FROM THE ACADEMY

This article was written by Jill BallaKohn, MS, RDN, LDN, of the Academyof Nutrition and Dietetics’ KnowledgeCenter Team, Chicago, IL. Academymembers can contact the KnowledgeCenter by sending an e-mail toknowledge@eatright.org

http://dx.doi.org/10.1016/j.jand.2014.03.004

824 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS

Question of the Month

How Can Registered Dietitian Nutritionists Use HealthCoaching Techniques?

THE CONCEPT OF COACHINGhas become fairly commontoday in the health care arena.There are people with various

credentials who coach others on thebenefits of eating healthy, exercising,losing weight, managing stress, orquitting the use of tobacco. Coachingmay be provided on an individual basisor for a group, occur face-to-face orwith the use of technology, and involvedelayed or real-time communicationwith the use of phone, Internet, email,fax, video conferencing, or socialmedia.1

It was predicted in the March 2012issue of the Journal of the Academy ofNutrition and Dietetics that “technology[would] transform nutrition coun-seling,”2 allowing more personalizednutrition information to be received,and this trend is likely to continue.“Telehealth” and “telemedicine” havebeen used by various organizations todescribe the delivery of health-relatedinformation across a distance with theuse of technology, regardless of itsform.1,3 Telenutrition, which “involvesthe interactive use of electronic infor-mation and telecommunications tech-nologies,” as defined by the Academyof Nutrition and Dietetics, is specificto registered dietitian nutritionists(RDNs), because it involves the use ofthe Nutrition Care Process (NCP) and issubject to state licensure laws.1

Health coaching, which often in-volves some form of telehealth, is away for RDNs to promote lifestylechange with the use of skills includingbehavior change models and commu-nication techniques, such as motiva-tional interviewing (MI). The use of the

“social ecological model” as describedin the Academy’s Practice and PositionPapers on “The Role of Nutrition inHealth Promotion and Chronic DiseasePrevention” explains how the RDN canconduct a nutrition assessment usingthis framework as a way to improvehealth outcomes.4,5 This is especiallyimportant, since barriers to behaviorchange can exist at multiple levels (eg,individual, family, environment).Being a nutrition expert is impor-

tant, but having the ability to commu-nicate the information in such a waythat people can apply it is even morecritical—a proficiency RDNs possess.Rather than advising a specific wayto eat, the coach works with theclient to find out how the topic relatesto him or her on a personal level. Thedelivery of this essential informationrequires a delicate balance betweentalking and listening.MI is a tool that can help with this

process. It’s defined as a “client-centered, directive method for en-hancing intrinsic motivation to changeby exploring and resolving ambiva-lence.”6 MI is a creative approach toconversation, allowing a person to findanswers on his or her own, and isespecially helpful if there is somereluctance to change or specific barriershave been identified.Coaching is a collaborative effort,

which means the agenda for each ses-sion is developed along with the client.Since subsequent sessions are commonwith health coaching, personal goalsare usually established and evaluated.This allows the client to apply theappropriate information and helps toreinforce the change in behavior. Timeand again people will say they knowwhat they need to do; however, theirgoals are either unrealistic or theyhaven’t found a way to resolve the in-ternal conflicts that have preventedthem from making progress towardthem. The coach can help them scaleback their goals, if necessary, whichhelps to promote change that is

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sustained for a longer period of time,thereby increasing self-efficacy.

Health coaching and the use of MIare both skills that require time forproficiency to develop. There areseveral organizations offering healthcoach certifications or training specificto MI. The Commission on DieteticRegistration offers a list of accreditedproviders for continuing professionaleducation. The Academy also offersresources on health coaching and howRDNs can be leaders in this emergingfield.

Healthcoachingcanbevery rewardingas an RDN, because it integrates the artand science of nutrition anddietetics butallows the translation of information insuch a way that elicits a change inbehavior from the client without havingto be told exactly what to do.

References1. The Academy of Nutrition and Dietetics

Practice Tips: Telehealth Challenges andOpportunities. http://www.eatright.org/WorkArea/linkit.aspx?LinkIdentifier¼id&ItemID¼6442476737&libID¼6442476714. AccessedDecember 20, 2013.

2. Rhea M, Bettles C. Future changes drivingdietetics workforce supply and demand:Future Scan 2012-2022. J Acad Nutr andDiet. 2012;112(3 suppl):S10-S24. AccessedDecember 20, 2013.

3. Institute of Medicine Workshop Summary:The Role of Telehealth in an EvolvingHealth Care Environment (2012). http://www.eatright.org/WorkArea/linkit.aspx?LinkIdentifier¼id&ItemID¼6442476842&libID¼6442476819. Accessed December20, 2013.

4. Practice Paper of the Academy of NutritionandDietetics: The Role of Nutrition inHealthPromotion and Chronic Disease Prevention.http://www.eatright.org/WorkArea/linkit.aspx?LinkIdentifier¼id&ItemID¼6442477004&libID¼6442476981. Accessed December20, 2013.

5. Position Paper of the Academy of Nutritionand Dietetics: The Role of Nutrition in HealthPromotion and Chronic Disease Prevention.http://www.eatright.org/WorkArea/linkit.aspx?LinkIdentifier¼id&ItemID¼6442476998&libID¼6442476975. Accessed December20, 2013.

6. Motivational Interviewing [Resources forClinicians, Researchers, and Trainers]. http://www.motivationalinterview.net/. AccessedDecember 27, 2013.

014 by the Academy of Nutrition and Dietetics.