Today we explore how to work with a client who is not engaged in following evidence-based or scientific guidelines, including preventive tests, and is not seeking out reputable sources on the Web and beyond. Instead, s/he hunts down information and recommendations from non-reputable sources, while not listening to your well-informed advice. It goes without saying that those reading this article honor and respect the scientific method, are skeptical of recommendations that lack a scientific foundation, and stay within the bounds of evidence- based guidelines that are worthy of publication in a peer-reviewed journal or textbook. The construct of evidence-based medicine has been around for about 20 years and is a relatively new, but essential paradigm in exercise program design and implementation. We are taught to refrain from making recommendations that are not firmly rooted in well-designed research studies, the more the better. However, our clients may not be like us. They may not trust or respect science-based recommendations. Perhaps they think of themselves as right-brain types who didn’t enjoy science courses in their education, and value intuition and creativity more than the scientific method. Maybe they are frustrated with the limitations of the scientific method, which generates recommendations based upon aver- ages and bell curves that don’t seem relevant to their personal circumstances. They may be more interested in what complementary and alternative practitioners have to say because these practitioners treat people who have been failed by conventional medicine. Some are justifiably concerned about how medical guidelines change dramatically over time. Lively debates have emerged recently among scientists and in the media about the pros/cons of mammograms, PSA tests for prostate cancer, and the value of annual physicals. Not long ago high carb/low fat diets were the universal recommendation for heart health; this is no longer valid as the evidence for low carb/moderate healthful fat diets is now compelling. The landmark June 2012 JAMA paper on weight loss maintenance by Ludwig et al., has overturned the science- based wisdom that a “calorie is a calorie” when it comes to energy expenditure.2 It turns out that high carb diets lead to an average of 300 fewer calories expended daily than low carb diets, a critical issue for weight loss maintenance. No wonder our clients may have become cynical about evidence-based   guidelines. So how do we bridge the gap between our science-based wisdom and guidelines and our clients who don’t trust our science-based guidelines and resist our recommendations? 1.    APPRECIATE  WITHOUT  JUDGMENT The only way a helping professional can defuse resistance is to get fully onto your clients’ side of the fence. Get down from your expert pedestal and honor your clients’ biological drive for autonomy, to choose their own path. Inquire openly and without even the tiniest whiff of judgment or expectation about how they make decisions on what to do to protect and improve their personal health. What is their approach to investigating options, whose advice do they trust most, how do they weigh up their options and decide? What do they think about evidence-based medical guidelines? Perhaps they will share painful stories about how they or close others have experienced difficulties with recommendations of reputable health care providers. Validate and show respect for their perspectives with authentic sincerity, however uncomfortable that might be. 2.    COACH DON’T PREACH Once your clients trust that you appreciate and respect their viewpoints, bringing down the walls of resistance, you have created an opening to facilitate their finding a new and improved decision-making process. Move into a collaborative coaching conversation where you encourage clients to generate new ideas on how best to make health decisions, and get permission to offer your ideas and wisdom. While it’s tough for our expert minds to give up control of having the right answers, it is human nature for your clients to value what they discover more than what has been imposed. Allowing your clients to discover a better path for themselves will, in fact, dramatically increase your impact and your clients’ success. And the bonus is that they will be more likely to be interested in your best advice. Originally published in ACSM Certified News Coaching Column

Today we explore how to work with a client who has a strong desire to lose weight and has agreed to track her daily caloric intake and energy expenditure over the past two weeks. You sit down to review her chart she sent you before your next session and quickly suspect she is under reporting her daily caloric intake and over reporting her daily energy expenditure. Clients more often than not engage fitness professionals to help them lose weight, a primary reason for getting fit, strong, and flexible. In our larger world, where we face a tidal wave of weight gain, the exception, not the rule, is for a client to succeed in losing weight and keeping it off. So let’s first acknowledge that this is a very challenging goal for you and your clients. Start with a beginner’s mind, assuming that you truly have no idea about what will work or whether your client will be successful. One method that has been proven helpful to those who have lost weight is daily journaling of eating and exercise activities, online or by hand on a printout you provide. The starting point in a weight loss endeavor is often to help a client get a snapshot of the balance of intake and expenditure, raise self-awareness of eating patterns, and help you spot obvious areas for tweaking and improvement. Approximately 5% of human beings were born with a “signature” character strength of self-regulation, which means this group is talented at self-monitoring, self-managing, and self-adjusting rapidly when needed. Some of them are aligned with a movement called “the quantified self,” gaining self-knowledge through numbers according to the tag-line at www.quantifiedself.com. The left prefrontal cortex, the brain’s CEO of a good self-regulator, enjoys collecting and evaluating data and loves to make decisions based on solid analysis. I happen to be one of those precious few as I weigh myself daily using a scale with 0.1 lb increments, and immediately change my eating habits if my weight rises by a half-pound, even if that day happens to be a family celebration. For people like me, perhaps you, tracking and recording information like energy balance is an interesting and engaging challenge; we take pride in doing it accurately, checking calorie charts carefully, asking lots of questions, and we enjoy reporting our results and observations. The simple act of recording our intake and expenditure can lead us to lasting changes in our eating and exercise patterns as well as sustainable weight loss. Unfortunately 5% is a small minority. What happens to those of us who aren’t good at self-regulation, who dread tracking and reporting things like eating habits, medical information, and finances? When you are asked or decide yourself to take on a task that you aren’t good at, it’s not fun, it drains your energy, you are easily distracted, and your performance isn’t great. The polar opposite of self-regulation is the strength of living in the moment, indulging your impulses, eating what you want, being spontaneous, being creative, and relying on your “gut” to make decisions. Someone who is not good at self-regulation, or whose self-regulating brain region is exhausted or stressed out with life demands, may not pay close attention to filling out your beautiful energy balance chart, may take shortcuts, or miss recording important information, make mistakes, or even hide the real data from you and/or themselves. Hence, you find yourself in a difficult situation. You don’t want to start down a negative path by questioning or criticizing your client’s tracking and recording skills and efforts. Yet you can’t really trust the data as a basis for your recommendations. A part of you feels frustrated and impatient because your client didn’t deliver what you hoped, and make it easy for you to provide an exercise prescription based on established evidence based practices. So how do you move this partnership forward? 