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11 February 2020

DIETARY ADHERENCE: CHECK YOURSELF BEFORE YOU CHECK YOUR CLIENT

by Martin Refalo 0

Adherence and compliance, arguably the most frequently used words in the coaching community. Why? Because they determine the degree of success experienced by the client but also happen to be the factors of success that many clients just aren’t able to uphold. Questions and concerns regarding a client’s lack of dietary adherence pop up at almost every…

Adherence and compliance, arguably the most frequently used words in the coaching community. Why? Because they determine the degree of success experienced by the client but also happen to be the factors of success that many clients just aren’t able to uphold. Questions and concerns regarding a client’s lack of dietary adherence pop up at almost every seminar I present at; How do I improve my client’s adherence? What strategies should I use to help my clients adhere? These are common questions that I’m asked on a weekly basis and am generally unable to address in a complete sense due to the multifactorialnature of dietary adherence. 

Many coaches are also fast to blame their client’s adherence (the point of this article) when results are lacking and progress just isn’t occurring at the desired rate. In most cases the problem is adherence, however, blaming the client doesn’t help the situation. It is important to remember that clients (most likely) hire a coach because they are unable to adhere to a plan. They have most likely tried numerous dietary strategies before seeking professional help but have fell short due to their inability to maintain consistency. As a coach, it is your duty to address the client’s adherence and respect the fact that they do not currently have the required capabilities to stick to a dietary plan. Prescribing a nutrition intervention and telling the client that adherence is important will not cut it. In my opinion, that is an example of poor coaching and exemplifies a coach’s disregard to a critical issue in which the client is essentially paying to help get fixed. This is where a true coach (not an Instagram proclaimed coach) separates themselves from the everyday personal trainer. 

Implementing a nutrition intervention with no plan to improve client adherence is like giving someone keys to a vehicle but not providing them with a map to their intended but unknown destination. They can drive around as much as they like but they will never end up making it.

A coach should investigate the client’s history to gather an understanding about why they have failed in the past – identifying the root cause of the adherence issue is of utmost importance and should come before the development of a nutrition plan. Once ‘adherence gaps’ have been identified, a suitable nutrition intervention may be implemented. I won’t be covering the ‘how’ behind tailoring a nutrition plan to a specific client as this is something that most coaches know how to do (although they may bypass history screening). Whether its macro tracking, a flexible meal plan, protein tracking, a visual food diary or simple guidelines…the chosen plan needs to be realistic, enjoyable, flexible and sustainable (R-E-F-S). These ‘features’ of a nutrition plan are client dependent – what one client finds enjoyable another may not. You better have an arsenal of nutrition protocols that you discharge on a case to case basis. Don’t be the IIFYM coach that prescribes an IIFYM approach to every client – if you’ve actually worked with clients face to face you’d know that some clients just aren’t up for it and some just quite simply don’t want to do it!

Check out my client Joe. Not one macro was tracked throughout this whole 12-month transformation.

Once you have prescribed the nutrition plan it is immediately time to start working on the client’s adherence. Like I said earlier, before blaming the client for their non-adherence and faulting them for their lack of progress, check yourself and the adherence plan that you have in place. If you don’t have one, I think it is time to take ownership and actually provide the complete service your client is paying you for.

Over my 6-year coaching career I have worked with 100’s of clients and have been exposed to the multifactorial nature of dietary adherence time and time again. Every client presents with different issues that require coaching adaptability – this is one of the aspects of coaching that I love most. 

To help mitigate adherence issues from both a coach’s and client’s perspective, I have developed a framework that has unknowingly been successful for me over the years. I didn’t consciously implement this exact framework with each of my clients, but when I think back to the strategies that I have utilised in the past, the same pattern tends to emerge. The following framework outlines what I believe to be the key components of dietary adherence that have emerged from my knowledge about the topic and my experience. This framework will only be effective if the nutrition plan is suitable for its recipient– that is, if an online coach prescribes a client a meal plan that consists of brussels sprouts in each meal, but the client doesn’t like brussels sprouts…both the client and the coach have other issues to address before getting to this framework. This probably happens a lot more than you think by the way. Same goes for very low-calorie diets, there is only so much hunger and deprivation that an individual can tolerate over time before giving in. Moral of the story, please be smart about nutrition programming.

