What is a wellness coach? Since the late 1990s, “Health and Wellness Coaching” began as both a model and approach to address health patients’ well-being, wellness, and life goals. Most commonly, health and wellness coaches work with patients to help them become healthy or overcome health issues, even (or especially) if they have chronic medical conditions.
Although we’ve seen medical advances and a steady increase in life expectancy grow over the past six decades in the US, we’ve also seen clinical outcomes and the quality of life lag or even decline. Trends of increasing chronic conditions and the worsening quality of life mean many people don’t feel as well or as well taken care of as they would like to be.
And despite innovations in medicine with surgical and other technological advances, it’s still a significant challenge to help patients struggling with their poor health. Wellness coaching is working on exploding the traditional model of physician-patient interaction from telling a patient what to do, to helping patients gain the knowledge, skills, and confidence to become informed and active participants in their care.
Wellness coaching asks patients what they are willing and able to do to improve their health.
Troubles in Healthcare
Currently, healthcare is often compromised through profit-driven practices and a lack of access to proper education, information, promotion, and engagement resources.
In 2015, Becker’s Hospital Review posted an article called 10 Thoughts From 5 Great Healthcare Minds. Malcolm Gladwell, journalist and author of five New York Times best-sellers, had this to say on changing the practice of medicine:
“You have to change the structure of the profession. I always use my 85-year-old mother as an example. What does my mother want from the medical profession? She uses far more of the healthcare profession than I do. Her needs are much greater than mine, as is typical of all of us. At her age, what does she want?
She wants someone who can guide her through what is becoming an increasingly complicated, confusing, and terrifying period in her life. She doesn’t just need someone capable of having those conversations with her. She needs a system that allows that physician to spend 25 minutes with my mother when she needs 25 minutes, which is not every time she goes. Maybe it is just twice a year, but right now, we have a system where finding 25 minutes twice a year is really hard.
So we can change who we select for medicine all we want, but unless we change the nature of medical practice, it is pointless. We are just going to have brilliantly gifted doctors capable of having these kinds of discussions who are forced into a system where they have got to run the patients through an electronic treadmill.”
Seven years later, this has never been more true. And the model of wellness coaching could provide some answers to the crises in healthcare.
Teach a Man to Fish
It’s the difference between giving a man a fish and feeding him for a day and teaching him how to fish and feeding him for a lifetime. More and more evidence shows that making sustainable changes in healthcare takes viewing patients’ care both within and outside healthcare settings.
Wellness coaching is about doctors creating partnerships with their patients to help them take ownership, leadership, and accountability for their health through conversations that ask open-ended questions to help patients develop their own reasons for change.
For example, if you have a patient with diabetes who confesses they are addicted to eating a pint of ice cream every night, you could work through an action plan where they eat only a half-pint of ice cream every night for a while. Once they succeed with this realistic goal, they may be ready to cut that amount down until eating ice cream at night becomes a rare treat.
People look to hire wellness coaches to help them with a wide variety of health issues:
- Losing weight
- Lowering their stress levels
- Managing chronic conditions
- Improving diet and exercise
- Kicking a nicotine habit
- Overcoming addictions
- Adjusting to life-altering health events, like a heart attack or stroke
A proper coaching process uses evidence-based interventions, including:
- Motivational interviewing
- Positive psychology
- Active listening
- Goal setting
- Health outcome metrics
- Methods of prevention.
Motivational interviewing is a counseling approach developed in part by clinical psychologists William R. Miller and Stephen Rollnick. It involves enhancing a patient’s motivation to change using four guiding principles, represented by the acronym RULE:
- Resist the righting reflex
- Understand the patient’s motivations
- Listen with empathy
- Empower the patient
Recent studies show that motivational interviewing effectively decreases alcohol and drug use, and evidence is accumulating in other areas of health, including stopping smoking, improving consistency of treatment and medication, and diabetes management.
Where a doctor might say, “You need to lose weight,” a wellness coach will ask, “How would your life be different if you lost the weight that you’ve been trying to lose?”
This key difference in communicating with patients has been effective in research studies. When patients make changes for their reasons and on their terms, they are more likely to succeed when compared with someone telling them what to do — which is much less motivating and more likely to instill resistance to change.
Motivational interviewing has been creeping into the medical profession. Still, with most doctors’ limited time for patient visits, there isn’t enough time to fully engage with patients using this technique. Hearing what a patient is saying and engaging them as much as possible in coming up with solutions for the various health issues takes more than the standard 15-minute visit.