1.    LET GO OF IMPATIENCE AND FRUSTRATION First get yourself into a positive, curious, and non-judgmental mindset, and set aside any frustration or impatience that will instantly impair your partnership with your client. If you show even a speck of judgment or disappointment, your client will withdraw, perhaps already feeling badly that she didn’t do a great job on her tracking homework and now you made her feel worse. 2.    GET INTO A MINDFUL,  CURIOUS,  AND  OPEN-MINDED  MINDSET Explore your client’s experience with completing the energy balance chart in order to help her gain self-awareness. View it as a starting experiment, an opportunity to figure out what the best next step would be. Was it a helpful exercise? Was it challenging? Was it boring? Did she do it immediately or wait for a few days and try to remember all the food she ate and activities she completed? Did she take her time or rush to put something, anything, in each of the boxes? What did she learn? What might work better? Who knows what your client will say and where she will land, but she will appreciate that you were totally focused and engaged, without assumptions and judgment, on her welfare, her efforts, her strengths and weaknesses, and what would work best as next steps. The outcome is a mystery until it emerges. Maybe she will realize that she forgot about recording important information such as her snacks, or miscalculated the number of calories in a food type, and decide to have another go at filling in your chart. Or maybe she’ll decide that instead she’d like to replace her junk food snacks with fruit and nuts, or eat oatmeal and a boiled egg instead of a doughnut for breakfast, as a simple starting point. One of the best things about being a coach is that it is never boring and predictable. Everyone finds his/her own path with our intent and creative input. It would be great if the research gave us the answers, such as completing energy balance charts as an essential starting point. Yet, how dull our work would be if a standard formula worked every time. Originally published in ACSM Certified News Coaching Column

Today we explore how to work with clients who have made New Year’s resolutions to lose weight and to get more physically fit. Of the 50% of people who make resolutions, fewer than 10% are successful. There is a lot of room for improvement. A resolution to lose weight and get fit emerges at least in part from an unstable and negative source of motivation. Clients often have an impatient and demanding inner critic declaring something along the lines of: “YOU SHOULD LOSE WEIGHT. It’s about time you get this done. I can’t believe you have not done this already.” The inner critic attacks one’s self-esteem and self-worth, basically inferring – you are not good enough. Its intention is to generate fear as a motivator to get you off your butt and into the gym, while eating salads and healthier food. Unfortunately, fear of failing or of being a failure, is not an optimal source of motivation. How do you help clients develop a robust start to their resolutions? Help them begin with self-compassion, which leads to a softer, kinder motivation that improves the brain’s ability to learn and change, and has been shown to improve the probability of success. Ten years ago, psychologist Kristin Neff, Ph.D., began to study self-compassion, leading to a growing body of research literature describing its benefits to mental health, management of emotional stress, and  performance. Kristin’s formula starts with mindfulness to notice and name the negative feelings that go along with being overweight and sedentary that you want to escape by losing weight. Suffer with these feelings for a few moments, instead of trying to push them away. Sadly, trying to push these emotions away is a temporary move as the brain doesn’t have the software to destroy negative emotions for good. These emotions will inevitably come back to bite you. The only way to get past negative emotions is to work through them. Then, help your clients feel a connection with humanity. “You are not alone, many others are suffering with excess weight.” Negative emotions do not want to be alone, they want company, to feel connected, and fortunately when it comes to weight loss, people are not suffering alone. Next is to help your clients be kind to their negative feelings. The biological method for soothing the scared emotions of a newborn is the ten- der soothing by its parents, releasing a neurochemical called oxytocin, the hormone of love. This same soothing phenomenon works just as well in adults, except we can soothe ourselves with big-hearted self-kindness. The last step in processing the negative emotions tied to today’s state of being overweight is to learn from them – at their best they are good teachers, they have messages to share. “The stress of being overweight is impairing my closest relationships,” for example. Or “I want to be a good role model for my kids so they don’t suffer the way I am.” A next part of the change process is to have your clients envision the future they want, a future that feels much bigger and more inspiring than a lower number on the weight scale. Harvard psychologist Shelley Carson, Ph.D., teaches us in her book, Your Creative Brain, that when we use the brain’s visual machinery to picture what we want, (i.e., hiking a mountain with our children, looking great in stylish clothes, having lots of energy to make the world a little better place every day) we increase the probability of success.1 Change the words: “I resolve” to “I dream.” The furrowed brow of “I will make myself do this” transforms into eyes filled with hope for a better future. Help clients get clear on what they really want that a lighter and stronger body will give them, something much deeper than the number on the scale. Ask questions like, “How will your life be better if you lose weight?” and “What is the ’why I want to do this with all of my heart’ that can be summoned in the many moments every day when you are tempted to eat a cookie instead of an apple, take the elevator and not the stairs, or hit the snooze button rather then getting out of bed to exercise.” The bigger the why, the easier the how. To conclude, in this column we’ve explored how to help clients develop a new approach to New Year’s resolutions, one built on mindfulness, with love and not blame, a heart’s desire not an inner critic, and a beautiful picture of what the future can bring. Next time we will explore more steps for turning resolutions into “I did it!”

