by Chris Kesser
With chronic disease on the rise, we simply can’t afford to continue doing the same thing over and over again. In my new book, Unconventional Medicine, I outline a new model of healthcare—one that relies heavily on allied providers like health coaches working alongside clinicians.
Health and wellness coaches are an incredible asset to any clinical practice and are an underutilized sector of the healthcare system. Health coaches support patients in making lasting diet, lifestyle, and behavior changes, free up physician time, and improve patient outcomes. From the health coach’s perspective, working collaboratively with doctors offers them a clear treatment plan and a meaningful and rewarding way to make a living. This article will discuss all of these topics and highlight the essential role that health coaches play in battling the chronic disease epidemic.
The ever-rising tide of chronic disease
When the conventional model of medicine was born, the primary causes of disease were acute infectious diseases: tuberculosis, typhoid, and pneumonia. The “one doctor, one cause, one treatment” paradigm was effective at restoring health.
Today, seven of ten deaths in the United States are caused by chronic disease (1). Consider the following statistics:
- One in two Americans has a chronic disease; one in four has multiple chronic diseases (2)
- 27% of children in the United States now have chronic disease (up from 13% in 1994) (3)
- By 2030, chronic disease will account for $47 trillion in healthcare expenditures (4)
Moreover, chronic diseases are often multi-factorial—the result of a complex interaction between genetic predisposition and several environmental factors. As of 2016, an estimated 85 percent of chronic disease can be explained by factors other than genetics (5).
Bad behaviors and the need for change
It’s evident that chronic disease is the single biggest threat to our health today. Moreover, it’s behavior change that is really needed to prevent and reverse chronic disease.
According to the CDC, the top five behaviors for preventing chronic disease include not smoking, getting regular physical activity, consuming moderate amounts of alcohol or none at all, maintaining a normal body weight, and obtaining daily sufficient sleep. Yet as of 2013, only 6.3 percent of Americans engage in all five of these health-promoting behaviors (6).
Why do only 6.3% of Americans engage in all top five healthy behaviors?
The reality is that behavior change is hard, and most people don’t know how to do it successfully. Everyone wants to get the most out of life. Everyone knows that eating junk food, remaining sedentary, and staying up all night aren’t good for them. Yet most people continue these behaviors anyway. They might try a drastic diet or exercise regimen, but these often aren’t sustainable in the long term. People need help making lifestyle habits that stick.
Physicians lack the time and training to implement behavior change
What about physicians? Can’t they help with behavior change? Unlikely. The average visit with a primary care physician lasts a meager 10 to 12 minutes—barely enough time to review the patient’s current medications, ask them about any new symptoms, and prescribe a new drug (7). It’s not even close to the amount of time necessary to assess their diet, behavior, and lifestyle; identify areas for improvement; and provide the support necessary for sustaining these changes. Even a Functional Medicine practitioner, who might spend 30 to 60 minutes with a patient, will be hard-pressed to instill lasting behavior change.
Moreover, most doctors, nurses, and physician assistants aren’t trained in behavior change. Instead, they are trained in the “expert” model of care, where they simply tell patients what to do and expect them to do it. This works when the patient is facing an acute health issue, but it fails miserably for long-term behavioral changes like managing stress, starting an exercise routine, or losing weight. For most people, information itself does not change behavior. Behavior change happens at home, not in the clinic.
Lastly, we simply don’t have enough physicians to make it happen. It’s estimated that we will have a shortage of 52,000 primary care physicians (PCPs) by the year 2025 (8). We’ll need PCPs to be focused on interpreting lab results, making diagnoses, and recommending treatment plans, not on primary prevention habits.
The role of health coaches
This is where health coaches come in. A recent review defined health coaching as “a client- or patient-centered process that assumes a working relationship/partnership develops between patient and [coach] to advance healthy lifestyle behavior change using tools such as nonjudgmental dialogue, goal setting, and accountability” (9).
In other words, health coaches can spend more time with the patient, walking them through ways to make behavioral changes last, and are often specifically trained in techniques like:
- Habit formation and reversal. Since only 6 percent of people engage in the top five health behaviors, reversing bad habits like smoking and forming new habits like eating well and getting enough sleep are the key to reversing chronic disease.
- Motivational interviewing, which encourages patients to link new behavior changes to their deepest needs and goals (for example: “I will change my diet and lifestyle because I want to live to see my grandchildren get married”).
- Positive psychology, which uses the patient’s strengths, rather than their weaknesses, to make behavior changes
Ultimately, coaches act as allies, helping the patient to build confidence and self-awareness, encouraging them to become their own health advocate, and supporting them in developing the skills to sustain new behaviors.
Plus, studies consistently find that health coaches improve patient outcomes and patient satisfaction. One systematic review concluded that health coaching was effective for patients with cancer, diabetes, obesity, and heart disease (9). These are some of the top chronic diseases plaguing our nation.
Can you imagine how much healthier we would be as a population if everyone was able to see a health coach once a week?