The Role of Motivation in Wellness Coaching and Weight Loss
Liberty University

Abstract
The consequences of the American lifestyle, obesity and its associated comorbidities, on healthcare costs is staggering. Physicians prescribe behavioral changes such as diet and exercise, and hand out information on how to decrease stress. Wellness coaching has an opportunity to address clients holistically in order to achieve the behavioral changes needed to improve people’s lives and embrace their full potential. Motivation, both intrinsic and extrinsic, is a complex construct or force causing people to act and its presence is needed for change to begin as well as sustained. Based on Self-Determination Theory where the combination personality, self-regulation, and autonomy in motivation yield behavior change. Wellness coaches collaborate with clients in the coaching process to motivate client’s to meet their goals, using the coaching experience and accountability teaches the client self-motivation, and coaching the client in motivating others. During the initial screening conversation the coach must determine if the client is a good fit for wellness coaching and if they have any hurts that a counselor needs to address to free the individual to move forward. The coach needs to understand how the client is motivated to ensure goals are S.M.A.R.T with the right mixture of motivation applied through action steps and accountability to meet goals. Motivational interviewing techniques offer the client insights and awareness of their emotions. To remain effective the coach must role model self-care.
Key words: obesity, wellness coaching, life coaching, motivation, self-determination theory, happiness, wellness, weight loss, exercise and diet, goal setting

Introduction
Turn on the television, pick up a lifestyle magazine, or peruse social media, and stories, pictures and tips abound with society’s ideal body image, programs and tips to lose weight, stories related to the medical research and the consequences of obesity, and the new term “fitspiration,” which is simply pictures of fit people with motivational phrases written on them. Headlines like “Oprah now eats bread and still loses weight,” Dr. Oz has some sort of “magic berry juice” to drink, or the latest workout available for purchase from a celebrity trainer promising that people will looked “totally ripped” like the people in the infomercial, and the newest “detox” or cleanse a celebrity is using fill America’s eyes, ears, and minds. Americans seem to get most of their health information through pop culture and what the Kardashians are doing. While there is truth to some of the information but without appropriate support or coaching, Americans are wasting lots of money and not experiencing results, which becomes demotivating in achieving their potential in their health and wellness. This paper will focus on the role of motivation as a key factor in changing behavior to increase an individual’s level of wellness and support weight loss.
Obesity Statistics and Healthcare Costs
Obesity is one of the biggest drivers of preventable chronic diseases in the United States and current estimates of healthcare costs range of $147 billion to nearly $210 billion per year (Cawley & Meyerhoefer, 2012). Some of the latest research shows that as an individual’s body mass index (BMI) increases so do the number of sick days from work, the number of medical claims, and the person’s healthcare costs (AHA, 2005). For example, an obese adult will spend 42% more on direct healthcare costs than an adult who is at a healthy weight (Finkelstein, Trogdon, Cohen, & Deitz, 2009). For severely obese patients, the costs of emergency room visits for chest pain are 41% higher and 22% higher for overweight patients than for people at a healthy weight (Peitz et al., 2014). Based on these statistics alone, reducing obesity, increasing activity, and improving nutrition would definitely help lower healthcare costs through fewer physician’s visits, medical tests, prescription drugs, sick days away from work, emergency room visits, and acute care admissions to the hospital as well as lower the risk of a wide range of preventable diseases. It would also empower people to live life to their fullest potential, improve their relationships, and better enjoy their families, their work and individual pursuits or hobbies.
Wellness and Positive Lifestyle Change
Wellness is not a trend or fad, but a philosophy that “…embraces a way of living that helps all people enjoy a more satisfying, productive, and happy life. Wellness is defined as a conscious, deliberate process that requires a person to become aware of and make choices for a more satisfying lifestyle” (Swarbrick & Moovsi, 2010, p. 2). A wellness lifestyle is balanced and focuses on cultivating healthy habits while avoiding or ceasing self-destructive behaviors, such as toxic relationships or work environments or substance abuse (Swarbrick & Moosvi, 2010). Health habits include proper sleep and rest, eating foods that nourish the body, getting enough exercise, engaging in meaningful activity like mindfulness exercises in mediation, and finding and maintaining meaningful community (Nemec, Swarbrick, & Merlo, 2015). Wellness coaching is long-term simply because these behavioral changes are complex with multiple contributing factors causing goal setting within each health habit to be a large undertaking typically requiring a team approach with the client’s physician, case manager, and nutritionist and other allied health professionals.
