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Beyond Macros and Weight Loss: Promoting Flourishing Health with Comprehensive Coaching

What is your role as a coach?

There seems to be a lingering perception in the fitness industry that the role of a coach is limited to helping someone achieve their body composition or performance goals. Whilst there isn’t anything inherently wrong with this, there is certainly more scope to improve the health of the individuals we work with. Comprehensive Coaching seeks to promote Flourishing Health, which includes one’s physical, social, psychological and philosophical health [1], to facilitate growth across different domains of life.

In addition to potential body composition changes and performance enhancement, a Comprehensive Coach will consider:

  1. Reducing dysfunctional behaviours and cognitions such as disordered eating, negative body image, psychological inflexibility and experiential avoidance, while

  2. Promoting functional behaviours and cognitions, such as a positive body image; behavioural commitment to clearly-defined values; metacognitive awareness of decision-making processes; psychological flexibility; and self-compassion.

When we understand the conditions people need to thrive, we can identify and target important variables amenable to improvement, thus catalysing positive change.

Flourishing Health

To flourish means to grow and prosper across different domains of life. Flourishing Health expands far beyond the physical domain to include one’s social, psychological and philosophical wellbeing. It is a comprehensive consideration of all of the factors that may influence one’s experience of health and wellbeing. This perspective of healthy functioning includes meaningful connections with others, mental wellbeing, self-efficacy, autonomy, resilience and a sense of meaning and coherence, amongst other things. Subsequently, health-seeking behaviours include not only eating vegetables and exercising, but also spending time with loved ones, managing stress levels, building confidence and developing a clear sense of direction.

It has been suggested that the absence of mental illness is not necessarily reflective of genuine mental health and that languishing, which is common, is also associated with considerable psychosocial impairment [2]. Inspired by this notion, Flourishing Health views health as a positive state, an expanding strength that is constantly achieved, and not simply a background operation of a well-functioning system. Moreover, flourishing in life could be a source of resilience, acting as a stress buffer against stressful events and life transitions.

We may consider Flourishing Health promotion from two perspectives: reducing aspects of maladaptive functioning, and promoting aspects of adaptive functioning. Six dimensions of psychological well-being are proposed: self-acceptance, positive relations with others, personal growth, purpose in life, environmental mastery, and autonomy [3]. Individuals who function well are comfortable with most parts of themselves, have warm and trusting relationships, see themselves developing into better people, have a direction in life, are able to shape their environments to satisfy their needs, and have a degree of self-determination. Taking care of one’s physical health is merely one aspect of achieving adaptive functioning; psychological, social and environmental factors play a role too.

Addressing Maladaptive Functioning

Addressing Disordered Eating

Given the conspicuous links between body weight, body dissatisfaction, eating-disordered behavior and mental health, and the fact that disordered-eating behaviours appear to be increasing [4], it is pertinent for coaches to be cognisant of the behavioural and attitudinal red flags that clients may display. Subclinical eating pathologies may affect a large subset of individuals and research has indicated that, in many cases, these individuals do not differ significantly from those receiving a diagnosis of anorexia nervosa or bulimia nervosa in terms of how distressing the symptoms can be and how they affect quality of life [5]. Eating disorder risk factors and behaviours, such as body image concerns and disordered eating, are associated with significant health impairments and are robust predictors of eating disorder onset [6]. Early intervention is thought to reduce the likelihood that an individual with subclinical eating pathology will develop a clinical eating disorder and can help to improve quality of life [7]. Crucially, a large number of individuals struggle to spot disordered eating behaviours in themselves [8] and those high at risk are less likely to reach out for help [9]. As coaches, it is our responsibility to be aware of this.

Symptoms of disordered eating may include obsessive thinking about food and appearance, restriction, repetitive shape checking, fasting or skipping meals, compulsive exercise, chronic dieting, obsessive calorie counting, anxiety around eating out, viewing foods as good or bad, fear of fat gain, feeling anxious without a plan, and a lack of flexibility. We can help clients to move towards more flexible and adaptable styles of eating by considering the context and circumstances under which dietary restraint is employed, methods of self-evaluation and self-regulation, and individual differences in eating disorder risk [10].

Reducing Negative Body Image

Body dissatisfaction is defined as a subjective negative evaluation of body size, shape, muscularity/muscle tone, and weight [11], and is associated with poorer mental and physical health-related quality of life [12], independent of its association with body weight or eating disorder symptoms [13].

Body image attitudes are comprised of:

  • Appearance evaluations - one's beliefs and appraisals (e.g., satisfaction or dissatisfaction) regarding their body, and