Abstract
It is in the best interest of our society, medical system, individuals, and company productivity that employers find solutions for long-term employee engagement and sustained transformation with wellness programing for weight loss. With staggering numbers of diabetes and cardiovascular disease, preventative measures such as weight loss are crucial to slowing down the obesity epidemic. The first part of the paper examines best practices and gives recommendations for improving employee engagement with digital coaching weight loss solutions. Through developing a culture of wellness where the norms are promoting healthy behaviors and lifestyle, assessing where individuals are in the stages of change, providing patient-centered incentives, and user experience (UX) of the technology, companies can improve the percentage of employees engaged with wellness programs. The second part of the paper examines how to enhance transformation in coaching provided by workplace wellness programs. Using the whole person web tool, integrating mind-body practices, and standardizing the level of coaching both for ethical reasons and transformative potential for the client, the likelihood of meaningful change can occur. Finally, this paper concludes with the author’s plan as a scholar-practitioner to continue with self-development and self-care as a certified coach working to improve the content of coaching programs in the digital health industry.
Keywords: corporate wellness, weight loss, coaching, corporate wellness engagement, transformation, digital health, digital weight loss coaching, online coaching
With 35% of the United States population being obese and 70% overweight and rising (Obesity Rates & Trends, 2018), organizations are opting to provide health and weight loss solutions as part of workplace wellness programs to ensure productivity and healthy bottom lines. While these programs are providing progress, the rate of engagement is not as high as the rate of obesity, making a drive to find solutions to close the gap necessary. Additionally, many of the coaching programs are great for the population of people that are at the stage of being ready to take action (Prochaska & Velicer, 1997), yet these programs lack the scope to be able to facilitate transformation for those in earlier stages of readiness to change or address individuals who hit subconscious blocks keeping them stuck in the frustrating place of wanting to lose weight but continually failing. Many of these weight loss and diabetes treatment programs are great at addressing nutrition and behavior modification, yet the coaches and the curriculum lack the ability to address underlying issues that may be preventing individuals from more meaningful healing.
Obesity is not only a public health issue; it has become an employer issue when in 2012 it was reported that obesity and its related health matters cost $300 billion in productivity loss (Taylor, 2012). With profits in jeopardy, biometric screenings, incentive programs, and health solutions have become popular corporate offerings. According to Forbes, more than two thirds of companies are offering comprehensive employee wellness programs and “when the investment is in programs targeting chronic diseases, such as diabetes and obesity, the ROI increases to $3.80 [from $1.50]” (Valet, 2015, para.4).
Workplace weight loss programs are now offering digital health coaching programs via telephone, text, video conferencing, and artificial intelligence (AI). It is no surprise that health coaching for obesity has proven to be a more effective solution for weight loss than conventional diets and obesity education (Sherman, Petersen, Guarino, & Crocker, 2017). That individuals are matched with a personal coach who provides personalized integrative care and accountability, means success rates are high and the popularity of health coaching programs is soaring. Given that these programs are fairly new and are evolving as technology improves, it remains to be seen what the long term success will look like.
While digital health coaching is becoming more mainstream, the question of meaningful engagement and transformation remains outstanding. Like any product in the open marketplace, there is competition for time and attention,and often employees are saturated with information and options to the point that they are ignorant of the programs being offered. Providing a weight loss coaching solution is not enough to attract users. Employers and providers must work together to find ways to improve employee engagement in these digital health programs and optimize transformation.
Engagement
With 70% of the population either overweight or obese according to the NIH, the rate of employee engagement in wellness programing seems low enough that there is a need for overall improvement in participation of the population is either overweight or obese (Overweight & Obesity Statistics, 2018). In a survey by United Healthcare it was found that only 19% of employees would be willing to devote 9 or more hours each week to exercise and healthy eating and only 24% would be willing to devote 1-3 hours (“Access to a Company Wellness Program”, 2017). Employee willingness to re-prioritize health must be emphasized to improve the health of the overweight population. Tapping into motivation is a multi-faceted and complex dilemma. In this paper, the role of company culture, stages of change theory, the ease of use of the technological interface, and whether incentives work to promote engagement in behavior change will be explored. While less than half (46%) of employees are participating in health assessments, the outcomes for the employees that do then engage in lifestyle change programs are proving to be successful and clinically significant (Soren et al., 2013). This gives hope to the idea that the more employers and providers explore ways to improve the rate of sustained engagement with overweight employees, the greater chance of improving the health of the US working population.
