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Unhealthy lifestyle behaviors are modifiable risk factors for several diseases, including cardiovascular disease,¹ type 2 diabetes,² cognitive decline,³ and many more. Nutrition and other lifestyle interventions are considered first-line therapy for many health issues. In fact, 60% of American adults have one or more diet-related chronic diseases.⁴ And while it’s fairly common knowledge that a major aspect of good health is diet, adhering to lifestyle change for the long-term can be challenging for many patients. Nutrition counseling is only included in an estimated 25-40% of primary care visits.⁴ How can clinicians educate their patients about diet and help them to maintain lifestyle changes for the long-term?

Many functional medicine clinicians are transitioning to team-based care with the integration of health coaches. One area in which health coaches are effecting change is in dietary and nutritional lifestyle modification. Health coaches can help patients achieve and maintain realistic dietary change at a pace that works for them. Research suggests that energy-restricted diets are not only ineffective in promoting long-term weight loss but may also predispose individuals to regain fat; food restriction can also trigger changes in energy metabolism, endocrine function, and, thus, body composition.⁴ Behavioral treatment may be more effective for both clinicians and patients. A 2016 systematic review of general knowledge in adults across five continents by Barbosa et al found that greater nutrition knowledge correlated with general well-being as well as socioeconomic factors, especially educational attainment, which may affect both the access to care and healthy foods as well as the knowledge and ability to implement better nutrition.⁴

Health and wellness coaching, and specifically nutritional coaching, is a promising strategy and potentially a highly effective approach for weight loss and healthy behavior change.⁵ In addition to helping patients lose excess weight,⁶ health improvements seen with coaching also include lower hemoglobin A1c and LDL levels,⁶ better glycemic control,⁸ and reduced hypertension.⁹

In the following video, Kalea Wattles, ND, talks about the value health coaches bring to a functional medicine practice.

Functional medicine begins when a solid foundation is developed between the practitioner and patient. Integrating modifiable lifestyle factors into a healthcare plan with the use of health coaches may improve patient responsibility and increase overall health and well-being.

For the patient, team-based care offers many potential advantages, including expanded access to care and additional services that are essential to providing whole-person care, such as patient education and behavioral health.¹⁰ A 2021 study, using 2013-2018 deidentified electronic health record data from US primary care practices, found that provider teams outperformed solo providers, irrespective of team composition.¹¹ Team-based care can also be considered “patient-centered”: relationship-based, making the patient feel known, respected, involved, engaged, and knowledgeable.¹⁰

For more information about health coaching, please visit the Functional Medicine Coaching Academy  (FMCA), an innovative program that teaches students how to apply core coaching techniques, positive psychology, and the principles of functional medicine to transform patient lives.

Both IFM and FMCA understand that changing a patient’s behavior requires a careful set of skills and strategies to help uncover what the patient needs to succeed. Functional Medicine Certified Health Coaches work in tandem with clinicians to provide consistent, team-based care to achieve better outcomes.

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References

1. Shrestha R, Copenhaver M. Long-term effects of childhood risk factors on cardiovascular health during adulthood. Clin Med Rev Vasc Health. 2015;7:1-5. doi:4137/CMRVH.S29964
2. Van Buren DJ, Tibbs TL. Lifestyle interventions to reduce diabetes and cardiovascular disease risk among children. Curr Diab Rep. 2014;14(12):557. doi:1007/s11892-014-0557-2
3. Phillips C. Lifestyle modulators of neuroplasticity: how physical activity, mental engagement, and diet promote cognitive health during aging. Neural Plast. 2017;2017:3589271. doi:1155/2017/3589271
4. Frame LA. Nutrition, a tenet of lifestyle medicine but not medicine? Int J Environ Res Public Health. 2021;18(11):5974. doi:3390/ijerph18115974
5. Dayan PH, Sforzo G, Boisseau N, Pereira-Lancha LO, Lancha AH Jr. A new clinical perspective: treating obesity with nutritional coaching versus energy-restricted diets. Nutrition. 2019;60:147-151. doi:1016/j.nut.2018.09.027
6. Alencar MK, Johnson K, Mullur R, Gray V, Gutierrez E, Korosteleva O. The efficacy of a telemedicine-based weight loss program with video conference health coaching support. J Telemed Telecare. 2017;25(3):151-157. doi:1177/1357633X17745471
7. Willard-Grace R, Chen EH, Hessler D, et al. Health coaching by medical assistants to improve control of diabetes, hypertension, and hyperlipidemia in low-income patients: a randomized controlled trial. Ann Fam Med. 2015;13(2):130-138. doi:1370/afm.1768
8. Thom DH, Ghorob A, Hessler D, De Vore D, Chen E, Bodenheimer TA. Impact of peer health coaching on glycemic control in low-income patients with diabetes: a randomized controlled trial. Ann Fam Med. 2013;11(2):137-144. doi:1370/afm.1443
9. Margolius D, Bodenheimer T, Bennett H, et al. Health coaching to improve hypertension treatment in a low-income, minority population. Ann Fam Med. 2012;10(3):199-205. doi:1370/afm.1369
10.  Okun S, Schoenbaum SC, Andrews D, et al. Patients and Health Care Teams Forging Effective Partnerships. Institute of Medicine; 2014. Accessed March 15, 2022.https://www.accp.com/docs/positions/misc/PatientsForgingEffectivePartnerships%20-%20IOM%20discussion%20paper%202014.pdf
11.  Pany MJ, Chen L, Sheridan B, Huckman RS. Provider teams outperform solo providers in managing chronic diseases and could improve the value of care. Health Aff. 2021;40(3):435-444. doi:10.1377/hlthaff.2020.01580