See the JPS Mentorship for our Nutrition Module: https://www.jpshealthandfitness.com.au/product/online-mentorship/

Like previously mentioned, investigate the clients dieting history and implement a plan that is tailored to them (remember R-E-F-S). Once this is done, the following framework can be implemented. 

1. Goal Setting

In many cases, a coach is hired for self-management purposesClients struggle to manage their own training and nutrition in a manner that is conducive to their goals. Some clients don’t even have goals but do want some sort of change to occur, in most cases a body composition change. It is the coaches job to explore the clients beliefs and values, establish what is truly important to the client, and set goals for the client’s self-management. Goal setting can increase the client’s self-efficacy, influence behaviour change and improve health outcomes.

Utilising the SMART approach to goal-setting is definitely recommended and is a neat way of ensuring the goal is suitable for the client and covers all important bases. If you are unsure about the SMART approach, here it is:

I am not going to elaborate on the SMART approach as it is pretty straight forward, rather I will provide other considerations that are often unconsidered. When setting a goal, it is important to investigate the following: a) factors that may impede the achievement of the goal, b) factors that may enhance goal achievement, c) the client’s confidence about achieving the goal. If a goal is set with disregard to potential barriers the chances of achieving that goal will be limited. It doesn’t matter how bad the client wants to achieve a certain goal, or how much the coach wants to push their client – if lifestyle barriers are present but not accounted for there will be issues. Conversely, a client may have a specific event coming up which could be used as motivation, exemplifying the importance of an investigation process and a not so ‘narrow’ goal. Furthermore, if the client lacks confidence and doesn’t believe they can reach the goal…well there is no point embarking on a ship that will never sail. Coaches shouldn’t push goals onto their clients, neither should they disregard the clients input. The goal setting process, in most cases, will require compromise from both parties.

Of course, setting a goal is only the beginning and their needs to be a monitoring stage followed by a re-evaluation stage. I won’t be touching on these today, but just know that you’ll never get to the other stages of the goal setting process if the initial goal doesn’t consist of the following ideals. 

Keep in mind, I have created these based on experience and have nothing to reference here.

I highly recommend considering these ideals when setting a goal. If ignored, the client may have already failed before they even embark on the planned intervention. From experience, goals that consider these ideals have the greatest chance of success. 

If an appropriate goal has been set using the above recommendations, an intervention can be planned out and implemented. I recommend using both long- and short-term goals to ensure the client has structure, direction and maintains motivation.

2. Knowledge

Once the goal is set, it is time to feed the client with knowledge. When it comes to dietary adherence, understanding the fundamentals of nutrition is important and often overlooked. Understanding how the plan you are trying to execute is actually going to work will help with adherence, don’t you think? I don’t know about you, but I’d be much more likely to follow a plan that I actually understood as opposed to a plan that I wasn’t completely sure about due to a lack of knowledge about how it actually worked. Unfortunately, too many clients get fed a nutrition plan with no explanation of why the specific plan was chosen for them, how it is going to work, and how it aligns with basic nutrition principles and basic physiology. Not to mention, how is the client actually going to succeed in the long run if they don’t even understand energy balance? If I had a dollar for every time I consulted with a client who synergistically answered ‘yes’ to “have you ever dieted or followed a meal plan?” but ‘no’ to “do you know what energy/calorie balance is?” I’d probably have an extra 100 bucks in my bank account.

Improving your client’s nutrition knowledge or nutrition literacy is imperative and will set them up for long term success with or without you by their side. Remember, to be a great coach, your goal should be to ensure your clients can one day venture out and manage their training and nutrition on their own– not so great from a financial standpoint, but definitely from a coaching standpoint. If you can take a beginner client to an advanced level and to the point where they no longer need you…you are one hell of a coach!

I am not going to outline exactly what you should be teaching your clients here, rather, I want you to make this decision. What do you think is critical to know for any individual embarking on a fat loss phase? What knowledge has helped you succeed in the past? To kickstart this process, I’d recommend taking your clients through the nutrition pyramid by Eric Helms (Muscle & Strength pyramids) and explaining its relevance to their situation. If you will be utilising scale weight as a data metric you may want to inform your client about the many factors that affect scale weight and the implications this may have on their progress. Have you discussed the post-diet plan? If not, educate them about the importance of maintenance, informed eating, and gaining weight in a controlled manner for body composition purposes. The more knowledge you provide them in small and frequent doses, the better!

