The Four Mechanisms of Action in Coaching for Lasting Change

We all have desires and wants, goals and dreams!  These are what motivates us. The great news is that we all have potential to bridge the gap between our current state and our desired state. It often just requires a change in our behaviour. Easy right??. Not always. This is where a coach comes in.

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Many studies have found that merely instructing someone to make behavioural changes often leads them feeling frustrated, depressed, and angry when the desired result is not achieved. We can all relate to this in some way, I’m sure. Human behaviour cannot easily be changed unless there is internal motivation to do so.  Internal motivators are the  fuel source for peak performance and positive change. A coach specialises in drawing on your internal motivations and helps develop strategies to help you achieve your goals.

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Let’s dive into behaviour and explore how a coach can help change certain behaviours that might be doing us harm, and  stopping us reaching our potential.

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It would be great if new 'desirable' behaviours would just appear, and the undesirable ones disappear; unfortunately they often do not. Behaviours are ‘learned’ which means neural connections have been made in our brains that enable us to easily recall and carry out the behaviour. Some of these are helpful like not touching a hot object or running away from a lion, but some are harmful like eating too much sweet food even though it tastes so good!

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A little science about food and energy to whet the appetite. While there are centres in the brain (the hypothalamus) that regulate energy intake within narrow limits, there are other areas (the mesolimbic system) that provide the emotional, pleasurable and rewarding aspects of eating: here is where we can be led astray!  This “reward” centre can greatly influences us and allows our brains to crave and to enjoy food even when we’re completely full. We all indulge!  Because of the power of these pleasure centres, the desire to eat can be triggered by emotions such as sadness, or environmental triggers, such as the smell or sight of delicious fast food, rather than just energy depletion.  And here is where we need to think what might trigger the drive to eat in us individually. Are we feeling down? Are we influenced too much by that freshly baked cake? Are we working too hard? Probably.

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The reward that is associated with eating can become an addictive behaviour and a nasty cycle can ensue resulting in weight gain, unless we unlock the triggers behind these behaviours. Enter the health coach.

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For any undesirable behaviour to be changed we need to first look at the parts that make up the behaviour. Firstly,  the triggers (called Antecedents) that prompt or cue the behaviour. Secondly, the action, or the Behaviour itself. And thirdly, the Consequences (or outcome) that reinforce the behaviour. In short, it’s all about the ABCs (antecedents, behaviour and consequences). When an individual and their coach has identified a behaviour they’d like to change, the initial focus is on identifying and understanding  the ABCs of that specific behaviour.

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Embarking on a journey to change long-standing habits, particularly around food and weight loss, can be challenging and sometimes overwhelming. But remember, you don’t have to do it alone. Health coaches are here to guide you every step of the way. They understand the complexities of behaviour change and are trained to help you uncover the internal motivations that drive you. With their support, you can develop personalised strategies that align with your goals, making the path to a healthier you not only achievable but sustainable. Stay encouraged—positive change is within your reach, and your health coach is here to support you on this journey.

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At rfynd, we have a range of programs that have the option of health coaching support. We know habit change is hard, and we want to support you the best we can to make the changes stick.

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By Lexi Andrews, Health Coach at rfynd.

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Embarking on a weight loss journey often involves more than just changing what we eat and how much we exercise. It requires a deep understanding of the psychological factors that influence our relationship with food and our eating behaviours, and often involves looking toward our inner thoughts, feelings, and sensations. The good news is, when you are willing to look inward and develop this deeper awareness of what makes you tick, you can take steps to better look after yourself in ways that promote positive health and wellbeing

The Connection Between Emotions and Eating: 

For many of us, food is more than just fuel – it's tied to our emotions, memories, social and cultural traditions and experiences. Emotional eating refers to the tendency to turn to food in response to unpleasant emotional experiences with the function of providing ourselves with comfort, soothing, or stress relief, and as a form of distraction. Whether it's reaching for a bowl of ice cream after a bad day at work or indulging in a bag of chips when feeling lonely or bored, emotional eating can sabotage our weight loss efforts and contribute to negative emotional states such as guilt and shame, which in turn may lead to further emotional eating – it can be a vicious, and subconscious, cycle!

