching can be hugely beneficial.
US based author and blogger Gretchen Rubin has identified 4 different personality types or ‘tendencies’ with regard to motivation which she defines as follows2:
- “The upholder – accepts rules, whether from outside or inside. An upholder meets deadlines, follows doctor’s orders, keeps a new year’s resolution.
- The questioner – questions rules and accepts them only if they make sense. They may choose to follow rules or not, according to their judgement.
- The rebel – flouts rules, resists control. Give a rebel a rule and the rebel wants to do the opposite
- The obliger – accepts outside rules, but doesn’t like to adopt self-imposed rules”.
Rubin states that “an upholder can train with a trainer or exercise on her own; a questioner can do either if he thinks it makes sense; a rebel will do neither, because the fact that she has an appointment or an item on her to-do list makes her want to disobey; an obliger can meet a trainer, but can’t get to the gym on his own”.
This is of course the author’s own opinion based upon observation but it is an interesting theory. It should be assumed that there is a spectrum when it comes to motivation and we perhaps change our tendencies depending on the circumstances. However, this provides an interesting insight into which individuals might benefit the most from the support a Health Coach can provide, the ‘Obliger’ being the most obvious type.
What Is Health Coaching?
What does Health Coaching offer, as a standalone service, that sets it apart from some of the more traditional options available?
Coaching as a profession allows for a coach to work with clients on any issue without requiring formal training or expertise in that area. However, by choosing a coach who specialises in Health Coaching it will often be the case that the coach will have a certain level of expertise in this area and may even have some formal nutrition training. A Health Coach may also have personal experience of health problems and an interest in health and nutrition which brings a level of expertise that a generalist cannot provide.
Health Coaching focuses on making long lasting changes to attitudes and behaviours and is by no means a quick fix. Initially, a coach would endeavour to create a level of trust and confidentiality with the client to ensure each session takes place in a ‘safe space’ to allow the client to open up and be assured that the coach is completely non-judgemental. Each session has to be client-led on the assumption that the client knows what is best for them and it is the responsibility of the coach to ask the right questions in order to help the client gain clarity and understanding of their own experience. A Health Coach may work with clients in the following key areas:
Accountability
Many people find it beneficial to have someone to check-in with to keep them motivated and on track. A Health Coach will hold the client accountable for any actions agreed in the session(s). Having an accountability partner can help to motivate the client to take immediate action as there will be a discussion at the following session around what action the client has taken. This is a strategy that some of the popular weight loss groups use as they often provide weekly weigh-ins which allows the group leader to hold the clients accountable for their progress.
Identifying limiting beliefs
Someone with a history of dieting or of being overweight will no doubt have developed beliefs about themselves in this area over time. A belief could be anything we tell ourselves is true, regardless of whether it actually is. It could be something we have been told by someone else but have taken on as our own or it could be something we have developed ourselves as a result of our own negative self-talk. We continually look for evidence to support these beliefs, for example, after a client has failed on a particular diet they might tell themselves ‘I’ve tried every diet and nothing works for me. I’m just rubbish at sticking to diets’. This then becomes true for them and they tell themselves it isn’t going to work before they have even tried.
A Health Coach would work with the client to identify their underlying beliefs and determine whether they could be limiting the client’s progress. Once the beliefs and their impact have been identified the client has the choice to decide how to use this new awareness and can work with their Health Coach on developing new positive beliefs that will support their goals going forward.
Obstacles and structures
The journey to making long lasting changes is rarely without obstacles along the way. Working with a Health Coach can enable the client to identify which obstacles they are facing, or have faced in the past, and then work together with their coach to define possible structures which could be put in place to enable the client to overcome these obstacles going forward.
Structures can be anything we put in place to support us, for example, a regular meeting with a friend for coffee and cake would perhaps not be the best structure for a client wishing to lose weight. A more supportive structure could be to change this regular meeting to a walk in the park which would ultimately support the client’s goal. Simply having a Health Coach as a support mechanism could be considered as a structure in itself.
