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Delivering The Behavioral Side Of Lifestyle Medicine Through Wellness Coaching

If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” –Hippocrates 420 B.C – 370 B.C.

Healthcare providers have been prescribing lifestyle improvement for thousands of years. The evidence has been built from the observations of Hippocrates all the way to the neuroscience of today. We know, from mountainous reams of data, that lifestyle affects the course of an illness or health challenge. The challenge for the healthcare provider of today is to see the “lifestyle prescription” translated into lasting lifestyle change. Many well-intentioned healthcare professionals have attempted to educate and admonish their patients into losing weight, ceasing the use of tobacco, managing their stress better, getting more sleep, being medically compliant/adherent, etc. Seeing actual success in behavioral change happening far too seldom, many have abandoned such efforts and just reach for the pharmaceutical prescription pad.

In recent years, however, there has been an exciting movement in the field of medicine that looks at how to use “lifestyle interventions” as first-line treatment.

“Recent clinical research provides a strong evidential basis for the preferential use of lifestyle interventions as first-line therapy. This research is moving lifestyle from prevention only to include treatment–from an intervention used to prevent disease to an intervention used to treat disease.” –The American College Of Lifestyle Medicine

The Lifestyle Medicine Movement has done much to establish an evidence base and it continues to examine research that distinguishes what appears to work for lifestyle improvement. Much of its attention has focused on nutrition, but more and more the field is realizing the importance of health and lifestyle behavior.

Wellness and health coaching has become the delivery mechanism for wellness programs, and its potential for the same vital role is being seen in Lifestyle Medicine. The reality is that the vast majority of clients that most wellness/health coaches see are already health-challenged in some way. They may already have a chronic lifestyle-related illness, or multiple risk factors that set them up for needing serious preventative help. Wellness/health coaches that work for disease management companies, insurance companies and many corporate wellness programs are already working with caseloads populated primarily by lifestyle medicine patients.

At past Lifestyle Medicine conferences, I’ve presented on “Wellness Coaching And Lifestyle Medicine: Covering The Whole Continuum”. and “Delivering The Behavioral Side Of Lifestyle Medicine: Wellness Coaching Skills & Concepts”. Together with other presenters on wellness coaching we have experienced a strong positive response from an audience made up primarily of physicians.

TP-WPOne of the key concepts of my talks that was especially well received was the idea of how the Treatment Plan needs to be integrated with the Wellness Plan.

Co-creating a Wellness Plan with our clients is one of the primary tasks for the wellness coach. Together we work with a structure that insures the client’s plan for lifestyle improvement will lead to success. A key part of that Wellness Plan will always be the “Lifestyle Prescription” that the client’s treatment team is recommending. What is key is that the Wellness Plan supports The Treatment Plan.

I will be talking further about this concept in my forthcoming book on the more advanced skills and methods of wellness coaching, but here is a sketch of the two plans and the way they overlap.

Treatment Plan

  • Diagnostically Derived
  • Treatment Provider Devised
  • Prescriptive
  • Responsibility on Provider to administer, responsibility on client to follow
  • Usually does not accommodate patient’s circumstances or abilities, may accommodate patient’s capacities.
  • Problem solving, solution finding oriented
  • Purposed for resolution of illness and disease, reduction of symptoms, healing
  • “Lifestyle Prescription” focuses on recommended behavioral changes leading to Lifestyle Medicine outcomes
  • Dependent greatly upon medical compliance/adherence

Wellness Plan

  • Derived through exploration and self-assessment combined with treatment recommendations.
  • Co-created by “client” and “coach”
  • Non-prescriptive – client centered
  • Responsibility on client to follow with coach’s accountability and support
  • Not only accommodates, but is derived from client’s circumstances, abilities and capacities.
  • Designed to eliminate barriers and develop additional support
  • Possibility, growth and self-actualization oriented.
  • Purposed for behavioral change and lifestyle improvement
  • Includes assisting client with medical compliance/adherence

Overlap Of Treatment And Wellness Plans

  • The Wellness Plan (WP) supports the Treatment Plan (TP)
  • TP identifies critical areas for recommended lifestyle improvement
  • Through “client-centered communication” WP aligns with the goals of the TP
  • Client engages, with coaching support, in lifestyle improvement behaviors that positively affect treatment outcomes
  • WP helps client with organization, accountability, etc., improving attendance for medical appointments and management of medications, self-testing/self-care
  • WP helps client make best us of medical appointments (self-advocacy)
  • WP helps client report more accurately to treatment team about changes in lifestyle behavior (providing more data for treatment decisions)

When clients are operating on a Wellness Plan that they have truly helped co-create with their own buy-in, the opportunity for weaving in Areas of Focus, Goals and Action Steps that support what their treatment team wants to see becomes obvious. Clients then have the structure and support they need to carry out the goals of the Lifestyle Prescription.

