In May 2018, I graduated with my master’s in public health from UNC Greensboro. This time in my life was exciting, but also horribly stressful. Finding a job was a daunting task. I applied to several positions, went on numerous interviews, and even took a job with a temp agency for a while. I was working outside of my field of study, and although I was happy to have a job, I was certainly not happy with how things were going. Luckily, throughout my time as an MPH student, I had built a personal relationship with UNCG Health Coaching. As a graduate assistant with HealthyUNCG, we had worked closely with the health coaching program and their co-directors, Regina and Dan.

I reached out to Regina who gave me a couple of amazing opportunities. Because I was certified through UNCG Health Coaching, she took a chance on me and gave me a part-time position as their program manager. She also introduced me to the Office of Wellbeing at Wake Forest University where I was hired as a part-time health coach. Within a matter of weeks, I went from a desk job at a temp agency to taking on over 20 health coaching clients and creating a new health coaching services program for UNCG employees. I was suddenly overwhelmingly thankful for those three long days of training back in December of 2016.

Over this past year, I have gained valuable experience managing graduate assistants and volunteer coaches as well as being given the opportunity to practice and fine tune my skills as a health coach. I have now worked with over thirty clients, and I think my biggest takeaway is that there will always be areas of improvement. I still have to check my “righting reflex,” and sometimes I find it difficult to step back and allow the client to be the expert on themselves. I have also found that every client is extremely different and sometimes you have to adjust your coaching style accordingly. I have also had to learn that not all of my clients will walk away from coaching feeling like their lives have changed forever. Additionally, when a client does experience great success and they attribute it to me, I have to step back and help them recognize that their success was not my doing.

This past year has taught me a lot about myself. I’ve developed a coaching style and management style. I’ve realized that I am more capable than I ever thought I could be. I have very much enjoyed my time here with UNCG Health Coaching. However, it is time for new adventures! Back in February of 2019, I was offered a position with Oklahoma State University to be their employee wellness coordinator. I attribute much of this new opportunity to the experience I gained through my graduate assistantship with HealthyUNCG. However, I believe my health coaching certification and the experience I was given in starting a health coaching services program at UNCG, put me over the edge. Soon after I accepted the position, they told me that they wanted to start a health coaching program at OSU and they hoped I would bring it to their campus. Who knew that the three-day health coaching training I took in December of 2016 would lead to my first full-time position in employee wellness?  I know I certainly didn’t. If this experience has taught me anything, it would be that I should never pass up on an opportunity. Who knows where it could lead?

Nicole Puccinelli-Ortega currently works as a Qualitative Research Associate at Wake Forest Baptist Health. After attending our June 2018 training, she now incorporates health coaching into her role as an interventionist on a study with individuals who have survived cancer. She uses motivational interviewing techniques to support them in making healthy choices while also promoting dynamic thinking.

Nicole saw health coaching as a way to enhance her existing skill set. More specifically, she is most excited for the opportunity to further develop her skills in reflective listening. She says that as much as she would like to make suggestions to her clients, they always seem to find their own way, which makes the whole experience worthwhile. Nicole knows that allowing the client to lead is important and that professionals in all areas of the healthcare field could benefit from the principles of the mindset shift. She also recognizes that all industries would benefit from this skillset.

When asked to give advice to any future coaches, Nicole states that you should trust what you learned during training. To remember that the ultimate goals are made for your client, not the coach. And to put the client in the driver’s seat and let them lead. When Nicole isn’t working, she loves traveling and meeting people from all over the world, taking care of her horse, Tucker, and donkey, Molly, and spending time with her husband and two boys.  

Jenita Lyons – “When you consider all of those barriers, health coaching sounds great but it’s not at the top of their list.”