A great way to begin to add coaching skills to your growing toolbox as a health professional is to reflect first on your own interest in change and growth. Have a good look at where you are noticing stress in your life, and then find an experienced coach to help you outgrow a struggle. Harvard psychologist Robert Kegan, Ph.D., describes stress as simply the signal that the demands of the moment are beyond one’s capacity. His book titled “In Over Our Heads” explains that the demands of adult life are over our heads at least some of the time, causing growing pains. Negative emotions are a force for good if you lean into them with self-compassion, and then reflect on and move toward new lessons that may emerge. You’ll find that a good coach won’t give you a prescription; instead s/he will co-create a new path forward, generating new insights and learning along the way. My “How Coaching Works” video on YouTube (more than 600,000 visits) captures the essence of coaching if you haven’t already seen it. A next good step would be to further develop your mindfulness skills, the precious ability to access the part of the brain that can stand back from the noisy voices in your brain, to watch the action in your brain as if watching a movie, rather than being embedded in the movie. Mindfulness skills allow you to be less reactive to passing emotional states, witnessing, naming, and accepting them without feeling hijacked and out of control. A mindful brain is vital to forming a warm connection with your clients and colleagues. Mindfulness training is now widely available. Check out mindfulness-based stress reduction courses and resources, developed by Jon Kabat-Zinn, Ph.D. You may want to look for books and courses on compassion, empathy, and nonviolent communication developed by Marshall Rosenberg Ph.D. In the last quarterly column we discussed the gift of self-compassion, to accept and embrace one’s negative emotions, including the frustrated inner critic that keeps telling you to raise the bar, to do better. Notice the inner critic and appreciate how it helps you; its intentions are good even if its methods are harsh. Suffer with its efforts to try too hard, instead of trying to push it away or fight back with anger, which as I explained last time is, “a temporary move as the brain doesn’t have the software to destroy negative emotions for good. They will inevitably come back to bite you. The only way to get past negative emotions is to work through them.” Then, negative emotions transform into a force for growth and learning. Many positive psychologists believe that the most powerful source of positive emotions, which optimize resilience in the face of adversity, is a sense of meaning and purpose – whether in the moment, making each moment a special contribution, or the arc of your life, what you hope will be your legacy. Read Victor Frankl’s M.D., Ph.D., book, “Man’s Search for Meaning,” the most widely read book on this topic. The importance of meaning is why coaches help clients identify and stay connected to a sense of purpose in each moment, day, and over a life stage, or a whole life. The more purposeful you are, daily if possible, the more you will inspire your clients to pause and reflect on what things mean and their intentions and purpose. The field of Motivational Interviewing has introduced excellent skills for new coaches to teach helping professionals how to “get out of sales and into fishing” to quote my motivational interviewing trainer colleague, psychologist Robert Rhode, Ph.D. Skilled use of mindful listening (not thinking about what you are going to say next or anything else for that matter), open questions that emerge from a beginner’s mind (no assumptions or expectations), and creative reflections, all deepen exploration and foster insights not possible in an expert-prescriptive communication model. Behavior change expert and psychologist John Norcross, Ph.D, ABPP, just released a new book on the Transtheoretical Model called “Changeology,” which is chock full of great tips for helping people change, matched to each stage of change, including Psych (getting ready), Prep (preparing for change), Perspire (taking action), Persevere (managing slips), and Persist (maintaining change). Coaches help clients organize their minds for change and success and if you find your mind to be disorganized you may appreciate my 12- month self-coaching course called “Organize Your Mind to Thrive” build- ing on the Harvard Health book I co-authored with Harvard psychiatrist, Paul Hammerness, M.D. – “Organize Your Mind, Organize Your Life.” While the course is intended for personal growth, the topics, webinars, and exercises are a rich source of resources for your professional life too. Last but not least, you may want to jump in with both feet and complete a reputable health and wellness coaching program offered by Wellcoaches (ACSM partner), Duke Integrative Medicine, University of Minnesota, or the Wellness Coaching Institute. Most of all, it’s fun to grow and change and coaches are privileged to facilitate the change process every day. Onward and upward, as I say. Originally published in ACSM Certified News Coaching Column

“My client is moving out of the area in two months and is afraid that she won’t be able to continue her program without me. How do I help her develop the resources to continue and to succeed?” The ideal accomplishment of a personal training relationship is that clients become self-sufficient: they learn to coach themselves to stay on track with a fit lifestyle. Of course that doesn’t mean that they won’t want to continue personal training sessions. A great relationship with one’s trainer has a special place in a client’s life. I often say that there are twin engines that need to be fueled and fired up to start and sustain changes in mindset and behaviors: self-motivation and self-confidence. A client’s relationship with a trainer can keep both engines on full throttle by revisiting the gains and benefits of a fit lifestyle, to recharge motivation, and  to co-create ways to navigate around barriers and challenges, to recharge confidence. Here’s a short list of open-ended coaching questions that could help lead a client to improve his/her motivation, confidence, and performance, in your absence. Tap into Motivation 1.    How might your move be a catalyst for you to learn and grow? Humans are meaning-makers; we are always asking ourselves – why is this happening to me? What am I supposed to learn from this experience to make the disruption worthwhile? Help your client find ways to make her move meaningful, to tap into her wisdom about new possibilities. Perhaps it’s time to build his/ her confidence in maintaining a fit lifestyle without you, or to experiment with new types of exercise. Or maybe this client will find a new trainer who brings a different and helpful perspective. 2.    If you were to imagine your vision for your lifestyle in this next phase, what would that look like? Just like an architect  draws a picture of a new house, the brain benefits from having   a vision or picture of what an ideal future looks like. Harvard psychologist Shelley Carson describes envisioning, a brain activation pattern, where brain regions related to visual processing at the back of the brain are activated, as a critical early step in the creative process. Help your client imagine a vision for his/her fitness or well-being, in writing or pictures. A good vision has magnetic force like that of deliciously warm sunshine, drawing us toward it. 3.    