Meet “Paula”. She is in her mid-thirties, a mid-level manager in a marketing department and internal coach. She has 2 kids, a husband and a job she really enjoys. Underneath that surface, she recently developed digestive issues that she could not ignore anymore. She went to some doctors, got some new nutritional plans and started to put them into her life. Her stomach started doing better and then she noticed her old pattern of loosening the reigns on those nutritional plans. She became worried as this pattern was familiar to her – one of struggling with her weight throughout her life. Even though she was happy about feeling better, she was not feeling energized about this new way of living and actually was self-sabotaging it because she didn’t feel as “ill” anymore. Her doctors were focused on her digestive issues and saw her as successful in their criteria. She, however, did not feel equipped nor confident that she could maintain this plan over time. In order to find an approach she could feel confident about as a long-term solution, she began working with a health and wellness coach.
Paula’s story of identifying some health problems and working on fixing them is our standard approach in our healthcare system. Unfortunately, what is becoming evident is that this approach alone is incomplete for creating a true long-term shift in our health and feeling of wellbeing.
A fundamental reason for this result is shown here in Dr. Travis’ Illness-Wellness Continuum.1
Foundationally, healthcare systems and practitioners are focused on identifying health risks and treating symptoms to prevent illness and disease (left side of continuum). The goal in this “illness orientation” is to alleviate symptoms of the illness and return back to “neutral” – neither ill nor well. When you consider that in 1900 the top 3 causes of death were infectious disease, it is understandable how healthcare managed with this orientation and treatment paradigm approach. Today, however, while we clearly still want to be illness-free, the “illness” orientation and approach are not sufficient for improving our health and wellness effectively, or sustainably. Why?
One key reason is the profile of our illnesses has changed since then. Instead of the infections of old, today we are mostly confronted with chronic disease. In fact, the CDC reports that 7 of 10 deaths are due to chronic disease and ~60% of adults have 1 or more chronic diseases.2 While genetics, environmental and social determinants are factors, there is widespread consensus and data showing we engage in various behaviors that actively pose risks to our health. These health risk behaviors are likely not surprising to you: smoking, use of alcohol, physical inactivity, unhealthy eating, lack of sleep and more.
Said simply: We, the human race, actively choose and engage in behaviors that significantly contribute to chronic disease – and chronic disease, is what’s killing us prematurely.3
Have you heard the phrase “sitting is the new smoking”? How many of us, or someone we know, have expressed feeling overworked with too many important commitments, reducing our sleep and increasing our stress? Even though we know, to some degree, about the result of our health risk behaviors we are consciously choosing, for the majority of us that knowledge alone is not enough to motivate us to take effective actions to create a result of us feeling healthy and well.
Why?
The underlying mindset of the illness orientation can only get us back to neutral, if you recall. Are you familiar with the Outcome and Reactive Orientations embedded in Bob Anderson’s work within the Leadership Circle Profile? If so, you may astutely be noticing a parallel between this “illness orientation” to the predictable pattern of the Reactive Orientation. Because the attention is on what we don’t want (illness) rather than on the greater outcome of what we do want (wellness), we predictably get episodic and short-term results from our behavior change efforts. 4
Shifting to a “wellness” orientation and defining that aspirational want can result in a more achievable and sustainable outcome of “wellbeing”, no matter where along the disease state spectrum we may be. This is true for us all – not just those classified as patients.
Here enters the pivotal role of a health and wellness coach (HWC). These coaches partner with clients who want to create lasting changes by evoking their vision, values and beliefs in order to promote their health and wellness, thereby enhancing their wellbeing. 5 The fundamental approach incorporates traditional coaching competencies with basic knowledge in a variety of health and wellness subject matter topics like nutrition, diabetes, heart disease, cancer, chronic disorders, anxiety and stress.
