How Health Coaching Bridges the Gap Between Knowledge and Action for Real Patient Change

Welcome to another episode of Patients Win, the podcast dedicated to reimagining healthcare so it truly works for the people it serves - the patients. In today's show, the conversation focused on the vital role of health coaching and its intersection with mainstream healthcare. The discussion explored how health coaching goes far beyond simple diet and exercise advice, digging into personalized support, shame reduction, and the foundational lifestyle changes that lead to meaningful transformation.

A key theme that emerged was the immense gap between knowledge and action, why so many people know what they "should" do, but struggle to make and sustain change on their own. Several points were raised, including the emotional hurdles patients face, like shame and past failures, and how a supportive coaching relationship can help break down those barriers. The episode also takes a closer look at how lifestyle medicine, built on six pillars including nutrition, sleep, stress management, and social connection, can empower patients to regain control over their health, 1% at a time.

Listeners will hear stories of real transformation, the surprising elements of health coaching that patients don't expect, and how integrating coaching into employer health plans can lead to dramatic cost savings and better health outcomes. If you've ever felt stuck in your health journey or questioned the role of supportive relationships in true healing, this conversation is for you. At the end of every healthcare decision, one question remains: Did the patient win? Let's find out.

Timestamps:

00:00 Introduction to Patients Win the Show

03:51 Studying health and lifestyle globally

08:22 Foundations of lifestyle medicine

11:11 Setting personal health goals

13:56 Creating a safe space to share

19:08 Intro to the lifestyle program

22:08 Transformational personal growth journey

23:59 Importance of human connection

29:44 Supporting Healthcare for Employers

30:52 Coaching success before medication

36:48 The importance of seeking help

37:20 Encouraging collaborative patient care

41:24 Overcoming excuses to start now

44:49 Appreciating Cecilia's contributions

Show Website - https://thepatientswin.com/

Primed Healthcare - https://primedhealthcare.com/

Troy Reichert - Show Host - LinkedIn - https://www.linkedin.com/in/troy-reichert-67606b5/

Dr. Jonathan Bushman - Show Host - LinkedIn - https://www.linkedin.com/in/jonathan-bushman-do-106821191

Media Partner - TopHealth - https://tophealth.care/

“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”

Transcript

SPEAKER_03 0:00

I also see a lot of tears. Even on the first call, I realized that so many people don't have the space to share what's going on and what's on their heart. When we keep it a secret, when we don't share what we're struggling with, it weighs on us. We try to remove that shame. We just remind people of listen, you are doing things well. It's not all bad. Let's talk about the positive momentum that you are gaining, even if it's 1% better.

SPEAKER_01 0:47

The patient. We're pulling back the curtain on a system that has become confusing, expensive, and often disconnected from the patient. We hear patient stories as we talk with leaders, doctors, innovators, and employers who are changing and challenging the status quo and building something better. If you care about access, affordability, quality, and transparency, this is your place. Because at the end of the day, every healthcare decision should answer one simple question. Did the patient win? And today to help us answer that question, we're going to talk about health coaching and his intersection with healthcare. I'm joined by my co-host, Dr. Jonathan Bushman, and our special guest, Cecilia, with whom Jonathan is going to introduce us.

SPEAKER_00 1:32

Yes, welcome, Cecilia. Thanks for joining us.

SPEAKER_03 1:36

Thanks for having me. I'm very excited to talk about all things health coaching. Thanks for having me.

SPEAKER_00 1:40

Absolutely. So Cecilia Denara, you are in Mallorca. Is that correct?

SPEAKER_03 1:46

Yes. I'm in Palma de Mallorca in the Balearic Islands of Spain.

SPEAKER_00 1:50

That's amazing. Well, um, if the jealousy isn't on my face, I promise it's in my heart. And uh, but I'm so thankful you're with us today. Um and we're gonna take a dive into health coaching. But before we do, Cecilia, um, you and I have had the chance to know each other and work together for several years now and um have experienced some really, really cool stories of transformation in in the lives of patients. And before we go there, I just want you to take a moment to introduce kind of how you got into lifestyle medicine and kind of your background and tell us a little bit about the company that you uh have formed and work with, and uh just tell us a little bit about that and how we got to this point.