Company Culture: The Importance of Top Down Messaging
There is a large sociological factor within the organizational setting that can lead to a higher likelihood of engagement with wellness and self-care. For a weight loss wellness program to succeed, there is a distinct need for executives and leadership to endorse and support wellness programs to set employees up for successful behavior change and positive attitudes towards healthy choices. To truly sustain employee wellness and weight loss initiatives, organizations must consider the cascade of offerings and policies that support weight loss. For example, cafeterias laden with high fat, high sugar foods, conventional vending machines, free breakfast donuts and soda fountains undermine employee efforts for behavior change towards weight loss goals. My experience working in this field with large corporations who have wellness programs when there is a lack of executive decision to change the food culture of the organization, weight loss wellness programs lose their impact.
Institutional Influence. The thoughtfulness of an organization’s food environment sends a message to employees that their diet and healthy choices matter to the leadership. For people who may be less inclined to make healthy choices, this culture can permeate unhealthy tendencies and push them to consider more nutritious meals. Linnan, Sorensen, Colditz, Klar, and Emmons (2001) suggested that multiple layers of influence predict employee engagement, one of them being the community organizing principles. Google, the giant tech company, is a great case study of how the institutional organization and leadership has prioritized healthy behavior and created a culture of health awareness. The extensive food program designed by nutritionists and behavior economists is mindfully designed to support employee wellness. “Canteens are laid out in a way that the salad bar and vegetables are the first counters people pass when they enter the canteen, and healthiest products are always put at eye level. Small plates are used to avoid overeating, and canteen managers are always on top of the food offering, making sure it never runs out of healthy options” (Google Food Program, 2018). Additionally, Marion Nestle, the prolific author and nutritionist, highlighted that the stoplight labeling system to classify food as red (don’t consume often), yellow (consume once in a while), and green (consume anytime) is visible on all foods so that employees are able to make informed decisions about what to munch on (Google’s Impressive Healthy Food Program, 2018). Perhaps unrelated or perhaps a correlation, it is noteworthy that productivity at Google is 40% above average (Mankins & Garton, 2017).
Motivational culture. Executive support goes beyond culinary choices and can be embedded within the entire organization to support employee attitudes, beliefs and readiness for change. When employees sense that health is valued by the larger group, are educated, and hold confidence in their abilities to control outcomes, there is a higher likelihood that individuals will be motivated to engage in workplace wellness programs (Hall, Bergman, & Nivens, 2014).
In a qualitative study, Hall, Bergman, and Nivens (2014) examined the determinants of participation in a workplace health program at large manufacturing companies. They measured the health climate using subscales comprised of health norms, organizational support, interpersonal support, perceived behavioral control, and readiness to change behavior. The study was based on the premise that with a positive organizational climate there is favorable employee engagement with workplace activities, learning, duties, and overall higher productivity (Billett, 2002). Hall et al. surveyed a diverse demographic, n= 349, with 44.4% male and 55.6% female. This well-designed study used reliability measures and found that all subscales with the exception of Perceived Behavioral Control had a reliability coefficient greater than α=.60. Their findings indicated that the health norms within the company are as important as individuals’ self-assessment of their own health as well as the perceived control of being able to make change. (Self-assessment and perceived control will be discussed in the following section). Following this finding, a question to consider is what contributes to a healthy social norm. Food culture, as discussed above, is one aspect. Additional pieces that reinforce the perception of leadership’s investment in employee wellness are on-site company gyms, subsidies for gyms, company sponsored athletic events, financial incentives for participating in bio-screenings, wellness workshops, and company influencers/champions. While the study by Hall et al. (2014) is limited to the manufacturing industry and relies on self-reported questionnaires, it is reasonable to assume that the notion that the level of a company’s culture of health correlates to levels of motivation and engagement with wellness programs applies across industries.
