Tim Williams: Hi, Cal, thank you so much for joining us on our Health Coaching and Beyond podcast. It's delightful to have you on. ⁓ I just wonder for the people who don't know you, have not met you yet, and there may be a few people, if you could introduce yourself, just maybe you could share a little bit in terms of ⁓ what's going on for you right now. And then of course we'll track back and find out kind of how you've got to this point. But yeah, Cal, introduce yourself to folks. As many of you know, in Health Coaching and Beyond, we mix up conversations between the two of us, chugging 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.

Callum: Yeah, of course. Thanks so much for having me on the pod. for those that don't know me, I'm a GP based up in the Scottish Highlands in a little town called Aberfeldy. So I do that a couple of days a week and then the rest of my week is split between doing some research at the University of Dundee into physical activity and lifestyle predominantly and then also along with

Tim Williams: This week, I'm talking to Dr. Callum Lees, a GP in Scotland. working part-time also at the University of Dundee, doing research with population health. He's passionate about people and the empowerment of individuals to improve their own mental and physical wellbeing, which comes across well. He is a co-founder of the community-led initiative Healthiest Town in Aberfeldy. Physical activity is one of the most powerful interventions we have, yet it's still one of the hardest to embed in everyday healthcare. So what's getting in the way and what might we be missing?

Callum: Hussein Al Zubaydi who I think just about everybody knows and has been on this podcast before. I'm the champion for physical activity and lifestyle at the Royal College of GPs.

Tim Williams: And you also have your own podcast as well, Cal, with Hussain I think as well. hope you enjoy this episode ⁓ Callum, who is also a husband and father of two.

Callum: Yeah, that's right. Yeah, Hussein and I and another close friend, Susie have a podcast called The Movement Prescription where we try to encourage our fellow health professionals to talk about physical activity with people of various health conditions.

Tim Williams: Great, So I'd love to kind of find out a little bit kind of how you've got to where you are now, because it sounds really interesting all the things you're involved in, but yeah, just share a little bit wherever you want to start.

Callum: Yeah, of course. I think with all these things, there's probably a lot of prejudice and I grew up in a very active family and was always incredibly active. So, you know, I kind of approach this from a fairly biased perspective, but it was probably particularly during my GP training time, was... was in Aberfeldy where I'm now working ⁓ my training and ⁓ during COVID that ⁓ there was a huge impact of the disease itself, but possibly what we noticed even more in our community was the ⁓ impact, particularly those kind of non-communicable diseases, ⁓ increase in blood pressure, cholesterol, ⁓ often these things were ⁓ some capacity linked to lifestyle. I use the word lifestyle kind of cautiously, maybe reluctantly. think sadly it's loaded with connotations of blame and I don't mean it that way. think an understanding of the social determinants is really important, but for lack of a better word, it's ⁓ what we use and are stuck with. So that and almost, not despairing would be the wrong but it very much felt like we were practicing. ⁓ Whack-a-mole medicine for one of the better phrase and I know who's saying is used that I don't I don't know if he used it in his episode and I'm sorry for those that are listening if it's repeated but you know, it just felt like we were waiting for someone's health condition to be bad enough that we can make a diagnosis to then throw medication at it and just wait for the next kind of conditional issue to crop up rather than going upstream and and and and addressing the rule of determinants. So in light of that, are on the back of that and with some amazing colleagues and I can't take much credit, but we set up a charity in our local community to try and make it the healthiest town in Scotland and it's called Healthiest Town Aberfeldy which is all fairly grandiose but really the intention is to remove as many barriers in the community to good health that people face. And that really got me on the path of being interested in preventative medicine. So I ended up getting an academic post at university. I had a secondment to the WHO for Europe and Copenhagen to do some work with their non-communical diseases team. And yeah, I kind of have remained in that space ever since.

Tim Williams: Wow. So, I mean, there's so much there I kind of want to pick up on. I mean, I did go and look at the kind of the Ebbelfeldy, the healthiest town, Ebbelfeldy. I did look at the website and so many great stories on there. But I just want to where you up to now. How's that developed?