Physicians and other healthcare providers can already start making use of wellness and health coaching as a delivery mechanism for the behavioral change they would love to see. Many of their patients already have wellness coaching as an employee benefit. Their company’s wellness program may already provide it, or they may contract with a wellness coaching provider company. More and more employees have wellness/health coaching available through their insurance provider.

Wise medical organizations and practices are hiring wellness coaches to become part of their staff or are outsourcing to them. Healthcare providers are sometime “wearing two hats” and combining their treatment work with coaching. Others are becoming more “coach-like” in their interactions and are then handing the patient off to the wellness coach for the longer process of lifestyle improvement.

The Real Balance Wellness & Health Coach Certification curriculum (http://www.realbalance.com) has included how coaches fit into the Lifestyle Medicine approach for over a decade. Our students come to us as a resource for learning how they can help deliver the lifestyle improvement that their Lifestyle Medicine clients seek.

Wellness Coaching to support Lifestyle Medicine is not just an idea whose time has come, it has already arrived!

Originally published on Real Balance blog. Reprinted with permission.


Dr. Michael Arloski is the CEO and Founder of Real Balance Global Wellness Services, Inc. (www.realbalance.com). Real Balance has trained thousands of wellness coaches worldwide. Dr. Arloski is a board member of The National Wellness Institute, and a founding member of the executive team of The National Consortium For Credentialing Health and Wellness Coaches. He is author of the leading book in the field of wellness coaching: Wellness Coaching For Lasting Lifestyle Change, 2nd Ed.

helping climb

Motivation Plus Mobilization: Coaching For Success At Lifestyle Improvement

“I just don’t seem to have the motivation to really make changes.” This is a lament frequent to the ears of health and wellness coaches. Our clients are often puzzled by a lack of success in their efforts to start living a healthy lifestyle, or keep such efforts going. They blame it on either a lack of motivation to get started, or that their motivation fades as old habits reassert their rule.

Coaches help their clients examine and re-examine whatever sources of motivation they have mentioned. They help their clients revisit their desire to change and what drives it. They look at fear-based motivations such as not wanting to have an illness get worse, or not wanting to develop the maladies that have been prevalent in their family. They look at the love-based motivators like caring enough about ones self, wanting to be there for their grandchildren as they grow up, the intrinsic joy of dancing, swimming, tasting delicious and nutritious food, etc.

Perhaps the coach concludes, like their client, that these motivators just ‘aren’t enough’. The next step is to begin a usually fruitless search for additional motivators. Their client runs out of ideas and coaching descends into ‘what about this?’ suggestion after suggestion. What is really going on? What’s a more productive avenue to explore?

Your client may have enough motivation. They may in fact, have listed three, four or more reasons they want to change. They may possess a terrific combination of motivators. Motivation is like the fuel for a vehicle to run on. The problem might not be the fuel, but the lack of an actual vehicle! The vehicle is a methodology, a structure, and a process that facilitates change. To get where they need and want to go, the client needs both a vehicle to carry them and the fuel to put in it.

How do we mobilize motivation? By providing our client with methodology. I’ve always been amazed at how simple successful change can sometimes be when clients have a well-developed way of achieving it.

Coaches often hear their client’s frustration at wanting to improve their lifestyle, but not having much of a history of success at it. If we inquire if they have ever started their change efforts by first taking stock of their health and wellness in a really clear way, we find they rarely have. If we ask if they have ever begun by first developing a thorough plan as to how they will make their changes happen, we often find them admitting that they usually just get their will powered amped up and set some sort of goals. Rarely have they ever carried out their change efforts with the help of an ally who helped them with support and accountability. And, all too seldom have they ever keep track of their efforts at change and actually written it down.