Image result for muscle and strength nutrition pyramid

The other usually unspoken benefit of providing your clients with appropriate and credible knowledge is the impact it can have on their values and beliefs. It is common for new clients to retrieve information (usually misinformation) regarding nutrition from sources they think are reliable, leading them to thinking they are well-informed about a certain topic, when in fact they are ill-informed. This is called a misperception – a mistaken belief.Shutting the client down and making them feel stupid for watching Gamechangers or reading Women’s Weekly is not the right way to attack this situation. The brain is prone to misperceptions, and you most likely carry your own misperceptions about certain topics too. Your client is no different, they don’t know how to decipher between reliable and unreliable sources of nutrition information. It is your job to teach them why carbs may not cause fat gain, why they can eat pasta, why eating after 6pm is fine…it is also in your best interest to teach them how to seek out valuable information and build up their ability to detect BS. Knowledge can help alter your clients beliefs about a certain topic and can reduce the chances of them acquiring misperceptions

3. Motivation

Building up the client’s motivation comes next. Many people like to say that motivation is overrated – I beg to differ. I don’t think that people who hold this stance have worked with enough general population clients face-to-face. Yes, overtime, motivation should take a backseat and clients should be able to get themselves to adhere without it…but initially, motivation is a must. Usually, client’s will approach you in a motivated state – picking up their phone and contacting you (or the gym) generally requires at least some motivation. The only issue is that motivation comes in waves and will most likely drop if you don’t have a plan to continually ‘boost’ their motivation. From experience, designing a long-term plan that the client can visually see and implementing short term goals along the way is a good start. This is quite a simple approach but the client has most likely never received this type of a plan from a PT before = instant motivation! Having a long-term goal is important but you can’t disregard the impact short term goals can have on the client’s long-term motivation. Celebrating these small wins is often what allows them to stay motivated from week-to-week and continue to progress. These small wins (achieving short term goals) can come in many ways, whether its weight loss, meal prepping for the first time, hitting a PB in the gym, completing all cardio sessions…I like to emphasise these minor accomplishments as they can manifest into exceptional motivation and major accomplishments down the track. Your clients should enter the gym and leave feeling better than before they walked through the doors and also with a sense of accomplishment.

Motivation as a predictor of dietary adherence is well established in the literature and anecdotally clients just don’t seem to follow the plan if they aren’t motivated (this is also backed up by research). In my opinion, intrinsic motivation (motivation that is driven by internal rewards) is what you need to tackle first. Is the client intrinsically motivated? If not, it is your job to make them aware of why they should be intrinsically motivated. Is it their health that is at risk? Some clients aren’t intrinsically motivated but have a legitimate reason for why they should (health), whilst others aren’t intrinsically motivated because deep down they don’t really want, nor do they need to achieve a specific goal. This is why goal setting is important – if the client isn’t ready to make the sacrifices necessary, according to their goal, they probably aren’t going to be intrinsically motivated. Intrinsic goals tend to be associated with the fulfilment of psychological needs and may be regulated by autonomous forms of motivation. Autonomous motivation is what you are after. Considering the nature of the current ‘fitness environment’, you can’t really blame new clients for being extrinsically motivated(motivation that is driven by external rewards – money, fame etc.). 

The current environment highly encourages goals that are based on body weight and physical appearance, as opposed to health and performance goals which usually produce adaptations that are desirable from a physical appearance standpoint anyway. It is important to understand that extrinsic motivation should not be disregarded, at the end of the day, most clients walk through the gym doors to improve their body composition and attract their desired sex. As a coach, it is your duty to uphold their goals, but if they are completely extrinsic you may want to utilise motivational interviewing to: a) reframe their goal, b) prove to them that you are on their ‘team’, c) shift their focus, and d) emphasise autonomy. The goal here is to somewhat maintain their extrinsic focus, but feed in some intrinsic factors that will improve their chances of adhering to the plan and actually achieving their extrinsic goal.

Overall, having a good balance of intrinsic and extrinsic goals that are tailored to the particular client is important. Without intrinsic goals the client is unlikely to adhere, however, without extrinsic goals the client’s motivation may be compromised. Delaying gratification is often spoken about, however, it is very hard to delay gratification in absence of frequent, immediate rewards that are extrinsic in nature and that provide a boost of motivation that the client needs.

This is PART 1 of a three-part series. The next two parts will cover the remaining components of the framework.

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