Podcast: Behavior Change with Brenda Gill
In this episode of the Well-Being Experts podcast, we’re discussing how to overcome resistance to behavior change. We sat down with Brenda Gill, Registered Nurse and Health Coach at Onlife Health, to talk about what a health coach really is, and what they’re not, and how essential their role is in a corporate wellness program. We discuss common barriers to behavior change and how to overcome them.
“There are a lot of individuals out there that want and need to make changes and they just need someone in their corner. They just need someone that will do two things – hold them accountable and, then, just be a support and a motivator.”
Want to dive deeper into this Well-Being Experts podcast? Here's the full transcript from our discussion with Brenda Gill, Health Coach for Onlife Health.
Brenda: There are a lot of individuals out there that want and need to make changes and they just need someone in their corner. They just need someone that will do two things – hold them accountable and, then, just be a support and a motivator.
Host: This is the Well-Being Experts podcast and you just heard from Brenda Gill, Health Coach at Onlife Health. We had the chance to talk a little about what a health coach really is, and what they’re not, and also how essential their role is in a corporate wellness program. Creating behavior change, it can be really hard for someone.
Brenda: But knowing that they’ve got this coach that they can just call and discuss these things with; that has no judgment; that’s only there to help them; and that wants to see them succeed. I think that matters and I think when we can tap into that and they can feel comfortable in that relationship, I just think that’s extremely important.
Host: On our ninth episode of the Well-Being Experts podcast, brought to you by Onlife Health, we’re discussing how to overcome resistance to behavior change. For more content like this, make sure to go to onlifehealth.com/resources. Enjoy the conversation!
Brenda: My name is Brenda Gill. I’m a registered nurse and a health coach at Onlife Health. I’m also an exercise physiologist and hold a Master’s degree in exercise and nutrition science.
Host: I would like to first start off with just having a review of what a health coach is and your experience with being one.
Brenda: I think the first thing that comes to mind is a motivator and support. Someone that will listen to what’s going on, what type of health issues you have, and then be able to steer you in a direction to make some improvements. And then hold you accountable for that as well and to motivate you to want to make those changes. Because I think what happens is we all have things we know we want to do, we want to make changes to, but it’s the getting started sometimes. And then it’s the continuing and just having that person there that can be in your corner, motivate you, hold you accountable, I think makes a big difference.
Host: How do you approach someone who is resistant to any kind of change when it relates to their health, their eating, all of the above?
Brenda: That does remind me of a story and a member that I met onsite. First thing she said to me was, “I don’t need a coach. I don’t want a coach.” So we just continued to talk and as we got through the conversation, at the end of it, she wanted to know if I was going to be her health coach. We had obviously gone from point A to point B and gotten her to a point where she felt like she really needed this, so she saw some value in it. And it really comes from the questions that you ask – motivational interviewing is a biggie – and just being able to lead someone down the path that sometimes I don’t even realize are headed down that path, but getting them to the point where they understand or know what motivates them to make a change.
Host: In between point A and point B, point A, I do not want anything to do with a health coach. Point B is like, “All right. Let’s do it. Let’s get started.” What happens in between those points of total resistance to acceptance and ready to implement?
Brenda: I think part of it – and what is helpful – is we had information. They had had a biometric screening, so we actually had data, if you will, to talk about and for me to share with them. These are what your numbers are. So those that were out of pattern led us to more conversation about what would be healthy options and how to bring those things into pattern. So as we’re discussing that, then she’s thinking about the things that, “Well, you know, I really should do that,” or, “I could eat better. Well, you know you’re right. I really don’t get that much exercise.” And then sharing with them, “Well, hey, these are the recommendations for exercise. The recommendations for fruits and vegetables servings.” Then as we continue to talk and she’s realizing, “Okay, there are some things that I could do,” then that led into, “Okay. Well how can I do this?” And she wanted to know the how, and at that point, she was ready to implement some changes.
Host: As a health coach, how do you help someone identify that how?
Brenda: That’s a very good question and it’s a part that I really enjoy. When I’m sitting down with someone and they say, “I know I need to eat better.” If you just leave it like that, you really don’t have any –
Host: All right. See you later. Job’s done.
Brenda: Right. You don’t really have any information and it’s not actionable. But then when you get to, “Okay, well, tell me more about that. Well what does eating better look like?” And then that gets them to think about, “Well, I guess I could eat more fruits and vegetables.”
“Okay, that’s good. Well, how would you do that? When would you add those extra fruit and veggie servings in?” And then they start to think about their day and when they could have that piece of fruit or when they could have those carrot sticks. And then we get more into, “Okay, well, that will get us to two to three servings per day, which is what the recommendation is.” And it’s, “Oh, okay. That doesn’t seem so bad. I think I can do that.” And so it’s just step-by-step, incremental changes that we’re looking at.
