Bariatric Weight Loss

Considerations for the Health Coach

Living With Obesity

• Poor sleep• Waking up tired• Joint pain and stiffness• Easily short of breath• Embarrassment from sweating• Difficulty finding/buying clothing• Size of chairs, booths, desks, cars

Misunderstood Terms

Medical:• Obesity = BMI over 29.9

Social Understanding:• 23-52% of overweight and

obese women perceive themselves to be at a healthy weight

• Social push for “fat acceptance” can ignore medical risks

2000

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 2000, 2010

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2010

1990

No Data <10% 10%–14 15%–19% 20%–24% 25%–29% ≥30%

Causes of Obesity

Behavior Environment GeneticsPhysical Activity Culture EthnicityNutrition School food Family hx

Food “deserts” Health conditionsPhysical educationParents’ educationConvenience FoodsLack of resources for exercise

Medical Outcomes for the Obese

• Increased chances of death from cancer by up to 52% for men, up to 62% for women

• Also increased risk for: gallbladder disease, COPD, heartburn, high cholesterol, heart disease, HTN, OA, clinical depression, sleep apnea, CVA

• #2 medical cause for death, behind tobacco (2004)

Common Struggles and Consequences of Obesity

• Depression• Anxiety• Low self-esteem• Poor body image• Social rejection by peers• Poor quality of interpersonal relationships• Potential negative impact on academic outcomes• Unhealthy weight control practices• Binge-eating• Avoidance of physical activity• Co-morbid health conditions related to obesity

Common Barriers to Weight Loss

• History of failure with multiple “fad diets” or infomercial exercise programs

• Mixed media information• Lack of energy• Pain• Difficulty moving• Embarrassment

Stigma of Obesity

At the Workplace: less likely to be hired or promoted; more likely to be fired

In Education: peers and teachers rate obese students are less intelligent, emotional and more likely to have problems at home

Receiving HealthCare: Physicians are the second highest cited source of bias, MDs also recognize this

Healthcare for the Obese

• Fewer preventive health services and exams• Fewer cancer screening tests, such as pelvic

exams and mammograms• More frequent cancellation or delay of

appointments• Less time spent with the physician, less

intervention and less discussion with the physician

Weight Is Personal

2008 – 250.4 lbs 2009 – 147 lbs250.4 weight 147

40.4 BMI 23.7

53% body fat 26% 160/88 BP 92/60

50” waist 28”

104 fasting blood sugar 80

226 cholesterol 167

Each Phase of Weight Loss = New Social Challenges

0

50

100

150

200

250

300

Mental Response to Weight Loss

Fear of failure

Fear of not being able to maintain

Lost “fat” friendsGained “new” friends

"Wow, you still look good!”

Seeing results – get-ting excited! Re-searching every-thing I can Noticing differ-

ent treatment at work and in so-cial situations Everybody

wants to give their opinion

Benchmarks and Challenges

• New clothes• When people start to notice• Positive and negative comments• Adjusting to new lifestyle• Adjusting to not being perceived as obese• Adjusting to new social situations• Vacations? Birthdays? Celebrations?• Any stressor could potentially derail you

How would you feel if you lost 100 lbs?

• “I didn’t even know how miserable I was!”• “I never want to go back”• “I am so grateful every day that I did this”• “It was the hardest thing I’ve ever done”• “I can’t believe how much energy I have!”• http://bmisurgery.org/_live/

Where do I start?Information Overload to Consumers

• OTC Medications: Alli, Fat Burners, Raspberry Ketones, Green Coffee Bean, HCG

• Prescribed Medications: Phentermine, HCG injections

• Fad Diets: Atkins, South Beach, 500 calorie HCG diet, Cabbage Soup Diet

• Dr. Oz, The Doctors

• Infomercials: DVDs, exercise equipment, electronic toning devices

• Spa Treatments• Cosmetic Procedures• CAM: chiropractic, massage,

herbs, acupuncture• Gyms• Social media, blogs, apps• Hypnosis

Learning Curve of Weight Loss

• Recognize unhealthy behaviors• Substitute unhealthy behaviors• Prioritize daily schedule (exercise, sleep)• Learning needs: stretch, exercise, heart rate,

cooking, meal preparation, grocery shopping• Coping skills – stress, anxiety, boredom• What to do with extra time and energy?

*These are great topics for coaching calls!*

Surgery is Effective…When Lifestyle is Addressed too!