Taylor (2012) suggested that long term success for improving total health (physical, emotional, and social) in corporate wellness programs is increased when “measurable business outcomes in areas such as absenteeism, productively, and safety incidents help refine goals” (p. 52). According to a case study on Lincoln Industries (Taylor, 2012), when the organization implemented wellness with business strategy, they achieved a 90% participation rate in employee wellness programing. In the article Taylor applied theory and research to suggest that as the front line of implementing business strategy, management has the power to create a culture of wellness by integrating wellness measurements into performance review. The more places within the company that the executive team links business and wellness, the greater the impact the culture can have on improving employee engagement with wellness programing.
Behavior Change Theory
Although the company’s culture has a large impact on the individual, there is another factor to consider in determining an individual’s likelihood to participate in health programs. The conversation concerning employee engagement starts with what the organization can do within the sociological structure to improve the likelihood that an individual will participate in wellness programming, as discussed above. The impact that company culture and health norms have on engagement is so intertwined with the concept of behavior change theory that it is important to consider the simultaneous impact that company health norms have on an individual’s likeliness to participate in health programs. Prochaska and Velicer’s (1997) transtheoretical model of health behavior change anticipates an individual’s health behavior based on where they fall within the six stages of change. The stages are identified as precontemplation, contemplation, preparation, action, maintenance, and termination. Prochaska and Vilicer (1997) add that other processes such as self-efficacy and temptations factor into an individual’s progress. As an example of how company health norms work hand-in-hand with behavior theory, consider Google’s food program. In my coaching experience, an overweight person in the preparation stage will have a low hurdle to move into action because the environment and cultural attitude supports actions that lead to healthier eating. They are more likely to choose the foods that the kitchen puts out first such as salads and vegetable based meals over pizza and french fries that are towards the back and labeled with a red light. This type of behavior, if consistent, can lead to weight loss. The Google food environment is set up to lower temptation, promote healthy action, and support those in maintenance phase, as well.
With at-risk populations, 40% are in precontemplation, 40% in contemplation, and 20% in preparation (Prochaska & Velicer, 1997). A company culture that promotes regular bio-screenings can easily move those in precontemplation to a more advanced stage of change. The “optimistic bias” discussed by Hall et al. (2014) indicates that an individual who perceives that they are at low risk for negative health outcomes and has a higher likelihood of experiencing positive outcomes compared to others, is less likely to engage in worksite health programs (p.773). They report that following a bio-screening where individual’s false self-perceptions of good health are revealed, the self-perception shifts. Through the lens of behavior change theory, the screening may provide a shift from precontemplation to more advanced stages of change and eventually into action. Linnan et al. (2001) stated, “employees in later stages of readiness to change were more likely to participate in a self-help program focused on exercise at work than were those in early stages of readiness to exercise” (p. 593). That organizations are providing opportunities for exercise is not enough; they need to find ways to move employees to the stage of action if they want to improve engagement and appeal to the most at-risk population.
In addition to health assessments, companies and providers can appeal to the at-risk population by tailoring marketing messages, offering appropriate programs and incentives to those that fall in the phase of precontemplation, contemplation and preparation (Langille et al., 2011).
Incentives: Good or Bad Idea?
Financial incentives to improve employee engagement in wellness programming must be properly structured to prevent futile investments and provide long-term benefit. The problem with financial incentives is that they are often structured in a non-meaningful way so that an employee goes through the motions to get the reward followed by no behavior change. After analyzing research on behavior change, smoking cessation, weight loss, and workplace wellness, Kullgren, Williams, and An (2013) provided a well thought out approach to financial incentives that addresses how to achieve sustained and meaningful success. The approach is patient-centered, meaning the incentive structure is sensitive and responsive to the patient/employee’s needs and preferences. As part of providing a more patient-centered solution, Self-determination Theory (SDT) factors in as a guide for policy that assumes that individuals are inherently motivated towards better well-being and will be motivated to take action when the psychological needs for autonomy, competence, and relatedness are met (What is Self-Determination Theory?, 2018). Kullgren et al. (2013) recommended that rather than financial incentives predetermined by the organization, the employee could feel more autonomous and thus more motivated if they chose the rewarded behavior and followed this with a personal goal that has a proportionally related reward. Following the chosen reward and the magnitude of the reward, the employee would then be able to choose the frequency of the reward. The rewards can also encourage social opportunities that facilitate behavior change and other supportive ways of ensuring positive community interaction, which satisfies the need for relatedness in the SDT model. The authors cited a company that successfully implemented these strategies and had long term smoking abstinence compared to other employer provided smoking cessation programs. It is reasonable to consider an incentive structure that facilitates internal motivation for healthy behavior change can translate into positive long-term results for multiple weight related disease such as weight loss, diabetes management, and cardiovascular disease.