How does your fitness and wellness help you live a life you treasure? Humans have a strong need for autonomy2, to march to our own drummers, using our unique life forces to learn, grow, and make the world a better place. Fitness and wellness is the fuel for one’s life force; it’s vital to be fit and healthy to live the life our hearts desire. Help your client discover and explore the connection between the life he/she wants to live and the physical and mental health and energy needed to support it. Build confidence 1.    What strengths and talents do you have to help you get to your vision? Only one-third of adults can identify their strengths; most of us spend more time thinking about our weaknesses. There is often untapped potential in strengths that clients use skillfully in their professional and family lives. One assessment used by coaches, called Values in Action Character Strengths, identifies one’s top five “signature” strengths — check it out at www.viacharacter.org. Perhaps your client is good at planning and execution, or creative problem-solving, or learning. You can discuss new ways to put these strengths to good use to stay on track with a fit lifestyle. 2.    What is one major challenge and three possible ways to overcome it? It’s important to help clients discover their capacity to be curious and creative in handling small and large obstacles that emerge to sabotage their good intentions to stay healthy. A brainstorming exercise, where you and your client come up with new ideas to navigate around a challenge, can help your client access his/her creativity to deal with the ups and downs that are unavoidable in busy lives. 3.    What is your special formula for being resilient? Your client has most likely handled some setbacks while at work and home. Help him/her identify the strategies and resources he/she used that worked best to get back on track. Was it reaching out for the support and counsel of others? Or his/her ability to discover the silver lining or meaning of the setback? His/her confidence in their ability to bounce back? His/her curiosity about what the lesson to learn would be? His/her persistence to not give up?  Once he/she has more clarity about what works, he/she can tap into her resilient formula when the need arises. Now it’s time to use your creativity to come up with open questions to explore how your clients could tap into their heartfelt motivation and use that energy source to continually improve confidence to live the life they treasure. Even better, consider getting trained as a wellness coach so that you can continue your client relationship when she moves away. Originally published in ACSM Certified News Coaching Column

A few weeks ago, I was sitting on a plane ride home on a Saturday afternoon after delivering a keynote presentation at the MDVIP CONFERENCE. Ignoring my beckoning email inbox to listen to music,  I came across a Van Morrison song I hadn’t listened to in a long while, called WHENEVER GOD SHINES HIS LIGHT. I was struck by how this line in the lyrics is a metaphor for this year for me:  He lifts you up, turns your around, puts your feet back on higher ground.. Whatever one’s spiritual or religious beliefs, life’s path seems to be shaped by two strong forces: 1. Our human drive to self-actualize and assert control over our destiny to improve ourselves and to make the world a better place. 2. The forces of the universe which… Do what the Rolling Stones described as “YOU CAN’T ALWAYS GET WHAT YOU WANT… YOU GET WHAT YOU NEED” OR they lift us up, turn us around, and put our feet back on higher ground. My higher ground this year includes a surprise surgery that took me to higher ground physically, and the experience of discovering a new way to think about COACHING THE WHOLE PERSON, OR SELF-COACHING OUR WHOLE SELVES, which took me to higher ground intellectually and emotionally. Some higher scientific ground on the type of positive emotions that improve physical health inspired me this year: Nature and Scientific American just published an article titled: HOW HAPPINESS BOOSTS THE IMMUNE SYSTEM. It describes the work of Barbara Fredrickson and Steve Cole and their July 2013 paper which proposes that having a purpose beyond oneself is related to improved gene expression of the immune system. Living for a higher purpose makes us physically healthier and more resilient – mentally and physically. To encourage your reflection on your life’s path – the intersection of your drive to self-actualize, your higher purpose, and this year’s forces of the universe, I want to share a webinar on Meaning-Making from my Organize Your Mind® series as a holiday gift:  WEBINAR ON MEANING MAKING. Coach Meg

CHS Health Services: Putting Wellness Coaches to Work by Debra Reid, Certified Wellcoach Who We Are: CHS Health Services, Inc. (CHS) is a health and wellness organization with employer-dedicated onsite health centers designed to provide meaningful, effective, and higher quality health care to employees and their dependents across the country. We build and staff health clinics on large company cam- puses based on the staffing model the client desires. We might place nurse practitioners, registered nurses, registered dietitians, physician assistants, physicians, and health coaches at their site. Our health coaches are any one of these experts and can also be fitness specialists. For  the last five years, we have worked with   a partner to provide health and wellness coach training for our coaching staff. When we hire new coaches, we let them know that they will be required to go through our preferred training and certification program in order to maintain their employment with us. We use the organization’s model as the foundation for training and blend that together with our CHS Health Services, Inc. methodology, protocol, and philosophy to provide the most comprehensive training program possible. Clients Response to Health Coaching: Health coaching has received high marks from our clients in engaging employees and improving health outcomes. These ingredients make for success within CHS. We have placed health coaches at various clinics and are showing positive return on investment for clients offering health coaching services. Coaching is Catching Other Clinicians’ Interest: Our clinic staffs have noticed the benefits of adding health coaching to the mix of services provided by our onsite clinics. One PA in particular mentioned that health coaching changes the atmosphere of the clinics to the point that she wondered why she wasn’t taught coaching as a part of her curriculum at medical school. She is now talking to her physician about it because she sees daily how coaching engages both patients and clinicians alike. Utilizing  Coaching  to  Reach  Beyond   the   Episodic   Visit: Through our health management and wellness coaching programs, we provide health management education, personalized health coaching, and coordinate patients’ medical care and referrals, all from one location. Even if someone comes into our clinic for an episodic visit, we provide coaching and information to ensure he or she gets the best possible care, and we address any other health concerns he or she has. Improving a patient’s health means changing behavior, and we know that health coaching is the catalyst to that change.