Host: Is there like a “if you do this, you’ll get that” type of?
Brenda: Yes, there is. Because like you said, everyone knows, “Okay, I should eat healthier. I should eat more fruits and vegetables.” That tends to be the first thing we talk about when we start talking about nutrition. How many servings of fruit and vegetables do you have every day? And the reason we do that is because we know – and science tells us – that the more fruit and veggie servings we have, the more – or I should say the less you are going to be at risk of a lot of health issues like heart disease, and diabetes, and even certain cancers. So when you put that out there to them that way, “These are the benefits of getting your fruit and veggie servings,” then they’re more likely to think, “Okay, this can have some benefit for me.” And then talk about just how I can actually get those servings in so that it doesn’t just seem like there’s a big chore that I’ve got to try to get all my fruits and veggies in.
Host: The theme we’ve been hearing so far around behavior change are the barriers everyone has, everyone faces. What are the most common barriers you see?
Brenda: I think for a lot of people, it’s no time. They feel they don’t have time to implement things. For some people, it’s an affordability issue. I can’t afford fresh fruits and vegetables. For some people, the goal that they have maybe really isn’t their goal. Maybe it’s one they think they should have or they feel that they’re being led by their employer to do certain things, so the goal isn’t really theirs. So they really haven’t bought into it or tapped into it. So I think part of my role as a health coach is to help them identify what those barriers are and then help them overcome them.
Host: Do you find that most people have similar barriers or are they, in fact, very different?
Brenda: I think they’re pretty similar. They tend to fall into two or three different buckets, really. The no time is a biggie, especially for exercise. “I work all the time. I come in at 6:00 or 7:00 in the morning. I don’t leave until 7:00 or 8:00 at night. When do I have time to exercise? When do I have time to eat right? I don’t get a lunch. I barely get dinner.” So we hear that a lot and so it’s really trying to help them figure out ways to get it in.
Host: When you’re meeting with someone for the first time – you shared a really good story earlier about meeting somebody and them not really being that interested, and then at the end they’re like, “Hey, you know, I actually want to do this.” Now, how often is it that someone, a barrier that they have is resisting change, and they don’t want to change. How often is it that you meet people like this? And then how, as a health coach, how do you overcome that to help the employee?
Brenda: I would say that’s fairly often that we will be with members who, because of their health plan and what has been put in place, feel that they’re being forced to work with the coach or to be a part of the whole process. So many times they come in very resistant and not wanting to work with us at all and they don’t feel that it’s fair that they have to be involved in this. What we try to do is, when we sit down with them, to really take that off the table, and let’s just focus on the member. Let’s focus on what your numbers are. Let’s focus on things that you can do to improve. Because even though your employer may have this plan in place and they want you to participate, if I’m looking at your results and I see gaps here, and I see opportunities here for you to be healthier, then this is something that we really need to talk about. And just try to get into the conversation of how important is your health to you. I try to get more from that standpoint.
Sometimes it works and the member will come away feeling like, “Okay, this is something that I need to focus on.” Other times, they won’t and they won’t want to talk with us any further. That’s okay, too, from the standpoint of we’re not there to force anyone to get involved in coaching. We just make sure they understand the benefits and the reasons that we’re doing this and why it’s important for them. I think that’s the key, letting them know that this is all about their health. This is not about their employer’s health, this is about their health.
Host: It sounds like a really big value is having the data from the biometrics. Because even if someone’s not interested, like, “I don’t want to talk to you,” but then you start pulling out these papers like, “All right. Well do you want to see this?” And they’re like, “All right, maybe.”
Host: Is that how it runs?
Brenda: Yes. That is huge. Because you’ll be sitting with someone and they will say, “Oh, I’m healthy. Oh, I eat great. I have a great diet. I exercise.” But then when you start peeling that onion back and start really talking to them and you see the numbers, “Well, but your blood pressure is 160/95 here,” or “Your cholesterol numbers are just way off the chart. Your blood sugar is not where it needs to be,” and they can actually see results. I think it’s very eye-opening for some of them. They don’t realize and then that just opens up a whole other conversation because it’s, “Wow. I didn’t realize this. I didn’t know. What can I do?”
Host: And that’s a big part of having that human-to-human connection, that face-to-face time with a health coach to achieve that.
Brenda: Absolutely. I like being across the table and able to look them in the eye. Now, we do telephonic coaching, we do secure messaging, and we can certainly reach members, absolutely. And I enjoy that end of it. But I would say I more enjoy being able to sit down across from someone and speak with them. And then the other thing is they can’t lie because I’m looking right at them.
