PRACTICE SPOTLIGHT

January 2012                      

Wellcoaches: Setting a Gold Standard

in Health & Wellness Coaching

An interview with Margaret Moore, MBA

Wellcoaches is setting a gold standard in health and wellness coaching, with founder and CEO Margaret Moore at the forefront of this dynamic movement addressing our epidemic of lifestyle-related chronic disease.  In her many roles, including founding advisor with the Institute of Lifestyle Medicine, her work bridges the fields of coaching and Lifestyle Medicine.

Moore views coaching as a key intervention within Lifestyle Medicine, and views the coaching model as a catalyst for transforming the current medical model into a partnership designed to help people establish healthier lifestyles. This model connects providers with experts skilled in facilitating lifestyle change.  In the way that providers now refer patients for supportive therapies following a stroke or an injury, providers within a coaching model prescribe Lifestyle Medicine and refer patients to a coach for implementation.

Moore acknowledges the challenge and complexity inherent in lifestyle change.  “Behavior change is much more complicated than taking a pill.  Successfully implementing Lifestyle Medicine requires re-engineering life priorities and behaviors.  People have engaged in health-damaging habits over a lifetime, and health behaviors are notoriously difficult to sustain.  Little by little, most people revert to their old habits.  A coach, in partnership with the physician, supports people in re-engineering their lives so they can integrate self-care in a way that lasts.” 

Dr. Michelle Tollefson, an OB/GYN and Lifestyle Medicine physician with certification through Wellcoaches offers her perspective, “Our recommendations to adopt healthy behaviors do not necessarily translate into lifelong behavior change. This is where health and wellness coaches play an integral role.  A skillful coach can empower the patient to implement the recommended lifestyle changes, and increase the patient's chances for lifelong behavior change success.  I see wellness coaches and physicians as working hand-in-hand, allowing patients to experience the full benefit of what Lifestyle Medicine offers.”

Margaret Moore notes that the role of the coach includes the tasks of a concierge.  “Not only does a coach facilitate a change process, s/he offers creative options that might work for a patient, helping a person organize their personal wellness within the broader context of their lives." She’s particularly interested in the way the brain works, drawing on today’s golden era of neuroscience.  “Change is a challenging and complicated process of building new brain networks.  Coaches facilitate that process.”  She describes how coaching sessions move patients from initial perspectives that may be a little chaotic or confused, toward greater clarity and insight, leading to more focused and more organized thinking. She notes that the process of change takes time and commitment. “It takes at least three months to reorganize a domain in your life.  We can get a lot done in three months, but ideally we need to allow one full year.  Following a three-month diet doesn’t change the brain.  Big leaps which are sustainable take more time.  It’s best to allow a year to transforming your lifestyle for good.”

The process of developing more clarity and more organized thinking is the focus of her new book, “Organize Your Mind, Organize Your Life” co-authored with Harvard psychiatrist, Paul Hammerness, MD.  Margaret, or Coach Meg, as she’s known in the book, writes, “No matter whether we’re helping Fortune 500 executives balance their lives or middle-aged sedentary individuals manage their health, the process and the tools we use are often similar.  In a nutshell, we help people organize their brains for change.  We help you achieve clarity, choose a focus, develop self-motivation and confidence, build a plan, and embark upon and complete the journey of change.” 

Moore’s own well-ordered mind, her background in biotechnology, and her natural talent for coaching provides her with a unique perspective.  Combining science and years of experience leading and developing people and teams, she’s created a robust framework that integrates findings across a broad range of fields - from the study of neuroplasticity to positivity and self-determination theory. “Wellcoaches has connected these fields into a well-orchestrated whole, and then innovated on top of that to develop a toolbox that goes beyond individual scientific silos into something more powerful.” 

She goes on to describe that our brains all work differently.  “You don’t know what will light someone up.  A person with low drive, for example, will need to construct self-motivation, a heartfelt drive. The same is true of a person with low confidence or low self-empathy.  Everyone has a different way in.  It might be through mindfulness or greater creativity.  We’re looking for the right key and we must have a large set of keys, or tools from which to draw, because we don’t know which will work best.  Coaching is more of a creative than formulaic process, built upon a solid scientific foundation. Because people don’t understand their own minds, the bigger the tool box, the more possibility of finding the right tool.  The role of the coach is to help a client sift through a lot of raw material and make sense of it all, to guide the process of change.  We combine two brains, increasing capacity and creativity by adding new perspectives. 

Margaret refers to coaching as a developmental process that helps people uncover their strengths and talents, apply those to self-care, and outgrow their old modes of thinking, feeling, and acting.  “You may have a patient who is great at organizing a birthday party for 30 ten-year-olds but has never applied those skills to her own self-care.”   She asserts that the best coaches have a strong foundation in the science of human change drawing from psychology and now neuroscience. 

