Health Coaching: Behavior Change Strategies

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If you are a health coach or thinking about becoming one, you know how challenging it can be to change a client’s behavior and habits. As health and fitness professionals, we are always building rapport and learning about our clients’ goals, wants and needs. We strive to learn about them and their lifestyle so we can work to improve their health and well-being. Getting into our client’s mind is how you can make change. We need to look at ourselves as change agents and, in this role, we can implement the following behavior change strategies to help our clients.

Behavior Change Questionnaire

Have your client complete a behavior change questionnaire. Feel out how ready they are to make a change and if they are coachable. The ideal client is one who is ready to change, motivated, and willing to listen to you and put in the work. The questionnaire should include questions like the following (ACE 2014):

• Are you willing to make this behavioral change a top priority?
• Have you tried to change this behavior before?
• Are you committed to making this change, even though it may prove challenging?
• Are you prepared to be patient with yourself if you encounter obstacles, barriers and/or setbacks?

The 5 A’s of Behavior Change Assessment

While you have these conversations with your clients, be sure to keep the 5 A’s in mind and take notes.

#1 Assess: Evaluate their current behavior, beliefs, and readiness to commit to a health coaching program. A great question I like to ask is, “what does ‘eating better’ look like to you?” This is an open-ended question, leaving room for the client to provide as much information as they can, so you can gather any details you need to help them.

#2 Advise: Provide personalized information specific to the client’s concerns and goals.

#3 Agree: Co-create a change plan in alignment with the client needs and preferences. This is a great place to gather their food likes and dislikes. My experience in health coaching has taught me that the more you can plan a program with their favorite foods in mind, the better the success for the client. This is also the perfect opportunity to let your potential client know that your program is not a diet. The word diet needs to be a thing of the past. Client’s often think ‘being on a diet’ means restriction—super low-calorie intake where they are starving all the time—which is unrealistic and unsustainable. Instead, health coaches should focus on what they like and create a sustainable meal plan that is not calorie restricted. Intuitive eating teaches you how to honor your body and break up with dieting.

#4 Assist: Identify barriers, implement problem-solving strategies, and discuss social support. How might their family and friends support healthy eating habits? A good support system, outside of you as the health coach, will be critical for the client’s journey.

#5 Arrange: Schedule a follow-up appointment and refer to a relevant professional as needed. We must be sure to stay within our scope of practice if we feel there is something specific the client needs. For example, a meal plan catered to their cancer treatment, or one that is designed to help their autoimmune disease, should be where we have professional references on-hand to direct them to a registered dietitian.

See also: The Power of Behavior Change Apps

Motivation and Willpower in Behavior Change Strategies

Besides identifying barriers like support at home or access to healthier foods, there are some internal factors we must consider as part of our behavior change strategies, and most of these come from within. The client should be in tune with themselves and how aware they are of their strengths and weaknesses, to best help us serve them. There have been studies done about certain internal thoughts and behaviors of clients who are currently going through a health coaching program, or those who are about to start (Berkemeyer &Whermann 2024).

Among intrapersonal factors related to successful behavior change, intrinsic motivation (often described as willpower) is often found to be the most important. In my experience, I have found that the client’s lack of willpower and self-motivation are extremely common barriers. I wouldn’t be surprised if just about all your clients have intrapersonal barriers—and maybe you have experienced this in your practice already. We need to think about baby steps! We never want to overwhelm the client, but instead make these goals achievable, timely and most of all, realistic and sustainable.

To specifically work on willpower, we slowly work with the client to find out why they feel they don’t have the ability to control their actions or urges. We should be tasking clients with a small action towards improving this behavior. As an example, let’s use a client who needs that sweet treat after dinner, and cookies are their go-to. If we start out by training the client to only take one cookie out of the cabinet, leaving the rest out of sight, that’s a great first step for about a week or two. Then we can begin to challenge them with the second step of the process, which is to do a cookie swap. For example, instead of Oreos, we make a cookie with healthier ingredients and less sugar. Eventually, over time, this cookie habit will become an on-occasion treat. This process will lead to success and positive results for the client because we are slowly cutting back.

Contrast this with the traditional method of just completely cutting the cookies and sugar out, which would only end up with the client feeling deprived, leading back to old habits. Look at this like a personal training session; you wouldn’t throw a client onto a barbell bench press without working to strengthen core and chest with lighter free weights first. The same goes for the mind; creating better habits over time leads to improved willpower (The Intuitive Nutritionist 2023).