Based on my experience I believe that incentives when structured the right way can improve engagement, along with sustained change, and this requires a company with the investment and bandwidth to be able to follow through to manage each individual. Financial incentives that are too general and inflexible only offer marginal success (Carrera, Royer, Stehr & Sydnor, 2018). However, this person-centric model may not be something that all companies can afford to do. Another potential shortcoming is that it relies on individual employees to self-report and know themselves well enough to set up a structure that makes sense. Working with a corporate coach that advocates for the employee and is not required to report on private heatlh matters or struggles to the organization is a feasible method of individualizing incentives for employees. It is possible that goals, targets, and correlating incentives will need to be adjusted as the individual gains more personal insight and understanding into their own inner world of motivation.
Technology and the Ease of User Interface
It is probable that a digital weight loss coaching program must be concerned with ease of use in the technology interface and provide consistent feedback to the user to maintain motivation and engagement. Though the research is currently limited in how scheduling tools (to meet with one’s personal coach) influence engagement, my experience within the digital health field is that it is crucial need for new patients to have a process with little to no frustration,otherwise people will quit before they even get started. A study looking at engagement with patient portals found that age, ethnicity, education level, health literacy, and health status influenced an individual’s active use of the portal to manage their health (Irizarry, Dabbs, & Curran, 2015). This finding indicates that a corporate wellness program that is offering digital solutions will want to ensure that the technology is in line with the demographics of the employee population.
Food and fitness trackers are often digital tools coaches use with clients to bring greater awareness to health behaviors. In any consumer product it is well known that engagement is dependent on the user’s emotional experience. In the case of health-related apps, two separate studies found that the level of personalization correlated to the longevity and success of the user. The first study, Asimakopoulos, Asimakopoulos, and Spillers (2017) qualitative research on motivation and user engagement with JawBone and FitBit, concluded that “users’ motivation and self-efficacy are highly dependent on successful data, gamification, and content design of the apps as well as sensing context and providing appropriate motivational feedback to the user” (p. 10). Interestingly, the digital technology has the power to contribute to behavior change. Applying the model of SDT, it is clear why wearables coupled with a coaching aspect to the experience improved engagement. Seeing the data provides the user with a sense of control; mastering the gamification aspects incorporated into the wearables provides a sense of competency; and in receiving personal feedback, the need for relatedness is filled and motivation is unleashed.
The second study, a retrospective analysis of digital coaching in weight loss, found that there was greater weight loss success when participants received personal food log feedback in between weekly coaching sessions (Painter et al., 2018). This finding indicates that the technology of the digital health provider should include a way for the coaches to be interactive with the technology to facilitate greater participant engagement with the program and healthy behaviors. The user’s experience in receiving consistent feedback can encourage greater participation.
Recommendations for Improved Engagement
Based on the evaluation of company culture, financial incentives, and UX, the recommendations for organizations and providers to improve employee engagement with digital health coaching programs are:
· Build participation in wellness programming into performance reviews.
· Incentivize managers to lead team challenges like sleep, steps, or consecutive days of tracked food.
· Eliminate all sodas and conventional packaged snack foods. Replace with readily available bowls of fruit and bottled water.
· Hold regular biometric screenings followed with personalized feedback from a behavior coach.
· Provide incentives for healthy behaviors, not outcomes, like number of coaching sessions attended, time spent in exercise, consecutive days of tracking.
Providers are recommended to prioritize meaningful and personalized coach-client interaction.
Transformation
Transformation can be defined as a simultaneous emotional and behavioral evolution that steps from greater self-awareness, is accelerated and possible when there is a trusting relationship (Scheepers, 2015). A trusting relationship allows the client to be vulnerable and go emotionally deep enough to uncover blocks to better health. Before sustained external transformation like weight loss, new habits, smoking cessation, etc., can occur, awareness and expression of the whole self must take place (About Whole Person Coaching, 2018).
