Wednesday, April 23, 2014

Health Coaches - Bridging the Primary Care Gap

As I set foot into medical residency in July, one of my biggest concerns is the amount of time that I'll have to discuss diet, exercise, sleep, and stress with my patients.  My frustrations in medical school were the driving motivator to establish Sweat and Butter.  A physician is neither trained nor incentivized to promote lifestyle change in their patients.  Health coaches, on the other hand, have the training that the healthcare system currently lacks in preventing the nation's most expensive diseases.  Normally, I write lengthy pieces focusing on the science behind lifestyle change, but this time around I'm going to keep my post short and sweet. 

When Sweat and Butter speaks to groups of health care professionals (e.g. physicians, nurses, nurse practitioners, and physician assistants), the idea of a "quick fix" is the first thing that we feel compelled to dispel.  If you have ever tried to lose weight yourself, you know that it's more complicated than following a simple "eat this, not that" list.  Physicians and patients alike continue to exhibit silver bullet syndrome in their search for easy solutions to complicated, ingrained problems. 

The tendency to seek a quick fix is a big problem.  The willingness of health care professionals to treat symptoms pharmaceutically without simultaneously treating the underlying causes for their unhealthy lifestyle is a Gordian knot.  In many rheumatology clinics, for example, patients would prefer to continue to take strong, expensive medications for their joint pain and skin flare-ups as opposed to transition to a gluten-free diet in an effort to curb their symptoms. On the other hand, some conversation with patients around the barriers that they experience regarding cutting bread and pasta out of their diets might make this a less daunting task.  Pharmaceutical companies and health insurers have catered to an increasingly impatient population of sick people who have now come to expect a quick solution to their multi-faceted problems.  This is a positive feedback cycle with no end in sight, and, as the cost of treating obesity-related disease eclipses $200 billion annually in the coming years, we need to reassess our approach.

Sweat and Butter's approach to helping clients lose weight has several advantages over the typical support provided in an outpatient clinical setting.  

First of all, health care professionals don't have sufficient time with patients to fully elucidate a particular patient's obstacles to developing lasting, healthy habits.  On the other hand, our health coaches spend sixty minutes on average during their first session with a client. During this session, which we call a "health history", we direct our questions to unveil the client's fears and their preconceptions about what it means to live a healthy lifestyle.  We get to know every detail of the client's life as it pertains to their lifestyle goals. In the clinic, you simply don't have the time required to understand these barriers.  

Second, you can't bill insurers for the effort required to build deep relationships with patients. Currently, a few major health insurers cover health coaching, but the programs are usually insufficient.  At Sweat and Butter, several of our clients have come to us skeptical of health coaching because the coaching service provided through their health insurer was less than adequate.  It isn't the advice that is lacking; it's the approach.  An occasional, impersonal phone call isn't going to build trust or keep patients accountable.  Our coaches meet with clients in person or on an internet service like Skype every two weeks, enabling us to gradually develop a trusting relationship.  It is important to recognize relationship-building as an important aspect of behavioral change for your patients.  Once we have proven that personal health coaching is a potential means of reversing preventable disease, health insurers may improve compensation.  

Third, in the short time allotted to counseling patients, health care professionals are probably giving incomplete advice.  In preparing his presentation for the 2014 PaleoFX conference, a friend asked me to browse my entire medical school curriculum to gauge the amount of training that I had received on counseling patients in lifestyle change.  My search revealed a paltry three lectures, and they were outdated, focusing on BMR and "calories in, calories out" as opposed to the science behind behavioral change.  When health care professionals do manage to squeeze in some advice in the outpatient setting, it's hasty and generalized.  For various reasons, patients have begun to tune physicians and other health professionals out. Furthermore, because it is reserved as an after-thought in the outpatient setting, weight loss and dietary advice is met with defensiveness.  Is it any surprise that your patients return six or twelve months later without having lost weight or without having made any lasting changes to their diet?  It shouldn't be.  If an engineer fails to complete a task with a specific type of valve, for instance, the failure doesn't trigger her to think, "Oh!  Maybe I should just use two of these valves."  She is more likely thinking, "I guess that won't work.  Time to try something new."   Likewise, in an effort to motivate patients to change their lifestyle, you are using an approach that has failed time and time again.  Instead of continuing to blame your patients for their failure to practice a healthy lifestyle, let's change things up.

As health care professionals, it's time to admit that you need help in the area of lifestyle modification.  As medical school curricula attempt to accommodate the rapidly expanding field of medicine, the study of behavioral change is being crowded out.  Health coaches are a special breed that can connect with your patients in ways for which you have neither the time nor training.  At Sweat and Butter, we are collecting testimonials and data that lasting lifestyle modification is possible for even the most difficult patients.  

The advice that we provide our clients is similar to the advice that you are hopefully providing in your office, but getting patients to change their ways will likely require much more than that. Your patients need to be heard, and you need to respect the complicated nature of behavioral change.  Some of the obstacles that we reveal in our clients have nothing to do with diet and exercise.  In our practice, we work with clients on five factors: sleep, stress, movement, diet, and relationships.  Some clients seek weight loss; others are chronically stressed out and sick because of it.  Regardless of their goals, they need help in prioritizing their lifestyle to feel better.  