SPEAKER_03 2:35

Yeah, thank you. Um, first of all, I just want to say we're so lucky to work with providers like you because this is our ultimate vision is to pair with providers that really want to see their patients do well and empower them out not only inside the practice, but outside in their in their home. So um I'm really excited to be here to talk about this. But my background is kind of all over the place. I grew up in Napa Valley, California, um, very far away from Spain, where I am now. Um but I grew up as an athlete. I did gymnastics and volleyball and basketball, track and field as a kid. So I was really involved in sports and had a lot of awareness around health just from the athletic perspective. But I didn't really know much about nutrition. And I grew up in a pretty traditional Hispanic household. So um I come from a family where, you know, my parents did their absolute best, but they were immigrants and immigrated young and had me young. So I kind of grew up on a standard American diet, but with some Mexican fusion, Mexican in there. And food is a really important part of our lifestyle. And so um, that being said, I also saw my family struggle a lot with our health. So we have a lot of type 2 diabetes, obesity, mental health issues, um, you know, high cholesterol, those kinds of things. And I was very aware of this from a young age. And so that's what kind of fueled my curiosity around lifestyle and prevention and health overall. So when I went to school, I studied um health science education, which is now called public health. I focused on preventative health care and um whole food plant-based nutrition, which really now my focus is just whole foods and fiber predominant. And so um, yeah, when I graduated from school, I went all over the world and gained lots of perspective internationally of how people live their life, hence why I mean, I've lived in Brazil, I've lived in Chile, um, and then all over the US. And it's really interesting because the comparison is quite big. So I have a I have a big passion for cultural adaptation, for learning from other cultures and how they do things. Um, and now that I'm in Spain, I just realize that the lifestyle was very aligned with with what I practice myself. So that's kind of why I ended up staying. I did my MBA here, learned Spanish fluently. Um, so I can coach in Portuguese, Spanish, and English now. So that's it's been a huge win. Um, and just my passion for lifestyle and lifestyle medicine has been really driving this whole um, you know, why I do what I do, because I see that it works with patients. So I applied it to myself. I do practice what I preach, I do my best. We're not meant to be perfect, but you know, being empowered with education is is really so important. So that's kind of how I landed in lifestyle medicine because um John, my co-founder, John Deezer, who actually founded Terra, um, we connected, had a lot of points in common, and grew a coaching team and had a vision after COVID when everything went remote to be able to give access to health coaching all over the country with many providers of many backgrounds. Um, and hopefully tapping into many pockets of the U.S., really allowing for access to education and accountability in a very easy way, in a seamless way, working with providers. So that's a little bit how I got started with this. And it's been five years now with Tara, almost five years. And I have to say it's just the most rewarding work I've ever done.

SPEAKER_00 5:54

Awesome. That's really cool. Well, I I I definitely uh you know this already, but um, in in primary care, we know that a 15-minute office visit, even a 30-minute office visit, will rarely change someone's life in terms of what they do, but the relationships built in those visits and the relationships that we have in the case of health coaching can make all the difference as well. One of the things we talk about consistently is that um, and honestly, one of the biggest things patients will tell me when I say, Hey, I think we should talk to a health coach, they'll say, Well, I know what I know what I need to do. That's exactly what they'll say. But I already know what I need to do. Okay. So they don't know what they're doing. Right, but you're not doing it. So, like, what's the difference between knowledge and action? And it's the lack of that filling that gap with a relationship with a health coach in many cases. So tell me a little bit about um for those of those that are listening and also the the physicians who have either not prescribed health coaching or lifestyle medicine or have trouble getting people to get there. What do you find? Uh, you guys do discovery calls all the time. What do you find uh that people object to? What is it the barrier that you help them overcome to believe that this can be something that would help be helpful for them?