Whole Person Wellness Web
The whole person wellness web is a tool that all workplace wellness providers can incorporate to facilitate transformation in individuals. It provides an inventory on every aspect of a person’s life and allows the whole person to be honored as a system with interrelated parts and not just a symptom or an illness. The traditional paradigm in the West has been to treat many illnesses or diseases as isolated issues, as seen in the case of obesity. Obesity is often addressed as a weight loss issue, so the lap band surgery emerged as a solution. While this procedure may lead to short term weight loss, it fails to address the whole person and all the aspects of the individual’s life. Consequently, it is not uncommon for lap band patients to binge eat, fail to incorporate exercise into their daily life, and lack other lifestyle behaviors that are needed to sustain weight loss (Snyder, 2009). While the example of the lap band is an extreme case, for true transformation to occur in any chronic personal health issue, especially weight, an individual must become aware of the interrelatedness of the core aspects of their identity so that the areas that are dissatisfying or dysfunctional can be elevated to new standards with strategic goal setting. Life coaching programs and corporate wellness coaching companies like Well People employ the whole person wellness web as the foundation of the coaching relationship to guide their clients through the process of reconstructing areas of life that are inconsistent with the individual’s objectives (Employee Wellbeing, 2018). The web’s components can vary between coaching providers and workplace wellness programs offering weight loss coaching. A tool that can help the coach and the client become aware of a person’s entire self is the operative component for enhancing transformation. While there are countless approaches in coaching, without a tool to help the individual gain a broader perspective, the weight loss initiative is limited to guiding the individual through surface issues. Consider a simple example of how the web can enhance weight loss coaching; if an employee buys healthy groceries and starts to walk a few times a week, but their career satisfaction is low, they may end up finding themselves at the drive-thru after a stressful day as a way to self-soothe, and in turn sabotage weight loss efforts. Simultaneous with healthy behavior changes, a coach can help the client set goals to improve any areas of life that are disempowering and provide the accountability that is needed to support whole life transformation necessary to achieve long-term weight loss success.
Integrating Mind Body Practices
Mind body practices are a diverse group of techniques that are designed to create a simultaneous shift in consciousness and health. They are either administered by a practitioner or practiced individually. Examples of mind body practices are acupuncture, meditation, energy healing, Qi Gong, and yoga (Mind and Body Practices, 2018). Weight loss coaching programs may be able to enhance their transformational effect on individuals by incorporating mind-body medicine tools into the coaching curriculum. Because the coach and the client are often meeting either over the phone, video conference, or group video in corporate digital wellness weight loss programs, there are limitations on mind-body practices that involve touch or movement. The optimal mind body medicine tools to supplement digital coaching are imagery and hypnosis. Imagery and hypnosis can easily be incorporated into a coaching session as needed.
The biggest challenges to overcome for weight loss are different for each individual and are often a combination of emotional and environmental factors. Though the research is limited, existing studies on imagery and weight loss point to multiple applications that address different aspects of weight loss.
Imagery and its impact on stress and weight. A pilot study with obese Latino adolescents aimed to look at the relationship imagery has on biomarkers of obesity such as insulin levels, adiposity, stress, and behaviors such as physical activity and dietary choices, and compared it to a didactic lifestyle education intervention (Weigensberg et al., 2014). The imagery group participated in 12 45-minute guided imagery sessions that started with 10-15 minutes of describing and anticipating the upcoming exercise, 20 minutes of working with the insight into the actual imagery exercise, and 10-15 minutes of debrief. The imagery included focused breath and muscle relaxation, relaxed place image, physical activity image, fullness symbol, healthy eating, image, personal meaning of healthy eating and physical activity, working with resistance to healthy eating, transforming healthy habits, and looking ahead.
The results of the study reported an increase in exercise and a decrease in sedentary behavior in the guided imagery group compared to the didactic group. There was no change in insulin resistance or adiposity in either group. However, the stress reduction imagery led to a reduction in cortisol levels that Weigensberg et al. (2014) claimed iscomparable to other mind-body modalities. The study’s strengths are in the randomization and the experiment design to isolate imagery and its effects on stress and behavior change. Though this pilot was done with teens, the findings are worth consideration with adults enrolled in corporate wellness coaching programs. With no reported side effects, the potential benefit of using imagery to help reduce cortisol levels is promising in assisting individuals to develop greater self-care, relax, and allow for new behaviors and eventual weight loss to occur.
