ollie: Hello folks, welcome back to our Health Coaching Beyond podcast. And I'm delighted today to be joined by Nikki Coughlin, who is a health coach from Northern Ireland, who, sorry, Southern Ireland. Got the get out right? ⁓ Who has spent her last four years specializing in health coaching for people taking GLP-1 injections. So we're promising a really interesting conversation for someone who really knows what they're talking about. So Nikki, welcome. As many of you know in Health Coaching and Beyond, we alternate conversations between the two of us, chewing over hot topics, latest news and emerging ideas, but also bringing you conversations with thought leaders and people we admire in the field of health coaching and beyond. This week, our focus is really on a scorching hot topic, exploring the use of GLP-1 agonists, the likes of Wigovie, Azempic and Munjaro. The numbers of people using these medications for weight loss has exploded, but alongside that, the side effects and problem

Nikki Coughlan: Thanks very much. Good to be here. Thanks sorry for the invitation.

ollie: Yeah, lovely. And it's always lovely for you to perhaps introduce a bit about your background and who you are and what your experience has been over last few years. associated with the medications is also ballooning. So who better to join us than GLP-1 specialist health coach, Nikki Coughlin. She's been a pioneer of health coaching support for people using these medications for weight loss for over four years. She has a deep insight into the ups and downs and shares her real life experiences here. Whether you're taking or considering taking a GLP-1 medication, you're a health coach or clinician supporting someone taking them, a friend or family member that wants more insight.

Nikki Coughlan: Yeah, absolutely. So I'm a certified health coach and a registered nutritional therapist, and I specialize in obesity care and supporting people on GIP1 medications. ⁓ so I started out in this field over four years ago. ⁓ so it was exactly the time when GIP1 medications ⁓ are are were getting prescribed for weight management increasingly. ⁓ so that's why I kind of entered ⁓ this space.

ollie: or just curious about the topic everyone's talking about, this is the episode for you.

Nikki Coughlan: And since then obviously, you know, the market grew a lot and today it's a it's a very different world compared to how it started a few years ago.

ollie: Yeah, you've really been one of the pioneers right at the start. And of course, GLP ones have been used for diabetes for nearly two decades now, haven't they? But since they got used for obesity, there's been an explosion of interest, hasn't there? So you were working for a company leading a team of health coaches, is that right? Have I got that remembered?

Nikki Coughlan: Yeah, yeah, exactly. Yeah. So for a few years I led the health coaching team at a digital obesity clinic in Ireland. So I was in a really privileged position to be able to work with doctors, ⁓ dietitians and and our our fellow health coaches as well, ⁓ to to really get to you know, how GIP1 medications can transform. ⁓ people's health and what what it can mean for them. ⁓ And I think I I learned a lot from this experience and I I really am a big advocate for integrating these medications into obesity care and also obviously health coaching as well because I had a first hand experience of the difference health coaching can make in these settings and in clinical care overall.

ollie: I've had the privilege of sitting alongside you on a course we've taught together around this now haven't we and just I see the way you explain it to other people really shows how much you know about the area. Fantastic and of course in GLP-1 the usage now has gone crazy isn't it? How many people in the UK are using GLP-1 injections now?

Nikki Coughlan: Yeah, absolutely. I I think it it it should be around ⁓ up to two million perhaps. ⁓ don't quote me on that, ⁓ but I think the latest ⁓ statistics shows around one point five to two million people and I can see it growing very rapidly from from this day onwards.

ollie: million. even sounds crazy, isn't it? And of course, there's only a fraction of those that will actually be prescribed that through the NHS and the sort of, so I guess the majority of people are getting those through private prescriptions, which was, which was how the company you're working with operated. Is that right?

Nikki Coughlan: Yeah. Yeah, absolutely. So I worked in a private obesity clinic and I think ⁓ this is still ⁓ the way of access for most people. ⁓ and in a publicly funded version I think there is there's not many people who can access the medications. I believe the criteria is quite strict, but correct me if I'm wrong on that. ⁓ but there are a lot of private healthcare companies these days who specialize in this area as well.

ollie: the support people get is very variable.