SPEAKER_03 7:15

Yeah, there's a lot in that question. I could talk about that. But there's I just want to start with, I mean, health coaching is so powerful for a number of reasons, and I'll get into that. But we're never forcing anything on anyone. You know, we welcome all questions. It is, I'll go into what a health coach actually does and doesn't, but um, from the provider perspective, if you've never heard of lifestyle medicine, it's basically an evidence-based medical model. It's a specialty that uses therapeutic lifestyle interventions as a primary treatment for chronic disease. So we're talking about prevention overall, right? What does that mean? We address, you know, nutrition, quality of sleep, physical activity, um, relationships in your environment, because our work environment and our home environment can drastically impact our health, right? Um, we're also talking about stress management. There's so many of our patients that are just so exhausted and burnt out from their professional life, but also, you know, have a family, have three kids, they never get time for themselves. So we're talking a lot about burnout and stress management because if you're not addressing your sleep and stress, you're never gonna lose weight. So there's we're going back to the foundations. That's what our team at Tara does is we're going back to the foundations, creating a very strong base, because then usually after that, things get better just on its own. So we're really talking about those, those main things, but there's six pillars of lifestyle medicine. The other two I didn't mention was um the positive social connection and avoidance of risky substances. So that's just kind of the very high-level overview of lifestyle medicine. Narcoaches are all board certified, um, which there's an extensive process to become a board certified health coach. But we're basically looking at um just supporting you, meeting you where you're at in whatever way that looks like for you, and small incremental changes at a time, one week at a time, building small, even it can be minuscule habits that end up adding up over time. And then after three months, a lot can change. Um, so the barriers to go back to your question about barriers. I think, first of all, knowledge does not translate to action. I mean, that's just classic, right? So many people do know that they need to, you know, eat less processed food or have less screen time. But when it comes down to it, well, when we're in the flow of the day and we've been working all day and we're burnt out and we just want to disconnect, like it's hard to not go on our screens and just, you know, be mindlessly scrolling on Instagram or something. It's, you know, we know it's not good for us, but that doesn't mean that we'll always do it. So we need accountability, and that's exactly what coaches are there for. You know, we we use modalities like motivational interviewing, habit formation, goal setting, smart goals, and we set up accountability systems that actually work for the individual. We're not just giving a one prescription for everyone. It's what works for you? Does it work to have a post-it on your fridge reminding you of your goals or of your wellness vision? Does it work to have a background on your phone or a reminder go off every day? What are the systems that we have in place that we can really leverage from? And we're implementing a lot of behavior change psychology as well. So there's we have a method to all of this. It's all science-backed to in science-based to help those patients really overcome those barriers of the blind spots, right? Things that they don't even see, that we can say, hey, all right, you're doing this, this, and this. What could we, what could we slightly adapt and just experiment? What can change in just two weeks of altering this one thing of not snacking at night? What could happen to your energy levels the next day, right? So I hear a lot of, I know what I'm supposed to do. I know I just am not doing it. Yeah, that's where the coach comes in. That's where we remind you is most important to you. We bring we bring up that, those sentences that you said with your wellness vision of, yeah, you want to have more energy with your kids. You want to be able to run up and down the stairs with your toddlers and you know go hiking with your grandkids or have enough stamina to um get through the workday and not be surviving on caffeine, right? It's it's everyone has their own individual goals, and we're there to remind you of that and remind you of what you already do well and keep building off of that. Also, we're having an information overload these days with social media, with YouTube, with podcasts, with different opinions of different providers and different approaches. It's just so overwhelming. Then we have all of the food noise, you know, constant messaging from fast food, from the fast food industry, and I mean what we're seeing on commercials, all of this is impacting us. And it is so overwhelming to know where to look and where to turn. So, with the guidance of the physician, someone like Dr. Bushman saying, Hey, we need to focus on nutrition, sleep quality, and getting your hormones in check, we will take those protocols and help implement them so that the patient can really feel like they're working on it outside of the practice and get empowered and get their habits going. Like I said, one very small step at a time, because the more a patient has to change at once, the less they can handle at once. So it has to be bite-sized. So I hope that answered your question, Dunes.

SPEAKER_00 12:29

I know that's good. That's fantastic, fantastic overview. And you know, as a as you went through that, you touched on a couple different pieces that uh I can say clinically um seem to be very common. And it leads me to a couple more questions, which is one is the misconception of what you know health coaching is or what it does, and what lifestyle medicine is. A lot of people think, oh, well, and it's diet and exercise, and it's so far much more than that. But the one thing that I've noticed, and um you know, this doesn't take on any specific group because it really happens across all ages and and and genders and roles in life, but it's not uncommon that I see um tears well up, I see hesitation in speaking, uh, and and really almost um patients coming from a place of um just down and out, and I've failed this before. Like I've just failed a lot. So why why is behavior change so emotionally difficult? And what role does shame and failure past failures play in that?

SPEAKER_03 13:40

Yeah, it's a great question. I also see a lot of tears. I mean, even on the first call, I mean, just to give you to give everyone an understanding, when a patient gets referred, they speak to me first and we do what's called a breakthrough call. And it's a half an hour chat that sometimes can go up to 45 minutes. I'm not gonna cut someone off, but because the that entry point, I I make people feel as safe as possible or try to. And I realize that so many people don't have the space to share what's going on and what's on their heart and what they're struggling with. And this is maybe the first time they're giving themselves an opportunity to share what has been weighing them down, what has been creating a lot of shame and our secrets, when we keep it a secret, when we don't share what we're struggling with, it just weighs on us, on our body, on our emotions, the way we perform, the way we interact with the world and with ourselves. And it is very common that I see tears on those first calls. And so imagine what the actually, when I pass off the patient to the coach, imagine what happens in those sessions when you're seeing the same person building that relationship, building that trust, building that rapport with that person who really just is so rooting you on. We're not cheerleaders, but we're supporting you in the positive momentum that you're gaining, even if you think that you had an off week. There's we try to remove that shame of like, no, maybe you didn't go to the gym every day like you wanted to, but you went twice this week. That's more than you did before. And you had one full fiber-filled meal out of the week, that was more than you did before. You know, these are all we just remind people of listen, you are doing things well. It's not all bad. Let's talk about the positive momentum that you are gaining, even if it's 1% better. If you've all read the book Um Atomic Habits by James Clear, it's such a great, such a great book. The I think everyone should read it in January of the start of every year because you talk so much about the 1% better. And when you shift 1% every day or every week, confidence is going along with that. Momentum is going along with that. And if you think about an airplane that takes off and is meant to land in Beijing, but let's say something is slightly off and the plane is going one degree left every couple minutes, you're gonna land in a totally different location. So if you think about that with your habits, how much just one small step can help build momentum and and confidence. That's where I think the shame just starts to fall away. And as you're sharing an opening with your coach, you're putting everything on the table. And it's not, it's not so scary sometimes when you, when you talk about it, because then maybe you hear that other people have gone through something similar. So shame is a really big part of our society. We're we're taught to just push it down. And when you work with your coach, it's really a judgment-free zone. You're building a relationship with someone. The core of coaching is a relationship. I say that, you know, medical background and specific expertise and in different niches. Yes, that's important. But the vibe has to be there. You have to fully trust your coach because you want to be able to feel super open to speak about what's on your heart. So the relationship is really the essence of removing that shame so that you can be super open and feel good about yourself as you go through the process.

