With the increasing obesity rates and the ever expanding list of associated co-morbidities the race is on to find effective treatments. Candidates include everything from fad diets to surgery, not to mention somewhat less orthodox and downright dangerous “treatments”. Weight loss is exceedingly challenging and should never be trivialized; however, there is evidence that most people can lose modest amounts of weight and improve other parameters of health including blood glucose regulation and risk of cardiovascular disease with a diet and lifestyle intervention. The problem is that these diet and lifestyle changes are hard to adapt and maintain.
There are a myriad of social, economic, personal, and environmental reasons for this, which are beyond the scope of this post. A recent study looked at retention in a weight-management clinic over six years found that even with a team of health professionals, 43% of the patients (516 of 1205) dropped out of the program before they were able to achieve sustainable weight loss. It is important to note that this was a program and included the whole gamete of treatments from physiological counseling to surgery in some cases (1). Perhaps it is time to look at how we are administering these programs and potential alternatives to their administration? We know that coaches can help athletes achieve amazing physical feats (sorry we’re still in Olympic fever mode) but could they help mere mortals lose weight? Perhaps what people need to help them lose weight is as simple as a coach. Leahey et al. (2) looked at the role of health coaches in weight loss. The authors randomized 44 adults to a behavioural weight loss program (reduced calorie, increased exercise), a fairly typical treatment; however the participants were also assigned a coach to provide ongoing support and information as well as encourage accountability of the participants.
There were three groups based on the types of coaches:
1. Mentor (12 participants) – an individual who had been successful with weight loss in the past.
2. Peer (16 participants) – an individual currently trying to lose weight.
3. Professional (16 participants) – a health care professional such as a doctor, nurse, etc.
All of the coaches were trained on how to provide feedback and on effective coaching strategies.
Those participants paired with a peer or professional coach lost an average of 9% of their body weight and those participants in the mentor group lost an average of 6% of their body weight. Weight loss of this magnitude is associated with significant health benefits and rivals that seen with current weight loss medications. Furthermore, the program would be relatively inexpensive to run.
Ultimately, having a program that is supplemented with a coach that is contacted via e-mail or phone decreases the time and number of sessions and thus cost of the program. As always there are limitations to the study. Firstly, the authors did not include a control group without a coach, which makes it difficult to determine if the coach vs. no coach had an effect. However, the weight loss is similar to that seen with traditional, resource-heavy programs (3). Additionally, the sample size was small and the study is of short duration (24 weeks is respectable for a research study but not long enough to evaluate long term effects).
For a pilot study this is a great start, and the 95% retention rate is astounding! We hope to see longer term studies with a control group in the future. It would be very interesting to see if coaches could help people maintain their weight loss. After all, there is a certain inherent logic to the idea. I can assure you that a try a lot harder in my hill intervals when the coach is running behind me than when I’m on my own so why not weight loss? We all need a mentor and cheerleader at some point.
No Baloney’s advice. Weight loss is extremely challenging so create the best support network you can. Having someone to support and encourage you, and who will hold you accountable (sometimes you need the tough love!) can only help, so build it in to your program.
Choose your coach wisely though, you want positive reinforcement and encouragement as well as effective feedback not someone who will be negative and demotivating. It’s also interesting to note that in the peer coaching group the participants lost similar amounts of weight so perhaps you just need a weight loss buddy.
- Gill et al. Predictors of attrition in a multidisciplinary adult weight management clinic. Can J Surg 2012; 55: 239-243.
- Leahey TM, Wing RR. A randomized controlled pilot study testing three types of health coaches for obesity treatment: professional, peer and mentor. Obesity 2012; epub before print June 25 2012. doi: 101038/oby.2012.179
- Wing RR. Behavioral approaches to the treatment of obesity. In: Bray GA, Bouchard C (eds). Handbook of Obesity Treatment. Marcel Dekker: New York, 2008, p. 227-48.