Health Coaching: The science and art of behavior change 

Scientific evidence supports the use of lifestyle medicine to treat and even reverse common chronic diseases but how do patients turn that information into sustainable lifestyle behavior changes? Lifestyle medicine clinicians are increasingly embracing the power of health coaching to help patients achieve their health goals. Ample scientific evidence supports the use of lifestyle medicine to treat many common chronic diseases. But what does it take for patients to turn that medical guidance into sustainable lifestyle behavior changes? 

Health and wellness coaching has emerged as a catalyst to help patients achieve their health goals within the framework of lifestyle medicine. Coaching builds judgment-free, collaborative partnerships with patients, empowering them to set realistic goals and personalized action plans with practical steps to address the root causes of their disease. 

Over 15 years ago, Jessica Matthews, DBH, NBC-HWC, DipACLM, FACLM, embraced the power of health coaching after seeing too many people struggle to adopt and sustain the very lifestyle changes that had the ability to transform their health and effectively treat their various chronic diseases.  

“I had accumulated immense knowledge about the science of lifestyle medicine, but I recognized that I needed a deeper understanding of the foundation of it all, which is the science and art of behavior change,” said Dr. Matthews, assistant professor and program director in the College of Health Sciences at Point Loma Nazarene University (PLNU), where she developed and implemented a graduate degree program blending lifestyle medicine and health and wellness coaching. The program built upon her board certification in both areas as well as her doctoral training in behavioral health with a focus in clinical integrated care. 

“I realized that the ability to not only educate, but to coach, support and empower people to take the lead in making these lifestyle behavior changes that I was advocating was the key ingredient that I was missing, as it is ultimately knowledge translated into empowered patient action that is the real secret sauce for unleashing the power of lifestyle medicine.” 

Information isn’t enough 

Lifestyle medicine and health coaching naturally complement each other. Lifestyle medicine is an evidence-based medical specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions including, but not limited to, cardiovascular diseases, type 2 diabetes, and obesity. Lifestyle medicine-certified clinicians empower patients to replace unhealthy habits with healthy ones by understanding the science and practical skills that support health behavior change.  

Health and wellness coaches commonly address with patients many of the six pillars of lifestyle medicine—a whole food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connections. Health coaching in a physician-led health team is shown to improve outcomes for chronic conditions like hypertension and type 2 diabetes. 

The growing availability of virtual medical appointments since the COVID-19 pandemic has made health coaching an option for more Americans.  

“Evidence-based lifestyle behavior interventions are proven to treat, prevent and even reverse many chronic conditions, but simply telling a patient what lifestyle changes to make is not enough,” ACLM President Beth Frates, MD, FACLM, DipABLM, said. “Knowledge is important but, to achieve lasting behavior change, patients and clients also need coaching to motivate them and help them determine how to make and maintain lifestyle behavior changes to improve their health and wellbeing.” 

Art and a science 

Changing deeply engrained lifestyle habits is a complex and multifaceted process. Physical activity and eating patterns are complex behaviors. Health coaches and clinicians with health coaching skills take into consideration each individual’s culture, values, family dynamics, living environments and other unique circumstances to help them create a personalized plan with small yet meaningful action steps forward.  

Dr. Matthews, also director of integrative health coaching at UC San Diego Health in the Department of Family Medicine, said her team will soon publish data showing that health coaching interventions reduced blood pressure and A1c levels in patients at a rate greater than other interventions offered within the health system. 

“I describe behavior change as both a science and an art,” Dr. Matthews said. “The science is learning from the decades of evidence available on behavior change; what works and what doesn’t in terms of initiating lifestyle changes, as well as examining the growing body of research to better understand what sustains it. The art is the communication skills— both verbal and non-verbal— used, not as a directive but in a manner that invites an individual to be an active and engaged participant in identifying practical steps forward.  

“Coaching is saying ‘I may be the expert on the medical science, but you’re the expert on yourself. Let’s combine our valuable knowledge and collaboratively work together.’” 

An example of coaching 

As a registered dietitian, Tasnim El Mezain, MS, RDN, NBC-HWC, is passionate about optimal nutrition. But participating in Dr. Matthews’ program at PLNU made her aware of how the other pillars of lifestyle medicine and nutrition interconnect and are optimized by coaching. 

El Mezain, lead clinical health coach at UC San Diego Health in the Centers for Integrative Health, recently coached a patient who was eating well but sleeping poorly and struggling to fit more physical activity into her busy life.   

“She said her long-term goal was to get to sleep by 10 or 11 p.m. instead of 2 a.m. and take walks five days a week,” said El Mezain, who was also a 2023 recipient of ACLM’s HEAL (Health Equity Achieved through Lifestyle Medicine) scholarship. “But the idea of that was completely overwhelming. So, we worked together to identify incremental and realistic steps she could achieve in the next two weeks towards her overall goal.” 

With El Mezain asking questions, the patient concluded a reasonable goal was to start taking a walk one morning a week at a nearby lake, at a time she knew there would be available parking but also other people there. She identified changes to her bedtime routine the night before her walk so she would wake up earlier and with more energy.  

“By asking her open-ended and strategic questions, so I was not directing her answers in a certain direction, she was able to talk through the obstacles and what motivated her personally,” El Mezain said, “She identified her goal–not my goal for her. It was no longer overwhelming and she was excited to try it out.” 

Future of health care 

The integration of health coaching into multidisciplinary health teams whose members are trained in lifestyle medicine can enhance whole-person, person-centered care. Certified health and wellness coaches work in tandem with physicians, dietitians, exercise specialists, nurses and physician associates to effectively address all facets of patients’ health. 

To further uncover the benefits of coaching skills within the lifestyle medicine paradigm, ACLM and the National Board for Health & Wellness Coaching (NBHWC) this year announced a strategic partnership. NBHWC, an affiliate of the National Board of Medical Examiners, has board certified more than 9,400 health and wellness coaches. 

National board-certified health and wellness coaches (NBC-HWCs) are valuable members of the health care team, but team members from different fields must still prioritize developing their own coaching skills to support patients in the journey of health behavior change, said Dr. Matthews, Vice Chair of the NBHWC Board of Directors.  

“Imagine the future of health care as an interdisciplinary health team whose members are educated and trained in both lifestyle medicine and coaching skills to support health behavior change, all speaking the same language and focused on achieving the same healthy outcomes in genuine partnership with patients,” Dr. Matthews said. “That is how you create meaningful and sustainable lifestyle behavior changes.”