We are all familiar with the statistics. Chronic conditions like obesity, hypertension, and diabetes are present in our population at unacceptably high and costly levels. More than 78 million American adults are obese, and more than 1 in 20 is extremely obese. About 70 million U.S. adults have hypertension with only 52 percent having the condition under control. Just over 29 million Americans have diabetes and an additional 86 million have prediabetes. The medical costs of these conditions are staggering – an estimated yearly total of $147 billion for obesity, $42 billion for hypertension, and $245 billion for diabetes. This does not take into account the additional costs of lost productivity, which among obesity, hypertension, and diabetes, are estimated to be greater than $70 billion per year.
One of the successful yet vastly underutilized remedies for all of these conditions is behavior change in the form of dietary and/or activity modifications. The reason behind the lack of success with lifestyle interventions is simple – behavior change is hard. There is however a tool that makes behavior change easier – health coaching. Health coaches have been around for several years, but despite growing evidence of their ability to help people successfully make behavior change, providers are rarely recommending that their patients seek out a health coach. Here is why you should start recommending a health coach to your patients now.
Health coaching works. A 2014 systematic literature review concluded that among adults with chronic diseases, health coaching leads to statistically significant improvements in weight management, physical activity, physical and mental health status. How is this accomplished? Well, a good health coach will take time to get to know a client and his/her goals, and help formulate a plan to help reach those goals. The right coach will guide clients to make well defined, measurable goals, and will keep clients on track by holding them accountable for making forward progress. Health coaching that achieves lasting results uses a personalized approach that fits each individual’s unique life circumstances.
Physicians are not trained to help patients change behavior. As doctors, we are primarily taught how to diagnose and treat disease. And although we are great at recommending patients lose weight, exercise more, or eat a healthy diet, we typically offer little advice on how to accomplish this beyond join a gym or see a nutritionist. A well-trained health coach is educated regarding behavior change, and uses a science based process to facilitate that change. Right now anyone can say he or she is a health coach, but the National Consortium for Credentialing Health & Wellness Coaches is working to change that. This group, composed of leaders in the health coaching field (including physicians), has set standards for organizations providing health coaching training. Furthermore, the NCCHWC is in the final phases of implementing credentialing standards (a component will be a written examination) for individual health coaches.
Physicians don’t have the time to help patients change behavior. Behavior change takes time. On average more than two months is required to successfully make a behavior change. That is obviously a lot longer than a typical 15 or 20-minute office visit. Health coaching is structured to provide the necessary time to be successful at behavior change. Coaching generally occurs over the course of 5-7 sessions with each session lasting from 30-60 minutes. The majority of physicians do not have a practice structure that accommodates this type of interaction.
When recommending a health coach, know that some insurance companies offer health coaching as a covered benefit, so advise patients to check there first. Most health insurance, however, does not currently cover health coaching, in which case patients can expect to pay anywhere from $45 to $110 or more per session. Given that change takes time, one should expect to have between 5 to 7 sessions. This is clearly a substantial financial investment, but the result of better health is worth it in the end. A more budget friendly option is group health coaching which can be done either online or in person, and also leads to positive results. One of the great things about health coaching is that it is effectively accomplished via telephone or video chat so patients should know that geographic limitations are not a concern. Counsel patients to look for coaches who offer a free consultation. A good coach/client fit is important in the coaching relationship, and a consultation visit can help provide that insight. Patients also need to ask what training the individual has gone through that makes her or him qualified to be a health coach. The National Consortium for Credentialing Health & Wellness Coaches has a list of approved training organizations.
Is health coaching going to help everyone? Of course not. There is nothing in medicine that benefits everyone universally. However, health coaching is a very useful tool to achieve behavior change and help reduce the burden of chronic conditions like obesity, hypertension, and diabetes. So please start recommending a health coach to your patients today.
Nicole Calloway Rankins is an obstetrician-gynecologist and an integrative health coach. She can be reached at Health and Wellness Coaching by Nicole Calloway Rankins.
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