The modern-day health coach brings together the principles of fitness, nutrition and emotional-behavioral balance to enhance an individual’s wellbeing with optimal lifestyle practices. To improve the health of our clients, we need to understand the fundamentals of behavior change and the skills used by health coaches to help drive those changes.
Behavioral changes occur when the former way of responding to something no longer “works” for that person. In other words, when we no longer feel that we are benefiting from an old behavior (or perhaps even experiencing detriment as a consequence), we begin the process of change. And yes, change is a process that occurs gradually. For example, losing weight is a common reason individuals turn to health and fitness professionals for help. The process of getting to that point most likely occurred as a result of slow changes over time involving decreased physical activity and poor diet, which resulted in higher body-fat composition, lower metabolic rates and subsequent weight gain. During this time, the individual likely experienced changes in the way she felt about her physical appearance, which is now affecting her self-esteem. She may have tried several crash diets only to quickly regain the weight once the plan was over. This compounds her self-esteem issues and decreases the belief in her ability (self-efficacy) to ever have the body she once had.
Good health coaches combine the science of exercise and weight management with the art of coaching and communication to deliver effective messages to help clients make meaningful changes that they can maintain for life. Two commonly used techniques are motivational interviewing and cognitive coaching.
Motivational interviewing is based on the idea that often times the individual is ambivalent about change. It is the health coach’s job to be sensitive to that hesitation and help a client identify his own strengths and motivation to work through the ambivalence. Using communication techniques such as open-ended questions, affirmations, reflections and summarized statements, a coach works with the client through a process of change that involves engaging, evoking, focusing and planning. This is done with the utmost care after sufficient rapport has been established so that the client doesn’t feel the need to defend his behavior. Instead, he can begin to take an honest look as to why he is at this point in his life.
Cognitive coaching involves helping a client challenge potential negative beliefs that lead to disruptive behaviors. Using the weight-loss client as an example, the health coach may experience a conversation that goes something like this:
Client: “I’m able to stick to a healthy eating plan during the day, but once I’m home in front of the television, it’s all over.”
Health Coach: “What happens at home?”
Client: “I like my chips and salsa while I watch my favorite program and once it’s over, I realize that I’ve just blown my diet. I figure I ought to start fresh tomorrow morning and just continue eating the rest of the night.”
Health Coach: “Is it really true that you ought to wait to start off fresh in the morning?”
Client: “Well, I guess I don’t necessarily need to wait till morning. It’s just something I’ve done in the past.”
Health Coach: “How has that strategy worked for you in the past?”
Client: “Not that well, because it usually takes another few days to get in the mood to try again.”
Health Coach: “What else might you try instead?”
Client: “I guess I can try not waiting until the next morning to get back on the program…maybe I won’t get so far off track.”
Health Coach: “Sounds like a good plan!”
By allowing the client to come up with her plan, you’ve helped her develop the skills and self-confidence needed to monitor her own program going forward. Additionally, your client will be much more willing to follow through with the plan since it was her idea, as opposed to someone else telling her what to do.
Health coaching offers many valuable tools in working with health behaviors subject to fluctuations in motivation such as diet and exercise. Health coaching expertise and certification are being adopted by a number of professionals, both inside and outside the healthcare space, including nurse practitioners, registered dietitians, personal trainers, group fitness instructors, chiropractors and more.