8 February 2019
NUTRITIONAL COACHING 101 – WHAT I’VE LEARNT IN 8 YEARS
I’m back… It’s been a while since I’ve had copious hours up my sleeve to sit down, sip a coffee and put finger to button to talk all things fitness and share my not so humble opinion. Kids, coaching my clients, running businesses and doing ‘life’ has been where the majority of my time has…
It’s been a while since I’ve had copious hours up my sleeve to sit down, sip a coffee and put finger to button to talk all things fitness and share my not so humble opinion. Kids, coaching my clients, running businesses and doing ‘life’ has been where the majority of my time has been spent. I will admit, creating content hasn’t been high on the priority list, however this piece will address something that I do see to be a priority – quality nutritional coaching.
Nutrition coaches are a dime a dozen and the diet industry saturated with ‘solutions’ and information as to how we can optimise health and physique. Not to mention, every week I get inundated with emails and messages from coaches, current clients and people seeking advice on how to best approach their diet and there still remains a heap of confusion when it comes to nutrition.
Whether it’s fat loss, contest preparation, general health or making weight classes for strength sports, I’ve seen, coached and heard my fair share. Being in the industry for over 8 years now, I’ve not only experienced quite a lot, but been fortunate enough to learn from some brilliant minds and I hope to pass on what I have learnt so that you as a coach of your clients, or your own, nutrition, can better understand the essential concepts surrounding nutrition.
Don’t get me wrong, my coaching services have not always been ‘sound’ and in the early years of my career, much of my practice involved poor advice and an inability to conceptualize and apply the science of nutrition. The objective of this piece is to teach coaches, clients looking to hire a coach or anyone interested what I’ve learnt and hope that you will benefit from what I have to offer…
A Primer on Evidence Based Practice.
Evidence Based Practice is an interdisciplinary approach to personal training that has been gaining popularity in the fitness industry over recent years in an attempt to eliminate unsound, risky and subjective advice.
The three main tenets of EBP which must all be accounted for within the prescription of nutritional recommendations:
- The Scientific Literature
- The Coaches Experience
- The Clients Needs
The EBP model has been used as a means to guide coach’s decision making for their clients by integrating the best available evidence with trainer experience in combination with the client’s goals, needs, context, characteristics, values and preferences and socioeconomic status to name a few. (1)
This has rapidly become the ‘gold standard’ for which nutritional coaching stems from. Whilst there are a number of different EBP models that exist across a number of fields, each aim to establish processes for the application of research to bridge the gap that exists between science and practice.
Asking questions, acquiring best available research, evaluating that research and then applying it to the context of the client followed by assessment of the outcome is at the core of EBP.
It should therefore come as no surprise that there is no universal way to do things and ‘perfect’ nutritional coaching is a pipe dream. That being said, there most definitely is a ‘better’ and ‘worse’ way to coach someone nutritionally.
The answer to all things fitness, especially nutrition, will always dependent upon context, and we as coaches are always subject to ‘varying degrees’, ‘outliers’ and adapting or making recommendations to our client’s nutritional plans based on their response to the plan and individual variations that are outside the confines of scientific explanation.
Becoming a great nutritional coach is therefore an ever evolving endeavor and a commitment to continued learning and awareness of the multifaceted nature of nutritional prescription.
Moreover, the evidence based community has often been focused on refuting ‘nonscientific’ approaches to dieting and has concentrated on delineating ‘facts’ rather than actionable approaches to dieting. Whilst this has many benefits in improving the quality of information disseminated to the lay, it fails to consider behavioural modification and provide solutions and processes for implementing the science of nutrition.
Navigating Nutritional Issues – Maladaptive Eating.
Whilst evidence based practice gives rise to an objective standard coaches should strive to meet, navigating the common problems individuals face in improving their health and managing their weight is the foundation of nutritional coaching. Whilst the scientific literature has sought out to understand and address the causes of energy imbalance resulting in weight gain and poor health, the specific causes of this imbalance remain unclear and need further exploration.
Food is essential to life. It supplies nutrients required by the body to sustain itself as well as provide energy for daily activities and functions. Eating is thus a crucial self-regulatory activity. However, food can assume importance and meaning beyond that of ‘nutrition’, resulting in maladaptive eating.