From her experience previously working as a full-time health coach, Jenita knew that adding health coaching to the menu of services offered by Norton Children’s Hospital could be beneficial for their patient population. As the Health and Wellness Manager, Jenita conducts consultations with providers at several pediatric offices to provide patient services that address topics like injury prevention, health education, and nutrition. In her position, Jenita saw the possibilities health coaching could provide to supplement observed needs. Although she is still fine-tuning health coaching into Norton Children’s services, Jenita has already noticed how difficult it can be to reach the families who could benefit the most from coaching. Jenita recognizes and appreciates the advantages of health coaching. She has even integrated her skills as a coach into her parenting style, allowing her young children to problem solve and devise solutions on their own. However, in the case of her patient population, families are often facing barriers that overshadow the possibility of coaching.

Many of Norton Children’s clinics are strategically placed in high need areas so that they are more accessible to their patients. They’ve even expanded their hours to be more accommodating to patients who may not be able to schedule appointments during normal business hours. Despite these efforts, the patients Jenita wants to connect with the most are facing barriers that are prevalent throughout many healthcare systems. Lack of transportation, limited time due to working multiple jobs, balancing school-work schedules, food insecurity, and high poverty rates are major barriers to care. Jenita notes: “ When you consider all of those barriers, health coaching sounds great but it’s not at the top of their list.” Despite the challenges of integrating coaching into Norton Children’s Health and Wellness services, Jenita is devising innovative ways to incentivize parents to engage their children in coaching sessions. On the radar for next year are you-tube videos of cooking classes integrating many health coaching strategies like meeting families where they are, using affirmations, reflections, setting SMART goals, etc.

People who meet Brett Bowers and hear him speak about his work as a health coach often respond with furrowed brows and tilted heads. The confusion that surfaces when many people hear the term “health coach” is all too common. Many are unsure about why he chooses to identify himself as a coach when he is licensed as a Professional Counselor Supervisor and Clinical Addictions Specialist. The uncertainty of the legitimacy of Health Coaching as a field is not an uncommon notion. However, Brett uses these moments as opportunities for teaching and education. Becoming a Certified Health Coach has assisted Brett in the counseling services he provides to the students at NC Central University’s School of Law. Utilizing the skills and strategies he gained through the certification process has allowed Brett to better navigate his role as a counselor, especially when his clients want to work on issues that are technically out of his wheelhouse. When a student comes in and wants to address topics like physical activity or nutrition, Brett is able to coach his clients through these topics without overstepping the boundaries of his professional expertise.

For Brett, Health Coaching pairs well with his theoretical stance and orientation on therapy. Operating from a more humanistic standpoint, Brett finds comfort in the opportunity health coaching presents to take a step back from his role as the expert and intentionally focus on staying curious, accessing content, reflecting, and listening at a deep level. Brett has found flexibility and creativity in what is often conventionally perceived to be a rigid therapeutic framework.

As a strong proponent of the state of North Carolina’s university systems, Brett is proud to have found the opportunity to apply his passions in a setting that he loves. Born and raised in the Triad, Brett is proud a proud North Carolinian. He has been affiliated with 6 different universities and lived in 8 different towns. He is experienced in 5 National Parks and several different river basins. Brett loves North Carolina, so much so that he says he’d “probably turn into a pumpkin” if he crossed state lines.

This is the second part of a two post series by one of our certified health coaches, Emily Burrows. Please look at the first part here: What if Weight Loss Doesn’t Make our Clients Healthier? UNCG Health Coaching recognizes that there are a diversity of opinions about this issue, and encourages thoughtful discussion that helps us learn to be better coaches. 

Coaching Beyond the Scale

So, you’ve come to the conclusion that intentional weight loss isn’t an effective or sustainable path to health. What now? How do you start to incorporate your new knowledge and interest in weight-neutral health promotion into your coaching work?

Here are some next steps to help you challenge your own weight bias and support your clients (and maybe yourself, too) in finding more peace with their bodies.

Question your language.

Words matter, and many commonly accepted body descriptors cause real harm. Terms like “overweight,” “obese,” “morbidly obese,” and even “normal weight” medically classify and pathologize body size based on BMI. Not only is BMI a terrible indicator of health, those words can unintentionally communicate to our clients that we believe their weight is abnormal and unhealthy, instead of affirming that bodies naturally come in diverse sizes and shapes.