by Jeffrey Ford Who We Are: Hilton Head Health was founded in 1976 as a 4-week weight-loss spa retreat center. Over the past 30 years, the center has evolved so guests are able to stay and participate in our Healthy Lifestyle™ program for up to 3 months. They can be submerged in the triad of health — fitness, nutrition, and SELF (Stress management, Empowerment, Longevity, Fulfillment). We offer a 1,200 to 1,500 calorie per day meal plan in which guests eat six meals throughout the day. We provide daily educational lectures on fitness, nutrition, emotional eating, and personal responsibility. Throughout the day we offer a variety   of fitness classes; we offer six to seven chances to participate in flexibility, strength training, and cardio classes. We also offer a variety of recreational activities, such as kayaking, biking, paddle boarding, and more. Finally, cooking demonstrations and hands- on classes teach our guests how to cook quick, healthy meals to prepare them for their return home. Our schedule is designed for guests to experience an entire week engulfed in making balanced, healthy changes in their lives, while still having a good time. What Was Missing From Our Program: I have been with Hilton Head Health for just over two years and was hired to create a continued support program for our guests. H3@Home Wellness coaching offers a component that was missing from our program before. Upon returning home, guests now have the option for continued, structured support from one of our trained wellness coaches to ensure the tools and knowledge gained during their stay are not just being put into practice, but are actually sticking. We were all very excited when H3 fitness director Adam Martin started throwing around the idea of at-home coaching and came across the highly recommended and leading-edge coach training program. Adam and I shared the same vision for our guests, and he trusted me to bring that vision to life. We are so excited that we are sitting here today with the program successfully put into action. How We Began: We made the decision that we were not going to start a coaching program at Hilton Head Health until we had a viable certification. We found that the coach training program we selected was a perfect fit and the focus went hand-in-hand with what we wanted to do here. We began the training with our entire program staff in June 2011 and we went through the training classes together and studied together. Learning about motivational interviewing and non-violent communication were particularly impactful to me. The format for structuring the coaching calls that the program uses has been huge for getting our program off the ground. I was the first coach to become certified, and right away we launched our H3@Home Wellness Coaching program. Implementing Coaching: We now offer a few different types  of coaching programs, all of which are based on what we learned in coach training. These are follow-up programs, and our goal  is for our guests to sustain success in living the healthy habits they learned here. All of our programs offer an initial    90-minute coaching session to get started. Then to create a group feel, we send weekly group e-mail messages, weekly text messages, and challenges that we give our guests at home. Guests have  30-minute calls with their coach once a week for 3 months. At the end of the 3 months, they either continue with the coaching or feel ready to move on. Coaching’s Impact: The biggest impact of coaching for our  guests has been accountability! We  felt the need to implement   a coaching program to become certified because although many of our guests are successful at home, we find several guests come back to our facility and need continued education and assistance. The difference today with the implementation of coaching is that these guests are coming back 50 to 60 lbs. lighter, with new sustainable habits, such as reducing work hours, exercising regularly, improved nutrition, planning, and journaling. Coaching has been a great way for guests to use the motivation that they get from staying a week with us and really focus on those habits as they go home. We have definitely seen more successful outcomes with our guests because of coaching. A little bit of accountability goes a long way!