• Most insurance companies require patients to demonstrate physician-supervised weight loss before surgery

• Most insurance companies require lifestyle evaluations with dieticians and therapists

• Some surgeons require nutrition classes before and after surgery

• Some surgeons/hospitals offer support groups for patients and family members

Bariatric Surgery Statistics

Source: BMIsurgery.org

Co-Morbidity Improvement

Darker color indicates 100% resolution; lighter color indicates improvementSource: BMIsurgery.org

Post-Operative Bariatric Lifestyle

• Prescription for nutrition for the rest of their lives

• High protein• Vegetables and some

fruits only for carbs; generally 10g carbs daily

• Exercise prescription to walk every day!

• Complications• Weight gain occurs when

members “cheat” their diets, resulting in diarrhea or vomiting, and eventual stretching of their stomach back to the original size

• Patients often cheat with shakes, soda, ice cream

Coaching Obese Members

Remember:- They already know they are obese- They have probably tried dozens of diets in the past- They are already being criticized or judged for it- Exercise probably has a negative connation from

their past- Diet really is a 4 letter word!

Coaching the Pre-Contemplative Obese Member

“I Won’t”• These people don’t see a

need for change• Accept them right where

they are• No lecturing!• Build trust• Goal for the call is to be a

catalyst for change

“I Can’t”• These people want to

change but feel overwhelmed by barriers

• Help bolster their confidence for overcoming their barriers

• Help sort out real barriers from perceived barriers

• Goal is to impart hope for the prospect of change

Coaching Considerations for Pre-Contemplators

• Listen• Express non-judgmental empathy• Praise them for knowing their barriers• Help them sort out their barriers• Goal: decrease the emotional response and

increase the rational response to enable a catalyst for change

Contemplative = “I Might”

These members need:• To get in touch and stay

connected with their strengths, core values, and intrinsic motivation to change

• Need to find strong motivators

• Need to understand their barriers

Coaching Considerations• Empathy! Empathy!• Help clarify their vision• Brainstorm ways to

overcome barriers• Share information, relate to

the member• Goals will be thinking,

feeling tasks to resolve ambivalence

Preparation: “I Will”

These members need• Powerful questions to

explore their strengths• Help to discover, design and

experiment with their own ideas

• Strategies for barriers• Goals that will yield “quick

wins” to bolster self-efficacy• Identification of resources

Examples• What are you willing to do?• Why is this important to

you?• Review core values• Let’s brainstorm some

possibilities…• Who is supporting you?• Ask member to formalize

commitments

Action: “I Am”

Specific Client Needs• Confidence, energy,

commitment to help them stay on the path

• Explore new solutions to new challenges

• It is easy to slide out of the action stage and back into contemplative during times of stress

Coaching Considerations• “Cheerleader”• Support but challenge them• Achievable short term goals• Social support• Plan environmental cues and

support• Gradual change leads to

lifestyle change!• Do you need to plan for any

stressful events coming up?

Maintenance “I Still Am”

Specific Tasks• Self-image as a normal

weight person• Social/Cultural-identity• New challenges and

setbacks• Potential boredom and

discouragement

Coaching Considerations• Help them find new role

models, new goals• Encourage them to find

ways to help others• Finding new ways to reward

themselves• Early recognition of lapses• Establish social support

Common Struggles in the Maintenance Phase

• How do I transition my workouts from weight loss to maintenance?

• How do I plan new goals?• How in the world do I go to social events now?• “Oh, you’re so skinny, you can eat that!”• Adjusting to needing more/less exercise• “It was just so easier when I was heavy…”• Maintaining motivation – its not fun anymore.• New social challenges – where do I fit in?• Extra skin issues….

Coaching Surgical Members

• What motivated them to have the surgery?

• What’s going well with their nutrition plan?

• Are they taking advantage of support groups and classes?

• Are they aware of resources in their area?

• How are they doing with exercise?

• Are they taking advantage of discounted restaurants and fitness centers?

• What do they enjoy most about their new lifestyle and health?

Summary

• Obesity is a multifactorial epidemic affecting all ages and can be enabled by our culture, societal standards and busy lifestyles

• Many obese individuals do not recognize they are obese or their risk levels

• As health coaches, we need to be ready to meet them and support them at their stage of change and hopefully help prepare them for what’s ahead

Sources:

BMI Surgery (2014). BMI’s Surgery Results. Retrieved from http://bmisurgery.org/_live/includes/bmisurgerysresults.php

Centers for Disease Control and Prevention. (2013). Adult Obesity Facts. Retrieved from http://www.cdc.gov/obesity/data/adult.html

Moore, M. and Tschannen-Moran, B. (2010). Coaching Psychology Manual. Baltimore, MD: Lippincott Williams and Wilkins.

Obesity Action Coalition. (2014). Understanding Weight Bias and Stigma. Retrieved from http://www.obesityaction.org/weight-bias-and-stigma