Callum: Yeah, it started out as a real passion project for a few of us, ⁓ very ad hoc, informal, uncoordinated, and it's kind of grown, or it has grown pretty substantially over the last three or four years. So we as a charity. We have a ⁓ program manager ⁓ who delivers a series of events and we've got someone leads on comms as well. ⁓ you know, probably ⁓ a lot of our focus is around food. There's a bit of a legacy in our town and ⁓ one of the retired GPs, I was actually got here, I was clearing out our office for it being painted and a GP in the 1960s wrote a series of essays about ultra processed foods. This is in 1962, how incredible is that? So there's a bit of a legacy sustainable ⁓ eating within our community and we've jumped on that legacy and we kind of have lots events, whether it's kind of ⁓ cooking classes for locals, whether it's growing groups or we have a growing festival that's been that a week the last few years but it's over weekends this year. have Community Cayley and do quite a lot of work with schools. ⁓ So yeah, ⁓ it's an ever-evolving project, it has its challenges ⁓ like all these things do but yeah it's a wonderful thing to be involved in.

Tim Williams: Yeah, and again, for those who've not ⁓ made their way yet to that website, it's great to kind of visit there and see the videos. Again, you live in such amazing surroundings, isn't it, as well, for people to get out in.

Callum: Yeah, it's a really interesting point, Tim, because we live in, in my opinion, it's just a beautiful part of the world, one of the most beautiful parts of the country. It speaks into this rural inequity and I think, often we think about inequity along ⁓ social inequity, but there's a rural inequity as well. And actually lifestyle, it's really interesting because of the challenges that presents. so ⁓ despite the fact we live in ⁓ the most beautiful part of the country, there's very little activity built into our days because we can park in driveway and we can park right of work. And so ⁓ when you're having communications ⁓ or chatting to patients or whoever it might be. When you're trying to frame physical activity, it's maybe a slightly different approach that you take in an urban setting where you can kind of build it into your daily commute, for example. So you're kind of almost selling a slightly different product. And it's the same with food. We have in Aberfellie, we've got one co-op in the town, which is kind of the major shop and the other big chain supermarket. So I wouldn't name brands, they're about an hour away. ⁓ So it does mean that if you're not planned or you're trying to you're kind of slightly more ad hoc with your shopping it's a bit more expensive because the foods in that are available in Aberfeldy cost more and that was a particularly acute challenge when the co-op was hacked was last year and the shelves were empty. So yeah yeah beautiful ⁓ and that comes with amazing opportunity and also some challenges.

Tim Williams: Yes. Yeah, and actually I had not considered that. So yeah, thanks for sharing that insight. Because again, I know we kind of talk about, you know, the easiest way to kind of be active is absolutely to kind of plan it into your day rather than be something extra that you do at the end of the day or somehow in the middle of the day, you try and fit it in. Yeah. That's really interesting. Because I noticed some of the stories there were for people who had started walking and there were people who'd managed to lose quite a lot of weight. They must have paid attention to their diet as well for that. And then the cold water swimming and things. So really inspirational stories that were there.

Callum: Yeah, we got a brilliant community and lots happening and it's been really fun to kind of tap into that and use people's journeys to inspire others. And so one of the things we did do is we created a 25 minute video for the waiting room and it was of six individuals talking about the changes they'd made to their life to kind of try and be more healthy. And it was kind of... intermittently plays on repeat in the waiting room and it's just recognizable faces in the community and hopefully it's tangible as a consequence as opposed to you people seeing something that's maybe unrelatable to them.

Tim Williams: It's all very well, it, as healthcare professionals to sit and give people advice or even suggest things. But actually, when people can see people who are like them doing things in their area, that makes a big difference, I imagine.