Most of my clients have been in their 20s-30s. Working with clients who are post-retirement age is new for me. What tips do you have for working with this population?” In a fast-paced culture that places a high value on youthfulness, technology, and peak performance, the interests, needs, and perspectives of senior clients are easy to misjudge or overlook. Listen and learn. What everyone needs, no matter what our age, is to be respected, appreciated, and heard. Social connections are vital to keeping us going with a health-giving lifestyle. And, opportunities to connect and engage with people and the world often decrease as we age. Your client’s time with you may become a precious opportunity for social connection in his/her life today. Slow down, be present, listen, and be genuinely respectful and compassionate. It’s hard to imagine being old when we are young, but do your best because it’s only a matter of time before you will be old too. Each person brings a unique history, stories, wisdom, and knowledge. Honor his/her history, stories, and wisdom, even if they have nothing directly to do with exercise. We all learn important life lessons from spending quality time with our elders. It is too easy to make assumptions about senior clients: what they can and can’t do, their goals and motivation. Listen first. Keep an open and curious beginner’s mind at all times. Value and appreciate what they know. Clients who have experienced decades of life have earned decades of life experience, which demands a whole lot of appreciation and respect from younger professionals. A coach’s starting point is to explore, appreciate, and value existing knowledge, skills, and experience well before collaborating on what new knowledge and skills are called for now. Older clients may have experimented with many diet and exercise fads or programs. They have hard-earned insights on what worked and what didn’t. Explore their memories of physical activities, even ones from decades ago. “What kinds of physical activities have you enjoyed, or worked best for you, even a long while ago?” and “What healthy habits worked for you the most in the past?” Or “what accomplishments have you made in work and life that showcased strengths that you bring to this new adventure?” Having clients recall past successes invigorates their confidence for new opportunities ahead. When you start by calling out and valuing a lifetime of learning, you show you value their wisdom. Be deeply present, genuine and sincere in your respect. Then your relationship is positioned to help a senior client lead his/her own journey of getting and staying fit, fostering much-desired autonomy in senior years. Explore meaning and purpose for being fit. One’s deeper, heartfelt purpose for being fit and strong is the most powerful kind of motivation, and particularly relevant to fitness goals for seniors. At this life stage adding life to years, not just years to life, becomes more important. Morbidity and mortality feel real, and who knows, could be just around the corner. Seniors are not looking forward to the inevitable life step-downs to the end, losing independence and freedom at every step. Spend quality time exploring why getting fit is important now. Get out of sales in and into fishing, as motivational interviewing trainer Robert Rhode advises. How would more strength, flexibility, balance, and vigor allow them to live life as fully as possible – continue driving, living in their own homes, taking care of themselves, walking without aid, and maybe even avoiding or delaying a debilitating event like a heart attack or stroke. Help them connect a higher fitness level to things they now value most. Look for role models – they are likely not yours. Often posters of fit 20-40 year olds in skimpy exercise clothes are posted throughout the gym to inspire clients to work harder. These images aren’t likely to interest or energize senior clients as role models. One of the proven strategies for igniting confidence is to identify role models who you can really relate to. People in their 60s, 70s, 80s, and 90s who are healthy, fit and fully alive. A good role model helps clients be more confident in several ways: clarify the new health and fitness habits they want to create, improve the effort they will invest, and extend the time they will keep at it in the face of inevitable challenges. Share the main findings of neuroscientists on taking good care of an aging brain. Neuroscientists are teaching us about the many activities that help the brain age well, not prematurely. Our biggest fear as we age is that we will lose our minds. This is where you can use your expert hat, exploring what senior clients know and don’t know about keeping their brains working well. Exercise is now the most-respected activity to delay terrible brain diseases like dementia and Alzheimer’s. A decline in curiosity is one of the early signs of Alzheimer’s disease. Encourage senior clients to try new activities and adventures. Learning new skills, like a new exercise class or routine, is a great way to invigorate the brain’s plasticity, improved further by the opportunity for fun social connections. Finding exercise buddies to cheer each other on, can make a big difference in well-being. Eating a diet full of healthy fats, antioxidants, and lean proteins provide good brain fuel. And last for today, having a reason to live, a purpose, something that is meaningful, where we contribute in some special way, keeps seniors going even as their brains and bodies decline.

[Editor’s Note: The following Expert Panel discussion was recorded on October 19, 2014 as the opening session for the Annual Meeting of the American College of Lifestyle Medicine. The following individuals participated: James M. Rippe, MD is Founder and Director, Rippe Lifestyle Institute and Professor of Biomedical Sciences at the University of Central Florida. He serves as Editor in Chief, American Journal of Lifestyle Medicine David L. Katz, MD, MPH is a well-known commentator on nutrition, weight management, and chronic disease prevention and is the current President of the American College of Lifestyle Medicine. Michael Greger, M.D., is a physician, author, and internationally known professional speaker and the Director of Public Health Director of Public Health and Animal Agriculture at the Humane Society of the United States. John H Kelly, Jr., MD was a founder of the American College of Lifestyle Medicine and served as its founding President. Margaret Moore, MBA is founder/CEO of Wellcoaches School of Coaching for health professionals which has trained more than 8,000 health and wellness coaches in 45 countries, and is co-founder and co-director of the Institute of Coaching at McLean Hospital. Following are excerpts from the conversation, featuring Margaret Moore’s comments: Ms. Moore:  Developing the evidence base for lifestyle medicine that would support broad-based reimbursement is a huge challenge. My perspective is informed by what it takes to develop and launch new medicines. I grew up in the biotechnology industry, over 17 years in four countries, and led multiple R&D teams. I was focused on developing evidence for new medicines and vaccines. Bringing a new medicine to the market is a simpler undertaking than implementing lifestyle medicine. When testing the biological effects of a new medicine in humans, researchers focus on one bio/chemical compound used in narrowly defined populations with narrow inclusion/exclusion criteria, thus aiming to show the benefit of a single medicine at one dose in one homogeneous population. Clinical development through Phase 3 studies to market launch and reimbursement proceeds on this narrow basis. Only after a decade or more does a medicine get tested more widely. Lifestyle medicine on the other hand is in fact many diverse medicines mixed together in a variety of ways with broad application across all demographics and health situations. The evidence needed to support financial reimbursement for a complex mix of lifestyle medicines on a broad basis is a heroic, long-lasting undertaking. We face another challenge, which is to enable people to use these medicines day in day out, in sustainable ways. I left the biotech industry 15 years ago, because I saw that people weren’t taking good care of their health by engaging in healthy lifestyles. This gap seemed critical to the health of all. I thought that if we could help people take good care of their health and improve their behaviors for good we could make much more impact than many of the biotech medicines that I might help develop. So I asked “what can I do to support engagement in healthy lifestyles?” My first step was to identify coaching skills and develop coaching protocols that could help people change their lifestyles, particularly when change is hard. Evidence was emerging on the aspects of human nature that are vital to the change process, that coaching could address. The scientific foundation of health and wellness coaching competencies and tools has strengthened considerably in recent years as evidence for the value of particular aspects of human nature has mounted. For example, empathy and self-compassion for