American Journal of Lifestyle Medicine

Primary Care–Based Health Coaching Intervention for Weight Loss in Overweight/Obese Adults: A 2-Year Experience

Results: Health coaching was associated with a mean loss of 7.24% initial weight after 12 months (95% CI = 8.68 to 5.90) and 6.77% after 24 months (95% CI = 8.78 to 4.76). Coached patients were more likely to achieve ≥5% of initial weight loss at both 12 and 24 months (P < .001). Health coaching costs were $288.54 per participant over 1 year. Conclusions: Primary care–integrated health coaching was associated with statistically significant weight loss in overweight and obese adults.

Primary Care–Based Health Coaching for the Management of Prediabetes

Discussion. A health coaching intervention used among primary care patients, with prediabetes, deserves further examination, as participants had a significant reduction in hemoglobin A1c and weight over 2 years.

ACCEPTED FOR PUBLICATION – August 2018 AMERICAN JOURNAL OF LIFESTYLE MEDICINE The Lifestyle Medicine Team: Health Care that Delivers Value

Filling the Gap: The Lifestyle Medicine Team The lifestyle medicine team includes two roles that expand the knowledge and skills of the clinical team: lifestyle medicine (LM) consultants and health and wellness coaches (HWC). Together they fill the gap of educating and supporting patients on how to live healthier lifestyles. The LM consultant is a physician, nurse practitioner (NP) or other health care provider specifically trained to provide preventive health care. This professional focuses on identification of risk factors for chronic disease; and helps a patient decrease and hopefully eliminate these risks. S/he helps a patient understand that most chronic illnesses are the result of an unhealthy lifestyle; and how changes in lifestyle will reverse, and in many cases, even cure chronic disease. In addition to the lifestyle medicine trained provider, the LM team may include a dietitian, an exercise specialist, a psychological counselor, a sleep specialist, and other health care providers who focus specifically on preventing illness, mitigating risk factors and attempting to resolve the underlying cause of the disease. The health and wellness coach (HWC) is a skilled professional trained in coaching competencies, typically combining a coach certification with lifestyle medicine education and a background in nursing, nutrition, exercise, or mental health. The arrival in 2017 of national standards and national board certification of health and wellness coaches, led by a partnership of the National Board of Medical Examiners and the International Consortium for Health & Wellness Coaching (ICHWC), is establishing a well-trained HWC workforce to support patients in making positive, sustainable change of their lifestyles. The content of the national certification examination includes four categories (coaching structure, coaching process, health and wellness, and ethical guidelines), encompassing 26 domains, and 140 competencies (ICHWC 9/4/18 4 website). The HWC is well-versed in the behavioral risk factors for chronic diseases, as well as commonlyused biometric measures, lifestyle medicine and wellness, and the impact of lifestyle medicine on chronic disease. To be eligible to become a NBC-HWC (national board certified health and wellness coach), coaches complete a HWC training and education program approved by ICHWC. The HWC collaborates with individuals and groups to identify “readiness” for change, foster autonomous motivation, and creatively navigate barriers to enhance engagement in health-promoting habits. With the application of this approach, the HWC explores possibilities and facilitates change. This process is distinct from the expert approach, which is focused on prescribing expert recommendations. The HWC is non-judgmental and curious, and helps patients discover their strengths and potential. Motivational interviewing techniques used to enhance active participation start with an open, accepting, and compassionate mindset. The HWC meets the individual where s/he is at on his/her wellness journey, and helps the person understand the deeper meaning and value of good health. The HWC helps a patient get to the root of his/her apparent non-compliance which oftentimes represents a lack of confidence in the face of his/her present life challenges. There may be an underlying mental health issue such as depression which limits the ability to maintain optimal health. Together, the HWC and patient unpack these challenges, navigating one challenge at a time (or more if a patient is ready) and then, together they celebrate success. The HWC helps the patient develop a personal vision and action plan based on what the individual is ready, able, and willing to change. Over time, the coaching process helps the patient steadily develop confidence as new strengths are gained and as a more positive mindset begins to emerge.