November 2013 Issue

Coaching Clients for Weight Loss — Incorporating Simple Techniques During Sessions Will Help Spur Clients to Success
By Laurie Beebe, MS, RD, LD
Today’s Dietitian
Vol. 15 No. 11 P. 40

Weight-loss counseling can be frustrating for both dietitians and clients. Telling clients that they must lose weight for health reasons or that they need to eat less and exercise more often generally produces little in the way of change.

However, when RDs relinquish their role as counselors and become coaches instead, clients often become active participants in their weight-loss program. They become invested in developing their own goals and action plans and are more likely to follow through and achieve the results they want.

The shift from counseling to coaching requires dietitians to learn new skills that are developed over time. A weight-loss coach listens more and talks less, asks questions in place of instructing, helps clients prepare for change, and offers strategies specifically designed for clients. Dietitians don’t have to use all the coaching strategies discussed here at once to help clients achieve weight-loss success. Using just one coaching strategy in your next session can help motivate a client and send him or her in the right direction.

Coaching vs. Counseling
Coaching involves being present, creating trust, partnering, and fostering accountability.1 Coaching is client centered, and it helps develop a better rapport with clients compared with counseling because it encourages them to get involved in the process of change. Coaches recognize that clients resist being told what to do, so they give clients freedom to make their own decisions.

In counseling, RDs advise or instruct to influence change, and the goals are counselor directed. For example, the dietitian selects handouts on portion control, label reading, and cooking methods before meeting with an overweight client. At the start of the session, the RD may tell the client what will be discussed and then instruct him or her on ways to reduce caloric intake.

But what if the client snacks throughout the evening on multiple single-serve portions of low-fat chips, cookies, and fruit juice? In this case, if the dietitian tells the client to change his or her eating habits, which aren’t the crux of the problem, the session won’t be effective. The client will sit and silently nod while the RD talks and directs the conversation. The result is poor rapport and communication, after which changes in eating habits are unlikely to occur.

In coaching, clients set the agenda. The coach asks open-ended questions about eating habits and behaviors, and allows clients to direct the conversation. The objective is to listen to clients, prepare them for change, and then assist them by eliciting an individualized plan that will work for them. When clients design their own plans with their own schedules in mind, they’re more likely to follow through. The RD as a coach is present to guide clients and ensure their plan is reasonable and nutritionally sound.

Who Benefits From Coaching?
Clients who will benefit most from coaching are those who take the initiative to visit a dietitian and are ready to make changes. They acknowledge they have control over their situation and desire a certain outcome. However, even those who initially resist change may transform the moment the RD stops telling them what to do and starts asking what it is they want, what it is they need from the dietitian, and what is possible for the clients to change that’s simple and involves taking small steps.

Coaching involves eliciting a plan to achieve a goal. For this to work, clients must know what needs to change. The issue of weight loss is ideal because almost everyone knows that high-calorie foods and sedentary habits must change in order to lose weight. The client has some knowledge of undesirable routines and some ideas about what dietary changes are more healthful. The RD as a coach helps clarify, direct, and support the client as he or she works toward identifying small and simple changes that will promote weight loss.

On the other hand, a person newly diagnosed with diabetes isn’t a good candidate for coaching because he or she doesn’t know what dietary and lifestyle changes are needed to maintain healthy glucose levels. The primary goal is to provide this information and ensure the client understands what’s required.

Starting With a New Client
With weight-loss clients, it’s important for RDs to schedule several sessions to begin working with them, monitoring goals, and tracking progress. Dietitians can use the first session to establish rapport and demonstrate to clients how small changes can make a big difference. Many clients who embark on a weight-loss journey try to change several habits at once and, as a result, failure often and quickly occurs. Once clients realize that small changes can add up and produce significant results, they’re more likely to relax and be more receptive.

