Wellness Coaching Australia's Blog

Promoting Well-Being through the Emerging Specialism of Health and Wellness Coaching




Introduction

The healthcare needs of the population are becoming more complex. The incidence of long-term health conditions is rising (World Health Organization, 2018) and so too is the  number of individuals living with multimorbidity (i.e. more than one medical condition). The evolving health needs of the population raises important questions about how we can respond optimally to the challenges that face us.

This article examines the potential contribution of health and wellness coaching (HWC) to the healthcare needs referred to above. Specifically, it introduces HWC as a  distinct and rapidly emerging intervention, examines the status of its evidence base and offers some reflections on its increasing popularity as a service offering. The article also considers what is currently known about those delivering HWC and some critical next steps if this specialism is to realize its potential as a mainstream offering that can attract funding  from commissioning bodies.

From sickness to health: empowerment and partnership

It has been estimated that only approximately 20% of adults are currently thriving (Keyes, 2002; Kobau et al., 2010). Although this finding relates specifically to the population  of the USA, it would seem reasonable to anticipate a similar pattern in the UK and Australia. An additional challenge is that many individuals struggle to master the type of changes

that would enable improvement (Prochaska & Prochaska, 2016). Whilst a variety of conditions call for health-related behavioural changes, many prove unable to make or  sustain these and it would seem that the traditional methods of information-sharing and professional advice alongside other efforts to modify health-related behaviours have been  of limited effectiveness (Kelly & Barker, 2016). In a context where there is both a growing number of individuals with pressing health needs and significant difficulties in helping many of those individuals engage in appropriate lifestyle changes, there would seem to be a compelling case for alternatives to the ‘expert-led approach’ and for developing innovative  approaches that can assist with building and maintaining health and well-being.

What is health and wellness coaching?

HWC is a relatively new, but rapidly developing, discipline. Originating at the start of the 21st century, coach training programmes began to emerge in North America in 2002 and  grew rapidly so that as of 2016, in excess of 53 academic and private sector programmes had trained over 20,000 health care professionals (Kreisberg & Mara, 2017). However,  many coaches call themselves health and/or wellness coaches without any recognised training.

As with many emerging disciplines, debates concerning definition, scope and differentiation abound as HWC attempts to delineate its terrain at the levels of theory and  practice and claim its place alongside other, more established health care professions. For the purposes of this introductory article, however, we find it conducive to draw from the  definition provided by Wolever et al. (2013) which defines HWC as:  “a patient-centered approach wherein patients at least partially determine their goals, use self-discovery or active learning processes together with content education to work  toward their goals, and self-monitor behaviors to increase accountability, all within the context of an interpersonal relationship with a coach” (p. 52). HWC can be understood, then, as a client-centred, collaborative intervention whose primary aim is sustainable lifestyle change. Whilst coaches bring defined skills and  knowledge to the process, the goals selected are client-determined and relate specifically to health and wellness needs with the coach positioning the client explicitly as the expert on  their own life (National Board for Health and Wellness Coaching, 2020). As such, client accountability is central to the process.  In general terms, HWC seeks to combine the insights from psychological theories concerned with motivation and behaviour change in order to devise coaching interventions that are bespoke for the individual client (Jordan & Livingstone, 2013; Mettler et al., 2014).

Thus, a comprehensive training programme in HWC is likely to draw upon fields as broad and diverse as motivational interviewing; self-determination theory; transtheoretical  models of change; positive psychology; cognitive behavioural principles and methods; social cognition; theories of emotional intelligence; mindfulness and neuroscience (e.g. Dossey et al., 2014; Jordan, 2013; Moore et al., 2015).

The diversity of approaches and perspectives that currently underpin the training and practice of HWC raises important conceptual and technical questions about whether this is a  distinctive form of coaching working towards the development of its own original knowledge-base or an amalgamation of theories and models from other fields that are  being ‘packaged’ in ways that meet the needs of a particular segment of the coaching market. In order to begin to explore questions of this nature, it is necessary to examine  what is known about the effectiveness of HWC and its evidence base in relation to different areas of health need.

The current status of the evidence base for HWC

To date, the most comprehensive summary of the evidence base for HWC is that provided by Sforzo et al. (2017). Their compendium of the literature represents a landmark  study in the field in that it summarises and synthesises the available studies for the purposes of assisting practitioners and advancing scholarly activity1. It comprised of a  dataset of 219 articles with a further 104 peer-reviewed coaching-related articles added in 2019 (Sforzo et al., 2019). Drawing on Wolever et al.’s (2013) definition of health co (see above) together with the similar findings of Olsen (2014) the compendium reviewed the literature in relation to  six clinical categories: weight loss and obesity, diabetes, heart disease, hypertension, cancer and cholesterol management. An additional category of ‘wellness’ covered multiple minority conditions.