negative emotions, and harvesting and amplifying of positive emotions, have gained recognition as interventions that improve health and support learning and positive change. But like lifestyle medicine, coaches integrate numerous small interventions into a whole, with a wide range of skill mastery, which makes for a complex mix to implement and study. We then find ourselves with multi-faceted coaching interventions of widely varying quality that deliver multi-faceted lifestyle medicines to people who live diverse and multi-faceted lifestyles. The path to widely applicable evidence becomes even more challenging. The way the biotech industry looks at medical research is to focus first on the most advanced and difficult cases. For example, researchers start with Stage IV cancer, not Stage I and certainly not cancer prevention. That strategy makes for a long, long road to wide dissemination across many lifestyle-related diseases where early intervention is ideal. Following this strategy, I am fostering clinical evaluation of coaching for fibromyalgia, for which there is no good treatment other than exercise. However, it has taken 10 years to get to the place where we have enough coaches who are skilled enough to handle well the challenges of fibromyalgia on a large scale. So a focus on the toughest health challenges has not exactly offered low-hanging fruit from the perspective of evidence and reimbursement. Thankfully developing an evidence basis for coaching and lifestyle medicine is not hopeless! I was inspired recently by Jeff Dusek who is an integrative medicine researcher at Allina, a hospital system in Minneapolis. He recommended that the health and wellness coaching field look to “practice effectiveness” studies, now more respected by the NIH, as a better way forward than the pursuit of many randomized controlled studies in many clinical populations. Rather than conducting lots of narrow, randomized studies on narrow homogenous populations, data is gathered and analyzed on tens of thousands of patients that all together create a picture of real world application and improved outcomes. This may be a better way to build an evidence base than pursuing a large number of narrow, randomized studies that could take decades to accumulate. The health and wellness coaching field is serving tens of thousands of coaching clients now. Even if there is too much diversity today to develop a strong case for evidence and wide reimbursement now, there is an opportunity to orient many groups using similar coaching protocols to measure and collect similar data, so we can generate outcomes data on a large scale going forward.  If we started today, a few years from now we could have a compelling evidence base. My last point is on the state of evidence-based medicine today. Dan Friedland, a physician in San Diego, teaches physicians, medical schools, and other organizations, how to practice evidence-based medicine.  He has developed a practical protocol starting with an online medical textbook and then drills down to find the randomized studies relevant to one’s circumstances. It turns out frequently that if you look for the evidence specific to your profile, you will drill down to find only one relevant study.  One randomized study with maybe 150 people. That was a real eye opener for me. In summary, given the challenges we face in developing an evidence-base for lifestyle medicine, I agree with Dr. Kelly. We must lead and get out in front, by defining and declaring sensible principles for evidence based lifestyle medicine that enable early and wide dissemination. The world is waiting. Many people are suffering. Dr. Rippe:  Here is the second question for all of the panelists.  “How can lifestyle medicine specialists be best utilized in treating lifestyle disease?” Ms. Moore:  I agree that the most skilled people in any helping profession will deliver the best results.  That is a great starting point. Here’s another angle to consider. If you think about the fundamental principles of motivational interviewing, the two questions to ask are “how do we build confidence in the delivery of lifestyle medicine?” and “how do we build desire and motivation for improved health and well-being via lifestyle medicine?” On the first question,  I think the world is now at a rock-bottom level of confidence about our collective ability to help people adopt healthy lifestyles. Motivation goes to sleep when confidence is low, so if we don’t build confidence levels, motivation will also not come alive. Often I have conversations with physicians who say “I don’t see a lot of hope.”  Even if we had a larger evidence base, we might still face the viewpoint that large scale change is difficult if not hopeless.  So the question really becomes “how do we build collective confidence in the delivery of lifestyle medicine?” Perhaps we need more storytelling, not just evidence.  I think we need to find ways to tell the many, many good stories that already exist to help build hope.  For example, what Kaiser Permanente has done to move the needle for healthy lifestyles and health improvements. In my experience having talked about wellness over many years, I have found that people are not jumping out of bed in the morning to engage in personal wellness. I understand Medicare’s reimbursement for wellness visits hasn’t taken off like a rocket.  So then we must ask “are we giving people what they really want?  Is there a different way to present this opportunity?” The lack of urgent interest in wellness has led me to think about two different directions.  One relates to our country’s competitive advantage and economic potential.  We are leaving a billions of dollars on the table because people don’t have the physical and mental energy to work hard and innovate. It would boost the economy significantly if everybody was really well and really healthy. The second thing, relates to brain function.  I find that people are significantly more interested and worried about their brain function than they are about their heart and lungs and limbs. I wonder, if we added to our agenda the concept of brain health and brain performance, whether people would come running to the offices of  lifestyle medicine practitioners who could potentially offer an approach to reduce dementia risk.  This is something all of us—especially the baby boomers–are really frightened about. To summarize, let’s think about how to build confidence in the delivery of lifestyle medicine, and what would bring patients to lifestyle medicine practitioners because they want what we have. Dr. Rippe: I have one final question that I would like to ask all of the panelists to briefly respond to:  Given the preponderance of unhealthy food options, strong advertising and sales tactics by the food industry, the pharma-healthcare industrial complex, lack of health literacy, a broken healthcare system and more, how long do you think it will take for us as a nation to change our ways and make real strides in lifestyle medicine? Ms. Moore:  One of the benefits of all that we went through last year with the launch of the Affordable Care Act is that people got a wake-up call and started thinking more about their health. I agree with Dr. Katz, we have to make this cool. Just like it is not cool to smoke, whereas, 40 years ago it was. When I started my career 30 years ago it wasn’t all that cool to exercise.  I worked with a lot of MDs and PhDs who thought “My brain works so well I don’t need to exercise.” Let’s think about specific ways to make positive lifestyle decisions cool.  How do we get celebrities on board?  I think you’re starting to see that. Hip hop videos, etc. That’s the future. It is about selling and marketing and emphasizing the fun about making positive lifestyle decisions. Dr. Rippe:  Nobody likes being sick but survey after survey have shown that people don’t know they are sick because they associate health with the absence of disease rather than a platform for being happier and having a fuller life. In short, a platform for better performance in life and more enjoyment. Dr. Rippe:  I would like to thank the panelists for their thought-provoking comments. I would also like to thank this large audience for your passion and commitment to lifestyle medicine.  It was Margaret Meade, the famous sociologist who said, “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”  The people in this audience are the change agents. It is clear from what the panelists have articulated that the core concept of lifestyle medicine, that daily habits and actions profoundly impact on both short and long-term health and quality of life, must be placed front and center in our healthcare agenda. I would like to say one further thing.  My wife and I put a quote on t-shirts for our children because we thought it was so impactful. The quote was “Without a dream there is no reason to work. Without work, there is no reason to dream.” So I challenge members of the lifestyle medicine movement that to make this happen, we already have the dream but now we are going to have to work harder than we ever have worked before to make it happen.  The world is waiting for our message.  Are we ready to answer the call?

