Efficacious Integration of Health and Wellness Coaching into Clinical Care for Weight Management: A Review and Proposal

Objective: We examined health and wellness coaching in a clinical setting to motivate patients to pursue healthy lifestyles towards effective and sustainable weight management, and proposed an efficacious approach to integrate coaching into clinical care weight management. Methods: We conducted a systematic review of literature for the past 10 years concerning coaching for weight loss in a primary care setting, which yielding 75 studies. Abstracts were reviewed and excluded if they concerned non-coaching interventions or coaching in the context of non-obesity. After exclusion and inclusion criteria, 11 coaching studies were considered for evaluation. Studies were considered efficacious if the coaching intervention resulted in clinically meaningful weight loss (> 5% initial body weight in six months) or statistically significant weight loss compared to standard care. Selected studies were analyzed according to the approach coaching was applied towards weight management including: who administered coaching, how patients coaching, dosage of coaching intervention, and the results of treatment. Results: Coaching resulted in clinically meaningful weight loss in nine studies and statistically significant weight loss in four. Coaching offered at least at a moderate dose (>1/month) with a trained coach was most efficacious in achieving clinically meaningful weight loss. Coaching interventions for longer time frames was more likely to foster sustained weight loss. Coaching was successful in a variety of settings and with electronic support. Coaching also significantly improved diabetes and cardiovascular risk factors, healthy behaviors, and self-sufficiency for maintaining these changes. Conclusions: The present study may contribute to the growing evidence of coaching as an efficacious and sustainable lifestyle intervention strategy for clinical weight management. It is recommendable for primary care practitioners to integrate health and wellness coaching into their clinical encounters to promote behavioral changes in patients who are overweight or obese. We propose that coaching is most successful when integrated for a prolonged time frame, minimally at a moderate to high intensity frequency, via various modes of delivery, and with a coach who has completed coaching training. Coaching was also successful when personalized to suit patient needs, which will help providers optimize patient care and enable patients become advocates for their own health.