Overall, the authors of the 2017 Compendium and the 2019 Addendum conclude that there is sufficient evidence to support the claim that HWC is an effective intervention – at  least in certain contexts and in relation to some specific, chronic, lifestyle-related diseases.  Moreover, the pattern of results suggests that HWC is potentially effective for improving numerous aspects of behavioural change associated with increased well-being. Nonetheless,  there is a need for caution. 1 To ensure that readers are provided with the most up to date information in the field, and given its importance to furthering understanding of the existing knowledge-base, we have based our  evaluation of HWC on the compendium rather than reviewing individual studies.


As noted by the authors, interpretation of the findings is confounded by a range of methodological limitations and complexities. Variations exist as follows:
• HWC was often delivered as an adjunctive intervention or as one of multiple
interventions.
• The number of coaching sessions and length of coaching programmes
fluctuated as did the length of each session.
• The nature of the coaching intervention provided is also unclear – what was
delivered by whom?

• Some participants had co-morbid or multimorbid conditions creating  complications in understanding the precise impacts of any coaching intervention on individual clinical conditions.


What can be concluded from this research? The wide scope of the literature reviewed in the compendium makes an important contribution to the knowledge-base underpinning HWC. However, it should be noted that the focus of the majority of studies reviewed was on the reduction of medical risk factors that are prevalent in the population today. The research was conducted predominantly in healthcare settings and would have been influenced by cultural aspects and demographic diversity.  It is clear then, that the evidence base for HWC is still emerging. Nonetheless, both the compendium and addendum offer some cause for optimism that the use of HWC in the medical field has at the very least, the potential to be a valuable adjunctive intervention to more traditional interventions such as information sharing and psychoeducation. Moreover,  HWC can potentially enable other well-being outcomes as outlined above.


The literature reported improvements in the following areas:

• Psychosocial benefits including quality of life, reduced depressive symptoms and perceived stress levels (Clark et al., 2014).

• Increased motivational levels in wellness-related areas including life  satisfaction, energy level, healthy weight, mental/emotional fitness and managing health (Mettler et al., 2014 ).

• Importance, confidence and readiness to change significantly improved in all areas.

These studies support the contention that there is potential for HWC to be used  outside of the medical arena.

Who is delivering HWC? Identifying an emerging workforce

To the best of the authors’ knowledge, a systematic investigation of this emerging workforce is yet to take place and knowledge of those drawn to train as health and wellness coaches is currently sketchy. However, work being undertaken by one professional body – the National Consortium for Credentialing Health and Wellness Coaches (NCCHWC), based in the USA started to create standards around who might legitimately qualify for this title. Following a summit in 2010, it was decided that the industry itself would define how such coaches would work rather than rely on criteria decided by the medical profession (Wolever et al., 2016a).

In 2014, a job task analysis conducted via a validation survey of over 4,000 practicing HWCs identified the core knowledge and skills required to perform the role and in 2015 the training and education standards were published (Jordan et al., 2015). I In 2016 an agreement was signed between the NCCHWC and the Medical Board of Examiners. A further name change of the NCCHWC to the International Consortium for the  credentialing of Health and Wellness coaches (ICHWC) occurred in 2017, in the same year as national certification began. In 2019, applications opened for international training  organisations to apply for approval and to gain eligibility for their graduates to sit for Board Certification. (NB: ICHWC is now known as the National Board for Health and Wellness  Coaching (NBHWC), referred to earlier. At the time of writing, 24 programmes have final approval with another 57 being transitionally approved by the NBHWC.)

However, the question remains as to the background and credentials needed by health and wellness coaches to train and work in the field. For example, is a health and  wellness coach competent to work in this field without having previously completed a healthcare qualification? Wolever et al.’s (2013) definition, cited above, is clear that health  and wellness coaches are healthcare professionals who have previous training in the theory of behaviour change, motivational theories and communication skills that are used to support their clients in achieving sustained change in their health and well-being. Nonetheless, the anecdotal observation by the authors that HWC is gathering momentum as an industry-wide initiative suggests that it may be a choice of career for others for whom working in the health arena is a vocation.


