{"id":16467,"date":"2023-12-19T16:40:36","date_gmt":"2023-12-19T16:40:36","guid":{"rendered":"https:\/\/lifestylemedicine.org\/?p=16467"},"modified":"2023-12-22T15:11:47","modified_gmt":"2023-12-22T15:11:47","slug":"science-and-art-of-behavior-change","status":"publish","type":"post","link":"https:\/\/lifestylemedicine.org\/articles\/science-and-art-of-behavior-change\/","title":{"rendered":"Health Coaching: The science and art of behavior change"},"content":{"rendered":"

Health Coaching: The<\/span> science and art of behavior change<\/span><\/span>\u00a0<\/span><\/h1>\n
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Scientific evidence supports the use of lifestyle medicine to treat and even reverse common chronic diseases but how do patients turn that information into sustainable lifestyle behavior changes? Lifestyle medicine clinicians are increasingly embracing the power of health coaching to help patients achieve their health goals.<\/p>\n<\/blockquote>\n<\/div><\/div>

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\"A<\/div>
Jessica Matthews, DBH, NBC-HWC, DipACLM, FACLM counseling a patient. Photo Credit: UC San Diego Centers for Integrative Health.<\/div><\/div><\/div>
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Ample scientific evidence supports the use of lifestyle medicine to treat many common chronic diseases. But what does it take for patients to turn that medical guidance into sustainable lifestyle behavior changes?<\/span>\u00a0<\/span><\/p>\n

Health and wellness coaching has emerged as a catalyst to help patients achieve their health goals within the framework of lifestyle medicine. Coaching builds judgment-free, collaborative partnerships with patients, empowering them to set realistic goals and personalized action plans with practical steps to address the root causes of their disease.<\/span>\u00a0<\/span><\/p>\n

Over 15 years ago, Jessica Matthews, <\/span>DBH, NBC-HWC, DipACLM, FACLM, embraced the power of health coaching after seeing too many people struggle to adopt and sustain the very lifestyle changes that had the ability to transform their health and effectively treat their various chronic diseases.\u00a0<\/span>\u00a0<\/span><\/p>\n

\u201cI had accumulated immense knowledge about the science of lifestyle medicine, but I recognized that I needed a deeper understanding of the foundation of it all, which is the science and art of behavior change,\u201d said Dr. Matthews,<\/span> assistant professor and program director in the College of Health Sciences at Point Loma Nazarene University (PLNU), where she developed and implemented a graduate degree program blending lifestyle medicine and health and wellness coaching. The program built upon her board certification in both areas as well as her doctoral training in behavioral health with a focus in clinical integrated care<\/span>.<\/span>\u00a0<\/span><\/p>\n

\u201cI realized that the ability to not only educate, but to coach, support and empower people to take the lead in making these lifestyle behavior changes that I was advocating was the key ingredient that I was missing, as it is ultimately knowledge translated into empowered patient action that is the real secret sauce for unleashing the power of lifestyle medicine.\u201d<\/span>\u00a0<\/span><\/p>\n<\/div><\/div>

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\"Physician<\/a><\/div>
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Information isn\u2019t enough<\/span><\/b>\u00a0<\/span><\/h2>\n

Lifestyle medicine and health coaching naturally complement each other. Lifestyle medicine is an evidence-based medical specialty that uses therapeutic\u202flifestyle\u202finterventions as a primary modality to treat chronic conditions\u202fincluding,\u202fbut not limited to,\u202fcardiovascular diseases, type 2 diabetes, and obesity.\u202fLifestyle medicine-certified clinicians empower patients to replace unhealthy habits with healthy ones by understanding the science and practical skills that support health behavior change.\u00a0<\/span>\u00a0<\/span><\/p>\n

Health and wellness coaches commonly address with patients many of the six pillars of lifestyle medicine\u2014a whole food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connections.\u202fHealth coaching in a physician-led health team <\/span>is shown<\/span><\/a> to improve outcomes for chronic conditions like hypertension and type 2 diabetes.<\/span>\u00a0<\/span><\/p>\n

The growing availability of virtual medical appointments since the COVID-19 pandemic has made health coaching an option for more Americans.\u00a0<\/span>\u00a0<\/span><\/p>\n

“Evidence-based lifestyle behavior interventions are proven to treat, prevent and even reverse many chronic conditions, but simply telling a patient what lifestyle changes to make is not enough,” ACLM President Beth Frates, MD, FACLM, DipABLM, said. “Knowledge is important but, to achieve lasting behavior change, patients and clients also need coaching to motivate them and help them determine how to make and maintain lifestyle behavior changes to improve their health and wellbeing.\u201d<\/span>\u00a0<\/span><\/p>\n

Art and a science<\/span><\/b>\u00a0<\/span><\/h2>\n

Changing deeply engrained lifestyle habits is a complex and multifaceted process. Physical activity and eating patterns are complex behaviors. Health coaches and clinicians with health coaching skills take into consideration each individual\u2019s culture, values, family dynamics, living environments and other unique circumstances to help them create a personalized plan with small yet meaningful action steps forward.\u00a0<\/span>\u00a0<\/span><\/p>\n

