This paper was presented for discussion at the International Macrobiotic Conference in Berlin on the 2nd November 2017. Discussion notes are at the end of this paper.
To assess health coaching as a delivery system for macrobiotic lifestyle advice. This paper explores the natural compatibility of macrobiotics and health coaching, as well as the benefits of using a well researched and effective methodology to deliver macrobiotic knowledge and content in a way that leads to positive lifestyle changes and medical outcomes.
Macrobiotics is a healthy, holistic lifestyle with a focus on nutrition from natural whole foods, whilst including exercise, movement, meditation, mindfulness, strategies for good sleep and various practices to develop a positive attitude to life.
Macrobiotics has been practiced widely in the West since 1960 when Zen Macrobiotics was published in English by George Ohsawa founder of modern macrobiotics. During the years that have followed, a body of knowledge has built up along with the practical experience required to make changes to a more healthy lifestyle. Coaching is essentially a method of training to deliver change. The coaching methodology can be applied to many subjects including work, sports, fitness and lifestyle. Macrobiotics is one subject that coaching, and specifically health coaching, can be applied to, to facilitate change. This marries the macrobiotic knowledge in holistic health care, with a well developed health coaching system for helping patients apply macrobiotics to their own lives.
Definition of Macrobiotics
For this paper I have used the name, Macrobiotics, to define the subject. Macrobiotics derives from Greek, meaning living a big life. I am applying it as a set of lifestyle changes that help us develop ourselves during our lifetime. Macrobiotics has had an emphasis on holistic health, as described by the founder, George Ohsawa, in his Seven Levels of Health.1
Definition of Health Coaching
Health coaching can be defined as; Helping patients gain the knowledge, skills, tools and confidence to become active participants in their care so that they can reach their selfidentified health goals.2
Delivery of Macrobiotic Health Coaching
Interaction between macrobiotic health coach and patient can be in person, via phone or various forms of internet-based communication. In addition various health coaching apps can be used to help track changes in health, calculate progress towards targets and remind patients of actions. These typically track weight, blood pressure, activity in the form of steps, exercise, meditation, sleep, and quality of life. When connected with a health tracking device, such as a Fitbit, there is greater scope for automatic measuring and recording of health factors. This can provide the health coach and patient with more information and may help the health coaching process.
Key Principles of Health Coaching
The following list has been published in a Clinical Trail of Integrative Health Coaching.3
1. The patient is the best source of information for personal behavior change strategies.
2. Education is provided when the patient is ready.
3. Goals are aligned with the patient’s vision of health and personal values.
4. Emphasis is placed on how to change behavior, not why current behaviors exist.
5. Plans are established for how to deal with setbacks.
6. The coach reinforces accountability using the patient’s own values and stories.
7. Only the patient is able to choose goals that are the most motivating.
8. Priorities are established balancing long-term vision and what is most salient in the patient’s present life.
9. Patience and belief in the patient are critical to establish trust in the coaching relationship.
10. Coaches guide patients in linking behavior change to their life purpose.
Health Coaching Process
Macrobiotic health coaching can be simplified to 6 steps.
1. Educate the patient about their health issues and potential natural, holistic solutions.
2. Guide the patient through the process of creating their own action plan.
3. Help the patient agree to realistic targets. Ideally the targets would be numerical.
4. Agree a start date.
5. Agree a time period that the patient can realistically commit to. This might lead to revision of the targets if the time period is too short to realistically achieve chosen targets.
6. Agree a support and review process.
Training Macrobiotic Health Coaches
Macrobiotic training courses have tended to focus on macrobiotics in terms of cooking, principles, philosophy, lifestyle changes and practice. This training would be enhanced if the students have a clear effective method to deliver their macrobiotic knowledge to patients. Training in health coaching would provide a structure for students to start working with patients.