Imagery and food cravings. Food cravings can be triggered at any time and are often hard to manage. A coach has the option to talk and guide the client through a list of alternative behaviors or can apply imagery techniques that allow the individual to experience what it is like to actually resist the craving. The research is not conclusive on the latter, however it is worth looking into the study to examine how imagery can holistically impact an individual trying to lose weight with a coach. Andrade, Khalil, Dickson, May, and Kavanagh (2016) tested a theory-based intervention called Functional Imagery Training (FIT). The premise of FIT is that “vivid, highly valued goal imagery will cope with craving imagery and key decisional moments such as when we may choose between eating some carrot sticks or a chocolate bar” (p. 257). The experiment was intended to test if FIT could impact high calorie snacking, improve motivational cognitions and influence weight change. Forty-five participants started with an imagery practice task of cutting a lemon so that they could understand how all the senses can be engaged by imagery. This was followed by imagining the positive experiences they may enjoy if they reduced snacking for a year, accompanied by prompts to enhance sensory and emotional effects of the imagery. Each participant followed this episode by ranking their image from 1 (no image) to 10 (extremely vivid). Following the imagery, participants were asked what actions they could take to reduce their snacking and raise their confidence levels to do so and then imagined another time when they were able to control snacking or used self-control. They were guided through further imagery of getting started with their goal, working through challenges, re-rating confidence and then developing a concrete plan. The final part of the FIT intervention involved identifying a routine behavior so that they could attach a daily practice of imagery involving how good it would feel to be successful in being in control of snacking behavior. The imagery was enforced with setting reminders and taking photos.
The researchers took special care to use multiple layers of imagery to enforce and reinforce the feelings and emotions of what reduced snacking would feel like and the feelings of the outcome. That craving imagery is so powerful, the need for repetitive and consistent imagery that allows the imager to hold long-term goals in their consciousness seems imperative for success.
The results in a two week follow up in fact did show that following the FIT imagery practice, participants increased the frequency of motivational thoughts as measured by the MTF-D questionnaire, decreased snacking, and lost a moderate amount of weight. The weight loss is debatably due to the Hawthorne effect and would need to be reassessed over a longer period of time to understand if there is a true correlation. Despite the need for more robust research, the side effects of imagery are little to nonexistent and can “speak” to people in ways that words cannot, making it a valuable tool to facilitate transformation in a way that traditional coaching lacks. The advantage of imagery is that it does not require extensive training and costs nothing to utilize in a session.
Hypnosis and weight loss. Hypnosis often uses imagery techniques to access the wisdom of the unconscious mind in a focused and relaxed state to facilitate behavior change. Reid (2012) pointed out that for overeaters, the over-indulgent behavior at some point had a positive intention. There is a perpetual inner struggle between the desire to change behavior and the need to address the underlying issue that led to the compensating behavior of over-eating in order to feel good. Consequently, there is tension between the behavior necessary to lose weight and the over-eating behavior that fulfills an underlying emotional need. Hypnosis grants the over-eater the opportunity to get out of their rational mind and create new associations with food that can lead to weight loss. Though it is not clear what happens in a trance state that makes hypnosis successful, the suggestions made to the person under hypnosis are highly accepted. According to Reid’s (2012) research described in his book, Hypnosis for Behavioral Health, “The act of visualization, whether guided by another or self-directed, has been shown to be an effective means of enhancing smoking cessation and weight management” (p.109). Suggesting to an overweight person under hypnosis in trance that they can see themselves as a permanent non-overeater is helpful in adjusting their personal behavioral expectations. Hypnosis is an art form where the person doing the hypnosis must be attuned to language and images that create an environment for the client to enter a trance state and make subconscious connections. While it is a great addition to any weight loss coaching, hypnosis requires extensive training to do well. This uniquely transformational tool may help people who are stuck at some point in their transformation and need an alternative way to access their potential.
Coaching Standards and Ethics
The ability for people to transform is innate but it takes a skilled coach to tease out new perspectives to create impact on behavior change. Too often coaching programs are in the business of advice giving along with an accountability structure, and do not provide true coaching which can be defined as a partnership guided by thoughtful inquiry and a creative process to maximize the client’s potential (About ICF, 2018) . While advice giving can be helpful, it limits the client’s process of change. When a coach has the skillset to be able to ask deep questions and hold emotional and relational space for what comes up in the client, there is a greater likelihood for individuals to continue to engage in coaching sessions and to achieve their health goals..