SPEAKER_01 17:02

Yeah. Do you find that uh some people have to change coaches because they can't establish that relationship or that trust?

SPEAKER_03 17:09

Yeah, that happens sometimes. I do my I do human pairing. So I there are there's human error just by by nature. I do my absolute best to read the vibe. You know, I know my coaches very well. We have a team of about 15 coaches that have been with us for five years, and I've gotten to work with them very closely. We also meet every week to to support each other, provide new resources. So I have a very good relationship with them. And when I'm doing the human pairing, sometimes there's some errors. Sometimes the vibe is not there. Maybe all the medical background is is aligned, but they're just not on the same page in communication style. So sometimes that's why I do frequent check-ins to see how the patient is connecting with their coach. And I also have an open policy. If they want to schedule with me and say, hey, it's just not vibing, that's okay. No worries. I'll switch you to a different coach. We'll switch every time until we find the right fit. So I'm I'm sure that we have someone on our team that will be a good fit. But um that does happen and but not frequently.

SPEAKER_00 18:06

That's great. So you you mentioned this earlier as well, that in and I know you're a purely virtual health coaching platform. You've got coaches all over the United States and obviously even abroad. Um, but what does it look like when a patient first enrolls? You mentioned the sort of the breakthrough call. What does that first 30 days look like? And how often do the patients meet with the coaches, and then what tools are you using virtually? I know I'm throwing tons of questions at you, but kind of lead us through that process of what what does it look like for that patient experience?

SPEAKER_03 18:38

That's a great question. We want it to be as seamless as possible. We want you to, you know, just follow each step without any questions, and we're here to answer questions if you need to. But essentially, when you refer a patient, you'll schedule an appointment with me. We'll have a breakthrough call that's around 30 minutes, but there's some flexibility around there. And we just discuss, you know, what's on what's on your mind, what is what's most important for you to change about your health and why. And we, you know, we put some clarity on why you're here, why you're on this call with me, right? And so then I talk about the program, the options, and the coaching options, and then you can decide to move forward or not. So it's a non-committal call, completely judgment-free, safe zone for you to just open up about what you would like to change and what you need accountability and support with. From there, if you decide to move forward, I'll pair you with your coach. You get an intro email, and the coach will take it from there. I'm always there in the background to support if needed, but the coach will be kind of the point person to deliver those uh live sessions. So the first session is up to 75 minutes long. That's really so the coach can take you through their whole protocol and ask you a few questions and really get clear about your wellness vision and then set up some action steps for the next months. And this is our standard lifestyle medicine program that I'm describing. That's three months that has 12 sessions. So one weekly session. So after that first call that's a little bit longer, then you just have a weekly appointment for 30 minutes. We try to have it on the same day, same time, so that there's continuity and consistency. Um, we're flexible about rescheduling. If you have a tight work schedule, just give us a heads up. That's all good. But essentially you meet with your coach for a half an hour on a weekly basis and you can chat with them through our HIPAA compliant app. We use Practice Better. And essentially, if you're having a hard time and it's midweek and you don't have a session for another four days, um, you can always text your coach and it comes in like a message. You're just using the app. We deliver resources through there, we deliver video content. We're always providing support in between sessions so that the patient doesn't feel alone. Um, we're also updating every provider on a monthly basis on each patient so that that gap, it's it's there's no gaps in between the care. Um they're getting enough the providers are getting an update on the changes that the patient has made, any points of concern, and then just a small write-up about what they've worked on. And that way when the patient goes back to their provider, they'll know what's happened in the last three months. So that's kind of what it looks like. That's the standard three-month lifestyle medicine program that can be focused on anything. If you're wanting to balance your hormones, if you're wanting to stress less, if you're wanting to sleep better, or work specifically on nutrition, that program can be adapted to exactly what you're needing.

SPEAKER_00 21:20

Very good. So I'm kind of curious about this too. Like, what what do you feel like surprises patients most about the experience?