Keep in mind that different individuals prefer different terms to describe their bodies, and while some words, fat, for example, may feel derogatory to some, others have embraced it or feel neutral about it. Respectfully follow your client’s lead, with the knowledge that you probably don’t need to use any descriptors for their body.

Explore what your clients are really saying when they use wellness words.

It helps to use the same language as our clients, or at least understand each other. That’s hard when health-related words can have multiple meanings and many of them are sub/consciously weight-centered. Explore these words with your clients and on your own, too. What do they (and you) mean when they say:

• Health: When you think of “health,” does your mind subconsciously translate the word to “weight?”

• Fitness: Do “fitness,” “exercise,” and many aspects of movement, from strength to cardiovascular endurance, mean burning calories or changing your pants size? Is “fit” used as a synonym for “thin?”

• Nutrition: Do “nutritious” and even “nourishing” primarily describe low calorie/keto/high protein/low sugar/”clean”/Whole 30/fill-in-the-blank-as-long-as-it-might-make-you-skinny food?

• Lifestyle change: When you hear “lifestyle change,” do you really hear “diet?”

• Self care: Do most “self care” behaviors point toward controlling your weight?

Broaden your referral community.

Restrictive and obsessive behaviors that would be diagnosed as an eating disorder in a thin person are often considered healthy and virtuous in someone in a larger body. Familiarize yourself with symptoms of eating disorders and get to know local fat-friendly therapists, doctors, and nutritionists so that you can refer your client toward deeper support if they need it.

Strategize about changing our culture’s fatphobia, not your client’s weight.

The benefits to being thin are very real. When you’re thin, attractive and affordable clothing in your size is consistently available. You’re less likely to be bullied or threatened on the street, online, or on a plane, because of your size. If you’re thin, you’re less likely to experience discrimination in the workplace for your appearance or be turned down for a job compared to people in larger bodies. When you go to the doctor, you are more likely to leave with a diagnosis and treatment rather than the overarching prescription to not come back until you lose weight.

For those who experience many of these challenges based on their race, religion, disability, gender identity, and sexual orientation, fatphobia can lead to additional daily stress, discrimination, and threat to their health. (Remember that oppression and other social determinants have a bigger impact on health than our individual behaviors.)

Our clients are being harmed by our culture and then blamed for being mistreated and disrespected. If we want to help our clients, we need to also take action against their oppression. If you’re in a thin body, Melissa Fabello and Melissa Toler have great advice on how to use thin privilege to fight weight discrimination and become a better ally.

As fat activist and author Virgie Tovar puts it, “Fatphobia is a form of bigotry and cultural abuse. Fatphobia is never a fat person’s fault. Fatphobia is always the abuser’s fault.”

Explore the research and ethics of dieting, fat stigma, and weight bias, and critically evaluate your role.

Even with our best intentions, the vast majority of us in the health field have participated in perpetuating diet culture. As you continue to educate yourself and hold yourself accountable, resist getting stuck in a shame spiral or getting defensive about your mistakes. You’ve been harmed by fatphobia, too. When you know better you can do better.

Support your clients in setting weight-neutral goals.

If a prospective client isn’t interested in weight-neutral goals and helping them lose weight feels unethical to you, give them space to find a different health coach (before money changes hands). Wanting to change your body is a rational response to irrational cultural expectations and it’s important to respect everyone’s body autonomy.

If, however, they are open to deeper exploration, it’s possible to validate your clients’ frustration with the present and their hopes for the future without reinforcing their desire for weight loss. Help them assess their readiness for weight-neutral, shame-free goals that get them closer to the healthier, happier future they’re envisioning for themselves.   

Finally, change can be challenging. If you’ve been coaching under a weight loss paradigm for years, you might make some mistakes. That’s ok. Lean into the body acceptance world with an open heart and open mind, and keep learning.