Callum: Yeah, I think this is something I've wrestled with, Tim, is... As someone that's really active myself, am I the right person to be advocating for physical activity? And the I've come to is yes, but I think ⁓ you're damned if you do and you're damned if you don't because on the one hand, people might you unrelatable and on the other hand, if ⁓ you're not active, then people will think, well, why should I listen to you? yeah, ⁓ and that's where, well, that's where the kind of health coaching and ⁓ the nuance in the that you provide comes in, I think, is... ⁓ is being able to tap into the psyche of people and not alienate or you're really hit home with your messages when you do have those opportunities.

Tim Williams: Yeah, it's really interesting. I was wondering a little bit about that in terms of how, I suppose, in some ways we know physical activity is really, really important. And yet we know that lots of healthcare professionals find it really difficult to kind of include that or even go there. And I just wondered, what do you think are the obstacles to that?

Callum: some of the research I've almost every health acknowledges the value of physical activity for both prevention and treatment of disease ⁓ and that's ⁓ unequivocal really. ⁓ And despite that, there's quite a big disconnect between that then being implemented in clinical practice with lots of people unable to that. Why is that the case? The barriers are... are fairly self-evident and probably the biggest of them is time. So yeah, our lack thereof. There was a really great paper in the BMG that was at the kind of in January 2025 by Johansson and colleagues talking about sacrificing patient care for preventative health. I'm not sure if you ever read it, but they write this really interesting paper which talks about the ever increasing demands placed on GP's time. And they say what is happening is we're We're trying to squeeze more and more in and what things are being missed. We're asking too much. it's basically the demand we put on health care professionals times unachievable and it's leading to moral injury. It was a really interesting piece. And I think it definitely resonates. so, you know, I suppose that's why it's happening. What's the answer is the next question. I think, I think. are of opportunities and ⁓ I don't think we should beat ourselves up too hard in the UK. think ⁓ I just off a call this morning with someone from Australia and she had come to the UK because ⁓ we perceived as world-leading in social prescribing, for example. And so, ⁓ yeah, I think that was really reassuring to hear. I think we're very good in the UK at maybe ⁓ not kind of recognizing our strengths. So, yeah, and that's definitely one, that's definitely an area of opportunity. Yeah.

Tim Williams: And so time definitely won, I can definitely see that. It's like how many things can you fit into your 10 minutes or your 15 minutes or whatever time you've got? And yes, the worry is that then you might miss other stuff that actually we absolutely do need to pick up if we're focusing too much on the prevention. So do you think time's the only thing or do think there's other things as well, Cal?

Callum: Yeah, I I published a paper on this, Tim. So you're, you're, I'm delighted you've asked. So time, ⁓ lack of resources and support, a lack of knowledge and then financial remuneration or a lack thereof. So they're, they're the kind of four big barriers. I think those last three are much more addressable and actually, ⁓ I think, you know, kind of leaps and bounds are being made there. ⁓ In terms of resources, things like Moving Medicine are doing a wonderful job at providing resources and support. In terms of knowledge, there's lots of mandates to include these things within undergraduate curriculums of healthcare professionals at the moment. ⁓ finances is probably the area we fall short, but there's no money anywhere. yeah, but yeah, again, it's interesting. At one point, smoking cessation advice was included within QOF payments. So it's not totally unforeseeable that other lifestyle measures could or should be included.

Tim Williams: Yeah, yeah. Okay, that's great. Thank you so much. And I suppose the other thing I'm just wondering about is, ⁓ yeah, you mentioned that you alluded to kind of the health coaching piece as well. So what's your thoughts in terms of how health coaching then might support people? So GPs have limited time. So where might health coaching kind of come in, do you think?

Callum: Yeah, I think there's a couple of things here. The first is that knowledge of physical activity or the prevention thing that you want to deliver is one thing, but knowing how to deliver it is equally important, if not more important. So a knowing how to deliver it, which is a key part of what you do. But actually the biggest thing I think from a health coaching perspective is knowing when to deliver it is being, you know, we are limited in time. ⁓ We have to be judicious about when we that time and ⁓ who is going to be ⁓ the best candidate for receiving that advice. And so, ⁓ you know, I think that ⁓ from a health coaching perspective, that's probably the thing I think ⁓ in my mind is actually, you know, choosing right moment to to kind of offer advice or choosing the right advice to offer in that moment. So I think that is a really key part and that's a really key thing that we should be trying to teach health professionals of the present and the future.