Coaching is defined as a modality that seeks to produce action, accountability, and follow-through. The International Coaching Federation (ICF) philosophy of coaching as written by Williams and Anderson (2006) is as follows:
1. Discover, clarify, and align with what the client wants to achieve
2. Encourage client self-discovery
3. Elicit client generated solutions and strategies
4. Hold the client responsible and accountable. (p.259)
These tenets are best met when the coach is trained to witness body language, tone, and other non-verbal communication in order to understand what is underneath the words. In other words, the coach needs to perceive what is needed by the client and not being said. The coach’s developed intuition can also give clues to the coach for how best to bring awareness and ask powerful questions to the client so that they can uncover unconscious blocks and move forward. Without coach training, the coaching session may fail to dive deep and remain superficial in content.
Digital health coaching companies that employ nutritionists, trainers, or other professionals are undoubtedly having some success with helping people in the action stage of behavior change, and yet they are limited in their ability to help those who are in the stage of contemplation and preparation. The ability to uphold the second and third coaching philosophy of client self-discovery and client generated solutions and strategies requires specific coach training.
The ICF provides an industry standard and ethical code for a profession that is not regulated in the same way that other healing professions like psychotherapy and acupuncture are. According to the ICF website (www.coachfederation.org), there are three levels of coaching credentials that require the coach to complete a certain number of classroom hours at an accredited school, client coaching hours, mentoring hours, submission of a sample recording of a coaching session, and passing a comprehensive test. All ICF accredited coaches have demonstrated that they can coach in adherence to the following eleven core competencies (Core Competencies, 2018):
A. Setting the Foundation 1. Meeting Ethical Guidelines and Professional Standards 2. Establishing the Coaching Agreement
B. Co-creating the Relationship 3. Establishing Trust and Intimacy with the Client 4. Coaching Presence
C. Communicating Effectively 5. Active Listening 6. Powerful Questioning 7. Direct Communication
D. Facilitating Learning and Results 8. Creating Awareness 9. Designing Actions 10. Planning and Goal Setting 11. Managing Progress and Accountability
While coaching companies that employ non-certified coaches are not in violation of Cohen’s (2003) ethical model of nonmaleficence, respect for autonomy, and justice, the question of beneficence is less clear. If beneficence is defined as having the welfare of the individual in mind and to maximize the potential of self-actualization, do coaches need to be ICF certified? What are the consequences of employing non-certified coaches?
The authors of a study investigating the ICF core competencies (Griffiths, Kerryn, Campbell, & Marilyn, 2008) pointed out that it undermines the business of coaching to develop programs and hire coaches that do not adhere to a standard. Griffiths et al. (2008) stated, “One of the fundamental premises of coaching is collaboration. Yet until now the coaching industry itself appears to have been somewhat lacking in this essential quality” (p. 12). Coaching is without a doubt a valuable tool and is still finding its way into the mainstream. In order to be taken seriously, companies must hold themselves to a high standard so as to contribute to strengthening the validity of coaching. While not all weight loss coaching companies require it, there is a move towards better standardization, as seen by the recent International Consortium for Health & Wellness Coaching’s partnership with the National Board of Medical Examiners to accredit wellness coaches through an examination process and test. For the time being, digital health companies must create their own ethos and regulate themselves in the quality of their coach hires in a way that maximizes the engagement and transformation of the client and contributes to the efficacy of the coaching industr as well as adhere to the ethical standard of do no harm.
Recommendations
Given the issues examined in this paper, and in an effort to enhance transformation for every coaching client that enrolls in weight loss coaching programs through their employer, my recommendations for providers are as follows:
· Implement a tool that allows the coach to assess the whole person and gives the client new insight into all the parts of their life that possibly need their attention.
· Provide the client with new ways to access insights and self-awareness. Integrate imagery into the coach toolkit to give clients a way to utilize parts of their brain that can lead to accelerated healing.
· Utilize hypnotic techniques in coaching. It is not economically feasible for every coach to be trained in hypnosis, so offer it as an add-on for additional fees.
· Employ coaches who hold an accreditation through one of the recognized coaching consortiums such as the ICF, IAC, or have passed the National Board of Medical Examiners.
