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BACKGROUND:
The continued rise of overweight and obesity in the population shows that
conventional treatments are not enough for the treatment of these diseases. New
strategies as health coaching focused on nutrition (called nutritional coaching) evince
their utility to complement the nutritionists' advice and maintaining behavioral eating
habits for a long term. There is already considerable number of studies supporting
the effectiveness of nutritional coaching. However it is necessary to define rigorously
what is nutritional coaching based on its strategies, which professionals can apply it,
and what kind of training is needed to achieve the skills that allow the performance of
quality interventions.
PURPOSE:
The primary purpose of this research is to review health coaching papers focused on
nutrition to assess the strategies used, the vocational training of the professionals
who execute the investigation, and the training in coaching that they received.
Impact on Coaching Practice
The result of our research aims to shed light on a concept that is becoming more used in
the field of health and nutrition in particular but which has not established a clear and
rigorous definition: nutritional coaching.
People who call themselves health coach or nutritional coach should be a health
professional with training in coaching.
With our research we make a wing called scientific community to make proper use of the
term, and ensure that professional get appropriate training to conduct an intervention from
the perspective of nutritional coaching.
In this way we can truly assess the effectiveness of coaching as an approach in the field of
changing eating habits, what the authors are fully convinced.
BACKGROUND AND PURPOSE
We found an absolute lack of rigor in the use of the term coaching. To perform an intervention with the coaching approach, the professional must be trained in this discipline. Nevertheless, most of the papers (57%) do not mention the training in coaching
that the investigators have received, although some of them (16%) specify other kinds of training in health behavior change as Motivational Interview and Counseling, as we show in Graphic 1.
The vocational training of the researchers is also important to be taken into account; in this line the results are shown in Graphic 2 and we can see that there is no uniformity in the vocational training of the person applying coaching. In 40% of cases this
information is not mentioned, often (16%) only indicates that the intervention was conducted by a health professional, and although dietitians are the most frequent (29%), diverse health professionals are referenced.
We found that in a 32% of papers the coaching strategies are not described, even though the term of coaching is used to refer their approach (Graphic 3). Focusing in the 19% of papers that specify properly the strategies used, a few are really well
detailed, but others just mention some of the strategies listed in the Table 1. It should be mentioned that many studies apply coaching by telephone, which makes it easier to implement and proves that is a valid way as long as the strategies used are well
specified.
What constitutes nutritional coaching?
Best practices in changing eating habits
Giménez-Sánchez Jaumea,c, Fleta-Sánchez Yolandab,c, Meya-Molina Albac
aUniversitat de Barcelona (UB); bUniversitat Oberta de Catalunya (UOC); cNutritional Coaching, experts en Nutrició
Graphic 1. Is the training in coaching mentioned?
Graphic 2. Is the vocational training of the professionals who
perform coaching mentioned?
Graphic 3. Is the coaching strategy mentioned?
METHODS
RESULTS
CONCLUSIONS
Identification
Acceptability
Inclusion
Articles obtained in
Pubmed:
113
Other sources
articles:
9
Examined articles:
122
Excluded articles:
54
Included articles:
68
We can consider it coaching
Just setting goals
Nothing mentioned
Based on other theoric models
Table 1: Identified strategies in successful interventions in controlling weight from nutritional coaching
approach
• Promoting awareness of the discrepancy between current and desired behaviors
• Assessing the benefits of change
• Helping patients connect with their values
• Providing information and sharing scientific data on the benefits of change
• Using communicative skills (empathic listening, use of open questions...)
• Setting realistic and achievable objectives to obtain small successes
• Showing confidence on patients
• Action planning
• Identifying and recognizing personal resources to overcome barriers: empowerment
Training in Motivational Interview or
counseling
ABSTRACT
DISCUSSION
On one hand, to conduct a nutritional coaching intervention a specific training in this discipline is necessary, taking into account both vocational training
and training in coaching. By the other hand, to ensure the quality of the intervention and make it possible to be replicated by other health professionals, it
is necessary to describe properly the strategies used. For example, many studies did not clarify the role of patients, do not define the methodology, or use
nutritional education as it was equal to nutritional coaching. Another example of the not proper use of the nutritional coaching concept is found in
interventions that declare to adopt the coaching approach and in which they just send motivational e-mails to the participants. Although this strategy is
useful as a complement, we do not consider it enough on its own to be regarded as an intervention from the coaching approach.
We would like to note that in several papers an incorrect translation to the Spanish language of the word coaching appears. Often it is translated as
education when they should keep using original concept untranslated, since it is not the same coaching and education.
The lack of standardization in the definition and operationalization of nutritional coaching, makes it difficult, if not impossible, to determine whether it is
certainly an effective way to focus on improving health eating behaviors and reduce the overall challenge of chronic diseases related to overweight and
obesity.
We encourage all the health professionals to do a rigorous use of the term coaching and describe in their papers the following information:
- Description of the coaching strategies followed during the intervention.
- The kind of training in coaching the professionals have taken to perform the intervention.
- Coaching tools used in the intervention.
- Intervention mode: by phone, one-to-one, in groups.
- Duration and frequency of sessions.
