Could digital health coach interventions like Holly Health help solve the metabolic health crisis?
In 2019, I was struggling with burnout, insomnia, depression and obesity. Overwhelmed with the sheer weight of behavioural and lifestyle changes I knew I needed to make, I knew I couldn't face them alone. So I booked an appointment at the clinic. The doctor asked me a few questions, and I told her that I had been struggling to sleep, that I felt low most of the time, and that I was using food to try and boost my mood and improve my fatigue. She prescribed me anti-depressants and sent me home. The appointment was 8 minutes.
I was furious and defeated by the experience. My doctor had diagnosed my immediate illness, but she hadn't helped me on a path to prevent any further disease. I had perhaps gotten access to the proper medication but had no clue what to do next and no ongoing support for the plethora of issues I was facing. I knew that my weight and psychological challenges were connected. But I didn't know how to address them.
How would I start my journey to improve my metabolic health? How would I forgo destructive habits for healthy ones? And how do I make a consistent change?
The Power of a Personal Coach
After leaving the doctor's office, I knew I would need help moving the needle on all my troubles. I tried all the diets, all the weight-loss strategies, all the mindfulness tools and ALL the apps. The "eat less, move more" solutions were failing, and my willpower was only so strong. I did everything I could, but I mostly did it alone. I had some successes, a lot of short-term wins and many setbacks.
I had 40kgs (88 lbs) to lose to get into my healthy weight range, and I felt I'd tried almost everything. However, with the state of my mental health, it felt insurmountable. I knew that if I were to make lasting behaviour change not just obsessively focus on weight-loss, I would need pretty intensive daily and weekly support.
One of my best friend's mom is a personal trainer and health coach, so I reached out to her, and our coaching relationship began. Jannette and I started by getting to know each other, chatting through my pain points and setting achievable goals. She was never interested in quick wins. Instead, she wanted to see my lifestyle change completely.
Starting Small
Jannette taught me that focusing on weight loss as the only determinant of health is a narrow view of whole-life health - and that paradoxically it can get in the way of your progress. Healthy lifestyle habits are associated with better long-term health outcomes regardless of the size of your waistline. Understanding that for longevity and disease prevention; mental health, stress management, social connection, nutrition, exercise, sleep quality and all sorts of other things are essential.
Knowing this is a relief to those of us who are exhausted by the ubiquitous advice to "just lose more weight". But it can also be extremely overwhelming! If everything is connected, where do we even start? The answer seems to be to start small.
Jannette helped me understand exactly what steps I needed to take on a daily basis and why those changes would help me. Starting small, she empowered and encouraged me to make gradual, consistent and lasting changes by building one habit on another.
These are some of the key things that helped:
- daily check-ins to help me stay on track
- educational content on whole-life health and wellness
- mindful eating and flexible nutrition
- chatting through mindset and stuck areas
- mindfulness tools and stress reduction practices
- nudges on the days she could see my motivation slipping
- building rewards into my life that weren't food based
- vision boards and visualisation practices
- confidence building and focused short-term challenges
- on some of the tough days, someone to lean on.
She didn't care solely about the numbers on the scale or how much I sweated each week in the gym but my mindset and mental health first because she knew that my mental and physical health was inextricably connected.
Flexible Nutrition over Restrictive Diets
If you're not battling with chronic illness, food allergies or training for a specific performance or physique goal, restrictive diets are usually not worth it for the average person. But most of what we are told about how to lose weight or improve our health is the "eat less, move more" approach dressed up in a million different ways. These approaches usually involve restrictive dieting and exercise programs that feel like punishment. And these fad diets wreak havoc on our long-term health, and often result in weight gain.
With the powerful influence of diet trends and the mixed messaging from nutritional "science" in the media, we often find ourselves in restriction and binge cycles when it comes to food. Over the long-term, these cycles can mar our relationship with food and even promote disordered eating.
Jannette taught me that instead of more restriction, it might be helpful if we tried more weight-neutral, evidence-based approaches with more compassion, kindness, curiosity and flexibility embedded in them. After all, I think we genuinely want to be healthy and strong for our whole lives and prevent life-limiting diseases rather than fit into a particular size of skinny jeans for two weeks. When we focused on the longer-term goals with greater flexibility, the weight came off more easily. Who knew!?
With the help of mindfulness practices and flexible nutrition tools, Jannette helped me build intuitive eating skills that naturally improved my eating habits and my relationship with food.
Long-Term Change over Short-Term Gains
With Jannette's help, I improved my relationship with food, I reached and maintained my healthy weight range, I can manage my stress better without sabotaging my health goals, I am fitter than ever before, my mental health problems lightened, and I am off my depression medication.
It's an understatement to say that Jannette changed my life. Despite my debilitating overwhelm, she helped me realise I had it in me to change my life and then supported me as I slowly and sustainably stacked one small habit on another. I am so grateful for her.