Confusion also exists in relation to the terms ‘health coach’, ‘wellness coach’ and ‘health and wellness coach’, the interchangeability of these terms and who should be  permitted to use which title. This question has been debated by several authors. In an interview with Snyder (2013), the view was expressed that the difference was arbitrary as wellness coaches would end up working with people who have health issues. It has also been suggested that health coaches work with people with chronic health issues, whereas wellness coaches are more focused on prevention and maintaining current health status (Kreisberg, 2015). This view was supported by Huffman (2016) who stated that wellness coaches worked to guide and inspire healthy people who wished to maintain or advance their overall health and that their work was more likely to focus on smoking cessation, fitness, nutrition and body weight management than on managing chronic illness. Where the line is drawn in terms of the needs of clients, or whether a line should be drawn at all remains unclear.

What can be concluded with greater certainty at this stage is that those drawn to training in HWC have varied professional backgrounds. The professions and professional groups represented within the specialism are highly diverse and include nurses, fitness and allied health professionals, health and other practitioner psychologists, coaching practitioners, human resources personnel, counsellors, yoga teachers, chefs, nutritionists, dieticians, exercise physiologists and physicians, amongst others (Snyder, 2013; Wolever et al., 2016b).

Although much of the work in HWC originated in the USA, groups are coming together in other countries to create standards and routes for credentialing and for formally  recognising the contribution of HWC to the health of the population. The UK Health Coaches Association offers coach membership and is currently designing standards and criteria for certification purposes. The Health Coaches Australia and New Zealand Association has recently been formed to represent coaches in that part of the world. The Global Wellness Institute has recently established an initiative on wellness coaching to explore, report and recommend action in relation to HWC activities globally. There is, therefore, a coming together of the community in recognition of the need for a united voice and a shared understanding of HWC and its delivery.

Unanswered questions and next steps for HWC

The introduction to HWC presented in this article reinforces the need for further investigation of this rapidly growing field. The evidence base is growing and overall suggests  that HWC can have favourable outcomes in the field of chronic illness. However, there are still many confounding factors that can create a degree of confusion over the results  reported in the compendium. Additionally, HWC is being offered in a highly diverse range of contexts but most of the research to date has been performed in healthcare settings. There are currently limited studies reporting the impacts of HWC conducted in settings where individuals have goals that do not relate to overcoming chronic health conditions.

It has been noted that those delivering HWC come from varied professional backgrounds (Jordan & Livingstone, 2013) and the question of what they need to know to  work safely and effectively in this field is still to be determined. As coaching is used in diverse settings professionals may need to be trained to focus on targeting specific client needs. For example, a health psychologist may be trained specifically to coach cancer patients. A care worker specialising in elderly care may have in-depth knowledge of dementia and seek coach training to complement their existing knowledge and skill-set. The specialist knowledge base needed to work in HWC still needs to be determined and is a task for the future.

At the time of writing, the impact of behaviour change on health and well-being takes on an additional meaning in the context of COVID-19. HWC could have an important role to play in responding nationally and globally to the challenges posed by pandemics. Coping with state-imposed restrictions such as lock down and social distancing measures, anxiety  related to separation from and the feared loss of loved ones, and financial pressures associated with threats to local, national and global economies, create a climate of considerable uncertainty and stress for everyone. For those additionally managing long term conditions, maintaining health regimes in the context of self-isolation and changes to the accessibility of health care services creates an additional set of challenges. As understanding of COVID develops, HWC may have an important role to play in designing and  delivering interventions tailored to those having to manage complex health issues in the context of exceptional circumstances.


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Global Wellness Summit and Wellness Coaching Initiative




In October, I was fortunate enough to be invited to attend the Global Wellness Summit in Singapore. This was an exciting event for me and also one I went into with some lack of knowledge of what to expect!  I wasn’t disappointed.  

A big influence on my decision to attend was an invitation to Vice Chair the initiative on Wellness Coaching. In case you are wondering what that means, (as was I) The Global Wellness Institute (GWI) supports a variety of industry Initiatives, furthering the international conversation about wellness in its many and varied forms. Each GWI Initiative is led by an Initiative Chair, who is a renowned thought-leader in his or her particular area of focus. I felt honoured and privileged to be approached to Vice Chair this particular project.  For more information on this take a look at their website:

Global Wellness Institute: Wellness Coaching Initiative

I am in very good company.

Over four days I listened to some incredible sessions presented by leaders in their field who covered the latest in research, thinking, science, and anything related to improving global wellness.  Asia featured prominently due to the location of the summit this year which made it very relevant to Australians who attended due to our close proximity. In prior years it has been held in places like New York, Switzerland, Italy, Morocco, Mexico, Australia and in 2020 the venue will be Tel Aviv (Truly global.). There was a great representation of our country with over 40 attendees who filled the stage for Australia’s photo!

