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. 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.