Natalie Digate Muth, MD, MPH, RD, is the ACE senior consultant for healthcare solutions, a practicing pediatrician and registered dietitian. Recognized as a Certified Obesity Specialist, Natalie has written for more than 50 publications and, in 2012, published her first book, 'Eat Your Vegetables' and Other Mistakes Parents Make: Redefining How to Raise Healthy Eaters.
Coaching Behavior Change: Accountability for Change
The most effective behavior-change plans build in accountability for change. In fact, as the legendary Stephen Covey, author of the 7 Habits of Highly Effective People, once said, “Accountability breeds response-ability.”
At first, building in accountability to a behavior-change program may place a lot of weight on the coach or trainer. For example, research supports that people trying to lose weight do better when they have at least monthly weigh-ins with a health coach. People who hire a trainer are more likely to show up for their workout than those who have no one else counting on them. People enrolled in a weight-loss program are less likely to be a no-show if they are required to pay a fee to cancel, or if they will get some type of reward or incentive for showing up. While the best programs have these types of measures in place, eventually and importantly, the accountability must transition to rest primarily with the client, who ultimately is the only one who can make a change happen.
You can help your clients develop more “response-ability” through accountability by incorporating the following four components into your behavior-change programs:
- Self-monitoring. The scientific evidence is clear: People who self-monitor behaviors such as nutrition intake and physical activity do better with weight loss and behavior-change programs. Help clients establish this new habit by requesting that they complete and return to you a nutrition and activity log. Avoid the temptation to offer advice or suggestions on how to improve the behavior. Instead, note changes in behaviors and acknowledge success or healthy change. Then, help the client to go through their own log to identify positive changes and non-food rewards for making positive changes. Lots of tools are available to help do this, including apps like MyFitnessPal, the USDA’s Supertracker tool (supertracker.usda.gov), a smartphone camera, activity trackers, and good old paper and pencil.
- Teach clients how to establish SMART (specific, measurable, attainable, relevant, and time-bound) goals. Effective goal-setting provides an end-date to achieve a new outcome. Writing the goal on a calendar and sharing it with friends and family members builds in accountability. Clients may need training to get in the habit of turning “goals” into SMART goals. For example, many people will come to you with a desire to “lose weight” or “eat better.” Teach your clients how to convert those goals into statements like:
- “I will become more physically active by walking for 15 minutes before work each day for the next two weeks.”
- “I will eat better by incorporating a fruit or vegetable into every meal and snack for the next two weeks.”
- “My goal is to lose 10 pounds in the next three months. I will do this by monitoring my nutrition intake so I eat about 1,800 calories most days. I will know if I am meeting this goal by entering my dietary intake into my food tracker each day.” (You can help your clients identify realistic weight-loss goals and calorie needs using the handy Body Weight Planner.)
- “I will run a 10K in three months.” (Note: Signing up for an “event” that requires training provides an additional layer of accountability to oneself, as the client must engage in the requisite training to be fit enough to achieve the goal to successfully complete the event.)
- Engage social supports. Social supports help to make change happen, especially when those supports include a partner who is counting on a client to show up and who will be disappointed if that person does not come. The stronger the social relationships, the more potent the impact. Ask clients to think about the people who are most influential in their lives. Together, identify how each of these people can help support clients in making the needed behavior change. For example, your client and his or her best friend might come up with a special trip to take together once the goal is achieved; a child or friend might agree to walk together at set days and times each week; a spouse might agree to not bring junk foods into the home.
- Develop an individualized “accountability plan.” Engage the client to develop an ideal “accountability plan.” Do this by asking the client, “How would you like to be held accountable?” Clients may choose to be accountable to the coach, family or friends, through social media or an app, or some other venue. Some may opt to schedule a workout into their meeting calendars and treat it as they would any other recurring meeting (prepare and show up). Others may choose to post their goal or workout updates on Facebook. Whatever the client decides, work together to develop an agreed-upon plan. The act of developing this plan already moves the client toward increased accountability.
Self-monitoring, goal setting, social support and client engagement all are potent predictors of successful change, at least in part because they help to build in accountability for change. Incorporating these steps into your work with clients will help them take “response-ability” for working toward the goals to which they are committed.
Earn an ACE Behavior Change Specialty Certification
No matter how you work with clients and patients, effective coaching can further heighten the impact of your program. As an ACE Behavior Change Specialist, you will possess the knowledge of behavior-change philosophy and emotional intelligence and, most importantly, the practical, hands-on skills to put it to use. Our comprehensive learning experience incorporates expertise from renowned experts and pioneers in psychology and coaching to help you learn how to develop rich, productive relationships and guide people toward sustainable change in one-on-one, group and virtual settings.