It's through building our relationship and all the success that we have had together that I have learned to appreciate the powerful and effective nature of personalised coaching.
A Personal Health Coach in your Back Pocket?
There are two big problems with explaining how a personal health coach was the most significant shift for me in getting me to reach and maintain almost all of my health goals. I, of course, have the privilege to prioritise and the means to engage in this kind of intensive support.
The problem is that:
- Professional and personalised help is practically and financially inaccessible to most people.
- And personalised health coaching doesn't scale. So how do the billions of people who need it get access to a health coach?
We know we can reach people with cellphones and that digital health interventions actually work. So, could technology make this kind of professional and personalised service accessible? Could a digital health coach provide the support people need right to their back pockets?
No, ChatGPT didn't write this article but with the new possibilities of AI, I'm more hopeful than ever about digital health interventions. We haven't even seen it live up to its potential quite yet but for now, AI might unlock scalable access to personalised and evidence-backed health coaching, and that is super exciting!
A year into my coaching with Jannette, I found Holly Health. Holly Health is:
"Personalised habit change support, for better population health. Holly Health, the digital health + wellbeing coach, supports sustainable behaviour change for physical and mental health, guided by clinical and psychological evidence." - HollyHealth.io
I was immediately interested in their thoughtful and empathic approach. So in 2021, I signed up for the Holly Health beta trial delivered over WhatsApp.
Holly Health felt familiar. Holly Bird was engaging with me just as Jannette had done. I loved it and was excited about the future of digital health coaches and how they could move the needle on solving the metabolic health crisis.
The Hope of Digital Health Interventions
There are around 6.8 billion smartphone subscriptions worldwide, and while this differs across countries, almost all the world owns a cellphone. Whether you're looking at low-tech, low-data solutions or premium subscription services, there are two things we know for sure:
- We can reach people with cellphones and,
- Digital health interventions actually work.
Needless to say, I have great hope in digital health interventions and the power of technology to provide scalable solutions for population-wide disease prevention.
As exciting as the digital health interventions landscape is, and let me tell you, I can geek out on all things health tech! I have been skeptical at the sheer amount of new entrants to the space and whether the teams behind these apps are thinking about sustainable and systemic solutions, not just quick direct-to-consumer profits.
The consumer healthcare market is increasingly competitive and highly lucrative. And the space is, of course, not without its problems, like dubious and sometimes terrifying data "privacy" practices. More importantly, as a social worker trained in systems thinking, I am weary about sustainable change and the scaling possibilities for health tech apps that don't think long-term or leverage primary care integration.
I have poured so much money into subscription health-tech services with very little long-term gain. So what moves the needle on metabolic health and lifestyle disease prevention? And can technology help solve this?
Prioritising Primary Care Partnership
Sadly my situation is not unique. Worldwide obesity has tripled in the last 50 years; about 1.9 billion adults are overweight, and 650 million struggle with obesity. WHO And about one in eight people live with a mental health disorder. But there are solutions.
One of the most effective primary care interventions for sustainable weight loss is high-intensity counselling, but face-to-face interventions to treat obesity and prevent cardio-metabolic disease require immense amounts of time and human resources. This creates a significant burden for primary care practitioners and health systems as a whole.
I can see this clearly now, how could my overburdened doctor have the time or resources to provide the support I needed? How could my doctor invest the time in one patient to coach me through the complex set of daily lifestyle and behavioural challenges that reverse obesity and help improve my mental health?
The truth is she couldn't. Health services are overstretched, and they need help. We need innovative solutions that relieve the burden on primary care and that support patients once they've left the doctor's office.
We saw rapid digital developments in primary care as a necessary response to the Covid-19 crisis, and there is tremendous potential in implementing effective new solutions with the insights learned. But we don't need more solutions, we need better ones.
The difficulty for the thousands of digital interventions available is not getting people to sign up to use a service but to stay engaged and continually utilise its features. Long-term success of novel digital health interventions relies on sustainable use. With health interventions in particular, I think it's imperative that tech is well designed, patient-focused, and integrated into existing health systems.
We need a platform that understands the human side of coaching but that partners with primary care.
In hindsight, I have great empathy for the doctor I saw that day because she was utterly overburdened with more immediate problems and had patients with much more urgent medical needs. I knew this feeling well from social work practice. You want to help people at the root cause level with their multifaceted problems, but you don't have the capacity.
Perhaps if my doctor had access to a digital health intervention platform that could support her patients to self-manage, it would improve patient outcomes and reduce overwhelm on clinical teams? A solution like Holly Health could be just what we're looking for.
Holly Health Review
I reached out to Grace Gimson, CEO and co-founder of Holly Health, and she kindly gave me access to the platform for review. In the following months, I will go through the onboarding process, commit to health goals for the year, and track my progress.
I can't wait to try out the fully-fledged app and see how it compares to a real-life health coach experience. Follow along for the in-depth review 🚀