Maladaptive eating patterns can be illustrated by excessively restrictive eating behaviours, rigid restraint, binging, grazing, undereating and a loss of control with food intake and have been shown to be associated with weight gain and health complications. It is therefore necessary for nutrition coaches to address these complications and transition from maladaptive to adaptive eating.
Adaptive eating can be characterized by flexible restraint, inclusive/balanced eating behaviours, appropriate caloric intake and body weight management. Properly controlled eating inherently contributes to physiological, psychological, biological, and sociocultural health and well-being.
There is a large degree of inter-individual variation in the behavioural, societal and environmental constructs which can cause maladaptive eating. That being said, there are a number of factors that prevent an individual in attaining an adaptive eating approach.
- Poor Nutritional Education:
A foundational understanding of nutritional sciences is required properly manage weight and health. However, due to the plethora of conflicting advice, misinformation and a lack of education, many individuals are ignorant and confused as to the important concepts of nutrition and how to apply them. (2)
- Cognitive Disinhibition:
Overeating in response to different stimuli, which can occur in a variety of circumstances is a primary cause of weight gain. Individuals who struggle to control food intake when presented with an array of palatable foods, are under emotional distress or have changes in environment will be prone to overeating and thus struggle to apply the principles of nutrition to their diet. (3)
- Rigid Restraint:
Successful dieting is a consequence of restraint, that is, to put aside instant gratification in pursuit of long term physique and health related goals. Restraint is the conscious restriction of food intake to prevent weight gain or promote weight loss, either rigid or flexible. Flexible dietary restraint can be defined as an inclusive diet, free from guilt whilst ‘rigid’ restraint is a dichotomous, all-or-nothing approach to dieting.
Rigid dietary restrain has been shown to increase the likelihood of weight gain, food focus, overeating, depression/anxiety, poor body image and symptoms of eating disorders. Flexible dietary restraint has been shown to result in positive outcomes when it comes to both weight loss, health and mental well-being when compared to rigid dietary restraint. (4)
- Poor Awareness of Hunger:
Hunger is the susceptibility to eat in response to perceived physiological symptoms that signal the need for food such as habitual, situational, and emotional cues. Hunger is driven by either internal and external signals and plays an important role in weight management.
The Goal of Nutritional Coaching.
It is therefore critical to effective nutritional coaching to address the aforementioned issues and identify the primary cause(s) of maladaptive eating. These issues should be addressed in order of priority as it relates to the individuals wellbeing and goals with the objective of nutritional coaching to:
- Assume an infinite approach to their client’s nutrition;
- Focus on education and improving client’s knowledge of the basic principles of nutritional sciences;
- Address behaviours, environment and cognitive disinhibitions;
- Transition from rigid to flexible restraint;
- Improve awareness of hunger and satiety.
Whilst there can be seen to be a number of objectives for nutritional coaching, clearly defining the end goal of nutrition is indeed nebulous. However, it is reasonable to assume that most individuals would desire a nutritional approach that allows them to:
“Manage weight and health with as much flexibility and minimal effort as possible”.
Similarly, the end goal of the coaching process should be to:
“Give clients the knowledge and skills necessary to assume autonomy over their diet”.
Achieving either of these objective is both complex and extensive and requires a continual effort on both the coaches and clients behalf towards improvement of nutrition.
Applying The Science – A Dieting Continuum.
In order to reduce incidences of maladaptive eating, coaches require a ‘system’ or process based on utility. To accomplish this, the system will require the stepwise education of nutritional sciences, behavior modification and improved self-awareness that is actionable rather than factual.
Learning how to implement a flexible/adaptive diet requires a steep learning curve. This is where most coaches only consider the immediate results of their clients, neglecting their level of knowledge and the underlying sociopsychology that may be preventing them from achieving their goals.
Conceptualizing a model of progression for nutrition and how to implement an adaptive diet is a critical first step for coaches.
Implementing Flexible/Adaptive Dieting
Researcher and author Eric Helms eloquently devised a systematic and actionable approach to learning how to implement a flexible diet in issue 1 and 2 of his research review, Monthly Applications in Strength Sport, the first issue is free and I highly recommend coaches and anyone looking to improve their approach to nutrition check it out.