Before the first session, send clients a questionnaire to complete and bring to the first meeting. The way they answer the questions will offer insight into their mindset and help you determine a starting point. One important question to ask is “What are five reasons you want to lose weight?” Typical answers include “to feel better,” “health,” “more energy,” “more confidence,” and “to look better.” The problem with these answers is that they’re vague. Clients can’t visualize something concrete that will dissuade them from eating a fat-laden dessert or crunchy snack when tempted.

The solution is to ask additional questions about why they want to lose weight. The real reason may be to wear shorts in public without feeling embarrassed or stop taking a prescription medication. Dietitians can say, “Tell me exactly how you’ll feel better when you lose weight” or “Tell me how you envision a typical day in your life once you lose X number of pounds.” These types of inquiries will help clients get a concise visual of what life will be like, how it will be better, and how they’ll feel. Clients can use these visuals when cravings strike or when they’re about to participate in an exercise class.

During the session, dietitians should discuss the stages of change (the Transtheoretical Model) with clients, which assess an individual’s readiness to adopt new, healthful behaviors that ultimately will effect change (click here for sample chart). Discussing the stages of change serves three purposes:

1. Clients may feel comforted knowing that it’s OK to resist changing habits, and that this doesn’t mean they’re destined to fail.

2. Clients may not be ready to make every change necessary for an optimal lifestyle, as demonstrated by the table, but making a few changes at a time shows they’re making progress.

3. Using the chart, clients can fill in an appropriate square with the date of their first visit, checking back periodically to note their progress with the current date in the applicable box (or boxes).

Clients will feel ready to make changes in more areas as they experience success with the good habits they’ve already adopted. Seeing entries move to the right side of the chart presents a visual demonstration that they’re moving forward.

Developing the Skills
As mentioned, switching from counseling to coaching requires learning a new set of skills: listening, questioning, and advising. The following is some background on each of these skills and strategies for putting them into practice beginning with your next session with a weight-loss client.

Listening
Listening creates a safe environment in which clients feel heard and dietitians discover what clients want. It helps establish a comfortable relationship, build rapport, and alleviate stress and frustration. While removing distractions and making eye contact are obvious physical signs of listening, there are purposeful listening skills that many RDs may not practice.

Thanks to the rushed nature of sessions and dietitians’ passion to explain reliable nutrition information, many attempt to inform clients as quickly and as much as possible to ensure they leave armed with all the information they need. In this manner, the dietitian is acting as counselor, directing the conversation and giving the client little opportunity to express his or her needs.

It’s best if RDs listen to what clients need and don’t make assumptions before they finish speaking. The shift to coaching requires dietitians to change familiar habits. To become more like a coach, practice entering a session without an agenda, try not to anticipate what clients need before they talk, and refrain from giving an immediate solution, which would mean you’ve stopped listening and started talking.

Perhaps two of the most difficult changes dietitians must make are to resist the urge to explain and advise during information gathering and to continue listening even when they disagree with their clients. For example, it’s usually difficult for RDs to hold their tongue while a client explains she wants to lose 40 lbs by the end of the month or says she wants to follow the new Paleo Diet. However, if dietitians immediately correct or advise (ie, tell), they quickly can ruin the chances of developing a good rapport and trust with the client, which are key to the coaching relationship. In time, the RD will be able to offer advice, but only after the client has been heard.

Questioning
Insightful questions prevent clients from giving RDs pat answers and help raise awareness. Dietitians can motivate clients to take action and make their own decisions based on their own answers. Forming the right questions can help provide information while also helping to resist the urge to give advice. The following guidelines can assist RDs during client sessions:

1. Avoid using the word “why.” Doing so implies that the client should do something. For example, the question “Why don’t you bring your lunch to work?” may cause resistance if clients feel they’re being shamed or told what to do. Asking the same question using the word “how” or “what” changes the tone. The questions “What keeps you from taking your lunch to work?” or “How would things have to change for you to prepare your lunch for work?” imply that a situation can be changed, not that the client is at fault.

2. Ask questions that move clients forward instead of those that seek to justify what went wrong. For example, “What can you try next time you’re hungry at 9 pm?” may prompt a solution, while “Tell me what you were thinking when you ate those cookies” focuses on what the client did wrong.