One new frontier which provides tools for coaching is Barbara Fredrickson’s impressive body of work which has shown that positive emotions open and broaden our thinking, and increase our resilience and capacity for change. There is also an emerging body of literature showing that positivity or mental thriving improves physical health.  Generating positivity is an important outcome of coaching because it improves self-efficacy and health.  In a recent grand rounds lecture, Moore invited the audience to imagine generating positivity instead of simply focusing on changing BMI.  “I suggest that we start by helping patients tap into what makes them flourish instead of just focusing on what needs fixing. The energy of thriving improves the capacity and resources for change, starting an upward spiral where successes generate more positivity.  When you feel healthy, energetic, fit, and alive, you will be more positive.  So, positive physical health generates positive mental health and vice versa.”

Acknowledging the need for more research to assess coaching outcomes, Moore envisions increased collaboration of lifestyle medicine and coaching within primary care.  “We need to evaluate what works best.  She points to the recently enacted Medicare reimbursement of counseling for obesity, which offers twenty sessions in a primary care setting over the course of one year.  “This is a bold move defining two dimensions: weight loss support delivered in the primary care setting and multiple sessions over a one year timeframe.  We need to build on that starting point.” 

She offers basic coaching principles that can be applied within the practice of Lifestyle Medicine:

1. First, recognize that many people are frenzied, stressed, and worried.  As a provider, you can create a space of calm and warmth.  We pick up on one another’s energy. The first energy to radiate is a calm warmth.
2. Show authentic empathy. Given life’s demands today, it is a struggle to start and sustain a healthy lifestyle.  “I know that change is hard, including in my life.” Help patients move on from past failures and missteps; “let’s focus on what you can change in the future.”
   
3. Next, generate positivity.  Ask, “What’s going well in your life?  What are you enjoying most?”  Begin with what patients most enjoy and what they most care about.  Take notice when they “light up” and reflect their positivity.  Even the simple act of sharing positive lab results first and complimenting a patient on what s/he is doing well, will allow him/her to think more clearly, and to be more open and engaged when you get to more challenging topics.
   
4. Then invite your patient to choose.  First, share your thoughts on priorities with them. “These are areas I think are most important for you to work on.”  Then find out what’s most important to you? Which are you most ready to work on?  How can I help you with that?”
   
5. Close with agreement on specific actions identified by the patient, in the area of greatest motivation and readiness, and a plan for accountability, such as sending a progress report in three months.  Commit to offering support, and shake hands.
   

Margaret maintains that healthcare providers must first engage in their own self-care, and invites them to take part in her upcoming program on self-coaching.  The 12-month program will teach the knowledge and skills needed to coach ourselves to be our best - in health and well-being, in our lives, and in our work.  Her suggestion to providers:  “Ask yourself what makes you thrive and then engage fully to become a role model.  Your thriving will be infectious for your patients.”

For Dr. Tollefson, coach training heightened her awareness of the need to attend to her own well-being.  “As a physician, I understood the importance of nutrition and exercise prior to the Wellcoaches training; however, it was while working with a coach myself that I finally made changes - eating healthier, exercising almost daily, and managing stress more effectively - that now allow me to live a much healthier and happier life.  If behavior change is difficult for a physician who understands the medical importance of leading a healthy lifestyle, imagine how much more difficult is it for many patients who want to take the advice of their physician but don't know where to start.”

Dr. Michael Jeremiah, Medical Director at the Carilion Clinic Family Medicine Residency Program agrees, maintaining that we need to move beyond content and embrace the science of what motivates and sustains change.  Dr. Jeremiah completed his coach training through Duke Center for Integrative Medicine, and now brings an expanded perspective into his work in teaching Family Medicine residents.  He presses residents to consider their own approach to patient care, asking, “What does this patient need to be successful?  What is she ready to work on?  What is she motivated to spend energy on?”  He sees the need for providers to move beyond simply telling patients what to do, instead helping them connect with their own intrinsic motivation for change.  

Coaching holds great promise as a key intervention within Lifestyle Medicine.  The work of Margaret Moore and others is pulling the psychology of lasting behavior change into the context of medical practice.  But Moore points out that the benefits of coaching extend far beyond improving measures of physical health. 

“Coaching helps people find their heartfelt desire and connect with why they care about being fit and well.  When coaching programs are completed, patients not only reach their goals, but they get a bonus: they get to change, grow, and develop, becoming their best selves.”

……………………

Margaret Moore, MBA

Following an impressive career as an executive in the biotechnology industry, Margaret formed Wellcoaches in 2000, which is now (in partnership with the American College of Sports Medicine) setting the gold standard for health and wellness coaching.  She’s a founding advisor of the Institute of Lifestyle Medicine, co-founder and co-director of the Institute of Coaching at McLean Hospital, and co-director of the annual Coaching in Leadership & Healthcare conference at Harvard Medical School.  She co-leads a consortium aimed at developing national standards and a collaborative research agenda for coaching.  Margaret donates one day each week to advancing research in the area of coaching and behavioral change.  She’s written and contributed to several books on coaching and Lifestyle Medicine and has co-authored a new Harvard Health book entitled “Organize Your Mind, Organize Your Life”.

LINKS:

Learn more about Wellcoaches 

Information on the book, Organize Your Mind, Organize Your Life

Margaret Moore's Grand Rounds presentation at the Cleveland Clinic: Coaching for Sustainable Change

Wellcoaches Readiness for Change tool