Nikki Coughlan: Very, very variable. ⁓ and I think this is one of the issues these days. ever since ⁓ these medications became available for weight management, ⁓ I think access has been growing very steadily over the years and is the it almost exploded ⁓ in the past year or past two years. ⁓ so access is not a problem anymore. People can access the medications, but the wraparound care is becoming a huge problem and a huge gap. ⁓ because ⁓ that this is what can make or break people's health at the end of the day. ⁓ I think it's a really great thing that ⁓ we can access the medications way easier, even through public or through GPs, also private settings. ⁓ but ⁓ that doesn't mean that we don't need the support with it. And this is I think where ⁓ we we lack support at the moment and that's a huge problem.

ollie: Yeah, and we're going to go on to dive down into that with you. But I guess thinking maybe for listeners, know, some people won't know exactly how GLP-1s work. Maybe you could just give us a very brief background about how they work and what sort of formulations they come in, because there's actually now an aural version coming out, isn't there?

Nikki Coughlan: Yeah, absolutely. It's it's just ⁓ got approved in the UK as well, so it is coming very, very soon. ⁓ so at the moment, ⁓ so GIP1 medications is glucagon-like peptide one receptor agonist. ⁓ this basically ⁓ a hormone that naturally is produced in our ⁓ gut in response to food. So basically, when we eat something, this GIP1 hormone is produced naturally, it tells our brain ⁓ that we are full. So it's it's signaling that we are full, you can stop eating, all good. So, what these GIP1 medications are doing is essentially adding on to that GIP1. So it's mimicking the same hormone. So it's going to tell your brain that you are full really, really quickly. So essentially, it helps you to manage your food intake a lot better. So, first of all, it will give you that satiety sensation. ⁓ And of course, there are other various benefits of the medications as well. So, aside from obviously being satiated quicker and feeling full longer, the food will sit in your stomach longer as well, so it slows down the gut motility. So, this is why you know, for example, the lax of noja very, very frequent because the food will sit in your stomach a lot longer. Gut motility slows down, so constipation can be a little bit of an issue. But the medications have other impact on your body, so it can help. manage your blood sugar a lot better. and also it has some quite interesting anti-inflammatory effect as well overall, which is still being researched and studied. So it has various impacts on our bodies, and so far, you know, there has been a lot of research going on around additional effects and additional areas where it might help, even with things like addiction. There are some really interesting ⁓ research going on. So who knows what else that will come in the future? Yeah.

ollie: Yeah, I guess the prime effect is in the gut, but I know there's GLP-1 receptors in the brain as well and other parts of the body aren't there, which does that, that accounts for some of the other effects of the GLP-1s alongside slowing the gut down and making you feel full.

Nikki Coughlan: Mm-hmm. Yeah, absolutely, yeah, yeah. So ⁓ it it alters the the brain reward signaling. So basically food will not trigger the same reward as before. So instead of you know ⁓ when you are feeling upset and maybe you want a cookie or some chocolate to get that feel-good ⁓ sensation afterwards, it kind of blunts down that ⁓ that effect in the brain and it really helps with the cravings. ⁓ so that's one of the very interesting areas of GRP ones. ⁓ so cravings will be reduced because that kind of reward will not be there. Anymore. And I I believe this is, you know, why they are researching it for other addiction reasons as well, or other addiction ways. ⁓ So yeah, it's it is really, really interesting. ⁓ And at the moment, the most let's say popular ⁓ GIP1 medication would be Tirzepatite, which is Monjaro. ⁓ and there's also some aglutide which is vigovi or ⁓ ozampic.

ollie: household names now almost aren't they though? So Zempik and Wigovie Manjaro. And of course some of those have more than one effect on this, it's GLP-1 and some additional receptor effects as well.

Nikki Coughlan: Okay. Yes, so ⁓ the GIP1 is semaglutide that would be Ozempic or Vigovi in the UK as well. ⁓ and that's just the GIP one. So that only works with that one hormone, which is our GIP1, versus terzepatide, which is ⁓ Monjaro, that works with two hormones, which is GLP1, ⁓ is one of them, and the other one is GIP, which is another ⁓ receptor agonist. So it's it's a dual hormone, so that's why. ⁓ they consider it let's say more advanced medication but it really depends on the individual biology. So some people respond to zepatite better than semaglutide so they might prefer Monjaro over Vigovi but ⁓ there is no way to tell some people then prefer Vigovi over Monjaro so down to down to their biology and I suppose the the oral version of Vigovi is the one that was just recently approved and so that's coming soon.

ollie: Yeah, goodness, and that'll make it a bit easier, won't it? And of course, these are long acting medications, aren't they? So as I understand it, so things like GLP-1 and GIP get released normally in our body, but they're around just for a matter of seconds, maybe minutes. But actually what this is doing is keeping those hormones active for days at a time, is that right?