Helms analogously compares the skill of dieting to control body composition and health to learning how to swim. Much like swimming, if you start in the deep end, without learning how to swim the outcomes will be dire. Therefore, a stepwise process for changing behaviours and improving nutritional knowledge is key to successful dieting.
The model of nutritional education and behavior change can be broken down into 4 stages:
- Dietary Awareness
- Rigid Dietary Restraint
- Flexible Dietary Restraint
- Adaptive Intuitive Eating
PHASE 1 – Dietary Awareness: Learning To Swim
The first step to implementing a flexible diet is ‘learning to swim’, that is, gaining awareness and improving nutritional education. Most individuals are unfamiliar with nutritional sciences and the basic concepts of dieting for weight management. Staring with actionable modifications is the primary focus in the first stage of flexible dieting and can achieved through:
- Tracking current food intake;
- Making small behavior changes;
- Reading food labels;
- Learning the basics of calorie/macronutrients; and
- Matching foods to macros.
PHASE 2 – Rigid Dietary Restraint: The Shallow End
The second step in implementing a flexible diet is to progress from dietary attentiveness to more accurately matching foods to macronutrients based on goals. The objective in this phase is to teach the client how to:
- Create their own meal plan(s) in assistance with a coach;
- Develop structure and habits that support their goals;
- Manipulate food intake based on daily/weekly requirements; and
- Assume more autonomy over how calorie and macronutrient targets are reached.
Although rigid restraint has been shown to lead to negative outcomes, it is an important element in nutritional coaching in order to teach the client how to ‘restraint’ before progressing to flexible restraint.
PHASE 3 – Flexible Dietary Restraint: The Deep End
The third step of ‘flexible dieting’ involves a more ‘freestyle’ and adaptive approach to dieting otherwise known as IIFYM (If It Fits Your Macros). This is where the individual will eat freely by the numbers and view food for what it is, energy and macronutrients. The aim of this phase is to:
- Limit dependency on meal plans;
- Accurately hit daily macronutrient targets;
- Modify food selection from day-to-day irrespective of ‘circumstances’.
PHASE 4 – Adaptive Intuitive Eating: Free Ocean Swimming
Dieting is not finite. Eating will continue for a lifetime and thus macro tracking is not the end of the line. Coaches/clients must adopt an infinite perspective to nutrition and learn how to be as flexible as possible without the constraints of ‘numbers’ to control body composition and health.
The drawbacks of calorie and macronutrient tracking are that it is arduous, unsustainable and unwelcomed by many, thus a more intuitive/habit based approach to dieting will circumvent the shortcomings of macro tracking. This phase will include:
- Minimal tracking whilst still reaching the end goal;
- Only track variables that are less habituated.
- Capitalizing on the habits and behaviours learned in the previous 3 stages;
- Focusing on hunger/satiety as well as portion control;
- Regular/Semi-regular auditing of food intake and body weight as a proxy for energy balance; and
- Improving self-awareness.
The deep end is not appropriate for ‘dieting phases’ as energy restriction and deliberate overfeeding will often lead to the dysregulation of hunger/satiety. For this reason, when the client’s goals are such that they require a more accurate control of energy balance they should transition back to step 3.
Furthermore, this stepwise approach to learning how to ‘’diet’ can help coaches/individuals determine an appropriate nutritional intervention based on their level of knowledge, goals, motivation and training phase.
Nutritional Coaching 101
Scope of Practice
Before delving into the various ways one can approach their diet, the first question that must be answered is:
Are personal trainers and strength coaches qualified to give nutritional advice?
Many coaches and trainers fail to consider their scope of practice, often acting outside what they are legally qualified to do.
Inherent to successful body compositional changes is a sound diet. All coaches know this and therefore give advice to their clients to ensure their service is satisfactory and produces the desired results. However, when it comes to nutritional prescription, that is advice outside of ‘basic healthy eating information and nationally endorsed standards and guidelines’. (5)
This becomes problematic for body composition coaches as what is required to optimise physique development typically requires deviation from the guidelines and standards endorsed by the ADA.