Compatibility of Macrobiotics and Health Coaching
George Ohsawa, the founder of modern macrobiotics, wrote of a set of principles that contribute to the healing process. These include;
1. Self responsibility - Many a man wishes to be cured by others or by some mechanical device, all the while bypassing his own involvement and personal responsibility.4
2. Thinking for ourselves - Ohsawa’s favorite motto was “Non Credo” (“don’t believe”), always see for yourself. For him, unhappiness was the result of poor thinking ability. He gave students two to three questions every day and expected answers or reports the next morning. He told us not to be imitators. If students answered his questions using someone else’s idea or writing, he gave them a minus mark, even if it was the right answer. He was happier if the answer was a student’s own thinking, even if it was wrong.5
3. Education - Educational: Improvement of judgment to enable man to establish and maintain personal control of his physical health.6 George Ohsawa’s student Michio Kushi wrote about;
4. Self-reflection - Sickness is actually a sign that some aspect of our daily lives is causing us to become out of alignment with nature. In one sense, it offers an opportunity to step back and reassess our thinking and actions, and to, hopefully, make the necessary corrections. In macrobiotics, this type of evaluation is known as self-reflection, and it is an essential part of the recovery process.7
The health coaching process encourages patients to;
1. Take responsibility by making lifestyle changes that will result in improvements to their health.
2. Think for themselves and be actively involved in planning out their own healing process.
3. Engage in an educational process that leads to greater understanding about their health issues and options to heal themselves.
4. Adopt an ongoing process of self reflection to connect lifestyle changes with changes in health.
Research on the Efficacy of Health Coaching
In a study of diabetes patients, improvements in the coaching group alone were observed for self-reported adherence, exercise frequency, stress, and perceived health status. Coaching participants with elevated baseline HBA1C (≥7%) significantly reduced their HBA1C.8
A study into the long-term effects of health coaching concluded that "most improved clinical outcomes persisted one year after the completion of the health coaching intervention.”9 This suggests that once learnt, positive, healthy behaviours will persist. This patient empowerment approach is summed up by the adage - Don’t give a man fish, teach him how to fish. An article published by the Teleosis Institute provide references to a number of research projects suggesting that health coaching is effective in providing improved outcomes for cardiovascular disease , diabetes, cancer pain and asthma.10
Potential Challenges for the Macrobiotic Community
The health coach process involves giving more power to the patient and respecting their choices. It is less prescriptive than the model of the counsellor advising the patient. More time is often required for the health coaching process. For example one and a half to two hours may be required, compared to the one hour appointments that have been used for the counselling model. There needs to be an on-going contact with the patient to review progress towards targets, help with patient issues, and provide support and motivation.
Health coaching is an efficient delivery system for macrobiotic content that has been shown to be effective in helping patients make sustainable healthy changes to their lives. In addition it is a process that is easy to teach to students during macrobiotic courses and provides students with a well established process to promote their work and begin the process of helping patients make positive lifestyle changes.
Health coaching is becoming well accepted among medical professionals as a valid method to help patients make holistic lifestyle changes. Changes to diet, exercise, sleep and reducing stress are increasingly seen as important in the treatment of diabetes, HBP, high cholesterol, obesity and various digestive ailments, including IBS, constipation and stomach acidity. Health coaches provide a low cost solution in helping patients avoid expensive medical treatments and the side effects of long term medication.
Macrobiotic health coaches are likely to find it easier to partner with doctors, health organisations and companies, using wide range of research to validate the efficacy of their macrobiotic health coaching. In addition as health coaching becomes more widely accepted as an effective methodology, potential patients better understand the process by which they will interact with a macrobiotic health coach. This demystifies the process and helps engender confidence in the macrobiotic health coach.
Carl Ferré, president of the George Ohsawa Macrobiotic Foundation and publisher of Macrobiotics Today, for providing reference material. www.OhsawaMacrobiotics.com
About the Author
Simon Brown was director of London’s Community Health Foundation 1986-1993, is the current chair of the Macrobiotic Association, author of Modern Day Macrobiotics, Macrobiotics For Life and The Feng Shui Life Coach. He helped organise international conferences for Macrobiotic Teachers since 2007. Simon worked with Diabetacare from 2015 to 2017 helping to introduce holistic interventions to patients with diabetes through training Diabetes Specialist Nurses as Diabetes Health Coaches. He also project managed the development of a diabetes health coaching app to help patients manage and track their blood glucose.