Understanding Food Cravings: 

Food cravings are intense desires for specific foods, often high in sugar, fat, or salt, that can feel irresistible. While cravings are a normal part of being human, they can sometimes be driven by emotional triggers or physiological factors such as hormonal fluctuations or nutrient deficiencies. Cravings can also be reinforced by environmental cues, such as seeing or smelling a favourite food, which can activate reward centres in the brain and lead to compulsive eating behaviours.

Strategies for Overcoming Emotional Eating:

• Understanding your triggers: Identifying the major life events or, more commonly, the daily life stressors that trigger unpleasant or aversive emotional experiences is important in the life cycle of emotional eating. Such triggers could include work stress or conflict, health issues, or financial stressors. It could also be a certain time of day, such as the afternoon slump at work when you feel fatigued, or the period of time after you have navigated the chaos of your kids dinner and bedtime.
• Emotional Awareness: Learning to ‘notice and name’ our emotions and then regulate these without immediately turning to food is a crucial step in overcoming emotional eating. Carrying out a daily emotion ‘check-in’ with yourself using an emotion list or chart is a helpful step in increasing your emotional awareness – research indicates that we sometimes only need to ‘name it to tame it’ to get some relief from the heat of an emotion. Journaling and talking to a trusted friend, coach or therapist are also ways to develop your awareness of the underlying emotions driving our cravings and open the door to developing healthier coping strategies.
• Emotional regulation: Once we are consciously aware of our triggers and the emotions that arise from these, we can move on to regulating, or managing, the unpleasant or aversive emotions in ways that promote positive health and wellbeing. Engaging in relaxation techniques such as deep breathing or muscle relaxation, or using mindful meditation to ‘ride the wave’ of the emotion can be helpful. Having a go-to list of other forms of distraction is useful, such as engaging in hobbies, reading, going for walk, or calling a friend, or just generally keeping your hands busy doing something else (there will always be chores to be done!). Keeping a list of emotion regulation strategies that work for you in a place where you can see them in times of vulnerability, such as on the fridge or pantry wall, is a top trick that many clients use.
• Mindful Eating: Mindfulness involves paying attention to the present moment without judgement, including our thoughts, feelings, and sensations. By practicing mindful eating, we can become more aware of our hunger and fullness cues, as well as the emotional triggers that lead us to overeat. Taking the time to savour each bite, chew slowly, and tune into our body's signals can help us make more conscious choices about what and how much we eat.
• Building Resilience: Building resilience involves cultivating coping skills and resources to deal with life's inevitable challenges and setbacks. Engaging in regular physical activity, getting enough sleep, and prioritising self-care activities that bring us joy and fulfilment can help bolster our resilience and reduce our reliance on food as a source of comfort.

Strategies for Overcoming Food Cravings:

• Balanced Nutrition: Ensuring that our meals and snacks are balanced and nutrient-dense can help stabilise blood sugar levels and reduce cravings for unhealthy foods. Aim to include a variety of whole foods such as fruits, vegetables, lean proteins, and healthy fats in your diet to support overall health and well-being.
• Planning Ahead: Planning meals and snacks in advance can help us make healthier choices and avoid impulsive eating behaviours. Keep nutritious snacks on hand, such as fresh fruit, nuts, or yoghurt, to satisfy hunger between meals and prevent cravings for less healthy options.
• Distraction Techniques: When faced with a craving, distracting ourselves with an engaging activity or taking a short walk can help redirect our attention away from food and reduce the intensity of the craving. Finding alternative ways to cope with stress or boredom, such as listening to music, practising a hobby, or spending time with loved ones, can also help diminish the urge to eat.

Navigating the psychological aspects of weight loss, including emotional eating and food cravings, requires patience, self-awareness, and compassion. By understanding the underlying causes of these behaviours and implementing effective strategies for managing them, we can develop a healthier relationship with food and achieve our weight loss goals more successfully. Remember that progress is not linear, and it's okay to seek support from friends, family, or professionals along the way. 

At rfynd, we believe in the transformative power of psychological change when individuals are provided with the right support and resources. That's why we offer a comprehensive support system that includes dietitians, health coaches and psychologists to guide and empower our clients on their weight care journey. We believe that sustainable change is not only possible but achievable for everyone.

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By Dr Minthali Price, Psychologist at rfynd and Kylie Russell, Dietitian at rfynd.