A mentee of mine was recently coaching a middle-aged woman who complained of a lack of motivation holding her back. As we began listening to the recording, the coach helped the client describe at least four strong motivators that had propelled her into action. She realized that when her children were younger playing with them had provided her with more activity and energy. Now her energy was low and she wanted to reclaim that. She also talked about hoping for grandchildren and wanting to be a very active part of their lives. The client was concerned about her advancing age and not wanting to lose the health she had. She didn’t want to become a burden to anyone. She went on to list at least two more motivators.

As the client described her lack of success at change, her conclusion was that she was just lacking motivation. She described coming home from work tired and just fixing a quick (though not necessarily healthy) meal and watching television in the evening. “I just don’t have the motivation I need” the client lamented. She intended to be more active and intended to eat better. All she had for a plan were intentions.

Doing a great job of coaching, my mentee gently confronted his client and recited the substantial list of motivators that she did, in fact, have. He questioned whether it was a ‘lack of motivation’, or something else that was missing.

Clients try to figure out what is keeping them stuck. Unless it’s a matter of identifiable internal or external barriers, clients often say it’s a lack of motivation. They are looking for an explanation and, frankly, they often don’t know what else to call it.

Co-Creating The Coaching Alliance

An often ignored part of coaching is the work it takes to Co-Create The Coaching Alliance. In addition to getting acquainted with our client and hearing their story, an important part of our first session with a client is to convey to the client just how coaching works. Clients are used to meeting with consultants, not coaches. They expect to be able to provide the consultant with lots of great information and hear the expert recommendations. We spoke about this from the coach’s point of view in our blog post, Making and Maintaining The Shift To The Coaching MindsetThe client also needs to make a mindset shift to get oriented to this new way of working with someone.

Coaching is about co-creating agreements. We co-create with our client agreements about how we are going to work together. Some aspects of our working together are negotiable and can involve compromise. However, we are not going to compromise the nature of our coaching relationship. That is, we are not going to agree to just be our client’s educator, and let go of the role of coach.

Part of what an effective coach does is to explain, in a succinct fashion, exactly how coaching works, how it is structured and what the benefits of this structure are. The client-centered nature of coaching is conveyed with real reassurance that the client remains the one in the driver’s seat.

Part of the coach’s job is to facilitate the client’s use of the coaching structure. The coach does this by showing the client how advantageous it can be to operate with a solid plan, to track one’s progress at making changes, etc. The coach provides tools that make these processes easier. Mobile apps for tracking can be recommended and then, importantly, integrated into the coaching accountability.

Mobilizing Motivation

Motivation can be puzzling and elusive, but when it is present a methodology, a structure, is what the client needs in order to mobilize it. By providing our client with the vehicle, we help them get where they want to go.

Word Origin – Coach: In the 15th Century the Hungarian village of KOCS was the birthplace of the true carriage or “coach” as the word evolved in English.

In other words we might define both types of coaches as: A coach takes you from where you are at, to where you want to be!

Originally published on Real Balance blog. Reprinted with permission.


Dr. Michael Arloski is the CEO and Founder of Real Balance Global Wellness Services, Inc. (www.realbalance.com). Real Balance has trained thousands of wellness coaches worldwide. Dr. Arloski is a board member of The National Wellness Institute, and a founding member of the executive team of The National Consortium For Credentialing Health and Wellness Coaches. He is author of the leading book in the field of wellness coaching: Wellness Coaching For Lasting Lifestyle Change, 2nd Ed.

Doctor and patient

A New Code of Ethics For Health And Wellness Coaches: Healthy Boundaries, Part One

The old New England expression that “good fences make good neighbors” applies to the world of professions as well as it does to rows of piled rocks in the old fields and forests of places like Vermont and Maine. The concept of professional boundaries seems to expand the more you look into it. In this and a following post we will look at role definition, ethics and scope of practice, boundary crossings and violations, self-disclosure, and other issues from the unique perspective of the health and wellness coach.

Since its inception just over twenty years ago the ICF (International Coaching Federation) has developed a Code of Ethics which it revises on a regular basis. The ICF also maintains an Ethics Community of Practice where you can bring ethics questions and learn from presentations.