If you’d like to continue exploring weight-inclusivity, Health at Every Size, and body acceptance, here are some leaders to follow:

Body Respect by Linda Bacon and Lucy Aphramor
Food Psych podcast with Christy Harrison
Ragen Chastain
Ijeoma Olua
Lindy West
Hilary Kinavey and Dana Sturtevant
Ilya Parker
Your Fat Friend
Sonya Renee Taylor
Virgie Tovar
Association for Size Diversity and Health
Fattitude   

Bio

Emily Burrows is a self-care coach and yoga teacher in Chapel Hill. She has her MPH from UNC-Chapel Hill but stays forever loyal to UNCG, where she completed her health coaching certificate and bachelor’s degree.

www.emilyburrows.com

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This is a guest post by one of our certified health coaches, Emily Burrows. UNCG Health Coaching recognizes that there are a diversity of opinions about this issue, and encourages thoughtful discussion that helps us learn to be better coaches.  The second part in this two-part series is now online: Coaching Beyond the Scale.

What if Weight Loss Doesn’t Make our Clients Healthier?

“I know if I just lose weight, everything will be better. My energy, blood pressure, fitness, confidence, relationships, family life, all of it. Every time I’ve lost weight I’ve felt better. I’m just too lazy to keep it off!”

Have you heard some version of this from a coaching client, friend, or even said it yourself? A lot of Americans, including our clients, see their weight as a major roadblock to health and wellbeing.

By the time they come to us, many of our clients are pretty experienced at losing weight. Many of them have been dieting on and off for years, decades, or even as far back as adolescence.

Yet, despite best intentions and a lot of hard work, they may have lost the same 10 pounds over and over again, sometimes regaining more weight than they lost on their diet.

Often, on the other side of each “weight loss journey” and weight regain are feelings of failure and shame. They’ve sunk time and effort and money into meal planning, carb counting, food diaries, gym memberships, weight loss programs, trainers, nutritionists, and lifestyle overhauls, and feel there’s very little to show for it.

Even though this cycle of weight loss, weight gain, and shame happens to the majority of folks who intentionally lose weight, instead of blaming the diet, they blame themselves.

Naturally it feels like helping our coaching clients get better at losing weight would be a good thing. After all, with weight loss we anticipate more respect, safety, economic security, social capital, and ultimately, health.

The medical and public health community, the $66+ billion weight loss industry, the media, and nearly every other corner of our culture have promised that sustaining intentional weight loss is doable and leads to improved health. However, what if these promises aren’t backed by research?

It’s possible that you’re saying to yourself, “That might be true, but my client still needs to lose weight for their health. I know I can help them!”

Before you jump into helping your client craft another weight loss goal, take a moment to consider the following:

Out of all people who intentionally lose weight, 95-98% regain it within 5 years.

The probability of sustained weight loss doesn’t increase based on their reason for dieting, even if the reason is a health problem. Yikes. Plus, up to 2/3 of those who regain the weight, gain more than they lost. Which is no wonder when you consider that body shame, a typical part of the dieting cycle, can cause weight gain (and worse health)!

It might still be tempting to try to be one of the rare 2-5% who keep the weight off long-term, except that:

Intentional weight loss doesn’t necessarily lead to better health.

It’s no secret that dieting can be a drag. To add insult to injury, weight loss doesn’t necessarily make you healthier. When people in larger bodies lose weight, they don’t acquire the same health outcomes of folks who were thin to begin with. Weight cycling, which is common among folks who diet, is closely linked to increased risk of diabetes, heart disease, osteoporosis, and more. Worse, studies show that when folks in bigger bodies lose more than 5% body weight, they’re at an increased risk of early death, even if the weight loss was intentional.

People in larger bodies who intentionally lose weight can have worse health outcomes than those who change their behavior without losing weight.

Dieting takes a toll on mental, social, and emotional health.