Since obesity and the quest for weight loss is actually a symptom of multiple and complex behavior changes resulting form the cumulative impact of an individual’s health habits, changing the focus from weight loss as the primary goal will create the potential for long-term success. One approach to improving wellness involves creating new healthy habits to replace an existing habit that is a barrier to improved wellness making weight loss a by-product of the larger picture (Nemec, Swarbrick, & Merlo, 2015). Common behaviors addressed are moving or exercising more and eating nourishing foods. Each behavior has multiple contributing factors like willpower, rewards, support system, environment, perceived margin of time, and motivation to implementing behavioral change and habit formation that support weight loss (Nemec, Swarbrick, & Merlo, 2015). According to researchers, motivation is the critical factor in eliciting sustained behavioral change in an individual (Ryan & Deci, 2000).
Nature of Motivation
Defining motivation is actually quite challenging given its internal nature. The word motivation means, “a force or influence that causes someone to do something” (Merriam-Webster Dictionary, n.d.). It is the force that not only causes action, but also sustains it when the initial desire wanes. It is logical to equate motivation to action, yet research has shown that motivation can be present in the absence of action because action is initiated only after reaching a point where action, as opposed to inaction, is the easier choice (Miller & Rollnick, 2013). It is difficult to study what constitutes the tipping point to act since motivation is such an amorphous subject. If a person is unmotivated, the inaction creates a space of self-awareness to explore what is preventing a person from initiating action and explores why people procrastinate. If coaching is about results, then motivation produces the results.
Even though motivation is often viewed as a singular construct, in the real world people are moved to act by different types of factors and their experiences and subsequent consequences are varied (Ryan & Deci, 2000). Relevant motivational factors that influence change and subsequent action includethe following: need, interest or desire, beliefs, expectations, and initiation (Nemec, Swarbrick, & Merlo, 2015). Needs are considered from the perspective of the individual making a behavioral change. Need involves external pressure to change while interest or desire, in contrast, is an internal pressure to change (Nemec, Swarbrick, & Merlo, 2015). These factors correlate with each other in that when there is a high need plus low desire or a low need plus a high desire, the motivation to act is present (Nemec, Swarbrick, & Merlo, 2015). If there is a low need plus a low desire, the individual likely will not take action and start to change (Nemec, Swarbrick, & Merlo, 2015). Next, in order to change a behavior, more often than not, a belief must change first. The individual must also believe that the new behavior will accomplish what the person wants, be congruent with what the person thinks he should do (values), and the belief that the person can actually change in his given set of circumstances (Nemec, Swarbrick, & Merlo, 2015). Fourth, expectations serve as the “pros and cons” of change and lastly, initiation of action can be well thought out and pre-planned or sudden, spontaneous, and seemingly reckless (Nemec, Swarbrick, & Merlo, 2015). Together, these factors influence a person’s motivation or taking action.
Self-Determination Theory Approach and the Types of Motivation The approach used to address types of human motivation and personality that is based on empirical methods is Self-Determination Theory (Ryan, Williams, Patrick, & Deci, 2009). According to research, “…its arena is the investigation of people’s inherent growth tendencies and innate psychological needs that are the basis for their self-motivation and personality integration” (Ryan & Deci, 2000, p. 68). SDT differentiates motivation by inquiring what type of motivation is being displayed at any particular time (Ryan & Deci, 2000). By considering these forces to act, SDT has been able to classify two main types of motivation, intrinsic and extrinsic (Ryan & Deci, 2000).
Intrinsic Motivation Intrinsic motivation is characterized by engagement in an activity because it brings pleasure along with some activities being labeled as intrinsically motivated activities because the activity itself is experienced as fun and pleasurable (Ryan et. al., 2009). For example, for some people dancing to music is an enjoyable and fun experience that causes them to return to the activity repeatedly simply for the pleasure it brings.