Law & Ethics in Coaching: How To Solve And Avoid Difficult Problems In Your Practice (2006) by Patrick Williams and Sharon K. Anderson houses considerably valuable information from the chief authors and other contributors.

With the development and growth of the field of health and wellness coaching, the question of ethics and scope of practice emerged with the realization that such coaches often face unique situations, sometimes interacting with the medical world, that require a fresh look. While the ICF Code of Ethics is to be embraced by all coaches, the need for something more became evident.

As an Executive Team member of The National Consortium for Credentialing Health and Wellness Coaches, I was honored to chair a committee last summer of extraordinary coaches who are part of our NCCHWC Council of Advisors.

Through our efforts “in August 2016, the NCCHWC created the Code of Ethics and Health & Wellness Coach Scope of Practice to serve as a reference for health & wellness coaches and faculty. The NCCHWC expects all credentialed health and wellness coaches (coaches, coach faculty and mentors, and students) to adhere to the elements and Principles and ethical conduct: to be competent and integrate NCCHWC Health and Wellness Coach Competencies effectively in their work.”

Please download the NCCHWC Code of Ethics and Health & Wellness Coach Scope of Practice here: NCCHWC Code of Ethics; NCCHWC Health & Wellness Coach Scope of Practice. You can also find copies of both documents in the Wellness Resources section of the Real Balance website.

Codes of ethics such as these serve as the primary guides to help form professional boundaries that we can adhere to. In Section Three of the NCCHWC Code of Ethics we find most of the references to boundaries. The most obvious boundary here is #23 – to avoid any sexual or romantic relationship with current clients, sponsor(s), students, mentees or supervisees. But, we also see in other items in this section, that much of the issue of boundaries also refers to creating clear agreements with our clients about the nature of coaching, how it works, confidentiality, financial agreements, etc. The client-centered nature of coaching is emphasized along with complete transparency, spelling out the rights, roles and responsibilities for all involved.

The issue of boundaries is more directly addressed in item #22. Hold responsibility for being aware of and setting clear, appropriate and culturally sensitive boundaries that govern interactions, physical or otherwise, I may have with my clients or sponsor(s). Here we are looking at how we create a safe environment for our client where they feel respected, comfortable and safe. While most individuals are at least somewhat sensitive to this in most social interactions, the coach must be especially sensitive about it because of the trusting nature of the coaching relationship. While not on the same level as clinical relationships, coaching clients must feel free to express themselves at a trusting level. The health and wellness coaching client who is attempting to gain insight about how they hold themselves back from being successful at weight loss, for example, needs to feel that they can reveal information about relevant feelings and experiences without feeling vulnerable. This shows up mostly in two areas, the appropriateness of touch, and self-disclosure.

While not inherently wrong, behaviors such as giving/receiving a hug from/with a client after a triumphant moment in coaching, may be misconstrued in its intention. For one client it may, according to some authors, “engender healthier relationships”, while for another it may feel like a boundary crossing, which other authors would argue, might “pave the way to a boundary violation.”  Coaches learn early on in their training to ask permission. Seeking permission first and respecting our client’s wishes can avoid such boundary crossings/violations. We avoid the pitfalls of assumptions and honor our client’s personal and cultural boundaries in this way.

Self-disclosure also has different boundaries in different cultures and with different individuals. We looked closely at this topic in a previous blog post “Self-Disclosure in Coaching – When Sharing Helps and Hinders“. We can remember from that post that coaches who do not self-disclose at all are not trusted, while those who disclose “too much” are thought to be incompetent. Our own self-disclosure, should never put undue pressure on our client to also self-disclose. Differences in culture, social class, family upbringing, etc. all can set very different boundaries around the issue of appropriate self-disclosure.

Originally published on Real Balance blog. Reprinted with permission.


Dr. Michael Arloski is the CEO and Founder of Real Balance Global Wellness Services, Inc. (www.realbalance.com). Real Balance has trained thousands of wellness coaches worldwide. Dr. Arloski is a board member of The National Wellness Institute, and a founding member of the executive team of The National Consortium For Credentialing Health and Wellness Coaches. He is author of the leading book in the field of wellness coaching: Wellness Coaching For Lasting Lifestyle Change, 2nd Ed.