Pursuing Self-Development
Coaching
In the coaching field, self-development and career development are hard to consider separately. As a life and wellness coach, I have the platform to model the power and results of living a wellness focused lifestyle with self-reflection, self-care, balanced eating, regular movement, and mind-body practices, not just for the people I coach, but the coaches I train, as well. As part of my self-development I am not only pursuing the Ph.D. in Mind Body Medicine, I am committed to continuing education with the International Coaching Federation (ICF). The continuing education classes with the ICF happen twice a month and address a range of topics from how to coach a racist (and looking for the racist tendencies within oneself), to how to market your business. Additionally, I trade weekly coaching with classmates from my coaching school. There are two great self-development benefits to this trade. The first is that I do not always think I have a topic to be coached on but because the session is scheduled, I force myself to look at what is most alive for me that day, even if it seems petty. Whenever I think that I have nothing to focus a coaching session on, I find myself at the end of the call feeling brighter, more optimistic and clear. The second self-development benefit of the coaching trade is that I get to consistently practice coaching technique following the ICF guidelines. Often in my daily work at the digital health company I work for I am not doing ICF style coaching or the coaching I am doing is modified for the weight loss behavior modification curriculum and resembles advice giving. Powerful coaching according to the ICF model, where the client makes radical perspective shifts, is a skill that must be cultivated and nurtured. When I eventually move from working in the digital health space to growing my own coaching business, it is important to me that my coaching skills be of the highest caliber and in line with the ICF model of master coaching. Self-development and career development are blurred in my process of continuing to move forward with coaching as a career.
Energy medicine
Reiki is another area of self-development that blends into career development. I discovered Reiki with one of my Saybrook classmates who is a Reiki Master. She trained me in level one Reiki after she recognized that my sweaty palms from hyperhidrosis were actually a powerful conduit for Reiki energy. Learning Reiki changed my negative perception of my sweaty palms into what I can consider a gift for healing. I will sometimes use Reiki with my clients that I see in person (as opposed to over video conference) and when I do, not only do I get feedback that they feel more relaxed, I can feel an openness in myself and a greater feeling of connectedness. A side effect of doing Reiki is that I sometimes receive images about the person I am doing Reiki on and then when I ask my client about what I have experienced, the images make sense to them. When this happens, it reminds me that life and reality are more than what is occurring in the physical and that my intuition is a powerful tool that deserves to be cultivated similarly to my intellectual studies. I realize that I have only scratched the surface with level 1 Reiki and plan to do the next two levels of Reiki training not only for my own development, but also so that I can offer distance Reiki to clients that I meet virtually.
Honoring My Self-Care
Self-care has always been a priority in my life and I plan to maintain this value. For me self-care involves daily movement, healthy food choices most of the time and not-so-healthy food sometimes, a daily meditation practice, weekly salt-baths, acupuncture, and body work. With a tendency for routine and perfection, I have come to realize that self-care is more than going through the motions or checking off a box on my to-do list. Self-care is also honoring the cycles we find ourselves in at any particular point in time and being kind to ourselves, always. This principle is something I must work to honor as I have the propensity to doubt and judge myself when I do not workout six times in a week, or feel like I need to be quiet rather than social. The desire to control my mood or what my body needs is the opposite of self-care. When I can practice living more from my body, allowing the flow of life to happen, and living less from my intellect, that is true self-care.
Conclusion
As a scholar-practitioner pursuing coaching in the developing industry of digital health, it is hopeful to recognize that the best practices for improving engagement and transformation are transferrable to many different types of wellness programs addressing chronic health issues beyond weight loss. Coaching programs have the potential to help people with smoking cessation, cardiovascular disease, stress management, drinking, better parenting, and overall higher quality of life. Employers have the ability to reach not just those who are ready for change, but those who need it and are not yet aware of it. While enterprises are occupied with ROI and financial bottom lines, I have the honor of considering what is best for facilitating change and improving the health of individuals with unique needs and challenges. It is crucial that I stay connected to my own growth and healing so that I may lead from experience and not just intellect and in a way that does not undermine evidence-based practices. Combining intuitive skills, research, and standardized practices to develop coaching curriculums and improving engagement is valuable not just for clients but for the industry of workplace wellness coaching to move forward.
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