SPEAKER_03 21:31

Uh that's that's a good question. I've seen all kinds of things. I not only do the first call, but I do the last one. So we do a check in at the very end where we just see how their experience went. And mostly what I hear a lot of different things, but mostly it's um because there's such a focus on weight loss in the US. What I hear when that's the goal is man, the wins that I came out of it that I came out of. From this was totally off scale. Like maybe the weight dropped, maybe they had some success there, or maybe they did get to their goal weight, but it was so much more than that. They discovered why it wasn't important to them. And through that journey of week by week just, you know, peeling back the layers, working on their habits, they're surprised at how much more confidence they have and how much more present they are for their families and at their in their professional lives and for their kids. They feel more patient, more calm because they're taking care of themselves for the first time. They're actually giving back energy to themselves so that they can show up in a in a more present way for their community in whatever way that looks. So I hear a lot of that. Like, wow, I wanted to lose weight, but it was so much more than that. Um, and also the experience of the relationship with a coach, I hear all the time, like, man, it's it's almost like this is a breakup or something. I don't want to let go. And they do they do have the option to extend and do less sessions or just do a check-in if they want. But oftentimes, I mean, and Dr. Bushman, we worked with your patients that really held on to some of our coaches, like just that's reviewing, you know, they're not quite ready to let go of that relationship. It's really a safe space where they can really open up about whatever they're needing assistance with that week. And it, it, you know, it's it's uh, it's truly a beautiful relationship. So they get surprised with that. They just thought, oh yeah, my coach is gonna, you know, prescribe me a diet. No, that's not what we're doing. We're not telling you what to eat. We're helping you discover what works for you. But it's so much more than just working on nutrition. So much more. It's it's that accountability, that relationship, that trust that they walk away from like, wow, I wasn't expecting that. I wasn't expecting to have such a strong connection.

SPEAKER_01 23:45

It sounds like you go from coach to counselor and back and forth, you know?

SPEAKER_03 23:50

Yeah, counselors have their have their place too, but we're really like, we're just helping patients remember what they're capable of. Right. We're in part, we're using positive psychology, we're using, you know, a lot of different modalities, but really we're just humans. We're humans allowing you to connect because we're so, I mean, we're on such a path towards being more and more disconnected. It has to be intentional now. It has to be intentional where we really make space and time to have authentic relationships with people. So that's I think part of the foundational aspect of this role is you know, connection is everything. Connection is everything. So with AI, I know that there's a lot of other coaching programs out there that are using AI bots and maybe more tech space, but that's why we're like we're human support with technology resources. We're using technology to leverage us. We're all about this, the live relationship, because that's really what makes a difference. That's what makes the needle move. You know, I've never had to look.

SPEAKER_00 24:55

Good. I was gonna say, I've never had to look a computer in the eye and be ashamed of what I haven't taken care of that I said I would. You know? Exactly. It's a different form of accountability, I promise, than the screen. The screen just doesn't do it for me.

SPEAKER_03 25:12

Automated empathy, man, it's just it's like when you call to get something fixed or something or trying to get a service or get through to someone, it's like, just put me through to a person, right? That's what it is. It's like when you're getting a reminder to take your steps. Like, yeah, that's helpful. It AI has its place, technology has its place. 100%. We are working with that too. But when you have someone that's waiting for you at 12 p.m. on Wednesday because that's and you're gonna talk about the goals that you had in place, it's a whole different level of accountability and self-check-in. It brings awareness. That's the whole point of this is bringing awareness to your habits. We're not like sergeants here saying, like, did you eat your green? No. Awareness. How were you eating your salad? Were you present? Were you paying attention to the textures, the colors, the taste of the food? Or were you just inhaling at your desk because you have your neck? No. Let's talk about how to schedule yourself in. That includes coaching too. That includes coaching as well. It's very different when it's just a notification or it's like chat PPT telling you what you need to do, right?

SPEAKER_01 26:14

Right. So Celia, with your pay various patients, do you see more women, more men? Is it evenly split? Who really engages with you?

SPEAKER_03 26:25

Yeah, it's all over. I mean, right now it's probably 60% women, the rest men. Um, I I'm surprised at how many men actually end up joining Tara and staying with it. We've had one patient in New York who's renewed his package six times with the same. And actually, it's with Terry. Yes, awesome. I mean, no surprise there, right? No surprise there. So yeah, um, I think men are really surprised at how much they get out of this because there's a lot of misconceptions about what coaching is, right? But once they enter it, once they start, they're like, oh, I get, I get it. It's it clicks. And then they're all about it. So um, yeah, we've been seeing more men come on the program, but I would say mostly 60% women, mostly between 45 to 65, I would say is the range. Mostly what we're seeing the most demand for is weight loss, um, horm horse, hormonal balance. Um, and yeah, a lot of GLP1 support. So that's kind and a lot of stress and burnout, like I was saying. A lot of people are working full-time, right? Families to to to balance, and it's really tough for them to do things on their own. So I'm seeing a lot of that profile right now.

