Health and Wellbeing Coaching in Primary Care

Article | Caroline Haines, Health and Wellbeing Coach at East Merton PCN

“This is the best thing I have ever done” said James (not his real name), a patient who was referred to me for obesity.

He couldn’t believe how well he had done. He was so happy and proud of himself, and his confidence was soaring.

I find it a privilege to hear people’s stories and help them on their journey to better health. James also had longstanding depression and anxiety and hadn’t really left the house for a number of months. His goal was to lose weight.

The first couple of changes he decided to make were to stop drinking alcohol and to stop snacking in the evening. Over the course of a couple of months he made many more changes.

James improved his diet by adding in some vegetables, increasing fruit intake, and removing takeaways.

He also added in some exercise. He started off by walking up and down his garden. This snowballed over time as his confidence grew and the last time I saw James he told me that he was jogging three times a week and also playing football with his friends.

He said he couldn’t believe the things he is eating now and the weight that he has lost (over 13 kg so far!). He has also realised that he is having far fewer down days which is contributing to a happier life.

The health and wellbeing coach is there to provide patients with the tools, knowledge and skills to manage their own health.

The majority of my patients (around 70%) have conditions that could be improved with weight loss. Or they might be at serious risk of developing conditions (such as diabetes) unless they lose weight.

I also see people with mental health challenges and some patients who want to give up smoking or alcohol.

Health and wellbeing coaching is a relatively new role which has been introduced under the personalised care umbrella. The aim is to help those patients with long-term conditions to become active participants in their own care.

Health coaching is a very different relationship to that of a doctor: patient. A doctor tells the patient what is wrong and how to fix it.

A coach asks the patient what they want and then we listen to their story: how they have got here, what obstacles are keeping them stuck, and what they would like to experience instead. In between sessions, the patient decides what changes they would like to make in order to get closer to their goal.

Coaching really works, especially with people who are really struggling to lose weight, because we get under the skin of why someone is eating in a particular way.

So instead of treating the symptom (e.g. overeating), we will try to address the underlying cause (which might be a negative belief they hold about themselves – such as “I’m not good enough” or “My family is fat therefore I will be too” etc). How we eat is nearly always wrapped up in emotions and how we are feeling.

Most people I see have been dieting their whole lives. They list off all the different diets they’ve been on or tried. Usually they are tired and exhausted of trying different eating plans.

The usual dieting routine goes:

1. deprivation (you can’t eat sugar or fat or whatever that particular diet dictates)

2. utilise all your will power

3. cancel any social events so as not to have any temptation

4. lose weight

5. feeling like it is too much hard work

6. go back to how you used to eat

7. put weight back on.

What I do is to help people to gradually change their habits. This means they are no longer relying on motivation. Motivation comes and goes so what we want to do is to create habits that last.

It’s like brushing your teeth in the morning, you don’t get out of bed and question whether you have the motivation to brush your teeth or not, you just do it. And that’s what we want to create with new habits around food, exercise, sleep and stress.

Coaching examines the mindset and the beliefs that we all hold about ourselves. There are many diets online that someone could follow if they didn’t know how to eat in a healthy way. But a lack of information is hardly ever what the problem is. If we have a belief about ourselves (that we are not good enough, pretty enough, skinny enough etc), what we’ll do is look for evidence everywhere that we are right because it is human nature to want to be right.

For example, I have a patient, Erin (not her real name), who has strong feelings of inadequacy and when she is feeling down she will binge on sweet foods. While Erin is bingeing, she says she knows she doesn’t want the food, but she’ll eat all of it anyway because she thinks she’s a failure and these actions (eating Easter eggs late at night) are confirmation to herself that, yes, she is indeed a failure. It is possible to challenge these beliefs slowly.

In the first session, I asked Erin to write down how she was feeling whenever she got the urge to snack. If she wasn’t hungry, then I wanted her to notice what the feeling was (boredom, sadness, anger, resentment etc), to sit with the feeling, and then go and do something that she enjoys like reading a book or going into the garden. This created a new coping mechanism when she was feeling negative.

Erin came back 3 weeks later. She was so happy when she came to the next session as she hadn’t binged once. She couldn’t believe how well having awareness worked for her. She lost 5 kgs in 3 weeks.

Health and wellbeing coaching in East Merton has taken some of the pressure off GPs and has ensured that patients are being seen by the right clinician.

For example, a GP might see a patient over the course of many years, they might see their weight creeping up each year and their health declining.

The GP might give them information on why weight loss would be beneficial. But for many people this isn’t enough. They need a more personalised approach, and this is exactly where health and wellbeing coaching can help

Caroline Haines

Health and Wellbeing Coach at East Merton (PCN)

Caroline Haines works part time as a Health and Wellbeing Coach for East Merton Primary Care Network (PCN) in Southwest London. She is also a regional Health and Wellbeing Coach Mentor for London. Caroline lives with her partner and four children.

You can follow her on Instagram @carolinehainescoaching