Positive psychology is a term coined by Dr. Seligman, president of the American Psychological Association in 1998. Positive Psychology is the scientific study of the factors that enable individuals and communities to flourish.
Dr. Seligman’s PERMA theory of well-being attempts to answer questions about human flourishing. Where traditional psychology has focused on what is “wrong” with people and what needs to be “fixed,” coaching focuses on what has, can, and will work better for you.
There are five building blocks with techniques that enable and increase flourishing:
- Positive emotion
According to the World Health Organization:
“. . . a happy, engaged, and fulfilling psychological and social life is not just a consequence of good health, it is what leads people to live a healthy and long life. Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”
Instead of rooting around for problems to dwell on, a wellness coach works with their patients’ strengths to help them improve the health behaviors they want to address.
Wellness coaching is best for people who feel their health needs haven’t been met through traditional appointments. An hour-long coaching visit allows the physician coach to understand how to fully address their patients’ concerns consistently with their values and preferences.
Anyone struggling with a chronic condition or who wants to prevent illness and optimize wellness can benefit from wellness coaching. To make the most of a session, the patient will spend time beforehand completing a detailed form that covers their past medical history, current medical issues, health goals, and lifestyle.
A comprehensive personal health history and self-reflection inventory will be conducted during the visit. The patient will be asked questions to learn more about all aspects of their life and condition. They’ll discuss how their diet, sleep schedule, daily stress, toxin exposure, and physical activity impact their health and well-being.
Identifying stressors and discussing lifestyle choices can inform changes a patient can make to address the root causes of illness. The doctor will also perform a physical examination and order lab and imaging tests to confirm diagnoses and guide therapy.
This visit is considered a specialty visit by most insurance plans.
Wellness coaches’ goal is for their patients to become truly well. A coaching session can put them on the right path to their optimal wellness, whether or not a disease is curable or reversible. Finding a way to help their body work its best no matter where they are on their healing journey.
They can often recommend approaches to help manage chronic health problems that don’t require prescription drugs or surgery. They look at many different types of healing options. They also want to empower their patients to care for themselves.
Diseases like diabetes, hypertension, arthritis, irritable bowel syndrome, chronic fatigue, or chronic pain can often be managed through lifestyle changes and integrative therapies. These include nutrition, physical activity, acupuncture, massage, behavioral health, and sleep hygiene.
It’s all about working with an expanded toolbox to help patients best utilize lifestyle changes, medications, physical therapy, exercise, mindfulness, and non-western medicine to address their problems, restore their energy, and feel their best.
Does Wellness Coaching Work?
Coaching is an effective way to help people manage various health conditions. According to a recent study, coaching:
“results in clinically relevant improvements in multiple biomarker risk factors (including systolic and diastolic blood pressure, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, fasting glucose, body weight, body mass index, waist circumference, and cardiorespiratory fitness) in diverse populations.”
Using wellness coaching techniques has been shown to help patients change their behaviors around preventing and treating diabetes, hypertension, hyperlipidemia, heart disease, cancer, and other chronic disorders. It is one of the best ways to treat lifestyle diseases.
Coaching has also been shown to help improve health-related quality of life and reduce hospital admissions in patients with COPD. No wonder some doctors’ offices are offering it, some insurance companies are paying for it, and private companies are even starting to offer coaching to their employees to lower their healthcare costs.
Training and Certification for Wellness Coaches
Wellness coaching is a relatively new field and, at this point, is an unregulated industry. There is no strict definition of what a health coach is, which adds to the confusion. In other words, anyone can hang out a shingle and call themselves a “wellness coach.”
Studies have determined the positive impact of wellness coaching on patients, especially in primary care settings. But an obvious challenge is seen in the “coaching of patients” when delivered by healthcare professionals (e.g., physicians and nurses) who are not properly trained.
However, some programs train and certify physician coaches. Three of the most well-respected are:
National Society of Health Coaches
“The National Society of Health Coaches describes Evidence-Based Health Coaching (EBHC) as the use of evidence-based skillful conversation, clinical strategies and interventions to actively and safely engage clients in health behavior change to better self-manage their health, health risk, and acute and chronic conditions resulting in optimal wellness, lowered health risk, improved health outcomes and decreased health costs.”
Note: The NSHC distinguishes between “wellness coaching” and “health coaching.” They prefer the term “health coaching” as a more accurate description, but I’m using the terms interchangeably for this post.
The NSHC exclusively certifies doctors with an active clinical license to practice. However, they also award a Certification of Completion to any non-licensed healthcare providers upon passing the guided self-study program.