A sub-theory of SDT is cognitive evaluation theory (CET) that focuses on the determinants of intrinsic motivation (Ryan et. al., 2009). CET does not determine causes of intrinsic motivation, but focuses on the conditions that promote or cripple it (Ryan et. al., 2009). CET argues, “…events that are perceived to negatively impact a person’s experience of autonomy or competence will diminish intrinsic motivation, whereas events that support feelings of autonomy and competence will enhance intrinsic motivation” (Ryan et. al., 2009, p. 110). Feelings of competence will not support intrinsic motivation unless the feeling is within the context of autonomy, making competence and autonomy necessary conditions for intrinsically motivated behavior (Ryan et. al., 2009). For example, the person who loves to dance to music and is using a dance class as an intrinsic motivator to exercise in order to lose weight could have a positive or negative experience in the class. If the music is too loud and all of the dance moves are new and intricate to the point that the person struggles to achieve success, intrinsic motivation decreases causing the person’s desire to return to the class to decrease because of feeling incompetent and not in control of the environment (I could not get the music turned down and it hurt my ears). This causes the new and positive exercise behavior to falter which, in turn, stalls weight loss.
Extrinsic Motivation In contrast, extrinsic motivation is engaging in a behavior in order earn an outcome outside of the behavior itself. For example, if the person attending the dance class can win a prize for attendance, the individual will experience extrinsic motivation. In the case of exercise, people continue for the long-term not because the activity itself is necessarily enjoyable every time they engage in it, but because they have something to gain from it (Ryan et. al., 2009). For example, Americans flock to weekend 5Ks, 10Ks, half and whole marathons and more to get the medal, bumper sticker, and t-shirt and will faithfully train for months so they can earn it.
Contained within extrinsic motivation is another sub-theory called organismic integration theory (OIT), which “…specifies a continuum of autonomy underpinning extrinsic motivations” (Ryan et. al., 2009, p. 112). At one end of the continuum an individual’s actions are motivated by externally controlled rewards or punishments so the behavior is not internalized and ceases if the reward or punishment ceases (Ryan et. al., 2009). The other end of the continuum, integrated regulation, could almost be considered intrinsically motivated behavior because of the corresponding control experienced by the individual that is consistent with his or her values (Ryan et. al., 2009). Self-regulation and understanding the varied motives that are combined and experienced within one individual becomes important in the role a coach plays as a collaborator.
Goal Setting and Motivation The goals or action steps to change behavior become part of the motivation process. Goals are “…the object or aim of the action” and, like motivation, have both an internal and external aspect (Locke, 1996, p. 118). Internally, goals are the desired end, and externally, they are the sought after object or condition with the idea guiding the action to get the object (Locke, 1996). Goals involve commitment and must be SMART (specific, measurable, attainable, realistic, and within a given timeframe) to motivate an individual to move forward (Collins, 2009). People realize that goals are integral to change and success, yet struggle to meet them. The typical American lifestyle in the 21st Century is overly busy, overscheduled, and chaotic so that a person seeks out a life coach or a wellness coach to unravel life in order to set realistic goals (Collins, 2009).
Emotions and Goal Attainment
Research has begun to address the mediating effects of emotions related to goal attainment. Sometimes, it is due to the perceived possibility of not reaching the goal that leads to feelings of helplessness making a strong sense of self-efficacy to meet the goal important to maintain the motivation (Bueno, Weinberg, Fernandez-Castro, & Capdevila, 2008). It is also important to note the emotional sense of the person feeling threatened if they to not achieve the goal (Bueno et al., 2008). It is the emotion surrounding weight loss that leads to feelings of helplessness. This is why weight loss goals are actually broken down into positive wellness behaviors a person can focus on and achieve. Wellness coaching provides stability, SMART goals that stretch the individual, and supports the individual as he or she navigates emotions that support or diminish motivation and goal achievement.
Christian Values and Goal-Setting For Christians seeking to make behavioral changes or implement healthy habits, determining the motivation to create a lifestyle change such as a weight loss goal needs to be reconciled with the person’s values and God-given priorities. Weight loss is not really the goal so much as one of the components of living a healthy life, moving more, eating nourishing foods, and decreasing stress. Extrinsic motivation like losing a set amount of weight in order to look good at a high school reunion has a short horizon of time in motivation because it potentially conflicts with temptation toward vanity as opposed to inner beauty. Scripture says, “Charm is deceitful, and beauty is vain, but a woman who fears the Lord is to be praised” (Proverbs 31:30, English Standard Version). There is freedom and intrinsic motivation found in living one’s values in goal setting because it has a positive effect on behaviors (Pearson, 2012).