- Establish mechanisms for monitoring and evaluation to ensure the accuracy of the application of coaching in the area of health and nutrition in
particular.
- Use of tools for evaluating the competence in coaching of the professionals participating in the intervention.
- Use of tools to evaluate the quality and effectiveness of nutritional coaching.
OBJECTIVE: The increase in the prevalence of overweight and obesity has
become a cause of major concern because of its relationship with chronic
diseases. Conventional treatments are not efficient to change it. There is already a
considerable number of studies supporting the effectiveness of coaching in the field
of health. The primary purpose of this research was to define the concept of health
coaching in the field of nutrition, called nutritional coaching, by evaluating the
strategies used, the vocational training of the professionals who execute the
investigation, and the training in coaching that they received.
DESIGN AND METHODS: We made a literature research in PubMed and
Cochrane with different combinations of keywords related to health coaching and
nutrition. We found 113 results and nine studies by other sources from which just
68 met all inclusion criteria.
RESULTS: Most are interventions in which professionals have not received any
training in coaching, or not specified, the strategies implemented are not described,
but they used the term coaching to refer their approach. We have identified in our
research the following strategies in successful interventions: promote awareness of
the discrepancy between current and desired behaviors; assess the benefits of
change; connect the patient with their values; provide information and share
scientific data on the benefits of change; using communicative skills (empathic
listening, use of open questions ...); set realistic and achievable objectives to obtain
small successes; show confidence in the patient; concrete an action plan; help to
identify and recognize their personal resources to overcome barriers,
empowerment.
CONCLUSIONS: Our research shows that the use of the concept of coaching is
not always rigorous, and the methodology associated with this approach is not
explained in detail. We encourage all the health professionals to do a rigorous use
of the term coaching specifying their training and describing the tools and coaching
strategies used.
REFERENCES
1. Ball G, Mackenzie K, Newton M, Alloway C, Slack J, Plotnikoff R, et al. One-on-one lifestyle coaching for managing
adolescent obesity: findings from a pilot randomized controlled trial in a real world, clinical stting. Paediatr Child Health 2011;
16 (6): 345-50.
2. Edelman D, Oddone E, Liebowitz RS, Yancy W, Olsen M, Jeffreys A, et al. A multidimensional integrative medicine
intervention to improve cardiovascular risk. J Gen Intern Med 2006; 21: 728-34.
3. Gimenez J, Fleta Y. Coaching Nutricional, haz que tu dieta funcione. DeBolsillo. Penguin Random House Mondadori.
Barcelona, 2015.
4. Giménez-Sánchez J, Fleta-Sánchez Y, Meya-Molina A. Comunicación en formato Póster “Cómo incrementar la motivación del
paciente a través del Coaching Nutricional”. 3r congreso FESNAD. Sevilla, 2015.
5. Giménez-Sánchez J, Fleta-Sánchez Y, Lombarte-Plaza L, Meya-Molina A. Comunicación en formato Póster “Habilidades,
roles y metodología del D-N para trabajar desde el enfoque del coaching nutricional”. Premio al mejor póster electrónico. VI
Congreso Fundación Española de Dietistas Nutricionistas. Valencia. 2014.
6. Ma J, Yank V, Xiao L, Lavori PW, Wilson SR, Rosas LG et al. Translating the Diabetes Prevention Program Lifestyle
Intervention for Weight Loss Into Primary Care. JAMA Intern Med 2013; 173 (2): 113-21.
7. Mehring M, Haag M, Linde K, Wagenpfeil S, Frensch F, Blome J, et al. Effects of a general practice guided web-based weight
reduction program - results of a cluster-randomized controlled trial. BMC Fam Pract 2013; 14 (1): 76.
8. Pearson ES, Irwin JD, Morrow D, Battram DS, Melling J. The CHANGE program: Comparing an interactive Vs prescriptive
aprroach to self-management among university students with obesity. Can J Diabetes 2013; 37: 4-11.
9. Rimmer JH, Wang E, Pellegrini C, Lullo C, Gerber BS. Te l e h e alth weight management intervention for adults with physical
disabilities. Am J Phys Med Rehabil. 2013; 92 (12): 1084-94.
10. Sherwood NE, Crain AL, Martinson BC, Hayes MG, Anderson JD, Clausen JM, et al. Keep it off: A phone-based intervention
for long-term weight-loss maintenance. Contemp Clin Trials 2011; 32: 551-60.
11. Shrewsbury V, O'Connor J, Steinbeck K, Stevenson K, Lee A, Hill A, Kohn M, et al. A randomised controlled trial of a
community-based healthy lifestyle program for overweight and obese adolescents: the Loozit study protocol. BMC Public
Health 2009; 9 (1): 119.
Presented poster at the conference:
Coaching in Leadership & Healthcare 2015.
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
DIETITIAN
PSYCHOLOGIST
NURSE
PHISICIAN
PEDIATRICIANS
PHYSIOTHERAPIST
HEALTH
PROFESSIONAL
NOT MENTIONED
YES
25%
NO
57%
18%
0%
10%
20%
30%
40%
50%
60%
70%
yes
no