Wellness Coaching & Heart Disease

Maybe The Last Heart Attack

Each year over one million Americans experience a heart attack, about one every thirty seconds. CNN produced a program recently about this that has everyone talking: Dr. Sanjay Gupta Reports: The Last Heart Attack. (watch the entire program while it’s archived here)

Following the odyssey of former President Bill Clinton and two more every-day Americans, Dr. Gupta introduces us to the work of Dr. Arthur Agatston whose method of screening for coronary calcium is considered one of the best predictors of heart disease. We’re also exposed to the work of Dr. Dean Ornish and Dr. Caldwell B. Esselstyn whose diet and lifestyle-based programs have shown recognized medical effectiveness at preventing and even reversing heart disease.

“Heart disease could be as rare as Malaria in our country if we put into practice what we already know,” says Ornish. Gupta asks “Could we see the last heart attack in America?” The program brings us excellent information about what we need to do, but hangs on the gigantic “if” in the middle of Ornish’s statement.

Doctor giving medicine to senior woman for arthritis painWhat we know is that medical check ups using the best testing methods available must be combined with successful lifestyle improvement. We know the formula. “Although people with a family history of heart disease are at higher risk, you can take steps to dramatically reduce your risk. Create an action plan to keep your heart healthy by tackling these to-dos: get active; control cholesterol; eat better; manage blood pressure; maintain a healthy weight; control blood sugar; and stop smoking.”  —The American Heart Association.

What they are recommending, is all about behavioral change.

The work of Dean Ornish has been widely accepted as medically legitimate for years, yet always qualified by mentioning that the probability of Americans adopting the lifestyle recommended is remote. Becoming a complete vegetarian, exercising regularly, practicing stress management skills and increasing social and emotional support is a tall order to say the least. Yet it works!Gupta’s report is telling us that change is possible, now we have to discover how.

Here are some suggestions for the behavioral side of preventing that potential heart attack.

1. Know about your current state of health, in detail. Don’t put off that check-up or blood-work, make a commitment to yourself to get it done.

2. Envision what you want your health to be like.


3. Ask yourself, “What has to change in my life for me to live that vision?” This creates a solid foundation for you to create the plan that you will follow to make your vision a reality.


4. Develop a wellness plan that has a series of small steps. Small steps overtime lead to large lifestyle changes.


5. Gather support for your plan. Share your vision and plan with the people you know who will be positive and encouraging.


6. Track your behavior. Avoid self-deception by writing down or entering on a phone app your progress.


7. Acknowledge and celebrate every success along the way to a better life.

For the person who has already had that first heart attack all of this information and the contents of “The Last Heart Attack” are especially important. Like David Servan-Schrieber says about cancer, there is a lot we can do about heart disease, and when we don’t let people know about the legitimate resources and information out there, we are giving them “false hopelessness.”

Diagram of healthWellness and health coaches need to know about this information as they help their clients explore their way forward towards a wellness way of living. Coaches need to insist that any client they are working with on health issues be under active medical care. Lifestyle improvement is no substitute for medical treatment. Taking on the more behaviorally demanding protocols of lifestyle improvement that Ornish and Esselstyn require may be incredibly easier and more effective with an active alliance with a wellness coach.

We know that people can be successful at improving their health if they can be successful at lifestyle change. Wellness coaching may be the bridge to span the huge gap created by the word “if”.


Reprinted with permission from the Real Balance Wellness Blog.

Michael Arloski, Ph.D., PCC is a licensed psychologist, Professional Certified Coach (ICF) and a Certified Wellness Practitioner. His work as a professional coach with Real Balance Global Wellness Services includes coaching people to achieve more of their potential in three areas: wellness coaching; leadership coaching; and mentor coaching of aspiring coaches.

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Pre-diabetes – A Wellness Opportunity To Help

There is an opportunity for wellness and wellness coaching to impact the lives of millions of people in a life-saving way. 79 million Americans are estimated to have a condition called pre-diabetes. Usually symptom free, without intervention they will develop full-fledged Type II diabetes within ten years and possibly endure physical damage to their heart and circulatory system along the way. Yet, according to the American Diabetes Association, if a person is successful at lifestyle improvement they can completely avoid the onset of diabetes 70% of the time.