Advances in ‘anti-obesity medications’ (AOMs) such as GLP-1 receptor agonists (GLP-1s) offer promising results for weight management. These medications are effective when used alongside diet and lifestyle modification. While the GLP-1’s mechanism of action is explained in detail here (link to ‘The truth about weight loss medications’ blog) we know they can significantly reduce appetite and calorie intake. However, with less food going in, ensuring you get the right nutrients becomes even more crucial. With so many people globally using GLP-1s to manage their weight, evidenced based guidelines have been released supporting clinicians on optimising nutrition for patients when taking AOMs¹. Summarised in this blog are the key recommendations from these guidelines including how to avoid nutrient deficiencies, and other factors to consider for successful weight management with GLP-1s.

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Energy intake

Since everyone's body is unique, our energy needs vary. Age, gender, weight, activity level, and even other factors play a role in how much fuel your body needs. For those wanting to lose weight, guidelines typically recommend a minimum daily calorie intake of 1200-1500 for women and 1500-1800 for men during weight loss². However it's important to remember these are just starting points.

Even if you're consuming enough calories overall, poor food choices can lead to nutrient deficiencies. This is especially true with GLP-1s, which can decrease appetite. To optimise health outcomes, a focus on nutrient-dense foods becomes important. These foods are characterised by a high micronutrient (vitamins, minerals) to calorie ratio, with minimal added sugars, saturated fats, and sodium. Examples include vegetables, fruits, whole grains, legumes (beans, peas, lentils), lean protein sources (fish, poultry), and low-fat dairy products³.

Very low-calorie diets (VLCDs) with less than 800 calories per day should only be undertaken under the close supervision of a specially trained professional, such as a registered dietitian, due to the increased risk of nutritional and medical complications⁴. These specialised plans often involve meal replacements and carry a higher risk of complications like dehydration and electrolyte imbalance⁴. They also cannot be used in the long term.

Remember that as you reach your weight loss goals, your calorie needs will likely change. This is where having the right support in place can help you adjust your intake to maintain a healthy weight in the long term. 

Dietary protein

When taking GLP-1s, protein plays a critical role in maintaining good health. Insufficient protein intake can lead to muscle loss, weakness, reduced immunity and various other health problems. The recommended daily protein intake varies depending on factors like weight and overall health. For healthy adults, the minimum recommendation is 0.8 grams of protein per kilogram of body weight⁵. However, for individuals with obesity aiming to lose weight, protein needs may be significantly higher, reaching up to 1.5 grams per kilogram of (adjusted) body weight per day⁴.

A combination of a calorie-restricted diet with adequate protein intake and physical activity seems to be most effective for weight management. This approach promotes fat loss while minimising muscle loss, although the exact influence of exercise on muscle preservation requires further investigation⁶.

Meal replacement products containing high-quality protein (around 15-25 grams per serving) can be a valuable tool for weight management, especially for those experiencing reduced appetite due to medications like GLP-1s⁷. This is particularly important for older adults seeking weight loss, as they are more susceptible to muscle loss (sarcopenia) due to aging [68]. Regardless of age, prioritising protein-rich foods at each meal is a practical strategy to ensure adequate protein intake for all individuals on a weight loss journey.

Dietary carbohydrate

While carbohydrates are a major source of energy, there's no need to severely restrict them while using GLP-1s. The recommended range for carbohydrate intake is 45% to 65% of daily calories,⁵. This translates to roughly 135-245 grams of carbohydrate per day for someone on a 1200-1500 calorie diet, or 170-290 grams per day for someone on a 1500-1800 calorie diet. Very low-carbohydrate diets (ketogenic) may not offer long-term weight loss benefits and can limit intake of fruits, vegetables, and whole grains - all vital sources of vitamins, minerals, and fibre⁴. If you prefer a lower-carb approach though, it's crucial to stay hydrated (drinking over 2 litres of fluids daily) and prioritise micronutrient rich vegetables and fruits to ensure you meet your dietary needs.

Dietary fat

Deciding on the right amount of dietary fat for weight loss can be individualised based on your preferences and tolerance. The recommended range is 20-35% of your daily calories, translating to roughly  25 to 60 g/day for a 1200- to 1500-kcal/day diet or 35 to 70 g/day for a 1500- to 1800-kcal/day diet⁵. Fat plays a vital role in absorbing essential vitamins and promoting healthy gallbladder function during weight loss, potentially reducing the risk of gallstones⁴. Focus on including foods rich in healthy fats like omega-3s (found in fatty fish), omega-6s (found in nuts and seeds), and monounsaturated fats (found in olive oil). Saturated fats like those from animal products and tropical oils (found in coconut oil) on the other hand should be limited. It's also recommended to avoid fried and high-fat foods to minimise potential digestive issues associated with GLP-1 medications⁸.