Nikki Coughlan: Mm-hmm. ⁓ yeah, e exactly. So that's ⁓ that's the main mechanism. ⁓ we we have an enzyme that breaks down this GLP one and the GIP in minutes, and they found a way to extend ⁓ the shelf life of these hormones. ⁓ and ⁓ and that's how it works, yeah.

ollie: Yeah, gotcha, wow. Goodness, and we can come, I I've heard people talk about this concept of food noise, isn't it, that actually it can be such a relief to people to have the quietening of that food noise, the pressure to want to eat stuff and so on, but I know that comes with side effects, and we're gonna talk about that a little bit later, aren't we, around the pros and cons, I guess, of not getting the reward from food. It can really help with weight loss, but also it comes perhaps with other... issues to deal with as well, which I know you've really worked on, which is maybe quite a good lead into, you know, why health coaching is valuable alongside these medications. So, so I mean, I guess, first of all, how successful have you seen these medicines been, Nikita? mean, know, millions of people taking them, there must be a reason, right?

Nikki Coughlan: Yeah, yeah, and I I have seen incredible transformations. I think it is it is true that it is a very revol revolutionary ⁓ medication and treatment. ⁓ and I think there is no there's no stopping it, right? Because if you look at the pipeline, there will be even more effective medications in the future. We will be reaching bariatric level weight loss, which is very significant.

ollie: That's bariatric surgery. So equivalent of having your stomach and stapled really.

Nikki Coughlan: Yeah, exactly. And I think that's incredible. ⁓ to be able to achieve that through medication without the surgery, I think that will that will definitely be an incredible achievement if we can do that safely. so I I did I do see, you know, incredible transformation and success on the medications, but I think it's really important to to note as well that ⁓ if you respond to the medication it's purely down to your biology. So ⁓ for some people, you know, if your biology responds to the medication, that's great. But you know, there are still many people who are not in that category and maybe they do try the medications and their biology just don't respond to it. So they cannot achieve ⁓ meaningful weight loss. ⁓ so I I I I just want to mention as well that it it is not anyone's fault if that happens. ⁓ It's a response from your body, ⁓ and there is no way of telling. They still don't know, you know, who will respond to it and who won't. and if you are in the in that you know fortunate position that your biology responds to it really well, ⁓ then you can absolutely you know achieve great things. ⁓ but as with everything, it kind of opens the opportunity window. But what you do with that opportunity is really down to you because ⁓ it will help to. blunt the cravings and and the hunger ⁓ signals. But ⁓ what I usually say is that the medication will not make decisions for you. So you will still have that choice to look after your health, to do things that maybe wasn't accessible before, but now with the medication you have the hat space to do that. And I think that hat space, I think is the single most important thing that I keep hearing from people, you know, that they finally have that cat space so they can focus on other things besides the food and the food noise.

ollie: Yeah, that's a lovely term, that window of opportunity. So clearly you're in the realm of offering health coaching support to wrap around the medication, to help people make the most of that window of opportunity. So how does that work, Nicky? And why would you say it's important?

Nikki Coughlan: when it comes to to health coaching and where can make a ⁓ real is to ⁓ is to accompany ⁓ people on their journey with the medication because it can really bring up unexpected ⁓ effects and unexpected things that they might ⁓ anticipate. So ⁓ I feel that this is a very emotional journey. ⁓ and if we consider our overall relationship with food, I think it's quite understandable why and how it is ⁓ a little bit of ⁓ an emotional journey on its own. ⁓ first of all, I think we all have very intimate relationship with food, but it really does tie into you know our Culture, our social habits, our you know, sharing meals with others, sharing meals with our partners, and of course using food as a primary coping strategy very often when we are stressed, when we are bored, when we can't sleep. So there's so many ways we are using food in our lives. ⁓ and all of a sudden, you know, when that's taken away from one day to another. That comes with challenges. ⁓ so it can, you know, challenge some of our relationships. For example, what happens when we don't have that ritual of sharing meals with others, when we don't have that, you know, drive to cook for our families because something changed. ⁓ and also, you know, if if that's if that's an important coping strategy, how we manage stress, ⁓ if that's taken away, we will still have those emotions that upset the stress, and we have to learn how to First of all, sit with it, which is incredibly uncomfortable. And second, very importantly, develop alternative ways where we can help ourselves. Because unfortunately, life will continue to be quite stressful. And we will need to make sure that we arm ourselves with different tools that actually help us. So there can be these unexpected things that happen on the journey. And that's why health coaching is so important.

ollie: Yes.