Dr. Matthews, also <\/span>director of integrative health coaching at UC San Diego Health in the Department of Family Medicine, <\/span>said her team will soon publish data showing that health coaching interventions reduced blood pressure and A1c levels in patients at a rate greater than other interventions offered within the health system.<\/span>\u00a0<\/span><\/p>\n

\u201cI describe behavior change as both a science and an art,\u201d Dr. Matthews said. \u201cThe science is learning from the decades of evidence available on behavior change; what works and what doesn\u2019t in terms of initiating lifestyle changes, as well as examining the growing body of research to better understand what sustains it. The art is the communication skills\u2014 both verbal and non-verbal\u2014 used, not as a directive but in a manner that invites an individual to be an active and engaged participant in identifying practical steps forward.\u00a0<\/span>\u00a0<\/span><\/p>\n

\u201cCoaching is saying \u2018I may be the expert on the medical science, but you\u2019re the expert on yourself. Let\u2019s combine our valuable knowledge and collaboratively work together.\u2019\u201d<\/span>\u00a0<\/span><\/p>\n<\/div><\/div>

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Tasnim Elmezain, MS, RDN, providing coaching to a patient. Photo Credit: UC San Diego Centers for Integrative Health.<\/div><\/div><\/div>
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An example of coaching<\/span><\/b>\u00a0<\/span><\/h2>\n

As a registered dietitian, Tasnim El Mezain, <\/span>MS, RDN, NBC-HWC,<\/span> is passionate about optimal nutrition. But participating in Dr. Matthews\u2019 program at PLNU made her aware of how the other pillars of lifestyle medicine and nutrition interconnect and are optimized by coaching.<\/span>\u00a0<\/span><\/p>\n

El Mezain, lead clinical health coach at UC San Diego Health in the Centers for Integrative Health, recently coached a patient who was eating well but sleeping poorly and struggling to fit more physical activity into her busy life.\u00a0\u00a0<\/span>\u00a0<\/span><\/p>\n

\u201cShe said her long-term goal was to get to sleep by 10 or 11 p.m. instead of 2 a.m. and take walks five days a week,\u201d said El Mezain, who was also a 2023 recipient of ACLM\u2019s HEAL (<\/span>H<\/span>ealth\u202f<\/span>E<\/span>quity\u202f<\/span>A<\/span>chieved through\u202f<\/span>L<\/span>ifestyle\u202f<\/span>M<\/span>edicine) <\/span>scholarship<\/span><\/a>. <\/span>\u201cBut the idea of that was completely overwhelming. So, we worked together to identify incremental and realistic steps she could achieve in the next two weeks towards her overall goal.\u201d<\/span>\u00a0<\/span><\/p>\n

With El Mezain asking questions, the patient concluded a reasonable goal was to start taking a walk one morning a week at a nearby lake, at a time she knew there would be available parking but also other people there. She identified changes to her bedtime routine the night before her walk so she would wake up earlier and with more energy.\u00a0<\/span>\u00a0<\/span><\/p>\n

\u201cBy asking her open-ended and strategic questions, so I was not directing her answers in a certain direction, she was able to talk through the obstacles and what motivated her personally,\u201d El Mezain said, \u201cShe identified her goal–not my goal for her. It was no longer overwhelming and she was excited to try it out.\u201d<\/span>\u00a0<\/span><\/p>\n

Future of health care<\/span><\/b>\u00a0<\/span><\/h2>\n

The integration of health coaching into multidisciplinary health teams whose members are trained in lifestyle medicine can enhance whole-person, person-centered care. Certified health and wellness coaches work in tandem with physicians, dietitians, exercise specialists, nurses and physician associates to effectively address all facets of patients\u2019 health.<\/span>\u00a0<\/span><\/p>\n

To further uncover the benefits of coaching skills within the lifestyle medicine paradigm, <\/span>ACLM and the <\/span>National Board for Health & Wellness Coaching (NBHWC) this year <\/span>announced<\/span><\/a> a strategic partnership. NBHWC, an affiliate of the National Board of Medical Examiners, has board certified more than 9,400 health and wellness coaches.<\/span>\u00a0<\/span><\/p>\n

National board-certified health and wellness coaches (NBC-HWCs) are valuable members of the health care team, but team members from different fields must still prioritize developing their own coaching skills to support patients in the journey of health behavior change, said Dr. Matthews, Vice Chair of the NBHWC Board of Directors.\u00a0<\/span>\u00a0<\/span><\/p>\n

\u201cImagine the future of health care as an interdisciplinary health team whose members are educated and trained in both lifestyle medicine and coaching skills to support health behavior change, all speaking the same language and focused on achieving the same healthy outcomes in genuine partnership with patients,\u201d Dr. Matthews said. \u201cThat is how you create meaningful and sustainable lifestyle behavior changes.\u201d<\/span>\u00a0<\/span><\/p>\n<\/div><\/div>

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