Dietary fibre

Many New Zealanders struggle to consume as much dietary fibre as we should. Data shows that Kiwi adults only consume around 20g per day, compared to dietary recommendations that state we should be consuming 25-30g of fibre per day⁹.  This is concerning because fibre plays a vital role in gut health and may even reduce the risk of heart disease¹⁰. Focusing on including fruits, vegetables, and whole grains at every meal can help you meet your fibre target. Check out our blog on ‘The benefits of high-fibre foods for weight management’ here (insert hyperlink) for more ideas on how to increase your intake.  Some people taking GLP-1 medications may experience constipation due to a lower food intake, and so gradually increasing fibre alongside plenty of fluids can help with this too. If dietary changes aren't enough to improve your bowel function, fibre supplements might be an option. Make sure you chat to your team about this. 

Micronutrients

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Those living with obesity are at increased risk of micronutrient deficiencies, which can further complicate health status and weight loss efforts. This heightened risk is often due to a combination of factors, including dietary choices, reduced nutrient absorption, and the increased nutritional demands of excess body weight. For instance, deficiencies in vitamins such as D, B12, and folate, as well as minerals like iron and calcium, are commonly observed in those living with excess adiposity^11,12. These deficiencies can lead to a range of health issues, from weakened immune function and fatigue to more serious conditions like anaemia and osteoporosis. When using GLP-1’s for weight loss, it is crucial to monitor and address these potential micronutrient deficiencies. GLP-1 medications can help reduce appetite and improve glycemic control, but they do not directly resolve the underlying nutritional gaps. Therefore, a comprehensive approach that includes focusing on a varied and nutritious diet, supplementation if required, and regular monitoring of nutrient levels is essential to ensure optimal health outcomes and sustainable weight loss^13,14.

Fluid intake

The daily recommended fluid intake for adult New Zealanders is 2.1 L/day for women and 2.6 L/day for men, with requirements increasing further with physical activity or hot climates⁹. Those receiving GLP-1s should be encouraged to achieve similar fluid intakes of  between 2 to 3 L/day. Ideally, fluids should mostly consist of water, low-calorie beverages (such as unsweetened coffee or tea), or nutrient-dense beverages (such as low-fat dairy or plant-based, calcium-fortified dairy alternatives). Most experts would recommend limiting or avoiding caffeine during weight loss due to the potential diuretic effect of high caffeine intake^15..

There is one fluid that would be wise to restrict, and that is alcohol. The New Zealand MInistry of Health Guidelines  state that “any alcohol consumption is risky, so if you drink alcohol, keep your intake low”, and avoid it completely during pregnancy and breastfeeding⁹ - although no one who is pregnant or breastfeeding should be taking GLP-1s!  Alcohol consumption can also slow weight loss because it adds empty calories to the diet, which can contribute to a calorie surplus and weight gain. Additionally, alcohol can impair metabolic processes, reduce fat burning, and increase appetite, leading to overeating and poor food choices¹⁶. 

The takeaway

While taking GLP-1s as a complementary therapy, focusing on a balanced and nutrient-dense diet is crucial. Incorporating plenty of vegetables, lean proteins, whole grains, and healthy fats can support satiety and help maintain stable blood sugar levels and ensure you get all the nutrients you need. Additionally, staying hydrated with water and low-calorie drinks is important, while monitoring and managing any potential nutritional deficiencies with guidance from healthcare professionals can further enhance the effectiveness of GLP-1 therapies in achieving sustainable weight loss goals.

At rfynd, we're delighted to offer our Medical Weight Loss Program clients our Wellness Essentials Package. This incorporates dietitian support as well as access to thousands of nutritious recipes and over 4000 workouts with our partners at Centr. Not only that, but you have your own health coach to guide you and keep you on track. We want to enable you to achieve the best results possible with the best support

By Kylie Russell, rfynd Dietitian, and Dr Cinthia Riguetto, rfynd Specialist Endocrinologist.

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