This is indeed an extremely grey area, especially with the legislation and regulation being quite disparate and unclear across the governing bodies and dependent upon geographical location. When it comes to what personal trainers are actually qualified to give advice on, they are confined to the gym floor. Even ‘nutritionists’ are not qualified to tell their clients what they ‘can’ and ‘cannot’ eat, with only qualified dieticians having the ability to give exact dietary advice.
Coaches and trainers shoulder therefore tread lightly and advise only on calorie and macronutrient intake and make general recommendations related to their client’s diet.
Prescribing A Nutrition Plan
It should now be evident that the type of protocol given to a client should largely be dependent on the individual’s level of nutritional advancement based on the four stages of learning outlined above, their, dieting history, goals, preferences and address any maladaptive eating behaviours.
Of note, many of the approaches will crossover and are not mutually exclusive from one another. For example, meal plans and calorie tracking can be combined to provide structure as well as improve knowledge of calories and macronutrients.
Here is a short list of the common nutritional approaches that can be used within various phases of the dieting continuum. As outlined above, ech approach should be selected dependent on the where the individual sits within the dieting continuum and will often carry over into subsequent phases:
Phase 1: Dietary Awareness
- Meal Plans
- Food Diaries
- Habit Based
- Calorie Tracking
Phase 2: Rigid Dietary Restraint
- Self-created meal plan(s)
- Calorie/Macronutrient Tracking
- Semi Tracking (Protein & Calories)
Phase 3: Flexible Dietary Restraint
- Calorie/Macronutrient Tracking
Phase 4: Adaptive intuitive eating
- Hunger & Satiety Journals
- Ad Libitum Eating
- Behaviour Focused
The aforementioned are simply methods to apply the principles and science of nutrition and physiology to an individual’s diet to achieve a desired body composition and learning outcome. The utility of any approach is predicated on what it aims to achieve as well as individual’s ability to consistently comply to the plan.
For example, meal plans provide structure and certainty of intake whilst habit based approaches are far less accurate in quantifying intake yet address underlying issues pertaining to food intake. Knowing the purpose and objective of any method will be the basis for which an approach is chosen.
In many cases, a combination of approaches will lead to superior results and is often necessary to transition through the four stages of implementing a flexible diet.
Poor Nutritional Coaching
If evidence based practice is indeed the gold standard to which coaches should be accountable to for their nutritional recommendations, then it should be clear when a coach fails to meet the standards of best practice. That is, they ignore the science, disregard the individual, become married to one approach or have little experience or knowledge in the application of nutritional sciences as it relates to the dieting continuum.
A common example of a coach who may indeed understand the science of fat loss but fail to take into account the individual is by prescribing perfectly calculated macros and calories to someone who is either poorly education about nutrition or has underlying psychological issues that would only be exacerbated with such an approach.
Even though on the surface, this approach would appear to align with ‘best practice’, it would not meet the standards of EBP as it is not accounting for the primary determinant of successful dieting – individualisation.
Similarly, many coaches pay little or no attention to the science of nutrition, metabolism and physiology often prescribe protocols that are inherently restrictive, unsustainable and ignore the need for adaption to a plan. Cookie cutter nutrition plans and generic approaches to nutrition are a dime a dozen and fail to meet the standard of evidence based practice or achieve positive outcomes.
Prescribing a plan dogmatically without an emphasis on progression/regression through the dieting continuum not only falls short of ‘sound’ nutritional coaching, but ignores the chief objective of nutrition – to be adaptive and sustainable.
Quality Nutritional Coaching
Understanding the dieting continuum.
As outlined above, understanding that a continuum of dietary and behavior change exists is at the forefront of effective nutritional prescription. Awareness of the high degree of inter-individual differences as they relate to ‘learning’ and ‘behaviours’ is required by coaches as too is a basic understanding of nutritional sciences.
Determining where an individual initially fits within the continuum is the foremost priority of a coach to appropriately devise an appropriate method to their diet. The objective is then to progress them through the phases of the continuum whilst ensuring they achieve their goals.
Successful nutritional coaching is highly reliant on the information gathering process. That is, collecting data, both objective and subjective, from the client to establish how best to approach their nutrition.
