When Health Coaching Backfires
It all started with back pain.
More than ten years ago, a physical therapist treated me for lower back problems that had worsened after my second child was born. Stretching, strengthening, and massage eased the chronic ache, but I still threw out my back on a regular basis. Not from pushing a stroller uphill or hoisting a toddler into a car seat — instead, simply getting out of bed or brushing my teeth could nearly immobilize me for part of a day.
Eventually, the physical therapist suggested I might be suffering from inflammation, so she recommended a health coach specializing in helping women address somatic problems through nutrition. Little did I know this would be the beginning of a years-long struggle in my relationship with food.
The health coach was bright, kind, and relatable. She was a recovering perfectionist and busy mom just like me. The personal story of healing her own issues through dietary changes made a compelling case. And she explained everything in a way that seemed to make perfect biological sense. I didn’t question it.
I considered myself “smart” about these sorts of things. I was pre-med in college, I hold two master’s degrees, and I love to nerd out on science journalism. The health coach had an impressive resume and ran an “institute.” She wasn’t a registered dietitian, but she had a nutrition certification (not that I knew the difference). There were glowing endorsements from past clients whose lives had been changed.
First step: send saliva samples to a lab so they could analyze my hormone levels. Very scientific. Hundreds of dollars later, I got results that supported the health coach’s theory about my underlying problem: “adrenal fatigue.”
My stress levels and dietary choices, including “the crutch” of caffeine, had “blown out” my adrenal glands, leaving my aging ovaries with no backup. Her conclusion was clear: my approach to living was unsustainable, and I would have no vitality or resilience left after menopause if I didn’t make drastic changes now. I still had time to reverse the damage and start living my best life. It was frightening, but she could guide me back to better health. I trusted her.
Though I had no known allergies or intolerances, I was told to start by eliminating or cutting back on a range of foods and ingredients, including coffee, gluten, soy, and dairy. Needless to say, I wasn’t very pleasant to be around.
Although she advised me to “keep things simple,” there were rules about eating certain macronutrients only at specific times of day, combining particular foods, and adding expensive supplements.
The pathologizing of my body and appetite went further. I could identify my other “problem foods” by keeping a detailed journal and checking my blood sugar five times a day. I dutifully went to the diabetic medical supply aisle at Target where I bought a glucose monitor and a jumbo box of lancets.
The health coach did talk about some other more holistic strategies: developing tools for stress management, expressing my needs directly, and trying to identify more things to enjoy in my life. But the bulk of our conversations focused on micronutrients, detoxing, how I might address my “diminished ovarian reserves,” why I should never eat more than a certain number of eggs per week, and moving toward eliminating more ingredients, such as sugar, corn, and GMOs.
A few sessions in, she noted I had “a lot of fear around food.” Go figure.
The recommended meal ideas and recipes were either elaborate or included ingredients I wouldn’t normally cook with — and certainly were unlikely to be a hit with my young kids. Fermented cabbage and black bean stew for dinner. Vegetable-quinoa porridge for breakfast. Sardines packed in a cooler for lunch on the go. I tried but just couldn’t do it.
I felt like I was failing.
Feeding my kids took priority. Unable to follow the complex set of guidelines from the health coach, I would often get really hungry and gorge on whatever gluten-free snacks and desserts I had purchased. That way, I felt I was abiding by at least some of the rules. I had trouble sleeping and started gaining weight. It seemed obvious that I was doing something wrong. That my body was wrong.
I remember going to our favorite Thai restaurant, one of those then-rare places where everyone in the family had a few beloved dishes. I had been so deprived of pleasurable foods, I didn’t have the willpower to order according to my new protocol. When I checked my blood sugar after lunch, it was the highest reading I’d ever seen. It was frightening. I wondered, am I feeling a little dizzy? Is that a headache? Am I extra thirsty?
A few weeks later, the kids asked to have Thai food again, and I could feel the panic creep in. During the meal, I wondered what I should eat and not eat. Even though the purple short-grain rice was one of my favorites, my fear kept me from having more than a bite. Should I “cheat” and have a sip of that gloriously orange Thai iced tea with boba, or no? I had kept myself from enjoying the foods I wanted, and it was generally a miserable lunch instead of a joyful family outing. The blood sugar reading after that “low-carb” meal? Even higher than before.
When I submitted my food and blood sugar journal for our next session, the health coach started using scary terms like “metabolic syndrome” and “pre-diabetes.” I was definitely in trouble. I should double down on my efforts, and she urged me to look into online Paleo Groups for recipes and community support. Maybe some root vegetables were the ticket.
During the holidays that year, I didn’t pack the glucose monitor when we traveled to see family, and I tried to relax around food, with the belief I would “get on track in January.” Back home on New Year’s Eve, we celebrated just the four of us; we made our traditional “hors d’oeuvres dinner” of delicious, rich appetizers — along with fancy cocktails for my husband and me. We each donned a silly hat, and our dining room selfie from that night remains one of my favorite family photos.
On a whim, I decided to check my blood sugar to see just how badly I was hurting myself with all the gin, potato chips, and Ina Garten’s onion dip. And what do you know? It was one of the lowest readings I’d ever had after a meal.
At my next session with the health coach, I asked how that number was possible after “indulging in all the wrong things.” Her reply: “Oh, because you were relaxed and having a good time.” Hmmm. That was my first clue that all of this stressing over my food might be truly counterproductive.
My notes from one session begin with questions I was supposed to ask myself in order to guide food choices: “What does my body need?” “What feels good?”
And then — I kid you not — the next line says, “eat mostly veg — clean,” “fruit okay but not too much,” “move away from grains.”