Wellness Coaching and Weight Loss People could hire several different types of coaches to meet weight loss goals. Life coaches, wellness coaches, weight loss coaches, or fitness coaches could be a good fit depending on the coach’s training and experience and the person requesting assistance. As a nurse by profession, this writer is not only a nurse, but also a coach making wellness coaching the appropriate fit. Wellness coaches assist clients in several areas which weight loss would fall under. Wellness coaching assesses health concerns, assists clients in setting wellness goals, and reducing stress (Grodzki & Allen, 2005). Weight loss is a health concern while placing the focus and goals on lifestyle change and habit formation. Wellness coaching also addresses the individual holistically making wellness coaching the perfect fit for everyone (Grodzki & Allen, 2005). Wellness coaches also work in combination with medical and other healthcare providers making a nurse who is also a wellness coach and has extensive education and training in exercise and exercise for specialty populations including the diagnosis of obesity, nutrition education, and strength and conditioning training highly desirable due to credibility (Grodzki & Allen, 2005). Ethically, this coach would not succumb to fads and gimmicks that are intensely marketed in the media to health clubs and personal trainers that feed the quick fix, fast food and convenience store mentality in this country. Research has shown that clients respond positively to wellness coaching because it is collaborative, the coach is seen as a partner, the coaching process focuses on developing the client’s strengths, and the coach asks clients what they think instead of telling them what to do (Sforzo & Moore, 2015). As a part of screening a client as a good fit for wellness coaching, the coach needs to take several factors into consideration. Research has determined that there are six distinct phases that a person goes through when making behavioral changes (Collins, 2009). The coach needs to assess whether or not the person has moved from the first phase, precontemplation, to the second phase of contemplation in order to know the appropriate starting point because it is in the second phase that people acknowledge there is a definite need to change (Collins, 2009). Precontemplation, the person who sees no need to change due to denial and fear regarding his current medical condition needs to develop trust in the coach so that he can feel safe enough to turn in and face the fear and acknowledge the need to change (Collins, 2009). If the client cannot face into the issue, a referral to counseling is appropriate to assess why he or she is stuck and to address hurts and healing (Collins, 2009). During the coaching process, the wellness coach deals with motivation several ways including motivating the client, using the coaching process experience to teach the client self-motivation, and coaching the client to motivate others through motivational speaking techniques. Motivation is created in the client by moving the client through each phase of the coaching model. First, fostering client self-awareness followed by the process of creating vision or the client’s cathedral statement of where they want to move and its mission (Collins, 2009). For example, a client whose physician told him he needed to hire a coach for weight loss so all of his health comorbidities would improve hires a coach and says as a part of his initial assessment that he is a fat Georgia boy who loves to cook. He is very self-aware and needs a vision for his life that is larger than his desire to eat. Loving to cook is wonderful so learning some new ways to cook could be an early place to brainstorm. This part of the coaching process is crucial because, as the coaching relationship develops and trust is built, the coach can learn how the client is motivated best. Research has shown that people typically respond to both intrinsic and extrinsic motivation when they are rightly applied to foster self-efficacy and autonomy and competence (Ryan et. al., 2009). Understanding how the client is motivated is crucial in the goal-setting phase of coaching as well as for accountability in the coaching relationship (Collins, 2009). This collaborative process where the coach understands the client’s personality and motivation, assists with coaching the client toward SMART and attainable intrinsic and extrinsic goals that feed the client’s vision and mission (Collins, 2009; Locke, 1996). Also if the client sets their own goals, they are more meaningful and the client takes ownership promoting autonomy, self-regulation and competence (Sforzo & Moore, 2015). Strategies will involve both external and internal motivated steps that the client sets for himself. Referring back to the example of the Georgia man who needs to lose weight to lower his blood pressure, his vision and mission revolve around family and doing activities that would make them proud. His long-range goals are to be healthy and mobile enough to play with his grandkids and to climb mountains that are 14,000 feet and higher. Weight loss is not even needed as an initial goal because this client needs to add some healthy behaviors to include healthy food and the appropriate kind of exercise in order to be fit enough to play with children and climb mountains. Weight loss now serves as a by-product of these goals and really as a reward in the end. Together, the client and coach brainstorm the action steps needed for each incremental goal and the potential obstacles (i.e. time management or non-supportive family members), and engage with a positive support system in order to stay focused and sustain motivation (Collins, 2009). Research has shown that being accountable to a coach as well as exercising with a group of people serves as motivation (Alexandris, Zahariadis, Tsorbatzoudis & Grouios, 2002).