Discussion Notes from the Presentation of this Paper at the International Macrobiotic Conference in Berlin 2017. This paper was presented as a possible way to use health coaching to deliver macrobiotic content. There was agreement that we use health coaching as one option to deliver macrobiotic advice. A health coaching module would ideally become part of our courses and accreditation processes. The health coaching process encourages patients to take responsibility, engage, think for themselves, self reflect and is more educational than prescriptive. These are all core macrobiotic principles. As the health coach facilitates the patient to set goals, agree an action plan, commit to a start date and duration, there is less pressure on a newly qualified student. We hope this will make it easier to start their macrobiotic career. Their work is made easier as they are following a well established model. It was noted that once the patient had set their own goals, the goals became a point of motivation. Decisions on lifestyle changes are then orientated around meeting the goals set by the patient. This provides clarity and focus. The Macrobiotic Association has already added a health coaching module to their minimum standards and has a professional title of Macrobiotic Health Coach and Cook.
- Herman Aihara, ‘The Seventh Condition of Health’, Kaleidoscope December 1980.
- Heather D. Bennett, Eric A. Coleman, Carla Parry, Thomas Bodenheimer, and Ellen H. Chen ‘Health Coaching for Patients With Chronic Illness’, Fam Pract Manag. 2010 Sep-Oct;17(5):24-29. http://www.aafp.org/fpm/2010/0900/p24.html#fpm20100900p24-bt1
- R. Q. Wolever, M. Dreusicke, J. Fikkan, T. V. Hawkins, S. Yeung, J. Wakefield, L. Duda, PFlowers, C. Cook and E. Skinner, ‘Integrative Health Coaching for Patients With Type 2 Diabetes: A Randomized Clinical Trial’, The Diabetes Educator 2010 36: 629 originally published online 9 June 2010 DOI: 10.1177/0145721710371523. http://journals.sagepub.com/doi/abs/10.1177/0145721710371523
- George Ohsawa, Edited by Carl Ferre, Essential Ohsawa, (George Ohsawa Macrobiotic Foundation 1994) Page 62.
- George Ohsawa, Edited by Carl Ferre, Essential Ohsawa, (George Ohsawa Macrobiotic Foundation 1994) Page 2.
- George Ohsawa, Edited by Carl Ferre, Essential Ohsawa, (George Ohsawa Macrobiotic Foundation 1994) Page 55.
- Michio Kushi with Edward Esko, Cancer Towards Preventing and Controlling Cancer with Diet and Lifestyle, (Avery 1981) Page 15
- R. Q. Wolever, M. Dreusicke, J. Fikkan, T. V. Hawkins, S. Yeung, J. Wakefield, L. Duda, P. Flowers, C. Cook and E. Skinner, ‘Integrative Health Coaching for Patients With Type 2 Diabetes: A Randomized Clinical Trial’, The Diabetes Educator 2010 36: 629 originally published online 9 June 2010 DOI: 10.1177/0145721710371523. http://journals.sagepub.com/doi/abs/10.1177/0145721710371523
- Anjana E. Sharma, Rachel Willard-Grace, Danielle Hessler, Thomas Bodenheimer, David H.Thom, ‘What Happens After Health Coaching? Observational Study 1 Year Following a Randomized Controlled Trial’, Ann Fam Med 2016;14:200-207. doi: 10.1370/afm.1924. http://www.annfammed.org/content/14/3/200.full.pdf+html
- Joel Kreisberg, ‘HEALTH COACHING EVIDENCE FROM RESEARCH’, Teleosis Institute October
8, 2015. https://www.teleosis.org/2015/10/08/health-coaching-evidence-from-research/