As I expressed concerns about imposing further restrictions, she suggested I take a break from the rules altogether and try a new experiment: I would “eat anything” and try to focus instead on “joy and pleasure.” Sounds lovely, doesn’t it?
Without that “free pass” feeling I had on New Year’s Eve, however, I found it really hard to put all of the rules aside. I don’t know if anyone can flip a switch and suddenly forget all the fear-mongering lessons they’ve been taught.
I started feeling “off” after eating foods that had never bothered me before, and I was even more confused. I now know many of my reactions were likely due to the “nocebo effect,” which occurs when something harms you solely because you think it will. Or maybe my whole digestive system was wonky from all the deprivation and worry of the previous months. Who knows.
Though I always tried to keep things relaxed and normal around my kids’ meals, I was a mess around my own food. I definitely felt worse than before I started trying to change my diet. I didn’t see how all of this stress, insomnia, and fear could be good for my body, adrenal glands included.
I considered not continuing to work with the health coach, but I had purchased a package and still had one pre-paid session left. I also didn’t want to be a “quitter.” I had that nagging worry that maybe I just wasn’t disciplined enough, that I was weak, unorganized, and generally bad at self-care. I felt a lot of shame. I remember my eyes filling with tears on that last call.
It was then she suggested my anxieties about food and my inability to implement her plans were probably the result of an eating disorder, and that I should seek an expert in that area. I didn’t know what to think. I felt accused, embarrassed, angry, scared, hurt. All the fun emotions.
I knew enough to know I didn’t meet the criteria for an eating disorder diagnosis, but the health coach couldn’t see any other explanation for my struggles. She couldn’t recognize that her own (well-intentioned) advice had contributed to my newly disordered eating patterns and a problematic relationship with food.
She did end our final conversation with some wisdom and compassion: why it was so important to be patient and caring toward myself, how the relationship with food was crucial, and that I deserved to have freedom in this area of my life.
So why didn’t we start there?
. . . .
It would have been nice simply to forget all the things I had been told during our sessions and just go back to feeding myself the way I had done before. While I wanted to kick that whole experience to the curb, I didn’t know how to move forward with confidence. It was really hard to ignore all the frightening arguments the health coach had made about nutrition and disease.
I kept worrying, maybe she was right? Was I permanently damaging my endocrine system by eating my favorite foods? Was I dooming myself to future suffering? If I have problems later on, will they be all my fault?
Later, after gaining weight and still feeling stressed about meal-planning, I was desperate for something to help me feel a sense of ease around food. More nutrition counseling didn’t seem terribly appealing, so I did what seemed logical at the time: I signed up for Weight Watchers.
Yes, you read that right. In an attempt to bounce back from a restrictive nutrition plan, I turned to a diet. But I didn’t see it that way at the time.
While this was before Weight Watchers rebranded itself as “WW: Wellness That Works,” they had already begun to sell the idea that it wasn’t an old-fashioned diet; it was a lifestyle. With Oprah as the face of the company, perhaps this was the good-for-my-soul approach I could actually follow forever and never have to worry about food again. If only.
Despite the glowing testimonials from “lifetime members,” this program wasn’t sustainable for me after about a year. Logging my weight into an app every week and consuming a dangerously low number of daily calories were probably the worst things I could be doing to take care of my body. At the time, I blamed myself for being unable to stick with such a “simple” approach that had “research” behind it. So much for feeding my soul.
Though I was no longer following a prescriptive plan, the accumulation of nutrition advice continued, subtly, to influence both my food choices and how I felt about myself after I ate something that broke a “rule.”
My desire to improve my health had completely backfired. I could see how problematic restricting foods could be, but I still had a lot to learn. And, boy, did I learn the hard way.
. . . .
When my own child later developed a severe eating disorder — catalyzed by a desire to “eat healthier” — I saw diet and wellness culture with new eyes.
I imagine almost every parent blames themselves if their child gets sick. I’m no exception. Did those months of buying myself gluten-free, dairy-free, and “zero-point” foods plant the seeds for this horrific illness? Did my own bouts of chaotic and restrictive eating set a poor example for my children? Had my kids overheard me say something about “inflammatory” foods along the way?
But I didn’t have time to wallow. I had to focus on helping my child get well. And that’s how I discovered the anti-diet movement, intuitive eating, and Health at Every Size®. Creating a different food culture in our home was essential. While helping my child recover, I also healed my own relationship with food.
It’s amazing how much work went into un-learning the harmful messages I had paid to receive over the years. And I had the “benefit” of motivation that was literally life-or-death. Reader, it was still hard.
Of course, I wish I could go back in time and tell myself to be more skeptical of certain “health and wellness” claims. But I also practice self-compassion. I was just trying to feel better, and I sought the support of an “expert” recommended by someone I trusted. The culture around me — abuzz with talk of adrenal fatigue, inflammatory foods, and gluten phobia — reinforced my decision. I did the best I could with the knowledge I had at the time.
I don’t believe the health coach meant to do harm. And I imagine there are people who have felt better thanks to that kind of care. But I also know I’m not the only one who got sent down a rabbit hole of self-doubt and disordered eating — or worse. Taking the “natural” or “alternative” approach to certain health concerns isn’t without its own risks.
And, oh, what about my back, you ask? As mothering became less physically demanding, and I had more time to take care of myself, my lumbar issues greatly improved. While I do still tweak my back from time to time, I now know the first step is not to blame myself. And I try to make sure I’m getting enough of the stretching and movement that tends to help me feel better.
More than anything, I now know, deep in my bones, that nourishing myself without restriction or fear is the healthiest thing for me, body and soul.