The coaching conversations involve motivational interviewing techniques like reflections, mirroring, and reframing what the client says taking emotions expressed into consideration (Sforzo & Moore, 2015). Through deep listening, the coach reflects the client’s emotional state offering new insights that enable “…clients to dig deeper to reveal their motivators, personal values and priorities, challenges and possibilities” (Sforzo & Moore, 2015, p. 22). Motivational interviewing techniques circle the client back to new found self-awareness and the coaching model repeats itself to an extent every session (Collins, 2009).
Personal Impact This coach has been affirmed repeatedly as being an excellent motivator. As this coach embarks on opening a private practice, this paper has opened this learner’s eyes in how God has uniquely gifted her with intuitive skills, a love for people, and motivational assessment and speaking skills based upon living out the Great Commission to make disciples and loving support people in fulfilling their God-given purpose. Wellness coaching is a business as well as a ministry for this student. Sharing Christ through wellness is a gift.
This learner is building a coaching business on the foundation of the unconditional love and approval by God frees people to care for them. True beauty emanates from the inside of a person. Biblical principles of beauty and God’s unconditional love and approval resonate with Christians and non-Christians and open a door to sharing the Gospel. Scripture says, “For you formed my inward parts; you knitted me together in my mother’s womb” (Psalm 139:13, English Standard Version). God knows each person intimately and desires a personal relationship. The Word also says, “For God so loved the world that he gave his only Son, that whoever believes in him should not perish but have eternal life” (John 3:16, English Standard Version). When an individual recognizes the Truth that he or she stands approved and loved unconditionally by the Creator of the Universe, it frees the client to set health goals from a place of deep security of value in Christ instead of pursuing vanity or feeling locked in the shame for life circumstances, brokenness, and choices that resulted in the weight issues.
In order to maintain trust and credibility, the coach must live authentically and practice consistent self-care in order to serve others (Collins, 2009). Nurses are also caregivers and work extremely long hours from a place of empathy and compassion in caring for their patients (Gershon, 2014). A nurse who is also a wellness coach has an increased need of motivation to practice self-care daily. She needs accountability and coaching herself. Research validates that unless the healthcare worker or coach takes time daily to care and nurture herself through experiencing joy laughing, setting personal goals and taking steps daily to move toward them, she cannot effectively attend to the needs of her patients or clients and ceases to be a credible and motivating force in their lives (Gershon, 2014).
Conclusion
The cost of healthcare and the quality of people’s lives has been significantly impacted by the fast-paced, highly technological, work-driven American lifestyle. Technological advances have also caused Americans to have more of a sedentary and stressful lifestyle. Between work, school, and family, life revolves around sitting. Add the typical fast food American diet and the obesity rate is understandable. Physicians tell their patients to move more, eat better, and lower stress. “Momentum breed’s momentum” or the more one sits still, the more makes it a challenge for sedentary people to find the internal motivation to change. Wellness is a philosophy of living a slower paced life to decrease stress and creating positive habits that feed the person body, mind, and spirit. Where weight loss may be the initial goal, wellness coaching gives the client autonomy and control in setting positive behavior goals, therefore, taking the primary focus off of weight loss. Wellness coaching, particularly by health care professionals who are also trained coach’s is a trend and niche where coaching is needed to fill the gap to serve people in improving their health and wellness in order to grow toward their God-given potential. Motivation is a complex construct that a wellness coach needs to fully grasp in order to effectively collaborate with clients who need to make significant lifestyle changes in their lives. Rightly applied motivation will propel an individual toward their goals while a misapplication will render a client feeling overwhelmed and helpless. Coaching people in weight loss from a wellness perspective is consistent with a biblical worldview. Self-acceptance and unconditional love are powerfully sustaining motivators to keep an individual moving towards their goals. This future coach is equipped, has extensive experience caring for and training people in wellness, and feels called to continue to minister to people in the wellness arena.

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