Nikki Coughlan: ⁓ because you know you you need that sounding board. and and of course health coaches can also help you to develop habits that are realistic for you, ⁓ irrespective of what you see on social media, because that's one thing, you know, we we will get a lot of and nowadays I think people get a lot of information from social media, but that's not your life. You're still on your own journey. And that's a huge difference. So I think there's a lot of work we can do to to support people on these medications.

ollie: Yeah, I can see that completely. And I've heard you say before that one patient said to you, felt like they'd lost a friend. know, that sort of like the emotional crux of food for them. And they really weren't prepared for that. Do you want to dive down a bit into that story, maybe that person or how you dealt with it?

Nikki Coughlan: Yeah, and I think that that brings up a really important aspect of this journey. So some some people definitely will benefit from psychological support as well. ⁓ and you know, I think psychological support is still not widely, you know, integrated into obesity care pathways, which I think is terrible. I think we would need, you know, health coaches, psychologists, dietitians, doctors, all of that. That would be a real comprehensive, you know, wraparound support that we don't have. Even if you look at, you know, the private setting. ⁓ you know, there is not not a whole person ⁓ clinic out there that does it all. so ⁓ the access is very limited. But ⁓ for for some people definitely the the relationship with food can be such an important aspect ⁓ in their mental health that you know they might find that they they they can't really go on the medications because again that if that primary coping mechanism is so important and maybe you know there can be a trauma in the background there can be you know different things, mental health aspects, then it's not always sensible to to go on the medication. But you know that's that's up to their primary care team to ⁓ to decide on that. but I definitely I will never forget ⁓ this you know I worked with this lady who described you know when she did start ⁓ the GIPO on medications and she was the one who described to me that you know She she did feel like she lost a friend, a very important friend that she could always rely on. She wa the friend was always there no matter what. ⁓ and essentially she decided to to stop taking the medication because she realized that you know she needed more support ⁓ and more psychological support. ⁓ but those stories are quite common as well, and that's why, you know. ⁓ it's not a a fix, it's not a quick fix. ⁓ it's something that needs to be evaluated in a whole person setting as opposed to just looking to, for example, a weight figure and prescribe a medication just based on that.

ollie: Yeah, I love it. And I'm really admiring the way that you're kind of, you know, you're aware of your scope as a health coach. You're not a psychologist. You're not able to give expert psychological support and you recognise the limits. But what would you end up doing then as a health coach often with people when they were taking these medications?

Nikki Coughlan: Yeah, so first of all I love to understand their why. ⁓ so really having a look at why why are they on this journey, while they are comfortable sharing, what would be their ideal outcome or what are their hopes, what's the North Star that we are aiming for, and and just to understand better, you know, where they are coming from, ⁓ I think it's important to to to really dive deep into ⁓ our goals and why we are doing what we are doing because there can be a lot of bumps and hurdles on this journey and we need to have ⁓ you know this whole picture of where do we want to get and very often weight is not the only thing ⁓ maybe it's on that list but there are so many other things ⁓ what we might want to do on this journey and it's important to keep an eye on those other goals as well because no matter what happening weight wise there can be other things that are improving and it's important And that can be, you know, for some people it can be health markers, you know, reducing cholesterol or blood pressure or or other things. ⁓ and for others it can be, you know, just feeling that their stamina is improving, their fitness level gets better, ⁓ maybe their energy gets better or their sleep gets better. So there can be other things along the way. So that's the very first thing that I always always do. and and depending on you know where they are at in life,

ollie: Love that.

Nikki Coughlan: Everyone has their own individual barriers and challenges that they are facing when it comes to achieving their goals. So always do some exploration. There no no two journeys are the same. So it's always slightly different for everyone. But depending on you know the individual I'm working with, it can be anything from you know just making sure that they are nourishing themselves on the GRP1 journey because appetite can change so much that it's important to adjust to that too.

ollie: So they're not getting enough quality food in their diet because they just don't want to eat anything. Yeah.