SPEAKER_04 27:46

Yeah.

SPEAKER_00 27:48

Oh, that's great. I'm gonna switch subjects just a little bit, but I'm gonna go back uh kind of where I got involved with Terra Health Coaching and the space that it sort of falls into within the broader scope of uh of healthcare. And we have to kind of talk finance and business and employers and purchasers and who's doing this. And there's a lot of obviously there's a lot of this is individual, individually driven, and/or, you know, the physician has put the person in line with you. Um talk to us a little bit about the employer basis where we're spending money uh hand over fist for, as you mentioned, uh GLP1s and many other different types of medication interventions to treat chronic conditions that are receiving little to no uh focus or attention on what got them there. The not not maybe prevention because maybe we're already there, but reversal and or much better control. So tell us a little bit about how you've been working with employers and um how you've tried to regain the focus of prevention within a population. Your your background was public health. That's what you what you knew, right? Like tell us a little bit about that.

SPEAKER_03 29:07

Yeah, so the employer space has been a huge opportunity because as we know, I mean, medication is extremely expensive, and a lot of employers are spending a lot of money on rising claim costs, like autoimmune protocols, for example, autoimmune conditions. There's so much money that's being poured into that. And also GLP1s, which is the hot topic right now, right? We do have two specific robust programs to support patients or support employees while they're taking a GLP one. But GLP1s, as we all know, it was not supposed to be a monotherapy. It was supposed to be used in conjunction with lifestyle interventions. That's where we come in to support employers in lowering healthcare spend and actually supporting their employees in getting better. And so there's a lot that goes into it, but we've had the opportunity the last two years to really dive into this. We actually worked with the DPC out in Texas, who um got contracted by a local veterans home, and all of their employees were given access to this DPC provider. Um, and that provider included us to do the health coaching. So he did the GLP prescribing, he did all the medication support, the medical side, and then we supported the employees on their journey alongside taking the GLP one. And in the first three months, there was an average of 10 to 15 pounds lost, and there was dramatically lower absenteeism, people were starting to run again, and there were three out of 20 uh employees, if I remember correctly, four out of 20 employees in the first three months that didn't even get on the GLP one. That they started on the G they started on the program, they had their breakthrough call with me. They were like, I want the GLP one, I want to be on it. Um, I'm eligible, medically eligible to take it. This is what I want to do. But our program works that the first month you do coaching alone without the medication. So you do four full sessions with your coach before you start a GLP one. And three or four out of those cases, those patients or those employees decided not to move forward with the medication because they were bringing so much awareness in that first month to their habits that they actually started to see some differences and were just curious about continuing and seeing what happened. They ended up completing the program without going on a GLP one. So, from an employer perspective, huge cost savings. Huge. Right. Um, and this year we've had the opportunity to work with another employer that has sent over around 30 patients or 30 employees. And I I've already done their phase one check-in call. So they've all done their first three months of the program at this point. And two patients have already stopped the GLP one and have continued only with coaching. And they were seen, they were on the lowest dose, they didn't titrate up to the highest dose. They just decided they wanted to try it on their own with the coaching and they're doing very well. So that and that what I see is the mental perspective, that shift is huge because we maintain their privacy. No one knows that they're in the program. So because they're all working together, right? But on their own, they're creating walking groups because they're all in walking challenges with their coaches. So and they're sharing information that their coaches are providing and they're comparing notes. And one employee even told me that she's going out to the garage, to the parking garage, and walking up the steps and taking 10 flights of stairs and not feeling winded for the first time. And that was in three months. So imagine this was this was to help maintain costs, this was to help lower costs on the employer side for the for the company overall. And the outcomes are so much more than that. So much more than that. So um, there's a lot of opportunity there. We are we are getting a lot of interest, more interest about how we can support um employees on GLP ones and also lower cost overall as we're addressing the lifestyle piece, um, which is a huge opportunity. Like I said, just autoimmune conditions alone. You can look at those um those spends and those costs, and it just keeps rising every year. So we have to do something about it, right?

SPEAKER_00 33:21

So I have a kind of a curious question.

SPEAKER_03 33:23

Yeah.

SPEAKER_00 33:24

Because uh I would think of this in one context uh clinically. I'm curious from health coaching. What what health advice do you think people most frequently overcomplicate?

SPEAKER_02 33:36

What health advice do they overcomplicate? Would this be from the provider or from the coach?

SPEAKER_00 33:43

No, I'm thinking I'm thinking from health coaching. What do they overcomplicate?

