Lessons of a Health Coach: What tāngata whaiora are teaching me about weight management
By Kylie Brown, WBOP PHO Health Coach
Published: March 2025
“Tāngata whaiora” is a person seeking health1. A term with a deeper meaning than ‘patient’ or ‘client’. I have had the opportunity to engage with almost 400 tāngata whaiora as a Health Coach at the WBOP PHO so far. My role is to help them make behavioural changes to improve aspects of their well-being. I help them to work towards what’s important to them and trust their ability to identify what they would like to change and how to go about this, often sharing information so they can make informed choices as we work together. Many whaiora I see present with weight management issues.
In an ideal world we would prefer the focus not to be solely on weight loss. It isn’t usually the most important or accurate measure of health and wellbeing and is often intertwined with some associated beliefs about appearance and self-worth. But the reality is, many whaiora present wanting exactly that. Since attending an in-house education session recently with our nutritionist, I was reminded of our role as Health Coaches in managing expectations. And this resonated with me. I thought perhaps I could be doing this better. Upon further reflection and thanks to whaiora, there are two key areas that are driving me to change my practice about weight management. These are:
1. Redefining what “healthy” means to whaiora, with whaiora; and 2. Managing whaiora expectations
Much of my weight management practice stays the same, like returning to healthy eating basics. Whaiora are teaching me that not many of us are getting even the basics right when it comes to nutrition. Especially when they tell me they have spent the last however-many-years dieting and restricting and still not getting the results they want. Many know now that diets don’t work, and they are returning to “that old chestnut” – the healthy lifestyle. In terms of nutrition, this is the basic foundational knowledge that we may hear about such as the “5+ a day”. Or if we know where to look, information on the food groups, servings, and serving sizes such as on Healthy eating basics | Healthify2. Some whaiora understand there’s more to it than just eating less and moving more. Yet many still don’t.
1. Redefining what “healthy” means
When whaiora come to me for weight loss, it is for one of two reasons:
a.
Weight loss for clinical health improvements
b. Weight loss for self-esteem or to be “happy”
Without a doubt, there are some health conditions that benefit from weight loss, such as joint pain and arthritis; type 2 diabetes; high LDL (“bad”) cholesterol; and high blood pressure, just to name a few. Some experts say as little as 5% of body weight can make a difference.3
I am learning that weight loss for clinical health improvements is a much better motivator as there are blood tests to measure against and see improvements. I try to help whaiora measure what really matters when it comes to their health and wellbeing. Whaiora who are more interested in “feeling better … sleeping better … having more energy … keeping up with grand/kids … having less pain … having better bowel movements! …” etc rather than focussing solely on weight loss, in my experience are more likely to make the necessary changes. Losing inches or losing weight can be a bonus. This is a move towards a more holistic approach to health, where aspects such as relationships, connections, mental, social and emotional health are taken into consideration and deemed important by whaiora.
As mentioned earlier, some whaiora I see understand health is more than just about diet and exercise. It’s more of a body, mind, spirit approach and as Health Coaches some of us use a tool called the Hua Oranga, based on Sir Mason Durie’s Te Whare Tapa Whā holistic model of health4. Picture a metaphorical house with 4 walls – physical, spiritual, social and emotional. If one of those walls is compromised, there is a danger the whole house will fall. There are areas in our life that can impact on our weight loss efforts. More on this later.
Weight loss for self-esteem or happiness is a tricky one for Health Coaches. As Health Coaches we must be as focused on supporting mental and emotional wellbeing as we are on physical wellbeing (and social and spiritual). We need to be extremely careful not to reinforce beliefs that how we look determines our value or worth. Helping whaiora understand that weight loss is a very small piece of the health and wellbeing puzzle can be challenging for us when we are dealing with whaiora’s underlying belief systems about themselves. To help whaiora build a picture of health and self-worth that isn’t weight-focused, we can encourage whaiora to:
• Focus on their talents and positive qualities;
• Catch themselves using negative self-talk and speak positively to themselves instead;
• Respect and appreciate what their body is capable of doing;
• Set health-focussed goals instead of weight-related goals;
• Talk about success in terms of how they feel and what they can do, rather than how they look;
• Avoid comparing themselves to others, especially with social media.
It’s also important for us to recognise when whaiora may need further support to build their resilience and emotional strength and separate appearance from self-worth e.g. input from a Health Improvement Practitioner or other professional. Based on the boxes of tissues I go through in my practice, whaiora make an appointment to see me regarding weight management, but before we know it the tissues are out, and the weight loss conversation has turned into something else entirely. I am learning that not many whaiora understand how things like stress and sleep can interfere with their weight loss efforts.
