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Are you ready for wellness coaching?

Some health care professionals are deciding that one-on-one help is called for to treat certain medical conditions

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By Jan Brogan
Globe Correspondent / January 2, 2012
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For a long time, Tania Cooper tried to ignore her health problems. She was upset by her rapid weight gain, but she didn’t want to believe she had high blood pressure, sleep apnea, or diabetes. “That’s what old people got,’’ she says.

She didn’t take her medication, and she refused to sleep with the prescribed apnea mask. The 34-year-old single mother of three girls says she put her health “on the back burner.’’

She became exhausted, anxious, and prone to headaches. One day she looked down at the scale and saw that the number had topped her pregnancy weights. “And I’d had really big babies,’’ she says.

Cooper, who was also diagnosed with polycystic ovarian syndrome, a hormonal imbalance often associated with weight gain, diabetes, and sleep apnea, found that no amount of dieting worked. She decided to try exercise and found Healthworks Community Fitness, a nonprofit health and fitness center, near her home in Dorchester. The center charges membership on a sliding scale and was able to hook up Cooper with a volunteer wellness coach.

That coach, Cooper says, changed her life.

Wellness coaching, individualized regular motivational sessions geared to helping people achieve better health and lifestyle goals, is not just for executives anymore. Much the same way that personal trainers made their way from the elite celebrity studio to a staple of the gym, wellness coaches are becoming increasingly accessible.

In a pilot program begun last fall at Harvard Vanguard in Chelmsford and Medford, wellness coach Heidi Duskey provides individual coaching to patients with weight and health problems at no additional cost. The idea behind the program, funded through a three-year grant by Blue Cross Blue Shield, is that it will ultimately improve and lower the cost of patient care, Duskey says.

Just last month, Medicare announced it would cover up to 20 sessions per year of intensive behavioral intervention for obese patients. Although the current parameters are restrictive, mandating that the service must be provided within a primary care doctor’s office, the wellness coaching industry sees this as a significant “foot in the door,’’ says Margaret Moore, co-director of the Institute of Coaching at McLean Hospital, and founder of Wellcoaches in Wellesley, a health and wellness training and certification program for coaches.

Even though the Medicare decision currently specifies that the sessions be provided by a doctor or nurse practitioner, Moore says it is an invitation for everyone in the field - including wellness coaches - to test new protocols and submit data.

She points to a randomized controlled study, published in November in the New England Journal of Medicine, that showed promising results when primary care doctors and wellness coaches worked together to tackle obesity. That study compared face-to-face coaching with both remote coaching (via telephone or Web) and a control group. The percentage of participants who lost more than 5 percent of their initial weight was 41.4 percent for those receiving face-to-face coaching, 38.2 percent for remote coaching, and 18.8 percent in the control group. Most significantly, the participants who received coaching had sustained the weight loss at two years.

What exactly is a wellness coach? At Wellcoaches, Moore’s certification program in Wellesley, trainees are expected to arrive with a background in fitness, nutrition, physical health or mental health and the curriculum includes studies in behavioral science and positive psychology.

But there are no set educational requirements in the industry nationwide, and anyone, from a vitamin salesman to an MD, can call herself a “wellness coach.’’ An October article in the Archives of Internal Medicine pointed out that because of “this inconsistent and ill-defined role, health coaching lacks a rigorous evidence base.’’

Moore says this is changing. She is on the leadership committee of the National Consortium for Credentialing of Health & Wellness Coaches, a group of more than 75 individuals and organizations in health care, including government agencies and academic medical institutions, that are working to develop national standards and competency testing.

On a recent visit with her client Tania Cooper, wellness coach Ashley Norwood came armed with a stack of paperwork that detailed the progress Cooper has made in the 18 months that they have been working together.

In that time, Cooper has lost 44 pounds. She’s gone from barely being able to walk her children to the bus stop to walking 15-minute miles on the treadmill. Her glycated hemoglobin and fasting glucose levels, both indicators of diabetes, declined to within a normal range, and her blood pressure has dropped.

Although an executive wellness coach may charge $200 to $300 per hour, there is a growing army of wellness coaches that charge between $50 and $100 per hour, comparable to a personal trainer or a massage therapist. Norwood volunteers her services to Healthworks free of charge as a means of giving back to the community, and later this month, she will lead a group-wellness class at Harvard Vanguard in Cambridge that will cost participants $10 per session.

Wellness coaching begins with a questionnaire, Norwood explains, in which clients are asked to prioritize what is important in their lives, including physical, emotional, and spiritual health. The client creates a “wellness vision,’’ along with as an honest assessment of motivators, strengths, challenges, and weaknesses.

“This is done together with me taking notes and prompting questions,’’ Norwood says. With that information in hand, she helps the client set various three-month goals that are broken down into more manageable weekly goals. Progress is supported by regular “check-ins,’’ in person or by phone, that are tailored to the client’s needs.

In terms of fitness, a weekly goal might be going to the gym just once during the week or trying a “yoga video.’’ In terms of diet, it might mean simply trying a new vegetable or reading a chapter in a book Norwood recommends to learn to eat mindfully.

Cooper says that initially she was interested only in losing weight, but the more she talked about her goals with Norwood the more she realized what mattered most was being healthy enough to raise her daughters. “I didn’t want to have the serious issues of an older person, and not be able to run up a hill.’’

Shifting the focus to health also made changing her diet easier. Cooper says that she had more success when she thought in terms of adding to her life, rather than depriving herself. She became interested in new, healthier ways to cook chicken and learned to experiment with foods like rutabaga, butternut squash, and tofu.

She also began taking her medication and using the mask the doctor prescribed her for sleep apnea. She started meditating every day and went back to school, and became an apprentice at a funeral home.

Coaching merely provides structure and accountability so that clients can achieve their own goals, says Norwood. “It’s not about me telling them what to do. Most people know what they need to do; they just can’t get themselves to do it.’’

Jan Brogan can be reached at janbroganbooks@gmail.com.

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