Tim Williams: Yeah, it's interesting that kind of word advice, because in my head, when I kind of hear the word advice, what I imagine in my head is I'm adding advice to someone's thinking while I do my thinking on them or on their situation. actually, is that what people need? Is that what people need? Or actually, what they may need is really good information. And I think sometimes as healthcare professionals, we think it's our job to give advice. And that's what people come for. That's what people ask for.

Callum: Ha ha.

Tim Williams: ⁓ And I also think we sometimes feel it's our job to download everything we know about something to someone. But actually, what you know and I know is that lots of people come to see us. They're already up to here, aren't they, with everything. And us downloading what we know about something is unhelpful. ⁓ So it is exactly that, as you've said, it's what's the information that people need and how can I present it in a way that they can absorb it and make use of it? Because actually, if we're just downloading stuff. It doesn't go anywhere, does it? That's my experience.

Callum: Yeah, yeah, absolutely. Kind of tailored and personalized is the key to these things and making sure that people know it's for them, not just a kind of copy and paste model.

Tim Williams: So you have social prescribers there, Cal, but you don't have health coaches. Is that right?

Callum: Yeah, so ⁓ with us in Scotland, social prescribers are commonplace. ⁓ Health coaching less so, I would say, and we actually, through Healthiest Town, managed to get some funding to employ a health coach to work within the practice. ⁓ Sadly, with all these things, ⁓ that isn't the case at the moment. That might come back, but that was something we managed to have for a couple of years, which was brilliant to have.

Tim Williams: And I suppose that's one of the things that I would be thinking that would take some of the pressure off the GPs if they had other people that could do some of that health coaching work. think GPs and healthcare professionals have a role in setting up those other colleagues really well. And I suppose making sure that we are singing from the same hymn sheet. So if someone's just giving advice and downloading information and someone else is asking them, what do you think? And how might you kind of think how you might work through this situation yourself? They're two different things. So yeah, yeah.

Callum: Yeah, multidisciplinary team working I think is key and I was recently lucky enough to travel. around the world to look at different models of delivering physical activity promotion and in Taupo, which is on the North Island of New Zealand, they had a really interesting model ⁓ which was ⁓ a basic GP ⁓ signposted or primary care, I should say more broadly, signposted ⁓ to a service which was led by health coaches. so the health coaches were the first point of contact. They spent a period of time with the patient and they basically made a plan, kind of found out well what does the patient want to do, what's their greatest need and then from there we're able to kind of direct resources that the patient might find most beneficial and so within this multidisciplinary team there was the health coach which was the first point of contact but then there was nutritionists, was physical activity specialists, there was psychologists Yeah, there was a range of other professionals in there, but the kind of the gatekeeper was the health coach. And a couple of learning points from there is, you know, I think first of all, ⁓ it needs to be individual led and so having a health coach as a gatekeeper was a really cool example. the other thing that was really interesting and dawned on me in that process is that actually thinking of singular issues as slightly reductionist, thinking of... physical inactivity as a problem in isolation isn't that helpful because you people often come with multiple issues whether it's physical inactivity whether it's whether it's nutritional deficiencies whether it's you know being overweight you know alcohol whatever it might be and so you know by making it a single issue it's probably not that helpful

Tim Williams: Yeah, was having a conversation with someone recently about that they were kind of thinking about putting health coaches in workplaces and they were wondering, know, should we have a health coach who's for sleep and one for activity and one for kind of weight loss? And I was thinking, well, actually the beauty of a health coach is that they are generalists, do you know what I mean? That they can absolutely support anyone, it's with their mental health or with their sleep or whether it's their chronic pain or... or their diabetes and I suppose the other point is that who has one of those things that's going wrong? Often they all overlap and they all interlink with each other.

Callum: work. The way our brains work is quite iterative and so we might think that the issue is one thing and then we sit down with a health coach and talk through things and suddenly we realize ⁓ no maybe this is the bigger thing I need to deal with.