SPEAKER_03 33:49

Uh I think I mean weight loss. There's so many misconceptions around weight loss. I think people really are under the impression that they have to either copy what someone's doing that they're seeing on Instagram or something, or they're just watching other people's influence, they're being influenced, right? And they're making it so much more complicated than it needs to be, or putting other things on them that maybe isn't even relevant to them, right? They don't understand. They don't understand that it's actually okay, you're sleeping five hours a night. Let's get that in check first. Like that, let's not overcomplicate it. Let's put your screens away for one hour before you go to bed. Let's do a shut off power-down hour and see how that helps. It's they're thinking I have to count my macros, get X amount of protein, work out an hour a day, cross-trained. No, like you gotta sleep first. You have to sleep first. Are you drinking water? Let's like it's we're taking it so simple that it almost sounds ridiculous. But when they actually look at what they're doing and start to track and bring awareness to their habits every day, they're like, oh man, I am actually only getting four and a half hours of sleep. I'm surviving on coffee all day. I eat my first meal at 4 p.m. Then I go home and I emotionally eat because I had no second to breathe, and that's the only relief I'm getting. My kids are running out. No, okay, calma. Let's take it back to simplistics. Like, how do we first address the absolute basics? Weight loss is so much more than hyper focusing on macros and hyperfocusing on X amount of whatever calories burnt. It's really sometimes just addressing the foundation. Uh, so that's where I see a lot of confusion of they come in like, okay, tell me exactly what to eat. Well, no, let's let's start from square one.

SPEAKER_01 35:41

I think it's so amazing that you guys basically customize everything for that individual. What is it they need? What is it that they're doing, what is it they're not doing? And that's different for every one of us. So uh taking time to address those, yeah.

SPEAKER_03 35:56

Absolutely. Every coach is lit is meeting that patient exactly where they're at. It doesn't matter what happened in the call before. They're starting over with every new patient. We're taking the referral that came in. The provider can list as much information as they want or as little as they want. It just helps us have a foundation of, you know, before we start that call, what to expect. And then we're speaking about the patient, about what is most important to them and kind of breaking that down and starting from the beginning. So there is no one prescription here. We're not sending you a protocol that one size fits all. That is 100%, you can go find that somewhere else, but that's not us. That's definitely not us.

SPEAKER_00 36:37

So if someone listening now feels overwhelmed or discouraged, uh, they're unhealthy or just feel stuck, what what would you want them to hear today?

SPEAKER_03 36:48

We're not meant to do things alone. There, if you're going through something, chances are someone else is going through it, and there's someone out there that can maybe help you just even unpack what that means for you. What does change mean for you? How, how is change possible for you? And if you're feeling totally stuck, every human experiences this at one point in their life, whether it be with finances, with health, with relationships, with location that you're living, profession, whatever it may be, we've all experienced being stuck. You're not alone, and we should never shame ourselves for that. So, my my biggest advice is if you want to just discover and talk through together what and how is possible for you, just get on the call with me. We'll chat it out. And it doesn't have to have an end product, it can just be an opening to create more awareness. And healthcare truly changes when patients aren't doing it alone. You know, one provider can't make everything happen for everyone. And that's where we love supporting providers and their work and being the bridge between the patient home and the medical practice. How do we connect the dots? And that's, I mean, I've always been a team player. I've been a basketball player my whole life. I've been involved, like everything magic happens in a team setting. And I think that that's what we always need to remember is that not every, not every coach is gonna be a right fit for a patient, but that goes for everything, right? We need to figure out and collaborate together. Do you have, are you of Chinese descent or are you of Russian descent? You have three generations living in the same household. How do you change your habits when grandma's still frying with Crisco? I don't know. Like, how do you how are the social dynamics gonna happen, right? Without offending the people in your family. You know, there's so much that goes into it. So if you're feeling stuck, I guarantee that someone else is going through it too, and that you're not actually alone in this journey, that what you're experiencing can be, it can be worked on. We can all through small changes, very, very small changes, make a huge difference over time if we just come with an open mind.

SPEAKER_00 38:57

Absolutely. Well, I think one of the biggest lies people believe is that they're just too far gone to reclaim their health. Um, but health isn't usually rebuilt through perfection, right? It's rebuilt through small, consistent decisions made with support, encouragement, accountability, um, relationships. Um, and maybe that's the bigger message today is patients don't just need access to healthcare. They need people willing to walk with them.

SPEAKER_02 39:25

Right.

SPEAKER_00 39:26

I really appreciate that role that you play and that role that Terra Health Coaching plays in walking with our patients, walking with people that are discovering and and finally achieving that change that they've they've long desired.