Important information that must be collected includes, but is not limited to:
- Behaviours & Habits
- Ideational values
- Pleasure systems
- Relationship with food/body
Detailed questionnaires, consultations, phone/skype calls and simply getting to know the client is critical in collating sufficient data about the individuals dieting history and level of knowledge and gaining an insight into the said factors. In essence, this allows a coach to determine a suitable approach that will serve as the ‘ideal’ starting point.
Starting with the evidence.
Once an appreciable amount of information is gathered, the scientific literature can serve as a great starting point in quantifying and qualifying a dietary intervention. Science is the surest path to the truth and nobody is exempt from the bounds of physiology. The following guidelines are extracted from The Muscle & Strength Pyramids which outlines the variables of nutrition in order of importance:
Underpinning successful dieting is adherence, that is the individual’s ability to comply and follow the plan. In the muscle and strength pyramids by Eric Helms he denotes that the three tenets of adherence are plans that are:
- Enjoyable; and
For most physique related goals, establishing the desired calorie and macronutrient intake will be merely an estimation based on formulas/calculations in an attempt to estimate individual energy requirements based on basal metabolic rate and activity levels.
The ‘calories in, calories out’ paradigm is founded in physics and the laws of thermodynamics state that changes in bodyweight/composition are largely driven by energy balance. A calorie deficit (less calories than maintenance requirements) leading to weight loss whilst an energy surplus (more calories than maintenance requirements) resulting in weight gain. (6)
Energy balance is not static and is indeed dynamic and highly dependent on activity levels, meaning that even the most advanced/common estimation techniques will have a degree of error and quantifying baseline energy requirements is merely guess work at best. Due to the nature of calculations being based on averages, individual differences in energy expenditure and response to energy intake make any formulation simply a starting point for later adjustments and correction.
Furthermore, tracking daily calorie intake across 7-10 days and measuring changes in body weight serves as an excellent means of establishing baseline requirements.
Formulas such as the Harris & Benedict Equation have been useful in quantifying calorie requirements as have anecdotal methodologies of leading physiology and nutrition experts such as Lyle McDonald & Alan Aragon.
Macronutrients are the key variables within a diet that must be manipulated for favourable changes in fat mass and lean body mass. Mechanistic as well as applied research on macronutrient intake for body composition is fairly well established, with much of the literature giving rise to the consensus that protein intake is of primary importance in energy restricted conditions and for muscle hypertrophy.
Therefore, protein should be the first point of call when determining macronutrient intake with anywhere between 1.6-2.8g of protein per kg of body weight have been cited by nutrition experts and the literature, dependent on total energy balance. In chronic, hypocaloric conditions, protein requirements may need to increase, whilst in hypercaloric conditions, protein intake may be lowered.
Following from determining baseline protein requirements, is prescribing fat and carbohydrate intake. This has been seen to be a secondary step in making up the remaining calorie allotment and should be dictated primarily by preference, provided minimum intakes are met and the approach is sustainable.
Recommended fat intake is 0.8-1.3g of fat per kilo of body weight and carbohydrates making up the remaining calories. The allotment of carbohydrates and fat or any macronutrient for that matter should not violate adherence or minimum intakes that could lead to negative health outcomes – 0.5g fat per kg of body weight and 1g of carbohydrates per kg of body weight. (7)
What may seem of less importance to many physique enthusiasts and body composition coaches is the role of fiber, micronutrients and water. However, nutrient deficiencies, low fiber intake and dehydration can all cause complications to one’s health. Therefore, ensuring that the dietary approach also accounts for fiber and micronutrient needs as well as hydration status is vital to optimal outcomes in gut health, satiation, wellbeing and performance.
The recommended fiber intake is 15g per 1000kcal whilst sufficient micronutrient intake can be achieved via an inclusive diet high in vegetables (2-3 serves daily) and fruits (1-2 serves daily). Water consumption should increase with finer intake, activity levels and adequate hydration status can be seen when urine is clear.
Meal Timing & Frequency:
The timing and frequency of food intake has been largely overstated and often understated. Whilst the specific scheduling and regularity of meals may not directly contribute to short term physiological adaptations that are favourable for body composition, the frequency and timing of meals can indeed improve their adherence to the diet a augment training adaptations.
