Wellness Coaching as Lifestyle Medicine: Covering The Whole Continuum by Michael Arloski, Ph.D., PCC
Prevention was always the touchstone used to define and justify the raison d’etre of the wellness field. Health educators, nurses, corporate wellness programmers and others involved in the wellness field over the last thirty years could always point to the consummate sensibility of prevention and health. Entire programs were built around the reduction of health risks and the prevention of illness. Now we are seeing that undeniable evidence concludes that wellness, i.e., helping people improve their lifestyle behavior, is an essential part of the wise treatment program for many chronic medical conditions (American College of Lifestyle Medicine).
Globally, according to the World Health Organization, non-communicable or "lifestyle" diseases account for nearly 60 percent of deaths. By 2020, this is expected to rise to 73 percent. The lifestyle behavior factor in such diseases is critical. We have come to realize that increasingly sedentary lifestyles, poor diet (not “poor” in the economic sense, but rather poor in the way diets are becoming increasingly uniform worldwide through industrialization of food manufacture, distribution and sales, e.g. convenience and “fast foods”), greater isolation, and increasing stress contribute to both the onset and the course of such chronic diseases as diabetes, heart disease,
asthma, cancer, hypertension, etc. The Center for Disease Control estimates that chronic illness consumes 82% of healthcare resources and costs in the U.S.A. (Center for Disease Control, 2004) A New England Journal of Medicine article estimates that people with chronic conditions receive only 56.1% the recommended care for their health challenges. The costs of medical noncompliance (which is entirely behavioral) is in the billions. (McGlynn, Asch, et. al., 2003). Clearly with such high rates of incidence the wellness field now faces a two-fold challenge of prevention and being part of the treatment solution. The people we serve span the entire continuum from those with severe health challenges to all who aspire to peak performance, and living joyful, meaningful and satisfying lives. We are zeroing in on the behavioral nature of
health and those in the wellness field are uniquely qualified to help, if we follow a model that is effective. The old models of “prescribe and treat” and “educate and implore” have caused a real lack of faith in “behavioral medicine” because they simply don’t result in behavioral change often enough or in ways that last. Just telling people what to do, even very authoritatively, or giving them great information and begging them to change, won’t get the job done. The paradigm shift that has already taken place is to create coaching alliances with those seeking to effect lifestyle changes and accompany them through the process of change to lasting success. As James
Prochaska says, “Change is a process, not an event.” (Prochaska, et. al., 1994).
The last several years has seen the development of new health and wellness coaching strategies for addressing the lifestyle behaviors that impact healthcare costs and public health. Making widespread use of health and wellness coaches, disease management companies have become a growing part of the healthcare industry that seeks to implement some of these new strategies. Employee Assistance Programs (EAP’s) are beginning to include health and wellness coaching in their services. Self-insured companies are exploring these same strategies to improve the health of their populations and thus contain rising healthcare costs. Increasingly, wellness
professionals in hospitals and corporate wellness programs are being asked to work with clients one-on-one, using a coach approach to increase the probability of real success. Health coaches can vary substantially in their methods and in their training backgrounds. They range from highly qualified masters degree-level counselors, ICF certified coaches, and registered nurses, all the way to less educated phone bank employees. Their contacts with patients range from 30-50 minute unlimited coaching sessions to quarterly ten-minute “check-in” appointments that mostly focus on verifying that the patient is taking their medication, getting tested often enough, etc., and encouraging good medical compliance. Some work with health risk assessment feedback and some are there merely to provide information about wellness program and insurance program benefits.
For the patient or client with a health challenge, the “lifestyle prescription” has usually been told
to them by a healthcare provider. They are often told to be less sedentary, manage stress better,
get more sleep, improve their nutrition, etc. If they can be directed to a well-trained wellness
coach, the prescription for lifestyle change can be successfully “filled”. By creating an effective
coaching alliance the wellness coach can guide the client through processes to 1) assess their
current level of wellness; 2) envision and determine areas of focus to work on; 3) factor in key
elements such as readiness for change; 4) identify measurable outcomes; 5) determine a course
of commitment and connect with motivation; 6) determine challenges in the way of success; 7)
develop strategies to overcome those challenges; 8) identify and recruit sources of support for the
journey; and 9) secure accountability methods to ensure success. The value that wellness
coaching contributes to the field of lifestyle medicine should be increasingly apparent as we
implement such models and study them further.
American College of Lifestyle Medicine. Lifestyle Interventions In The Treatment Of Selected
Diseases – Summary By Disease. http://www.lifestylemedicine.org/resources/LMabstracts.pdf
Arloski, M. (2007) Wellness Coaching For Lasting Lifestyle Change. Duluth, MN: Whole
Persons Associates.
Prochaska, J., Norcross, J, & Diclemente, C. (1994) Changing For Good. New York, NY:
Harper Collins/Quill. 1994 Harper Collins, 2002 Quill reprint.
Center for Disease Control; The George Washington University, National Health Policy Forum
“Medicare’s Chronic Care Improvement Pilot Program: What is its Potential?” NHPF Brief No.
797 May 10, 2004.
McGlynn, Asch et al. The Quality of Health Care Delivered to Adults in the US , NEJM 2003;
348:2635-48