SPEAKER_03 39:42

Absolutely. I mean, the the I think what keeps me going and what motivates me so much to be on this journey with patients and with providers is seeing how much patients change at the very end of the program where they're telling you that they're taking professional photos for the first time, they're including themselves in family portraits for the first time, doing things that they've never done physically before because their body hurts less. Like those are huge off-scale wins, right? Those are those are things that the numbers can't show. And so I think that's that's the part that always really surprises me is that wow, you you did, you achieved your goals. Maybe it looked different than what you were imagining, but we're here. This is a starting point, and this is where you can continue now. Um and so there's just so much magic that can happen. And on our GLP1 program, that's a year-long program, it's really interesting because you mentioned something, Dr. Bushin, about it's not being perfect, it's not about being perfect. And some patients feel some guilt when they haven't been staying on track. Let's say they didn't complete the goals that they wanted to, but that's and then they don't show up for their session. But I say that's when you should show up even more. That it's when you should show up because you can say, hey, everything went out the window this week. And that's totally fine because they're guaranteed that you did something right this week. You did something right. You made some choices that helped you move forward. And it helps you get out of that hole faster because that's where shame comes in, right? Is when we don't talk about what we're not feeling good about. And so it stays in us, that energy stays. And that's when I say show up for the coaching session, even more. Come and bring all of yourself because we're here to help you get out of that faster.

SPEAKER_00 41:24

I've I've had that as the objection in many cases to start, well, now's not a good time, you know, school's wrapping up, or the holidays are coming, or I just did this, just changed jobs, yada, yada. I've heard all of them. And those are my favorite things to hear as excuses because it immediately gives me the opportunity to say, no, actually, this is the best time because of that. And the reason this is the best time is because if we can do this and we can prove this through a tough or challenging season of life, just like we go back to the coaching thing and the sports thing, any athlete will tell you, I grew more, achieved more, and I'm and I've never been prouder than the ability to get through this time right here because of an injury I was facing, because of what was going on off the field, because of, you know, various different things. It is when we are stretched in multiple ways that we have to dig deeper. And when we dig deeper like that, I've seen this even in my faith. When you are broken and you have to dig deeper, your faith goes to a level you didn't know it could go. And your health can do the same thing. So bring it on, patients. Bring on the excuses. We're ready for them. Uh, we will meet you face to face and we will walk with you through it.

SPEAKER_03 42:41

You know, those challenges are essential because if life were easy, what would be the point? We would have no resilience. We wouldn't know how to come out of things. We come out of it stronger always. If you show up for yourself and just keep putting one foot in front of the other and asking for help when it's needed and build resilience along the way.

SPEAKER_01 43:01

Yeah, absolutely. Hey, Celia, I have uh one uh final question for you. So what role, if any, does uh integrative nutrition or functional medicine play uh in the coaching you do or in you know basically lifestyle medicine as we've been talking about?

SPEAKER_03 43:17

Yeah, do you have experience with functional medicine and integrative nutrition?

SPEAKER_01 43:21

Uh-huh. My daughter actually just graduated with her master's uh in that. So that's why you know I'm I'm trying to understand it myself.

SPEAKER_03 43:29

Yeah, absolutely. Those are different modalities, and I think there's so many crossover that there's a lot of crossovers between integrative nutrition, which is really just whole person nutrition, right? You're looking at the whole person, looking at all aspects. And functional medicine, we actually have coaches specified in functional nutrition and medicine, Michelle Loche, who's one of our coaches out on the East Coast. So we do have people in those specialties, but with lifestyle medicine, there's a lot of a lot of overlap with those other modalities. Most of it is the role that it plays is foundations. I mean, most people are so concerned about protein, but yes, protein is essential, especially if you're a woman in your mid-50s on a GLP one. Yeah, we need to preserve that lean muscle mass. Like that is your metabolic protection. We need to preserve that. Protein is important. However, what I know across the board for all those things is and for America in general, everyone needs more fiber. We need fiber. So that's that's kind of the role that I would say within all those modalities. We're looking at the basics and starting from like let's work backwards here. Are you getting enough fiber? Are you getting enough, uh, are you hydrating enough? Are we sleeping enough? That all of those things are integrative and looking at the whole person. So that's kind of lifestyle medicine is somewhere in between.

SPEAKER_01 44:49

Yeah.

SPEAKER_00 44:50

Absolutely. Well, thanks again, Cecilia, for joining us today. Thank you for the work that you do. And um, from a very personal perspective, thank you for what you do for the patients that we send your way. I've seen some amazing uh lifestyle changes, but really just amazing stories that have come away from from your support and your help. And um, I'm a big fan. I think it's a very underrated and actually just an unknown part of healthcare that is uh underutilized. And um thank you for the the support that you give us. We wish you the best. And of course, if there's anything we can do for you, we want to know. But thank you for joining us.

SPEAKER_03 45:28

Thank you so much for having me. It's been an honor to speak with you guys today. And Dr. Bushman, you're such an inspiration. We're so lucky to work with providers like you. So thank you for doing all that you do because you send us amazing patients that are so willing to learn, have such open minds, and that speaks volumes to who you are and your practice.