“I have found NSHC’s materials to be very thorough and practical. I like that it is condensed and immediately relevant to my clinical practice as a family medicine provider!”
— Dr. Denise White-Perkins, Senior Staff Physician, Dept. of Family Medicine, Director-Institute on Multicultural Health, Henry Ford Health System, Detroit, MI.
Duke Integrative Medicine Center
“Lifestyle and well-being are now being recognized as critical drivers for optimal health. The Leadership Program in Health and Well-Being focuses on teaching participants the benefits of health promotion, lifestyle change, and prevention to use that knowledge to improve the health of their patients and communities. This one-year online leadership development and business mentoring program includes three in-person immersions at Duke, a personalized mentorship experience with faculty from Duke’s Fuqua School of Business, and an opportunity to work with a Duke-trained health coach. You’ll learn from world-renowned faculty the knowledge and skills necessary to successfully develop, launch, lead, sustain, and grow a health and well-being program and lead transformative change.”
Duke’s target audience is allied health professionals, nurses and nurse practitioners, and physicians and physician assistants. The learning objective is to educate the healthcare team on the clinical, operational, and business aspects needed to successfully run a Health and Well-Being operation.
“…My research focuses on helping children live their healthiest life possible through nutrition, activity, and engagement in community activities. I have expertise in childhood nutrition issues, including obesity in children and teenagers. I have a special interest in patient-centered communication and am passionate about seeing physicians, patients, and parents communicate with each other to meet their mutual goals. I believe a shared decision-making approach benefits patients and their families the most. Duke stands out in a lot of ways, especially the integrated system of care so that children can get various care all in one place.”
— Sarah C. Armstrong, MD, Medical Weight Management Specialist, Pediatrician, Duke Children’s Heath Lifestyles, North Durham, NC.
Wellcoaches School of Coaching
“Professional health and well-being coaches are expert facilitators of sustainable change in mindset and behaviors. Translating science and innovation into a coaching practice, Wellcoaches teaches you how to use evidence-based coaching tools and processes designed to help others change, grow and thrive.”
In January 2000, Wellcoaches founded the first coaching school for health and well-being professionals with a vision of creating a new health professional who is an expert in facilitating behavior change.
They collaborate with partners, including the American College of Sports Medicine and the American College of Lifestyle Medicine, to help everyone who works in healthcare and wellness learn how to coach to improve health, well-being, and quality of life. They are also an approved training program for the National Board for Health and Wellness Coaching.
“Collaborating with Wellcoaches School of Coaching has transformed our institutional approach to supporting physician well-being. The physicians who underwent training and certification are newly empowered to walk this journey toward meaning, purpose, and engagement with their colleagues and with themselves. They are well prepared to work 1:1 with their colleagues and engage in small and large group coaching, which has been invaluable for improving system-level issues within the institution.”
— Kerri Palamara McGrath, MD, Director of the Center for Physician Well-being, Massachusetts General Hospital.
What Does Wellness Coaching Cost?
The time commitment and cost of coaching are highly variable. Some people do very brief coaching — even one session — for a specific medical problem. In contrast, others may participate in coaching for months or years to manage weight, diabetes, depression, or hypertension. The cost varies with the skill and experience of the coach.
Some employers and medical plans may cover this, as there is abundant evidence that, for example, health coaching around issues such as weight loss can significantly lower healthcare costs. Physician coaches take privacy very seriously, and they have a professional code of ethics. Still, there are not the same HIPAA-level privacy protections as there are when you visit a medical office.
Coaching appears to be as effective when administered remotely by phone or online as face-to-face coaching. However, this provides great flexibility, as coaching can be performed in person, over the phone, or via a Zoom call.
Unlike health fads that come and go, wellness coaching has strong evidence behind its effectiveness in improving physical health and well-being. Becoming a health coach can be deeply rewarding as you promote happiness, build resiliency, save patients money, and help people live longer and more fulfilling lives.
For more on the business part of setting up as a health coach, check out: Smashwords: Health Coaching Business Start-up: A Resource Guide for Clinicians eBook.
Wellcoaches authored the first coaching textbook in healthcare and well-being, now in its second edition. The Coaching Psychology Manual, the foundation of their program, is recommended reading for National Board Certified Coaches.
It’s widely used as the text for several coach training programs and academic courses, including a Science of Coaching Psychology Course at Harvard University Extension School.
Does pivoting to become a wellness coach appeal to you? I’d love to hear from you if this emerging area of medicine interests you. Send me an email or set up a call!