Nikki Coughlan: Yeah. Exactly. And that's a huge problem as well, to to make sure that they remember to eat and they eat enough. ⁓ so that can be a big one. ⁓ but very often, you know, we work on learning more self-compassion and creating space for our own needs. I think that's a very common theme that I noticed, ⁓ you know, just to to have that high pressure, to live in that high pressure. ⁓ environment whereby you come last on that list and of course, you know, you survive the best way you can, but you just keep giving. ⁓ and learning how to take some space for yourself, for your own health is actually I think one of the biggest areas that almost always needs a a a slight improvement or a slight change. ⁓ but learning to be kinder and more compassionate ⁓ is a big part of what I'm doing.

ollie: I know that's great and I can see that. When we talk about health coaching, we always talk about a little bit of a hierarchy and actually the baseline for us in anything is around that self-compassion, how you value yourself and your sense of self-worth. And so often that's lacking, isn't it? Particularly in people who trying to lose weight, they're trying to maybe do things for other people rather than for themselves and satisfy social norms and expectations. And that can actually be quite self-persecutory in a lot of ways, can't it? And I really value that. know, making sure that's right. And that helps the longevity of the journey for people, I guess, and the sustainability in the end.

Nikki Coughlan: Yeah, absolutely. And I think it's it's important that we remember that there's a lot of stigma and shame attached to obesity and and even you know going on GIP on medications still the conversation is changing but it's changing very slow, like everything, you know. ⁓ so I think that's that's important to to take into account. So anyone who starts on a GIP one medications, you know, they can face that stigma even in healthcare settings. ⁓ makes it really difficult.

ollie: Yeah, yeah. I know I've heard that so many patients that you say they don't want to tell their family. They're not going to tell their brother or their parents or whatever. They're worried about the stigma of people saying, and even when they start to lose weight, they worry that everyone's going to go, ⁓ you're taking the jab. So that's again, something you help people deal with.

Nikki Coughlan: Yeah, absolutely. Yeah, absolutely. There's still that cheating narrative, you know, ⁓ it's cheating, ⁓ it's a quick fix and all these other things and yeah, definitely having some some space so you can talk about it freely. I think it's important too. ⁓ you know, because at the end of the day health coaches are also, you know, sounding boards and it's a non judgmental safe space where you can express all the frustration and all the, you know, difficulties that you face on this journey and that can be so helpful to to have that space.

ollie: Yeah, absolutely, I can totally see that. And of course, there's some very real side effects that often come up. You've alluded to the nausea and the kind of fullness, but also there's this issue around muscle loss, isn't there, that people worry about. So do wanna talk to how health coaching supports mitigating some of those side effects?

Nikki Coughlan: Yeah, I think one of the things that we mentioned briefly already was around the appetite fluctuations. So I think one of the ⁓ easiest thing on GIP1 medications is to forget to eat and nourish yourself. ⁓ you know, it it will give you that window of opportunity that, you know, food will stop becoming the number one priority. So that's great. That you will be in a much better position to make decisions around food choices. ⁓ but at the same time you can either, you know eat the same or or not care about what you are eating, but because you are eating less than happy days, or you can make sure that you're nourishing your body with with what it needs. And because your appetite is reduced, you have to fit in a lot more nutrition and a much less ⁓ amount of food. ⁓ so it's important to be smart about it. because you know th your body will still need protein, it still needs, you know, good fats, it will still need a little bit of carbs as well. So all in balance. ⁓ and ⁓ if you know you rely on the appetite suppression and your appetite is suppressed so much that you are skipping meals or ⁓ you're just not eating at all, then it it will backfire and that's where you know problems can ⁓ start happening like you you might notice becoming weaker or very tired and exhausted and and those are just signs that you know maybe you're not eating enough. ⁓ and that can be really tricky as well because One of the things that will happen is that the hunger signals will not be there reliably anymore. So instead of actually feeling that usual hunger that you are used to, there might be other ways that you know you your body might signal that you need food, like maybe getting a little bit dizzy or lightheaded. So it's almost like you have to ⁓ learn again, you know, your body's signals and make sure that there is like steady nutrition coming in. And I think that's where health coaches ca ⁓ can really help because you know you can really co-create a strategy to make sure that you eat enough. There can be smaller meals more frequently throughout the day. There can be reminders on the phone that work super good. ⁓ and and there can be, you know, tailoring some of the meals you are eating to make sure that ⁓ it's a bit more nourishing.

ollie: Yeah, and I think you've alluded to this and it's really struck me in talking to you. I hadn't really realised how variable the kind of appetite suppression can be. So it's not just consistent. Sometimes it can be really full on and other times it kind of backs off. So people are dealing with this a little bit of an on-off sort of situation.