Tim Williams: Yes, and often, you know, that comes up in supervision quite a lot. You people will come and they'll be referred for weight loss. But of course, it's rarely ever just weight loss. I mean, there's a whole load of stuff which is going on, I suppose, for people. And again, that's what health coaches with appropriate training and remaining in the scope of their practice. But that's absolutely what they can support people with. Now, this is a bit of a risk cow, because you've done two, I think you did two days of our health coaching program, didn't you?

Callum: Yeah, yeah, yeah, yeah.

Tim Williams: I'm going to put you on the spot a little bit. so what did you take away from that in terms of your clinical practice?

Callum: Yeah, absolutely. think I've done a of health coaching before. ⁓ So, ⁓ but ⁓ the biggest thing was ⁓ just acknowledging at stage of change people were in. so ⁓ offering targeted support. Tim, think it was... ⁓ It was your question, which I loved and I've used and taken on, which is, ⁓ what are you doing to look after your health? It's such a great opening gambit because it gives a real indication of, of, ⁓ of... ⁓ of where people might be at. Does that make sense? So yeah, I think that would be, ⁓ I always try to credit you. I can't remember if it you or Ollie, but I always try and credit you. But yeah, I think that's a really great way to kind of open a conversation about lifestyle or ⁓ whatever it might be really.

Tim Williams: Yeah, that's it. It was on his question, actually. So you do have to start cleansing off. I don't mind taking it. I don't mind taking it. yeah, I mean, that was, again, it was trying to tune in, wasn't it, to kind of someone's confidence, knowledge and skills in terms of how they were, you know, how knowledgeable, confident, skillful they were to manage their own health and wellbeing.

Callum: ⁓ sorry, sorry Ollie. Yeah, Tim, you might have had a lot of credit for this.

Tim Williams: That was point of the question. And therefore, by asking that question, you could really quite quickly an idea about is this someone who takes their health really seriously and prioritises it, for lots of good reasons, is it their health and wellbeing is way down the list of priorities and therefore you're gonna have a different conversation with them, I suspect, ideally. Yeah, okay. And I suppose what gives you the biggest hope at the moment for primary care and where you are in Scotland, gives you the biggest hope at the moment?

Callum: Absolutely. Good question. Maybe reframing that, the thing that I love most about my job is the people. think people are amazing, ⁓ they have wonderful stories and we're all kind of striving in the same direction. We all want better health for everyone, don't we? And so ⁓ one of the things that I've been really kind of... interested and passionate about is in our community is that drive for kind of community health like what does that look like I suppose it's similar to neighborhood health but ⁓ yeah there's a famous poet from America called Wendell Berry he talks about ⁓ the ⁓ Health of an individual is a contradictory in terms because you know, cannot, I cannot be healthy the people around me are healthy because they determine my health to a certain extent, whether it's family, friends or the wider community. so ⁓ investing in that. ⁓ yeah. And on that note, ⁓ I think that neighborhood health, think, look, I think a lot it needs to be refined. And obviously it's not that relevant to me up here, but I think it's a cool start. I think it's a really cool ⁓ direction of travel. and hope can be in a way ⁓ which really speaks into need ⁓ for ⁓ communities to come together and strive ⁓ good health. ⁓ But that would my, ⁓ that would be, ⁓ think there's a of hope. Yeah, ⁓ I'm positive.

Tim Williams: Yeah, no, you come across very positive. mean, it reminds me of the work of Cormac Russell. Don't you come across Cormac, but yeah, the asset-based community development. And again, I remember we had some conversations early on, but he was talking about actually the health of individuals being a product of the health of that community. That's one of his big things. And I think that's so important. suppose, yeah, ⁓ the kind of the neighborhood working and it seems very a positive step forward, doesn't it?

Callum: Yeah, I have come across Cormac, yeah. Totally.

Tim Williams: for that.