Host: They can’t escape you.
Brenda: They cannot escape at all, absolutely.
Well-Being Experts is supported by Onlife Health. With 20 years of industry experience and over 10 million covered lives, Onlife knows how to drive the ongoing engagement needed to create real results. Find out why health plans and large employers nationwide trust Onlife Health as their comprehensive wellness provider. Visit onlifehealth.com to learn more.
Host: So now they’re a yes, their behavior has changed. How do you keep that behavior changed long-term? How do they get engaged right away and start benefiting from living a healthy life?
Brenda: I would say right off the bat, they need to have some small thing that they can do when they leave there. Now, their long-term goal may be to lose 50 pounds and that’s daunting when you think, “Okay. I’m going to lose 50 pounds. How am I going to do that?” How do you eat an elephant? One bite at a time. So let’s start with one small thing, one small change that you can make.
What I like to do is not so much focus on the pounds, but focus on the activities that will lead to losing those pounds and then let’s just look at eating healthier or getting some exercise. So one very small thing could be, if they’re not getting any exercise at all, can you devote ten minutes to just walking every day? “Okay, that doesn’t sound so bad.” When are we going to do this? How about on your break at work? So instead of taking a smoke break maybe or instead of just doing nothing, how about you just walk for ten minutes? Let’s just start there. And what that really is is meeting them where they are and moving from there.
Another thing might be the whole eating healthier. Just to think, “Okay, do I have to cook foods differently? Do I have to buy different foods?” Let’s just look at getting just one serving of fruit every day. Can we just look at that? What type of fruit do you like? “I like bananas, I like apples.” Is it reasonable that you could have an apple, just one apple every day? “Yeah, I think I could do that.” Then let’s work that in. So just small changes, initially, and then those just build up until you’ve gotten to the point that you want to be, but you’ve got to start somewhere.
Host: Do you also do coaching on not just what you’re eating and exercise, but also for the mind and like some of those benefits that come from that?
Brenda: Absolutely. We also coach on stress – stress management – and that’s a biggie, because when we’re there in the screening, and we ask them about stress, and we’ll say, “Rate your stress on a scale of one to five with one being very little stress, five being a lot, and really more about the impact that the stress has on your life.”
“Oh, I’m at a four. I’m at a five.” You know what? We probably need to look at that before we look at anything else. Let’s look at managing the stress and getting that to a lower level – a more manageable level – before we talk about implementing some other changes. Because if you’re worried about something over here, if you’ve got all these things going on, then what are the chances of you actually being able to take on something else and stick with it?
Host: When you really look at it, what is stress? Chemically, the impact it has on you. How it occurs? I think everyone says they’re stressed, but really when you look at through more of an official viewing of it, how would you describe that?
Brenda: There’s good stress and there’s bad stress. And stress is very real. It affects people in different ways. The body doesn’t know the difference between good stress and bad stress. The body is going to act physiologically. It’s going to react to whatever the stimuli is not knowing if it’s good or bad. For instance, getting married is a happy occasion, but it’s very stressful. That’s a good stress. Losing a job, on the other hand, that’s stress as well, but bad stress. The body is going to react the same and the body reacts in so many different ways, from loss of appetite, headaches, body aches, depression. There’s just a whole laundry list of things that will occur when someone is under stress.
So it’s really important to help the member be able to manage those things. And for many times, it’ll just be a small thing of just finding ten minutes a day to just be still really, or to do something that will relax you. Just ten minutes. And stress management is something that you have to practice ongoing. You can’t just do it one time and then be okay. It’s something that you have to do every day, just devote some time to that, to being able to just be calm for a bit before you can tackle something else.
Host: Are there any suggestions on what activity to do for ten minutes?
Host: Any favorites?
Brenda: Absolutely. Deep breathing is a biggie. Deep breathing, guided imagery, just sitting in a room closing your eyes, and just being, just sitting there and just breathing very deeply. In fact, we’re doing some challenges at work at Onlife and we had one on meditation yesterday. And we – literally, there were a few of us that went into a room and we had our clinical manager to just have us close our eyes and just walked us through just relaxing, just deep breathing. Ten minutes and we finished. We just feel very refreshed and I can go back and tackle the things that I have to do.
Host: In your experience as a health coach, when you’re talking with someone about their goals – what they’re trying to achieve – I’m curious to hear what is the success rate? If they decided they’re going to do it, what is the success rate? And how long does it normally take to meet that success as they’ve defined it?