2. Managing expectations
This leads me to managing whaiora’s expectations. Invariably, many whaiora believe that weight loss equals health. However, these are not actually the same thing. Positive changes to health can be achieved with little or no weight loss. Things like adequate hydration and nutrition, physical activity, feeling fitter and stronger, reducing stress, getting better sleep and being in less pain, can be incredibly helpful and healthy, yet not be reflected on the scales. Therefore, it’s my role to help whaiora manage their expectations around health and understand that making changes to improve health and well-being can be irrespective of weight change.
Two main questions I always ask whaiora are:
1) “how are you sleeping”; and 2) “how are your stress levels?”
It never ceases to amaze me how many whaiora admit they are not sleeping well, and their stress levels range from gently bubbling away under the surface to “sky high”. They will say that they are doing everything right and don’t understand “where I’m going wrong”. It comes as a surprise to many that sleep and stress can impact on their weight loss. It does. Greatly.
Sleep
Sleep plays an important role in controlling blood sugar levels; regulation of appetite and weight; and metabolism (energy use)5. If whaiora aren’t sleeping well, hormones become imbalanced, and this interrupts the signals that tell us when we are full or hungry. When we don’t get enough sleep:
• the hormone ghrelin increases (which stimulates appetite and promotes fat storage);
• and the hormone leptin decreases (which regulates hunger and fat storage)
This imbalance explains why whaiora say they often don’t feel satisfied after a big meal, feel hungrier than usual and/or overeat6 .
They don’t always go hand in hand but often whaiora have trouble sleeping if they are under stress. In a chronic stress situation, i.e. long-term, the body doesn’t know when the stress will end so it saves energy in case it needs it in a “fight/flight” situation. It doesn’t help that many whaiora turn towards food when under stress and this can sabotage best efforts. Which is why it is so important that stress levels are prioritised and managed.
Stress
Not only stress impact on their best weight loss efforts, but chronic stress also leads to other health conditions such as diabetes, heart disease, high blood pressure, anxiety and depression7 . It certainly doesn’t help when the cause of stress is weight. This is where I find our role as Health Coaches is so important to help whaiora understand that there is so much more to being healthy than just our weight, as well as managing expectations around weight loss.
Stress doesn’t have to be the short-term “possum in the headlights” feeling, nor does it have to be from external factors. Our body doesn’t know the difference between a real experience and our thought of an experience; hence a real or perceived threat can cause us stress.
When we experience stress at any level, it produces hormones adrenalin and cortisol. Adrenaline increases our heart rate to pump blood around our body to the extremities (arms/legs) to prepare for “flight/flight”. A high heart rate over a long period of time can lead to the aforementioned conditions.
Cortisol however, tells the body to conserve energy to deal with the impending danger and therefore slows down all non-essential functions such as digestion, as well as many other bodily functions. This slows down our metabolism and our digestion changes. Our body wants to save energy and store fat in case we need it later, this is often the visceral fat. Cortisol can also promote overeating as it encourages us to eat when food is available (which is 24/7 these days) and can be referred to as “emotional eating”7. I work with many whaiora who experience “food noise” which is a preoccupation with food.
The good news is that any step to getting healthy has a snowball effect. Starting in one area, e.g. stress, sleep, nutrition or exercise, flows into the other areas. For example, if exercise helps with stress this can influence a better sleep which in turn influences energy levels, which can help make you start feeling better, therefore making better food choices and lo and behold, we start getting healthy!
I feel I have been a bit PC so far but what I have also experienced from whaiora is small changes equals small results; big changes equals big results. Losing inches and weight loss is possible. I see it. But this is now a bonus, not the focus. Every whaiora is different, some start slow, some jump right in. Slow is good as it involves habitual changes which are sustainable
over time. Whaiora can start noticing changes in a short period of time if they jump right in, the danger here is sustaining it. However, progress is progress, and these are all wins.
Tāngata whaiora are teaching me a lot. They already come equipped with the strengths and resources required to make the necessary changes. It’s our role as Health Coaches to educate and help them see their strengths and resources when they can’t, particularly in other aspects of their lives.
References
1. Involving Families - guidance notes (health.govt.nz)
2. Healthy eating basics | Healthify
3. Weight loss: the options and the evidence - bpacnz 2022
4. Te Whare Tapa Whā | Mental Health Foundation
5. Te Kete Haerenga and sleep | Healthify
6. Stress and Weight Loss: What You Need to Know - Penn Medicine
7. Stress | Healthify
8. Cortisol & Weight Gain: How Stress Is Linked To Weight Gain | Juniper (myjuniper.com)