A new vocabulary is making it's way into the lexicon of modern day speech. Words and terms such as "lifestyle medicine", "disease management", "lifestyle illness", "wellness coaching", "health coaching", "chronic illness coaching", and, I like this one, "diseases of civilization", seem to be showing up everywhere in the wellness and healthcare fields. Indeed what we used to call "behavioral health" when I was president of the Ohio Society for Behavioral Health and Biofeedback is hardly recognizable today, and that is a good thing!
As the United States heads into a year of monumental change on the political front, we know that some kind change will and needs to happen within healthcare. There is fear and uncertainty, but mostly there is optimism that we will see more access to the healthcare and services that people need. At the forefront of this change will be the mountain of evidence that shows that HOW people live their lives, their behavioral choices, is THE major determining factor in the health of the U.S. population.
Let me throw some stats at you. According to the U.S. Surgeon General, 70% of the diseases and subsequent deaths in the U.S. are lifestyle-based. According to the CDC (Center for Disease Control), lifestyle-based chronic diseases account for 75% of the nation's $1.4 trillion medical care costs. We are finding that lifestyle modification is a cost-effective means to reduce the estimated costs of ~$120 billion for tobacco related illness and ~$90 billion from sedentary behavior and overweight/obesity annually in the US alone. We know these stats and yet it seems such a slow process turning the ship to a new course.
An example is the 2004 (five years ago!) INTERHEART study that showed that 90 % of first heart attacks (myocardial infarction) suffered by people can be attributed to nine risk factors: cigarette smoking, an abnormal ratio of blood lipids, high blood pressure, diabetes, abdominal obesity, stress, a lack of daily consumption of fruits and vegetables, as well as a lack of daily exercise. Four of the nine are entirely behavioral. We could argue that the presence or absence of the other five are also lifestyle-related. This study was no small population, fly-by-night study. We're talking about a global study looking at 15,000 patients with a first acute myocardial infarction (AMI) and 15,000 asymptomatic control subjects in 52 countries throughout Asia, Europe, the Middle East, Africa, Australia, and North and South America. (http://www.ncbi.nlm.nih.gov/pubmed/15364185).
The evidence already out there is exciting! What are we doing with it? We want people to improve their lifestyle behavior. We've tried telling them, educating them, frightening them, shaming them, bribing them, and more. Well-meaning healthcare professionals and even people with the title "health coach" or "wellness coach" have tried a diagnose-and-suggest approach. "Why don't you try this?" There has to be a better way...and there is.
Wellness coaching, when it is practiced by a well-trained individual, is a behavior change methodology. It's not just a grab-bag of interpersonal skills and suggestions for how to be healthy and well. It's not just a technique for better communication. It is a way of working with a person, as an ally, to help them: 1) take stock of their wellness, 2) envision themselves living their optimal lifestyle, 3) create a real plan to find their way successfully through change, 4) track their progress so they know when and how they are being successful, and 5) get the accountability and support they need to follow through and make the changes last. It is a behavioral solution for a behavioral problem.
The healthcare field is slowly recognizing that "more of the same" is not working. Healthcare is realizing that wellness coaching includes not just "helping well people be even more well", it includes helping the patient with a chronic illness to improve the course of their illness significantly by succeeding at making proven lifestyle improvements.
Michael Arloski, Ph.D., PCC