Brenda: I think that comes back to setting the small, actionable goals rather than the large goals. For instance, with the weight, we’ll go back to that. So if I know I want to lose 50 or 75 pounds, we can keep that number out there, but I think what’s more helpful is to break it down. And we’ll break it down into three to five pound increments with say, a six to eight week follow up. So that gives the member a shorter window of time, a smaller goal, and an opportunity to have successes along the way. What I’d like to tell my members is we celebrate every pound, every pound lost, so that they’re not discouraged. Because I think when we have a large goal out there and they’re trying to do that, any setback in that – if they don’t reach that – tends to be a de-motivator, if you will. Then they feel like they don’t want to go any further – “I can’t do this,” – so keeping it small. Like I said, we typically will follow up in about six to eight weeks and we’ll have specific plans and action items that would occur during that time period. So that at the end of that, they will have a much greater chance of hitting their goal.
Host: Now, to zoom out a little bit, one question that would be really interesting to hear – as we’re starting to get into the end of this conversation – what is something you wish the healthcare industry realized about human behavior?
Brenda: For one thing, it’s not easy, in terms of changing behavior. There’s a whole field of study around that and that’s why we’re here today. So it’s not a quick fix and I think employers and the healthcare industry have to understand that there has to be support along the way. You can’t just come up with a plan, throw it out there, and say, “This is the result I want,” and just expect it to happen overnight. It takes some time and we’re talking about individuals. You know these are people, people with all sorts of things going on in their lives, and so while they may have the desire to do certain things and to make improvements, they may just not know how. Or just maybe the will isn’t quite there yet and so it takes some time.
Host: Yeah. I love – that’s awesome. So sometimes you might meet someone and they might not be interested. Now on the other side of that, you might meet someone and they’re all about it. What is that experience like for you?
Brenda: That is a wonderful experience, very gratifying. It just lets you know, “Okay, this is why I do this.” And I would say I have it more so when I was a telephonic coach and actually had a caseload. And so I had members that I was talking with routinely, consistently, every couple of months or so, and I had some that seemed to just relish having the conversation. They had our phone number programmed in their phone, so when it rang, it said health coach. Some of them even had my name attached to it and they knew it was me and they answered the phone, “Hi, Brenda. How are you?” And they seemed enthusiastic and excited and wanted information and that just lets you know, “Okay, what I do matters.”
Host: It’s a wonderful validation.
Host: Now how can that member – they’re all about it. How can they maximize their relationship with a health coach? So they’re not being really over eager and being – that energy is being directed in the wrong, inappropriate way. How can they really just take full advantage of everything that you have to offer?
Brenda: I would say being available for their follow-ups. Like I said, when we talk with someone, when we end that conversation, we’ve set their follow-up for the next time. So anticipating that that phone call is going to come and that we’re going to have that conversation, find out where they are at this point, and then help them to move further. And I would say to just stay engaged in that process and really work with the coach on finding those small little incremental things that they can do and making sure that they’re doing those things. And then not feeling bad, if they don’t hit something, because this is just human nature and life happens in between and just being open to the dialog with the coach.
Host: I love that. It’s such a safe place, I feel like, talking with you in that. If you’re my health coach, I feel like that’ll be really okay to do. Any final thoughts about behavior change, health coaching, all the above?
Brenda: I feel that what we do is very important. There are a lot of individuals out there that want and need to make changes and they just need someone in their corner. They just need someone that will do two things – hold them accountable and then just be a support and a motivator. And they may not have that person in their day-to-day lives or the people that they’re in contact with every day, they may not feel as comfortable with, they may feel embarrassed. But knowing that they’ve got this coach that they can just call and discuss these things with, that has no judgment; that’s only there to help them; and that wants to see them succeed; I think that matters. And when we can tap into that, and they can feel comfortable in that relationship, I just think that’s extremely important.
Host: And I can tell that is extremely important to you and I know you find great joy in this and spend an entire career dedicated to this. I so appreciate you sharing your story here with me, Brenda.
Brenda: Thank you.
Host: I can’t wait to, hopefully, to talk with you again soon in the future about health coaching and you working with all these members and helping them achieve their goals. And so thank you for doing what you’re doing.
Brenda: Absolutely. Do you need a coach?
Host: Yeah. I would, actually. I will talk to you. That would be wonderful.
Thank you to today’s guest, Brenda Gill, and a big thank you to you for listening along with us. Well-Being Experts is brought to you by Onlife Health, a comprehensive wellness solutions company that has spent years working with health plans and large employers nationwide.
Today’s podcast and additional perspectives from the Well-Being Experts can be found at onlifehealth.com/resources. We welcome your comments, questions, feedback, all the above at firstname.lastname@example.org.