Mindfulness
We all live such busy lives and many of us are eating ‘on the run’ meaning that we are usually eating whilst doing something else in order to save time. This approach, although seemingly efficient, can have negative consequences on our health in the long term. Working with a Health Coach on being more mindful can have a positive effect on how, when and what we eat.
Mindfulness is the concept of being present. This means focusing only on the task at hand or current situation at any one time. Mindless eating is very common as meals often take place in front of the television or at our desks where the focus is taken away from the food. It can be easy in these circumstances to finish a meal and not remember actually eating it or what the food tasted like.
Coaching In The Public Health Sector
It appears that coaching is slowly entering main stream healthcare with the NHS rolling out Health Coaching Training Programmes in 2013/14 for doctors, nurses and other health professionals in the east of England3. According to the NHS Health Education Department in the region, the aim of the programme is “to enable clinicians to have conversations with their patients that are empowered and shared;
- Motivate patients to self-manage
- Improve patient experience and satisfaction
- Support organisations to deliver effective long term condition strategies
- Create clinical champions for shared decision making”
This is an exciting development and it is encouraging that adopting a coaching approach is beginning to enter the main stream and is no longer seen as an alternative treatment or therapy. However, with the financial burden facing the NHS in the UK one would assume that there would be strict criteria to determine who would be eligible to participate in such a service.
Why Choose Health Coaching?
With obesity rates rising and the diet industry booming, a new approach certainly needs to be considered in order to offer an alternative to those wishing to lose weight and, most importantly, keep it off in the long term. Obesity in itself can be a risk factor for other serious health conditions and therefore the impact of rising obesity levels could further increase the financial burden on public health services.
Preventative care
The market for Health Coaching amongst those who are already struggling with a weight or health problem is an obvious one, however what about those who are healthy but want to stay that way? Dr. Michael R. Mantell, in his article for the Huffington Post entitled
The New Success: Preventive Health Coach4,
explored the possibility that in the future we might consider employing a Health Coach to monitor our wellbeing on an ongoing basis just as we might routinely outsource our taxes or financial affairs to an appropriate professional. This is a very exciting potential opportunity for Health Coaches in the future.
Taking responsibility
With the public sector under increasing strain it’s unlikely that the healthcare system will be able to change it’s focus from the treatment of illness to prevention. It is therefore up to the individual to take responsibility for their own health and wellbeing and this is where the support of a Health Coach can be invaluable. It’s easy to lay blame on our circumstances, background or family but ultimately we are responsible for our own health.
Society and the media tends to be focused on quick fix solutions and fad diets but those who have been on the dieting rollercoaster will understand that these options may work in the short term but are extremely difficult to maintain. It is the responsibility of the Health Coach to educate clients and potential clients that changing habits and behaviours takes time if the changes are going to be long term.
What Does The Future Hold?
Coaching has become more main stream in the UK in recent years and the recognition of Health Coaching as a skill within the NHS is a positive step forward. With the increasing obesity rates it is important that Health Coaches promote their services as an alternative weight loss option by communicating the benefits of the service they provide.
It should be noted that this is not only relevant for weight loss but also for those facing other health related challenges in which coaching could be of benefit. Empowering a client to take responsibility for their health can be a life-changing experience. By educating the public on the efficacy and benefits of coaching the profession can gain further popularity and support.
References
Health & Social Care Information Centre. Statistics on Obesity, Physical Activity and Diet – England, 2014. [Online] Available from: http://www.hscic.gov.uk/catalogue/PUB13648 [Accessed 7th April 2014].
Rubin G. Do You Agree About These Motivations of the Upholder, Questioner, Rebel and Obliger? The Happiness Project. Weblog. [Online] Available from: https://www.gretchenrubin.com/happiness_project/2013/03/do-you-agree-about-these-motivations-of-the-upholder-questioner-rebel-and-obliger/ [Accessed 7th April 2014].
Health Coaching Training Programmes. NHS Health Education East of England. [Online] Available from: [Accessed 7th April 2014].
Mantell M R. The New Success: Preventive Health Coach. Huffington Post Healthy Living. [Online] Available from: http://www.huffingtonpost.com/dr-michael-r-mantell/the-new-success-preventiv_b_4953233.html [Accessed 7th April 2014]