US-style health coaching makes inroads into UK

Earlier this year, a group of 20 doctors, nurses and administrators gathered in a room at Wythenshawe Hospital in Manchester, north-west England. It was for the first of four one-hour sessions on how to improve their health, run by volunteer Suzy Glaskie, a health coach.

By the last session, participants were reporting they had lost weight, were eating more healthily, feeling less stressed, sleeping better and, in the words of one doctor, “feeling so much more positive about the future”.

Health coaching is relatively new to the UK but is making inroads into companies and National Health Service preventive medicine programmes, designed to reduce doctor visits and hospital admissions.

Glaskie’s sessions included nutrition, sleep, stress management and exercise, all lifestyle management areas where health coaches ply their trade. She is a member of the UK Health Coaches Association, which is trying to lay the groundwork to professionalise the sector.

Figures from Public Health England show 131m working days a year are lost to sickness absence in the UK and one in three workers with a long-term health condition has not discussed it with their employer. The costs to the UK economy and the government are an estimated £100bn and £50bn, respectively. In the US, the Global Wellness Institute has put the annual loss to the economy of illness at work at $2.2tn. This has spawned a $6bn US health coaching industry with an estimated 100,000 health coaches and educators and, with it, lessons on the most effective ways to provide services.

Soeren Mattke is director of the Center for Improving Chronic Illness Care at the University of Southern California. He was formerly at Rand, the US think-tank, where he was the lead author of a 2013 study on the effectiveness of corporate wellness programmes for the US departments of Labor and Health and Human Services.

One of the report’s findings was that lifestyle management interventions as part of workplace wellness programmes can reduce risk factors, such as smoking, and increase healthy behaviours, such as exercise.

“We find these effects are sustainable over time and clinically meaningful,” says Mattke. He says workplace wellness programmes can help contain lifestyle-related diseases, the main cause of sickness and early death as well as US healthcare costs.”

Mattke says however he has become a little cynical about the health coaching industry because of the way wellness programmes are being delivered.

“Some clever companies found a niche that has become a [corporate] benefit. Companies have tried to mechanise a public health problem through cookie-cutter, call centre-based health coaching that targets the whole workforce, which is a giant waste of money. A public health problem needs a public health answer.”

He is also critical of human resources departments that buy “off-the-rack programmes” from companies that are reluctant to let results be scrutinised and publish very little evidence that what they do makes a difference.

The Rand report found about half of US employers with 50 or more employees — which account for three-quarters of the entire workforce — offered wellness programmes.

Mattke thinks companies would get better results by spending less and being more creative. “You can change food in the cafeteria, change vending machines, provide opportunities for exercise, and try and instil a culture of health.”

Chris Tomkins, head of wellbeing at health insurer Axa PPP in the UK, says his company’s programmes are the opposite of one-size-fits-all. “We do not offer health coaching to everyone,” he says. “We identify the higher-risk individuals — raised blood pressure, weight, cholesterol — and engage those people. The accusation directed at the wellness industry has been that it makes fit people fitter, but this way companies only spend money on those who want health coaching and need it.”

Axa has abandoned the phone as the main tool of delivery of its three-month health coaching in favour of digital platforms. Three months is considered the time it takes to change behaviours. “Success is if an individual no longer needs us,” says Tomkins.

Rozelle Kane, a neuroscientist, psychologist and clinician involved in a coaching start-up, defends the new profession.

“What motivates me are the outcomes,” she says. “Health coaching is on the cusp of being a significant new trend in workplaces due to the changing nature of health needs and the opportunities afforded by digital health technologies, big data and artificial intelligence.”