Dr. Travis’ Iceberg model of Health and Disease nicely depicts the layers of focus that health and wellness coaches uncover with their clients. Rather than stay at the tip of the iceberg addressing just the current state of health, they partner to dive beneath any illness classifications, environmental influencers, and/or potentially limiting beliefs standing in the way of achieving their desired state of health and wellbeing. HWC focuses on empowering clients to create lifestyle changes in their behavior, especially health risk behaviors.
This is why health and wellness coaches are increasingly being incorporated as important professionals and adjunct treatments within the healthcare continuum. A compendium of research exists supporting that HWC is a promising intervention for chronic diseases.7 Employers, insurance providers, diverse healthcare settings and mainstream influencers like Oprah are recognizing and acknowledging this new profession as vital in improving our global health.
Accordingly, the Health and Wellness coaching field has reached a new level of professional standardization. Beginning in 2017, the National Board of Medical Examiners (NBME), in collaboration with the re-named International Consortium for Health & Wellness Coaching (ICHWC) – began administering a national certification exam to professionally credential individual health and wellness coaches.5
What does that say to you about Wellness – and our search for it?
Wellness – the quality or state of being healthy in body and mind, especially as the result of deliberate effort.
If we asked our nation where it would rate itself from 1-10 in terms of its own health and wellness, it’s safe to say the rating is low. Consider also that chronic diseases and the health risk behaviors that cause them account for almost 90% of the nation’s 3.3 trillion in annual healthcare spending. In contrast, the other half of the population considered “well”, e.g. lacking a chronic disease and displaying low health risk behaviors, only account for 3% of our annual healthcare spending. 2 We have experienced an unsustainable rise in lifestyle diseases within the last century. In short – our nation as a whole is not feeling “well” and we are suffering a great economic, physical and emotional impact.
The good news is there is increasing conversation and awareness about this – not just between doctors and their patients, but in households, in companies establishing wellness initiatives and in communities leveraging population health approaches. The awareness is also growing that a focus on “wellness” must be taken by all, including healthcare professionals themselves. While these roles often focus on serving others first, a growing body of literature shows provider burnout is high and prevalent.6 Similar to the oxygen mask scenario on a plane, in order to provide effective healthcare to patients, healthcare professionals must also first put the figurative oxygen mask on themselves – and focus on their health and wellbeing – in order to best serve their patients or clients.
Health & Wellness Coaching is the change agent that shifts the culture and delivery of healthcare from dependency to empowerment.
Let’s come back to Paula. In working with her health and wellness coach and defining a wellness orientation for herself, she learned what underlying assumptions were keeping her from feeling empowered in the choices she could make in her own behaviors. She identified that “flexible and discipline” are a key polarity for her and how to leverage both upsides in order to keep her illness symptoms at bay within her new wellness orientation. She learned about her inner saboteurs, how to recognize when they show up, and how to work with them in order to experience overall wellbeing.
As we – individually and our healthcare system – continue to shift from an illness orientation to a wellness orientation, we have the real possibility of reducing our prevalence of chronic diseases and healthcare costs and transforming everyone’s state of health to one of wellbeing!
References:
- Travis, JW & Ryuan, RS (2004) Wellness Workbook: How to Achieve Enduring Health and Vitality, 3rd Berkeley, Toronto. Celestial Arts.
- https://www.healthitoutcomes.com/doc/chronic-disease-is-healthcare-s-rising-risk-0001
- https://www.cdc.gov/chronicdisease/about/costs/index.htm
- Anderson, RJ & Adams, WA (2016) Mastering Leadership – An Integrated Framework for Breakthrough Performance and Extraordinary Business Results. Hoboken, New Jersey. Wiley & Sons.
- https://ichwc.org/
- Compendium of the Health and Wellness Coaching Literature, American Journal Lifestyle Medicine
https://journals.sagepub.com/doi/full/10.1177/1559827617708562 - Olson, KD Physician Burnout – A Leading Indicator of Health System Performance? Mayo Clinic Proceedings. Vol 92, Issue 11, p1608-1611 (Nov 2017)