It’s hard to feel carefree when you’re hungry! Although we’re promised better quality of life, happiness, and confidence with weight loss, intentional weight loss efforts are associated with higher levels of anxiety and depression. Many of the rare people who maintain significant weight loss beyond 5 years show symptoms of disordered eating, exercise obsession, body preoccupation, and/or atypical anorexia.

As wellness coaches, our priority is helping clients improve their health and overall wellbeing. Intentional weight loss not only doesn’t improve health, it can cause harm.

Want an alternative to dieting? The health benefits we usually associate with weight loss can be achieved by behavior change (in the absence of weight loss), with less risk to our clients.

The Health at Every Size movement rejects weight-centered health promotion and instead emphasizes size diversity, embracing all facets of your wellbeing (not just physical health), eating based on internal cues, and enjoyable physical movement.

People who practice Health at Every Size accept and feel better about their bodies. They enjoy many of the health improvements we anticipate with weight loss, like lower blood pressure and increased insulin sensitivity. They’re also more likely than dieters to take better care of themselves and their bodies long-term.

Rejecting weight as the barometer for health goes against the status quo! Fortunately, there’s a growing community of coaches, doctors, therapists, nutritionists, and other healthcare providers who are committed to weight-neutral health promotion.

Look for part 2 for tips you can use in your coaching practice to help your clients (and maybe even yourself) prioritize wellbeing without the scale.

Emily Burrows is a self-care coach and yoga teacher in Chapel Hill. She has her MPH from UNC-Chapel Hill but stays forever loyal to UNCG, where she completed her health coaching certificate and bachelor’s degree.

www.emilyburrows.com

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I’m making an assumption here, but if you are the kind of person who decided to be a health coach, you are probably the kind of person that is empathetic, wants to help people and genuinely cares for, maybe even love, your clients. Good coaches are empathetic people. We can feel for our clients and build rapport with them.

Empathy is the ability to feel a part of others’ emotions. It is a necessary aspect of our survival. When we see someone drowning, we fear for them and have an impulse to pull them out of the water, just like we assume someone would pull us up.

This empathy and love that is helpful for you in creating a coaching alliance can also hurt.  Think about a client or a loved one who is doing something unhealthy: they never sleep, they keep dating the wrong people, they drink too much. They keep getting hurt, but don’t seem to learn and change. Does it hurt you to think about them? How much money would you pay to take that pain away, to fix them?

As a health coach who loves someone suffering from addiction, I am very aware of this dynamic. When it was the worst for him, I would have done anything to help him get better: I would have emptied my bank account to pay for rehab if I had to. This overwhelming feeling did nothing for him. Instead, it brought me down and kept me from taking care of myself. Likewise, in previous jobs, when a client was in pain, I was inclined to take that pain home with me. I couldn’t understand how to feel happy in a world where I knew others were suffering. I wanted to give everything to help everyone.

Within recovery circles, the term “loving detachment” is used to describe a way for people to get space from their addicted loved ones. This extra space protects and gives both parties a way to prioritize themselves and their own healing first. This isn’t done out of selfishness, but out of self-interest and care. As Beverly Conyers writes for the Hazleden: “Detachment is neither unloving nor unkind. It’s simply accepting the fact that we can’t live our loved ones’ lives for them.”

I think of this in connection with the way that, as coaches, we learn about checking our “righting reflex.” When we want to tell a client that they need to quit smoking, we are doing it because we care. However, we know it doesn’t work.

If we realize that we cannot fix someone, we become free to support them instead. This means, while we care about them, we don’t feel the pressure to solve their problems. Instead, we can encourage them to develop their own solutions and skillsets.

By detaching with love, we can let our clients know that we are not going to fix them. They have autonomy and responsibility. As coaches, it reminds us that we need to stick to what we can do: we can guide them, support them, give them the tools they need, and help them identify what they want to do for themselves.

Detaching lets us focus on our growth as coaches and as individuals. It gives us freedom, peace of mind and clarity.