Nikki Coughlan: Yeah, it can fluctuate a lot, especially at the start when you go on the medication first. You know, people do report very variable appetite signaling ⁓ and hunger. ⁓ and that's very normal. And also because you know the ⁓ the medication is is mostly once weekly, ex ⁓ the injectables are once weekly. ⁓ so you know it's it's very common to hear that by the end of the week, you know, the ⁓ the effect of the medication reduces, so they feel a little bit hungrier, which is perfectly normal. ⁓ but but it does vary, so you have to kind of get used to it. Some days you might not tolerate a lot of food, other days you might be a lot hungrier, so you have to have the kind of plan A, plan B on those days, you know what fits in.

ollie: Yeah, absolutely. Yeah, I can see the benefit. I'll keep, there's so many topics to bring up, so many things going through my head, but of course, the other big worry is of course, when people are, they've lost their weight and they want to come off the medications or reduce them, it's that maintenance piece, isn't it? And I think that's again, where health coaching can really help, isn't it? In terms of helping people to maintain their weight loss and come off the medications maybe.

Nikki Coughlan: Yeah. Yeah, that's always a tricky question, isn't it? I think ⁓ everyone is talking about maintenance these days. and I think no one perfectly figured it out yet because ⁓ what we know is that because obesity is a chronic disease, ⁓ you know, it is expected that people will need to remain on treatment in order to

ollie: Mmm.

Nikki Coughlan: ⁓ to to be treated for their obesity. So that's the current clinical guidance. So that means that you know clinicians do not recommend stopping the medication simply because you know the expectation is that once you stop the medication, you will regain the weight. Similarly as you know many people who would stop their blood pressure medication from one day to another, you know, we would expect their blood pressure to be all over the place afterwards. So it's kind of ⁓ the same story here now the the type of medication might change so there is some ⁓ there is a good research coming out now what happens when you know we switch someone from injectable to ⁓ the oral medications and that can help with that maintenance piece so the kind of medication might change but it is expected that someone when someone stops the medication they may regain the weight not everyone not all the weight ⁓ but that might happen and and there are a few different reasons behind that. You know, there is a very very very strong biological current that you might experience once you stop the medication. You know, the body will fight back, the brain fights back, it doesn't really like when we lose weight, so the brain will be like, ⁓ gosh, we need to survive here. Let's let me put on all the adipose tissue back. ⁓ so you know there are very strong biological processes. It's not because someone loses their willpower that just happens because you know our brain regulates our weight. and ⁓ that doesn't mean that you know people don't desire, don't want to stop the medication. So and that's perfectly fine to to try. I think everyone is We we health coaches advocate for that self-efficacy and self-management. So if someone decides that they want to ⁓ see how they get on without the medication, that's their decision, they can absolutely try that. ⁓ and I think this is where, as you said, the health coaching support can be really, really helpful because ⁓ you know, if you have a routine in place that you work together on that you're really happy with, ⁓ you know, where you are, no matter how that looks like for you. ⁓ then carrying that onwards is really important because things will change when you start the medication. You might notice feeling a lot hungrier, there might be new stressors in life that happening, ⁓ and you might need to have a really solid foundation to get back to. So I think ⁓ as as always with health coaching, it doesn't have to be just at one stage of the journey. You can decide to work with someone at the start, in the middle, at the end. ⁓ it's

ollie: Mmm.

Nikki Coughlan: if that's a more sustainable approach for you. ⁓ but but it does matter because, you know, when the medication stops there are there will be some effects, you know, that you will notice definitely.

ollie: Yeah, I and I'm really picking up there, Nicky. Like a true health coach, you're very non-blame, non-judgmental, and the focus is on keeping people in control and in the driving seat. But I do see that if you can help people to really lock in new habits and new ways of doing things, as perhaps they back off the medication a bit and the biological kind of suppression might start to recede and actually there are benefits. right, of reducing the dose and sort of, you know, not having so much medicine in your body, but not if it means that you kind of regain all the weight and lose the ground you've made. So I can see that, that tricky balance. It can be, can be really good to, and yeah. So the other, I wanted to explore this. I've heard you say one point, one of your patients was actually a food critic. Do you want to tell us that story? Cause that was somebody who I guess made their living out of tasting food and ⁓