It would be impossible to document everything I learnt and suffice to say the following topics were a few touched on during the four day agenda:

  • Mental Wellness 
  • Wellness retail 
  • Rejuvenation and anti aging
  • How people are aging -  baby boomers
  • Artificial intelligence
  • Wellness in the workplace
  • Solutions for jet lag (!)
  • Asia’s growing place in the wellness industry
  • The business of Purpose (corporate and individual)
  • Epigenetics
  • Sustainability
  • Evolution of the spa and retreat industry 
  • Energy medicine
  • Physical activity trends in the world
  • The role of nature in wellness
  • Value of CBD oil
  • Wellness Tourism

Here are a few random facts that piqued my interest in no particular order:

  • $109b is being spend on Fitness, $230b on sports and active recreation, 29b on Mindful movement
  • Baby boomers describe themselves as more optimistic, personally gratified, idealistic, loyal, driven and able to cope with technological change than either Gen X or Millenials describe themselves.
  • A comment on Maslow’s hierarchy of needs – surely mental health should be included as a basic need?
  • Energy medicine – our hearts send more signals to our brains than the brain sends to our hearts (multiple neurons are found in the heart and gut – not just the brain).
  • Getting rid of used textiles creates massive amounts of landfill and are a huge problem to the environment (recycle clothes).
  • Drugs and natural substances exist that have been shown to have anti-aging benefits (metaformin, fisetin, nicoltinamide,  hGH were a few that were mentioned).  Spas will become the plae where rejuvetation procedures will be delivered.
  • 69% of all deaths globally each year are a result of preventable diseases
  • Wellness in the workplace is about culture not programs!
  • Poverty will be decreased enormously – by the education of women
  • Digital and face to face wellness programs will sit side by side. One will not replace the other.  Instead they will cater for different things, but both will meet some need.
  • Amplification of community – social accountability ensures a behaviour becomes a habit
  • If you want to help a community, don’t impose from the outside, enrol the people themselves
  • If we underestimated the power of Asia, consider this.  They have 60% of world population, 50% of world’s middle class, 50% of global GDP by 2040!
  • Some very creative solutions to getting the world moving include: Plaza Dancing in China 100 million people (including the elderly) are dancing choreographed dance in plazas
  • Having open streets (traffic free) in America-Caribbean is driving exercise
  • Australia has the highest life expectancy in the world – at 83.
  • A robotic dog called “Albo” is helping improve the quality of life in aged care homes by engaging the resident and improving the communication of preschool kids.

You might wonder what all this fascinating information had to do with my profession and background?! I was lucky enough to host a table on Wellness coaching and enjoyed some interactive discussions with a group of people who chose to attend. Throughout the summit, I recognised multiple opportunities for wellness coaching to support projects and yet also realised that there is still a lot of misinformation about our work (Several times the term was used in conjunction with the word “advice”.)  Yet we are getting the attention that our work deserves. By staying in touch with wonderful organisations such as the GWI, I can only hope that we will gain traction and credibility and people will come to understand exactly what we do. The journey continues!

The Australian attendees at the 2019 Global Wellness Summit

*Photo Credits: The Global Wellness Institute; Global Wellness Summit and Fiona Cosgrove.

The Underside of Wellness


The Underside of Wellness

We assume that we work in a field that has appeal to anyone on this planet. Who doesn’t want to improve their health and wellness?  What could possibly be bad about working towards this outcome?

Well, think again.  Wherever there is a strong argument for one approach, there will be someone who argues against it!  (Remember the fitness movement and the articles and books sending the message that “Exercise can kill”?)

Of course, freedom of speech, sharing ideas, playing devil’s advocate etc. are all good things so when I came across the following interview, I listened, (non judgmentally) and attempted to filter out the learning or awareness that came out of what Dr. Spicer had to say.  

Dr Spicer was interviewed on Life Matters radio program and was promoting his book The Wellness Syndrome where sure enough, the main message was “Wellness is simply the latest obsession”. I will sum up Dr Spicer’s comments (and a bit of his rationale) and then counter them with a few of my own.