3. Don’t use “queggestions.” These are suggestions posing as questions, such as “What if you made your lunch the night before?” or “Could you keep a full water bottle at your desk?” These are ideas that may work for the dietitian, or someone else, and not necessarily for the client. The more open-ended the question, the more opportunity the client has to think of an answer that will work for him or her. Questions such as “How can you remind yourself to drink water more often?” or “What would be a convenient way for you to have water accessible?” leave the solution wide open. Clients can think of scenarios that may not occur to their dietitian, such as “Each time I hang up the phone, I’ll go to the water cooler and drink a cup of water.”

Good questions also help clients plan ahead. “What will you do if you get hungry after lunch?” or “When will you fit the two-mile walk into your schedule?” will ensure the client leaves with a solid plan, including strategies to circumvent roadblocks.

Advising
At some point, giving advice probably will be necessary when working with a weight-loss client. The goal is to advise without telling, correcting, or making the client feel as though he or she is doing something wrong.

In counseling, RDs tell clients, “You need to eat three meals a day for nutrient distribution and appetite control” and then maybe ask “Will you do that?” assuming clients believe it’s in their best interest. In coaching, information is dispensed objectively and in a way in which clients won’t perceive they’re being told what to do. The client still has the freedom to make his or her own decisions.2 Here are three key factors to effective advising:

1. Ask permission to share. According to Jennifer Corbin, a master certified coach and president of Coach U, a global provider of coach training programs, “Advice without permission is criticism.” Precede advice with a question such as “May I share my concerns with you about your decision not to exercise?” or “Would you like to hear some of the benefits of a food diary before you decide not to keep one?” Clients feel respected when dietitians ask permission to give advice. Clients feel as though they’re in control, and RDs have their attention before speaking.

2. Provide the facts without offering personal opinion. Instead of saying “I don’t like people to be on a 900-kcal diet,” say “Nutrient deficiencies, alterations in metabolism, and extreme hunger make a 900-kcal diet unsafe and unsuccessful for any length of time.”

3. Elicit feedback from clients once they’ve heard what you said. Ask “What do you think about including some carbohydrate foods in your diet now?” or “Does what I’ve said change your mind at all about skipping breakfast?” This allows clients to share where they stand on the subject. Dietitians can better judge how to proceed, and it shows they’re considering their clients’ input.

Wrapping Up the Session
At the close of each meeting, ask clients what they’ve learned, what they’ve realized, and what they plan to change or work on over the next week or two. These questions will remind clients of the action steps they’ve proposed and how much information they’ve gathered. Arranging the next session at this time also is helpful to ensure there’s a follow-up appointment.

Shifting Gears
The most common question asked by dietitians who are considering coaching is “Where will I find all this time to listen and for the client to talk?” The answer is that RDs will spend less time talking as the client talks more, so the time they spend in sessions will even out in the end.

Practice listening more and get familiar with questioning and advising in daily interactions with family and friends. Ask your teenager “What would it take for you to do your homework before dinner?” Or ask a coworker “May I tell you what steps to take to better prioritize your workload?” If RDs put themselves in the navigator’s seat instead of the driver’s seat, they still can prevent clients from veering off track. The difference is that clients will take the trip at their own pace along the route most familiar to them.

Dietitians can’t go wrong by listening more, asking questions, and asking for permission before giving advice. Shifting from counseling to coaching quickly will develop rapport as clients feel more heard and empowered. Clients will be more likely to follow through with the action plans they helped design and be encouraged to make and keep more follow-up appointments as they work toward achieving their weight-loss goals.

— Laurie Beebe, MS, RD, LD, is a trained personal coach who coaches clients and mentors dietitians by telephone from her home-based office in O’Fallon, Illinois (www.mycoachlaurie.com).

 

References
1. Coach U. The Coach U Personal and Corporate Coach Training Handbook. Hoboken, NJ: Wiley; 2005.

2. Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change. 2nd ed. New York, NY: Guilford Press; 2002.

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