Nikki Coughlan: Yeah. Yeah, yeah. ⁓ my god, I loved working with her. ⁓ and I think ⁓ it's I I I I was able to witness ⁓ so many, you know, transformations, so many different journeys as well, and I really loved hers. and yeah, she she was a food critic and obviously she was quite apprehensive starting the medication because ⁓ back then, even back then we knew that you know it will change how she experiences food. So it was definitely, you know, one of her livelihoods, so it was a real concern. ⁓ and at the end of the day, what she described to me ⁓ on ⁓ on on her journey is that she was able to enjoy food a lot more than before. And I found that really fascinating. ⁓ what she described, because since then ⁓ I heard that from other people as well that instead of you know not being able to enjoy food altogether, it was quite the opposite. They learned to enjoy even more. ⁓ because I suppose Well, I can speak on their behalf, but what I imagine might happen ⁓ is that because you don't have that urge, that drive to you know eat the food very fast, very quickly, it's you know, when ⁓ before the medication it the food might serve a different purpose ⁓ for just to you know just to take in as much food as possible. Versus here, you know, when your appetite hunger reduces, you don't have the same drive. You might be able to actually slow down and be more present and and really savor it. ⁓ I think that's an interesting aspect that I heard some people mention. ⁓ and I think that's that happened ⁓ to her as well. but aside from her story, one of the very interesting things, and I think it really goes to show how complex ⁓ obesity really is, is that you know, I I witnessed people changing their entire professions and you know, quitting jobs, taking different jobs, doing huge changes in their life because they realized that one of their, you know, one of their primary triggers or ⁓ one of the the mechanisms that were really unsupportive is actually, you know, their livelihood, their jobs. And in order for them to feel healthier, become healthier, they actually had to change their profession altogether and and find another job. And I think That really goes to show, you know, it's a it's a really complex issue. It's not just about someone's weight or how much food we are eating. We have to look at the environment. If the environment is really unsupportive, ⁓ then we can have the best intention in the world, but it will be an uphill bottle and you know, that's a that's one aspect that we need to consider.

ollie: Yeah, I can see that. know, that getting to that root cause, isn't it? What is it that's driving the emotional eating and the sort of self persecution that often goes with the chronic disease of obesity, like you say, and actually changing your environment can be really powerful, can't it? And I can imagine having a coach to support you through that, really important because it's a really difficult thing to go through alone, right? But having someone who's non-judgmental, giving you space to think, try some things out, help you review the success or not of things. I can just see the value of it hugely.

Nikki Coughlan: Yeah. Absolutely. Yeah. I'm fan of it. ⁓

ollie: So, yeah, yeah, of course, Nikin, you're very good at it as well, I know. And so tell me about the evidence you've seen of success then. I mean, I know you've sort of, you're really curious about research, you led that whole team ⁓ working there in Ireland. What evidence did you see of the additional success of health coaching, I guess, really?

Nikki Coughlan: Yeah, so ⁓ there are ⁓ some really good research coming out. Now obviously ⁓ the research that we have at hand is mostly you know private clinics publishing their own ⁓ user data. ⁓ so I wish there was randomized control trials that are, you know, ⁓ examining the health coaching outcomes, but we are not quite there yet. Hopefully one day. ⁓ but you know what the what the clinics are publishing, obviously they are o ⁓ about their own cohort is really promising. So ⁓ those you know integrated care teams who actually have health coaching on board, they do report ⁓ you know better weight loss ⁓ overall, so more weight loss and also ⁓ improvement in quality of life. ⁓ so that's really important. ⁓ so it can be anything from you know nutritional adequacy. To you know, physical activity improvements ⁓ that is measurable. ⁓ I think it is still ⁓ a ⁓ quite difficult thing to research because we don't have those validated health coaching specific outcome measures ⁓ just yet. ⁓ there are some you know really good tools out there, but not none that would be you know the single one to use. ⁓ so far we rely on you know these ⁓ cohort studies ⁓ that are being published from. private clinics, but it's still very encouraging and it still, you know, definitely shows that ⁓ health coaching has a has a has a place in obesity care and in clinical setting in general and they do make a difference ⁓ because you can see very clearly that, you know, those who engage with health coaching more have better outcomes than those who don't. So I think that's a very good direction.

ollie: Yeah. ⁓ thanks, Nicky. That's a really honest reflection. I think that's always a risk, isn't it? For people like us that, that value health coaching, that we're very biased and we want to sort of say it's great for everything. ⁓ but I can see it coming out in more and more of the national guidance and the frameworks around support, the importance of the emotional support and the, ⁓ the wraparound support, as you say, because it's the changes in lifestyle and the changes in your mindset and your long-term habits that really, determine whether the medicine

Nikki Coughlan: Yeah.

ollie: is successful in the end or not. Like you say, it gives you a window of opportunity, that window of opportunity has to be capitalized on with all these other changes as well.