For this reason, nutritional coaching must also take into account the individuals schedule, preferences and goals to determine which patterning of food intake will best align with their needs and objectives.
For most physique and health related goals, meal frequencies of 3-6x per day at intervals that fit within an individual’s schedule. To support training and augment the muscle protein synthetic response to resistance training, allocating a bolus of protein and carbohydrates around the workout (1-2 hours either side) is supported both by the literature and anecdote. (8-13)
There are no legal supplements that can directly yield fat loss or muscle gain. Thus, supplementation must aid a sound approach to dieting and aim to either assist performance or make up health deficits caused by the diet.
Feedback & Response to the diet.
Like all effective coaching, the true success of any diet comes from the adjustments and amendments made to the protocol based on individual feedback and response to the prescribed plan. Not only is progress through the four stages of the dieting continuum desirable, but enjoyment of the diet and adherence are the cornerstone of long term body compositional change.
Weekly/Daily check ins should be used as a means of assessing physiological changes to the diet and provide quantitative data such as scale weight, progress pictures, girth measurements etc. Moreover, obtaining qualitative is imperative in assessing factors such as mood, energy levels, enjoyment and important factors related to compliance.
Adjustments and Transitioning.
As stated, true coaching comes from the continued assessment and adjustments to the plan. Using the information collated through client check ins will assist in making the necessary adjustments and tackle key variables that will further progress. No plan will work forever, both as a function of physiological changes in response to energy intake and circumstantial changes in goals, lifestyle, environment, nutritional age etc.
To this end, nutrition must be revised, altered and adjusted to maximize results as well as transition towards a flexible, sustainable approach that will help the client achieve their long term goals.
Adjustments will typically need to be made to address one or more of the following:
- Adherence Issues: Behavioral modification and addressing the food environment.
- Psychosocial Issues: Periodic breaks from ‘dieting’ breaks, addressing relationship with food and body.
- Physiological Stalls: Adjusting energy intake/expenditure by reducing/increasing calorie intake and exercise.
Not only are adjustments and amendments to the plan necessary for the aforementioned reasons, but all coaches should plan prospectively for their clients to ensure that continued education is upheld to improve the level of autonomy that they assume over their nutrition.
Finally, the role of a coach is to also forecast changes in goals, stressors, circumstances and lifestyle to ensure that the plan can be adjusted accordingly to preserve adherence and minimize regression as i relates to the clients nutritional advancement.
As I am sure you are now aware, nutrition coaching is indeed complex and ambiguous. However, by following the basic tenets outlined in this article, the standard of coaching can indeed be improved and the outcomes for clients positive.
(1) Evidence-Based Medicine Working Group. Evidence-based medicine: a new approach to teaching the practice of medicine – JAMA. 1992;268(17):2420-2425
(2) Nutrition Education in an Era of Global Obesity and Diabetes: Thinking Outside the Box, – Eisenberg Et al (2015)
(3) Aspects of Eating Behaviors “Disinhibition” and “Restraint” Are Related to Weight Gain and BMI in Women – Hays Et Al (2009)
(4) Validation of the Flexible and Rigid Control dimensions of dietary restraint – Westenhoefer et al (1999).
(5) Fitness Australia: Position Statement – Scope Of Practice For Registered Exercise Professionals .
(6) The energy balance equation: looking back and looking forward are two very different views. Schoeller et al (2009)
(7) International society of sports nutrition position stand: diets and body composition (2017) Aragon Et Al
(8) Meal frequency and energy balance – Bellisle Et Al (1997).
(9) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an 8-week equi-energetic energy-restricted diet, Cameron JD etl al (2010) :
(10) Carbohydrate does not augment exercise-induced protein accretion versus protein alone, Staples et al (2011)
(11) Ingested protein dose response of muscle and albumin protein synthesis after resistance exercise in young men, Moore D et al (2009)
(12) Resistance exercise enhances myofibrillar protein synthesis with graded intakes of whey protein in older men, Yang Y (2012)
(13) Nutrient timing revisited: is there a post-exercise anabolic window? Aragon Et Al (2013)