A client recently described the challenges in moving a project forward because many stakeholders were concerned the objective would not be met by their stated deadline in the future. Understandable, since they are working on a statewide initiative that must meet nationally regulated standards—a huge, months-long project. It wasn’t the difficulty of the tasks or countless regulations that stalled progress, however; it was the discussion about possibly not meeting future deadlines—despite the progress toward meeting them. With spring quickly approaching, I offered a suitable analogy to help think through the issue. The problem seemed to be that the stakeholders were focusing on the harvest before the soil had been prepared and the seeds planted. Keeping the harvest in mind, the most important steps now are to cultivate the soil and plant the correct seeds. Then the team can water, weed, monitor, fertilize and adjust as needed in continued preparation for the harvest. Worrying about the “what ifs” and possible missed objectives, still months away, seems to be wasted time and energy. Much to my delight, the gardening analogy provided a way for my client to clearly communicate to the stakeholders that they needed to focus on first things first: prepare now, harvest later. The project moved forward. What projects are overwhelming you? While it’s important to have the end goal in mind, success happens when we take one step at a time forward. Break the objectives into chunks. That may sound overly simplistic; however, simplicity works well in a fast-paced environment to minimize “what if” distractions. How’s this for simple? Start at the beginning. Pause. Individually or in a group, picture the harvest. Become clear on the desired outcome. With that vision in mind, describe what needs to be done when and who can best accomplish these steps. If you or others start leaping into the future, stop the conversation. Come back to right now. What can be done right now? This week? This month? If the “what if” worries about the harvest persist, even after bringing the discussion back to the current need to plant seeds, there’s a skill that can help reduce the tension and anxiety – a skill that can help adjust those feelings, simply by influencing your thinking. It’s the cognitive skill of REAPPRAISAL, basically paying attention to your thinking – all that chatter in your head, the stories you tell yourself – and asking critical questions. “What’s the reality or truth here?” “Is this as catastrophic as I’m imagining? “What can I influence and what can’t I?” Really listen to the stories you’re crafting in your head. You’re the author! Choose to write a different story to keep moving forward without stress and anxiety about next steps. You may need to help your team members with this skill, using the same type of questions. As you reappraise the situation this way, you change your thinking, your feelings, and ultimately your behavior. You will be surprised at how far you will go, and how fast, when you focus on planting the seeds rather than worrying about the harvest. Reminds me of one of my favorite quotes by Robert Lewis Stevenson, “Don’t judge each day by the harvest you reap but by the seeds you plant.” Originally published at KATELARSEN.COM/THE-MOST-IMPORTANT-STEP-TO-COMPLETE-HUGE-PROJECTS/

I have written before about the practice of journaling as a chronicle of growth, a canvas for problem solving, and an entry point into the subconscious. One creative approach, called “Stepping Stones,” was developed by Dr. Ira Progoff in his Intensive Journal workshop. “Stepping Stones,” writes Dr. Progoff, are “indicators that enable a person to recognize the deeper-than-conscious goals toward which the movement of his life is trying to take him.” They are the significant points of movement along the road of our lives, how we got from there to here, and what steps we selected along our path. Here are some examples of Stepping Stones: I was born. My sister was born. My father left. I got married. I began a career. I was unable to have children. I followed my heart. I remarried. I lost my job. I am being reborn. OR Innocence. Divorce. Coming Home. Patterns and Cycles. Falling in Love Motherhood. Creativity Contained in each Stepping Stone is an entire phase of one’s life, with memories and stories of years. Each phase may represent a varying amount of time • perhaps only a few months and perhaps many years. When creating a list of Stepping Stones, select those periods that seem to have had significance on how we are living our life today, letting no more than a dozen or so come into the foreground. Writing about a Stepping Stone allows us to find lessons that were incomplete or heal wounds that weren’t fully nursed. Note that Stepping Stones are neutral in that they do not designate failure or success; they simply symbolize the movement of our lives. Coaching Challenge: Use your heart to choose a Stepping Stone to contemplate. Then, begin your writing with this Springboard phrase, “It was a time when•” Allow yourself to fully experience the story through your writing and write until you are finished.