Nikki Coughlan: Yeah, exactly. Yeah, because ⁓ at the end of the day, health coaching is there, you know, for those between appointment kind of ⁓ life that that makes or breaks ⁓ anyone's health and progress. You know, we can show up on all the doctor appointments and ⁓ and and try our best to to look after our health, but what happens between all those appointments, you know, it's life and and what do we do? Like there's so many, you know, challenges and hurdles that we have to get through.

ollie: Yeah, yeah.

Nikki Coughlan: ⁓ to to improve our health and I think health coaching can make such a huge difference. ⁓ and I think ⁓ hopefully this will get even more and more recognition in the future. That's that's what I'm hoping for. But I think there's also a lot of improvement to do in terms of ⁓ integrating more health coaching into clinical settings because from what I see, you know, most of the investments let's say I I ⁓ obviously have more oversight over private the private healthcare systems, ⁓ but I do see you know more investments going into clinical care which is absolutely is crucial, very important, don't get me wrong. But because you know health coaching and and lifestyle behavior support is recognized as a crucial, crucial addition ⁓ to obesity care ⁓ I do feel like more investment would be needed to make sure that, you know, it it actually happens because I don't see that happening as much as as I want to.

ollie: Yeah, absolutely. Yeah. And I mean, I know this is not the purpose of why you came on here at all, but it's, it's, and we try not to be too promotional on this. It's just good to have discussion about key, topics, but, ⁓ we're delighted that you are helping us with the education piece. You know, the NHS is invested in over a thousand health coaches and if they understand how to support people, fantastic. And equally people working out privately as health coaches, if they've got these skills to support people, I think it, like you say, it really is a service to the system. So we have our joint program now, don't we? day where we do background metabolic science in the morning and in the afternoon, it's all around you teaching people how to use health coaching skills to support people taking GLP-1 type medications. And we're really grateful for that. Next one, it will be live in November. So we're taking bookings for that through our website. also you practice privately as well, Nicky, don't you? I suspect you're extremely busy. Have you got any capacity to support people if anyone's listening to this and they think, ⁓ I'd love a bit of support from Nicky?

Nikki Coughlan: Yeah, sure, sure. ⁓ my website is GIP Onecoach dot IE, so ⁓ anyone can look me up and contact me. Always happy to have a chat. I'm very open.

ollie: You certainly are, you're very inclusive in sharing, and very generous in sharing your insights, Nicky, which is really hugely valuable. Now, like you say, being one of the pioneers from the start, know, since this started being prescribing for weight loss. And so just say that way again, glponealthcoach.ie.

Nikki Coughlan: GRP One coach, ⁓ those guys. Yeah, yeah. Thanks, Ari, I really appreciate that.

ollie: DLP one coach. Yeah, lovely. You're gonna be overwhelmed now. That's that. Yeah. But ⁓ I can certainly attest to the sensitivity and the generosity of your support all round. Thanks, Nikki.

Nikki Coughlan: No, not at all, not at all. And and I'm I'm also very happy to chat to other health coaches because you know this is a very growing field even with ⁓ GLP one care. ⁓ so anyone who is interested in GLP one care, send me a message. I'm very happy to chat to help you get started or to answer any questions. I'm really, really passionate about this field and I think ⁓ there's so much space for more health coaching specializing in obesity care. ⁓ so yeah, more the more the bet the better.

ollie: so they can find your contact details through that website. Yeah, lovely. Thanks, Nicky. Well, thanks so much. I'll stop with that. I feel like I could go on for ages. There's so much ⁓ other stuff we could talk about, isn't there? But certainly about the emotional adjustments to this and it's an emerging field. So we'll watch it closely and we're really privileged to be working together with you and thanks so much for your time today.

Nikki Coughlan: ⁓ yeah. Like Thank you, Ali.