Personalized Health Planning with Integrative Health Coaching to Reduce Obesity Risk among Women Gaining Excess Weight during Pregnancy

Abstract

Health coaching is an emerging behavioral intervention to improve outcomes in chronic disease management and prevention; however, no studies have investigated its utility in postpartum women who have gained excess weight during pregnancy. A 32-year-old primigravida woman who was overweight at conception and gained 23 lbs more than Institute of Medicine recommendations for her pre-pregnancy body mass index participated in a 6-month personalized health planning with integrative health coaching (PHPIHC) intervention. The intervention included a baseline health risk assessment review with a healthcare provider and eight biweekly, 30-minute telephonic health coaching sessions. The participant demonstrated improvement in physical activity, energy expenditure, knowledge, and confidence to engage in healthpromoting behaviors. Although the participant did not reach the target weight by completion of the health coaching sessions, follow up 8 months later indicated she achieved the target goal (within 5% of prepregnancy weight). This case report suggests that PHP-IHC can support postpartum women in returning to pre-pregnancy weight after gaining excess gestational weight. Future research and clinical trials are needed to determine the best timing, length, and medium (online, in-person, telephonic) of PHP-IHC for postpartum women.

Efficacious Approach to Integrating Health and Wellness Coaching Into the Clinical Care for Weight Management: A Systematic Review and Proposal

“…Literature extensively shows health and wellness coaching is efficacious for weight management in a variety of primary care settings for obese and overweight patients ranging from children to adults (Table 1). Coaching has been successfully implemented in the care of children [44,45] , adolescents [46] , and adults [10,[47][48][49][50][51][52] . Coaching has also been incorporated into patient care with a variety of health professionals.…”

“…Coaching has also been incorporated into patient care with a variety of health professionals. This has been achieved with coaches plus PCP collaboration [8,10,4244,53] , with coaches alone [31,[44][45][46][47][48][49][50]52,53] , with physician coaches [34,46] , and with auxiliary health professional coaches such as Medical Assistants [38,47,54] , Nurse Practitioners [50] , and Registered Dietician Nutritionists [31] .…”

“…As to a method of implementing coaching in a clinical care process, this has been done for groups of patients [10] , parent-child groups [44,45] , via one-on-one sessions [10,31,34,38,[45][46][47][48][49][50]52] . Coaching was also integrated in-person [10,31,34,[46][47][48][49][50][51]54] and remotely via telephone [10,45,49,52] , a study-specific website [10] , email support [10,14] , as well as general mail, text message, and virtual video visit [45] .…”

“…The dosage of coaching interventions offered to patients varied as well including low-intensity or less than monthly coaching [31,4547,50] , moderate-intensity or at least monthly coaching [10,31,4951,54] , high-intensity or at least weekly [10,34,44,[46][47][48][49][50][51][52] , or with a combination of these throughout the intervention [10,31,47] . Length of intervention ranged from approximately four months [34,44,46] , six months [47,52,54] , approximately one year [45,[48][49][50] , and multiple years [10,31,51] .…”

“…Concerning health improvements, coaching has helped patients achieve clinically meaningful weight loss [10,31,[47][48][49][50][51]54] , maintain significant weight loss for two years [10,51] , decrease waist circumference [50] , decrease blood presure from hypertensive to normo tensive [49] , improve BMI from obese to normal [38,41,48] , normalize blood glucose levels [31,48] , and normalize cholesterol levels [31] . Other benefits of coaching included a general weight and fat loss [14,44,52,54] , lowered blood pressure [46] , lower triglyceride levels [46] , improved BMI [43][44][45] , lower HbA1c levels [43] , improved anthropomorphic body measurements [46] , 4 and behaviors conducive to weight loss [14,44,45,52] . Appel et al [10] RCT Clinically meaningful weight loss achieved and sustained in both intervention groups, with weight loss for both intervention groups being statistically significant compared to control (P < 0.001) with more individuals in the in-person HWC group achieving 5% or more weight loss (P = 0.73) compared to remote HWC Ball et al [46] RCT; Comparing HWC to single counseling session Compared to control, HWC groups had greater weight loss (P = 0.004 for HIP, P = 0.025 for YLP) and decreased BMI (P = 0.0002 for HIP, P = 0.03 for YLP).…”