A cookie-cutter approach isn't going to work.  Health coaching is a resource that needs to be tapped into as a bridge between patients and their primary care clinicians.  At Sweat and Butter, we have an approach that has been proven through experience to meet your patients' needs between office visits.  We help to foster lasting, healthy habits by challenging clients to make small, realistic adjustments, one baby step at a time, which allows for sufficient reflection on successes and failures.  This is the missing piece in your efforts to motivate patients to live a healthier lifestyle.  If we collaborate, you will gain time, insurers will save money, and your patients may achieve lasting well-being.   

Nathan Riley is a 2014 MD candidate at Temple University School of Medicine.  He writes about food, movement, sleep, relationships, and stress in order to bridge the gap between his patients and evolutionary theory and clinical evidence. You call follow him on Twitter @BeyondtheMD.  He can be reached at  You can also connect with him on Google+. 

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Wednesday, April 9, 2014

A Mud Race: Your New Goal For the Summer

My legs were feeling stiff from the mud that was caking on my skin, making it uncomfortable to bend at the knee as I ran.  I knew what whatever lied ahead was going to test my strength, but I was determined to press on.  While on the trail I was able to assess my condition, and I realized that my bruised legs would be horrifyingly black and blue for days to come and the scratches that I had accrued were starting to sting.

I laughed a little under my breath as I jogged on: "Why I am doing this to myself?" I was surprised that my response was an instant and resounding, "Because it's not often that we get to play like this!"  It's true!  No matter how crazy some of the obstacles were throughout the Tough Mudder, I was loving life at every step.  Being outdoors, challenging myself mentally and physically, surrounded by friends and helpful strangers was a breath of fresh air.

I have never been an athletic person and even less of a competitive opponent.  My first Tough Mudder was an intimidating venture, because I thought that I was going to be the weakest link in the team, and I feared the embarrassment of failure.  It is important to physically prepare for these events so that you minimize the risk of injury.  At that time, I  maintained a relatively relaxed workout routine, though I by no means trained diligently for the race.  From the beginning I was supported by friends that assured me that it was going to be a day dedicated to team work and fun.  
Turkey leg, no manners and no cares

If you have ever considered the challenge of an obstacle course race, I highly recommend it! There are people of all different shapes and sizes that take the challenge, and the entire day is loaded with a palpable positive energy.  I was pleasantly surprised to realize that no matter what physical condition you may be in there are obstacles that can hit everyone's strengths and weaknesses.

I found it endearing when I came across a large beast of a man who was hesitant to start one of the obstacles.  The burly guy was nervous about crawling through an underground tunnel that was pitch black once you were inside.  I coaxed him in by telling him that I would follow closely behind him for support.  We both made it out on the other side and he gave me huge bear hug because I had helped him through his fear of confined spaces.  Thankfully we kept bumping into one another at other obstacles, and he was able to hoist me over huge walls that I could not do on my own.

I have a few of these under my belt now.  Without fail, I cry at the end of each race.  To be honest, I'm not exactly sure why I get so emotionally overwhelmed, but I do know that the entire day of activities exhausts me.  After a good 20 seconds of emotional release, happiness overrides and hunger proceeds!  It is important to fuel up after such rigorous activity, and let me tell you that the first meal after the event is a glorious, well-earned experience.  

My favorite parts of these kinds of events are as follows:

"Let's get weird"
* The only one you are competing with is yourself! - The challenges are fun and unique to test your abilities.  If you are unable or unwilling to do one of the obstacles you are free to walk around and skip it.  I loved feeling free  to laugh at myself during my failed attempts, and I relished  the feeling of success when I completed an obstacle.  I finally completed the monkey bars on my 3rd Tough Mudder, and I couldn't have been happier.  High-fives never felt so good! 

* You get to move your body like a kid again - I never realized how liberating it was to run, jump, crawl, swim, reach and stretch!  I was brought back to the feeling of recess where everyone just let loose and had fun.  I definitely had to push myself to complete the race, but I enjoyed the opportunity to move my body in ways that I do not do on a daily basis. 

* Camaraderie - The whole day is full of those connections that Sweat and Butter tells you to seek out. We explain the importance of being present and mindful with yourself and others. They are not necessarily life-changing interactions but having a the same goal as everyone else, people cheering you on and even simply acknowledging the people around you makes for a special environment.  

* The challenge - I cannot tell you enough how much self doubt I discovered during these events.  Knowing that I had all day to complete the course gave me some solace, but I had to counsel myself just to keep going. The course allowed me to take physical obstacles head on even when I knew that failure was almost a guarantee.  It was clear to me that, whether obstacles were physical or mental. overcoming that self doubt requires a first big step.  I have been able to translate that experience into many life experiences such as avoiding a big project that needs to be done at work where the pressure was too daunting to even get started.  This fueled many ah-ha moments for me throughout the day.  I enjoyed proving myself wrong over and over again by saying, "See you can do it!" 

If you have been curious about doing one of these events I suggest that you leave your reservations at the door and sign up!  Get a group of friends together and make it a bonding day for everyone.  You can dress up around a specific theme or just go in with the ultimate goal of pushing yourself past your comfort zone.  If you have been needing some extra encouragement, having a goal like an obstacle race is also a great motivator to get active and stay healthy throughout the process before the big day.

Curious? Get pumped!

**Disclosure: I am not writing on behalf of or for the Tough Mudder or any other obstacle races.  All opinions are my own, and these are personal stories of my experience with races. 

Stephanie Telep is a co-owner and health coach at Sweat and Butter.  She received her training at the Institute for Integrative Nutrition and holds a bachelor’s degree in Psychology from Duquesne University.  She hopes to help others make necessary changes in their lives while fostering a positive and healthy attitude.  She can be reached at

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