Interpersonal Factors in Behavior Change Strategies

We’ve discussed the role of willpower in behavior change strategies, but it’s worthwhile to note several other intrapersonal factors, such as:

• the ability to set goals
• having a sense of accomplishment
• a desire to improve self-confidence
• determination
• persistence
• thought and coping processes
• problem-solving skills
• emotional states
• state of health
• knowledge and skills
• general planning
• usual activities
• habits

As health coaches, we help set a client’s goals for them. We also should take responsibility for writing down dates of when those goals should happen (Welch 2019). For example, if the goal is to drop 5-8 pounds, that could be achieved 30 days from now. This way, both you and the client are on the same page and you both know what is to be expected. This is a great way to help create behavior change by coaching clients on how to set their own goals in the future.

You will also run into clients who would rather not have the pressure of setting goals; even their own. As a health coach, this is to be respected. Have flexibility with the client on how they want to work with you. Change up how you coach them and focus on how they feel each week, versus a goal number on the scale each week. When clients see the scale start moving in the right direction, that is where a sense of accomplishment comes from. They will feel super successful and proud of themselves, which in turn creates motivation to keep going.

Along with changes on the scale, the client will notice changes physically, for example, when their clothes feel looser and they are losing inches. From that experience self-confidence begins to return. This then propels them to increase their determination; to keep on track, to see another pound down, and to stay consistent and persistent. We all know that consistency is key to any health and fitness program to see results. Working to stay consistent can often be a challenge for clients. One way to help them maintain consistency and stay on track is to work on smaller goals with them. Again, this goes back to using baby steps to help them create a behavior they will continue each day. That way, when they look back 60 days from now or a year from now, they will see significant progress. This habit could be as small as adding another eight-ounce glass of water into their day, which is just one example of a sustainable and achievable goal.

A final noteworthy set of intrapersonal factors related to behavior change, include emotional states, coping processes, and navigating social situations. Some of the most challenging factors we face as health coaches, are coping with emotions, stress and social events. For some of these clients, they have been through traumas or other life events that can impact mental health. Coaches should be there to provide support and listen to what may trigger them to overeat or eat the wrong food.

Many times, a client will go for chocolate as a coping mechanism, or a meal heavy in carbs to satisfy and help themselves feel better. We need to help our clients understand that when they’re already experiencing mental and emotional stress, adding the overconsumption of processed foods or sweets can make those feelings even worse. So, what are some ways we can coach clients on how to manage these emotions? One way is simply to encourage physical activity that they enjoy. For example, to practice guided meditation with your client, to focus on deep breathing as well as yoga or stretching. All these activities feel physically good, which translates to happy feelings or an elevated mood, which may be at least partly due to the release of endorphins (Matthews 2022).

As little as 30 minutes a day of enjoyable physical activity is all a client needs to improve stress levels. This stress reduction can include any activity they enjoy, such as walking outside, lifting weights, cycling, swimming, and the list could go on. As health coaches, we should also help to get them moving, even if it’s a simple 20-minute walk. We are also motivators not only to create better habits pertaining to food, but also to movement.

It’s helpful to remember that we are the client’s resource, and we must be sure they understand how important it can be to cope with emotions in relation to well-being, and ultimately to getting the results they want. We grow up hearing, “here, eat this lollipop and you’ll feel better” or “here is a piece of candy, this will help!” We are catalysts to change the perspective of how we have viewed food from an early age. One of the responsibilities as a health coach implementing behavior change strategies involves changing the thinking pattern, to look at whole foods the way we once looked at candy as a kid. We are catalysts to change that perspective, which is so often learned in the early years of life. We must switch those behaviors and habits, to now look at movement and whole foods as conduits to feeling better mentally, physically, emotionally and spiritually.

See also: 5 Crucial Behavior Change Variables

Practicing Behavior Change Strategies

As health and wellness coaches, we empower the client to take ownership of their health and well-being, and lead the process of change toward the recommended lifestyle. We want to be sure the client has the knowledge and tools available to them so they can live their best lives. This industry is growing because more and more people are realizing how strength training and cardio, along with a nutritious meal plan that consists of whole foods, equals a better quality of life.

In order to continue behavior change for the long-term, we as health coaches need to continue cultivating connection, motivation, positivity, self-compassion, personal strengths, and commitment to the client. By first addressing a client’s strengths and highlighting their positives, for example, we may find they stayed on track for an entire week. Ask them how they felt after that week. Most likely they will tell you how much of a difference they feel in day-to-day life, and typically I’ll hear “less bloating” and “more energy”. Being a health coach is super rewarding, but if we don’t begin with the client’s readiness to change and use behavior changes strategies from the outset, results will not follow. Continue to be your clients’ cheerleaders in leading them to a healthier lifestyle.