  • Wellness has become something else to worry and feel guilty about (consider the bloggers whose daily routine is something we can never aspire to).
  • Wellness trends are associated with abstinence and possibly self punishment.
  • Wellness encourages too much self-obsession (think of all the ways we have of monitoring everything we do.
  • Wellness behaviours are time stealers and take up huge amounts of our day.
  • Corporate wellness programs are becoming a way of discriminating against new employees who are not fit and thin.
  • Organisations are taking the view that a successful CEO must be able to run a marathon or climb a mountain and  productivity and wellness are inaccurately linked.  
  • Pressure is being put on employees to train.
  • Wellness is becoming a cult.
Yes you are probably thinking, “wow”! but let’s face it there are some things we recognize as being, if not problems, potential problems and this is what we must be aware of and accept that some of what he says could have merit.

However….

First, all the above points are referring to extremes.  

“Bloggers who have huge followings and expound living the perfect, rigorous healthy life with rules around everything could well make people feel somewhat inadequate.”   
My response – choose who you follow!  We need to take some responsibility over what we expose ourselves to.  What motivates that blogger?  Are they boasting or helping?

“Wellness behaviours are cultish and like religious rituals.” 
My response – anything taken to extremes can be sinister.  If a ritual is a habit, then that sounds like a positive way of incorporating a few new ones into our daily routine.  Becoming aware of what we do automatically is the first step to changing it.

 “Corporate wellness has become a way of discriminating.”
My response – taken to extremes yes, but high energy that comes from being well is definitely associated with productivity.  Anything that our society can do to encourage healthy behaviours as being the “norm” is a good thing.  If an individual does not want to consider their health as important, go and find an organisastion who doesn't care about this aspect of their employees’ lives.

Dr Spicer’s final comments are about the backlash that the wellness movement is having.  “Dude food” is increasing where people can eat as much as they want and eat real, high fat meals.”
My respose - Hey, if that’s your choice, it’s your body.

 “People are looking for meaning rather than happiness.”
My response – Agree (finally) - and we need to be.  If we search for happiness, it will elude us. If we try and find meaning in our lives, the incidence of depression will decrease.

 “The rise of neo-stocism – the belief that gains can only be made through pain and suffering and fight clubs, extreme work outs, tough mudders etc. are now becoming very popular.”
My response – there will always be people who want these things. Let everyone find what works for them.. There are plenty of softer “wellness” options out there!

In conclusion, I respect many of Dr. Spicer’s views but worry about the way people might interpret his message as encouraging a total lack of regard for whether we have healthy lifestyle habits and a continuation of the growth of lifestyle related illnesses.  

At least we’re doing something to try and slow it down.

The recording of Dr Andre Spicer was found at this link 

https://radio.abc.net.au/programitem/pg9G1mr82G?play=true



Seeking your help for a Research Study on Behaviour Change


The field of study in Behaviour Change is a fascinating one, and one that as Wellness Coaches we can all continue to learn from and can apply with our clients when new research comes to the fore. 


Just for a change, we are inviting you to be a participant in a current study one of our Level 3 graduates is conducting for her Post-Graduate research through the Queensland University of Technology (QUT). The topic: “Psychological Factors that may Help or Hinder Weight Loss Behaviour Change”. 

This is your opportunity to contribute to an area of study that you, as a coach, can benefit from. So if you answer YES, to either of the below questions, then jump online and complete this simple 15-20 minute anonymous questionnaire and be part of a study that we can all actively benefit from.

Words from research host, WCA Level 3 graduate, Carly Dyer 

Have you, or the clients you work with, ever tried to lose weight? Have you ever wondered why some people are successful in losing weight while others are not? 

I’m an Australian postgraduate student at Queensland University of Technology (QUT) and I am conducting research into psychological factors that may help or hinder weight loss behaviour change. I am looking for adults who are overweight at the moment to participate, regardless of whether they have been trying to lose weight or not. I am also looking for adults who have successfully lost weight in the past two years to participate.

Participation is easy – just follow this link to complete a 15-20 minute anonymous online questionnaire. You can refer past and present clients directly to this website too.

CLICK HERE TO COMMENCE THE ONLINE QUESTIONNAIRE > http://survey.qut.edu.au/f/181251/277e/

Alternatively, you can request a participation invitation be sent to you via email or sms that you can easily forward on to your clients. Please contact Carly Dyer – carly.dyer@student.qut.edu.au for more information.

Many thanks for your consideration of this request, as the more people who complete the questionnaire, the greater the potential impact of the study.

Please note that this study has been approved by the QUT Human Research Ethics Committee (approval number 1400000410).

Carly Dyer 
Honours Student
School of Exercise and Nutrition Sciences
carly.dyer@student.qut.edu.au 

Dr Esben Strodl
Supervisor
School of Psychology and Counselling
+61 7 3138 8416

Faculty of Health, QUT



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