Callum: Yeah, yeah, absolutely. I think, look at, change... We go, I went to medicine to try and make a positive change, but I think sometimes the way to make the most changes is by engaging with politicians in some capacity. I don't necessarily mean by going into politics, a local academic inspired me to go and meet my local MP in lobby because as health professionals, as members of the community, regardless of what role we have, we have a voice. so if we're passionate about improving health, we should take that passion. to the people of power and in our case that's our local MPs and MSPs.

Tim Williams: Yeah, agree. Well, I really appreciate you doing that advocacy. That sounds really important work. And what's next then for you, Cal, and I suppose what's next for Aberfeldy?

Callum: I make this all up as I go along Tim, I just follow my passions. I don't know what's next, I really don't. As we were talking just before we went live, we've just had our second kid and so definitely, yeah, life is viewed through a different lens and trying to carve some space for family time is important. yeah, and I... Yeah, and maybe I should have done that when you asked me to introduce myself. The way we introduce ourselves speaks volumes of what our priorities are. And I probably should have started by saying I'm a husband and a father as the opening gambit. So anyway, forgive me for that. I'll do that in the future. So yeah, in terms of Abrafeldi, think our biggest challenge with a lot of... health promotion, but in Aberfeldy we notice again, again, is ensuring that we do it in a equitable, a social equitable way. And so ⁓ that's something that we are trying to do, we strive to do, but we can still make progress in. And so, yeah, just constantly refining and reviewing what we're doing and just, yeah, just ⁓ hopefully becoming ⁓ a community of health.

Tim Williams: Yeah, and are you, people coming to see you and kind of find out what's going on there locally? Because it feels really inspirational. I know there are other places kind of doing this kind of stuff, but it feels such a deliberate kind of aspiration to kind of be the healthiest town in Scotland. I mean, it seems, you know, it's very, yeah, you're aiming high, which I think is just great.

Callum: Yeah, we wanted to have a race for the top. was a kind of a bit tongue in cheek really. yeah, do we intend to inspire? Not really. You know, we've been inspired by others. What happens in Froome, for example, is a really wonderful kind of inspiring thing and there's community groups all over the country. So yeah, if we inspire, great, but it's definitely not, it's not why we do what we do.

Tim Williams: Well look, mean we're coming to a close now, which is sad. Well I'm going to, in fact, I'm going to just check, Cal, is there anything else you want to share before we kind of come to my last question, but is there anything else you want to share about the work that you do?

Callum: And I don't think so. I don't think so, Tim. think, yeah, it probably all sounds a bit better than it is. I'm not sure how much impact some of it has.

Tim Williams: Okay, well look, I'll finish with this question. So what's one thing then, Cal, that you would like every clinician to do kind of tomorrow, you know, in their normal kind of day-to-day job that would promote physical activity? What would you have them do, I suppose?

Callum: focus on themselves. I think that's the most important thing. What we know is that active health professionals make active patients because they're much more likely to prioritize it in their conversations. yeah, be active and... When one thing that I heard an environmental doctor talk about ⁓ was that actually advocacy only matters if you then talk about it or make it visible. be active and be visible. would be my one piece of advice or two. I don't know. That's probably two.

Tim Williams: Right, so me going on and on about the fact that I do cold water swimming on a Monday morning, I should carry on doing that, Cal, is that what you're

Callum: 100 % yeah, even if people get annoyed, yeah, tell them it's good for their health, yeah.

Tim Williams: Yeah, exactly. It's like that kind of saying, so how do you know if someone's a cold water swimmer? Don't worry, they'll tell you. It's kind of what I'm losing. Nice one. Great. Well, it's been really good to kind of catch up with you. And I appreciate all the work that you're doing. And I know you kind of you're very self-deprecating. You think, well, actually, you know, I'm not doing much. But I think, you know, through your podcast and through the research you're doing and all that kind of work, you're just raising the profile and the importance of physical activity, but also

Callum: Yeah, absolutely.

Tim Williams: about how do we engage people in their own health and wellbeing and movement, let's say movement rather than maybe exercise is the key, isn't it?

Callum: Yeah, yeah, well thanks Tim, that's kind of you. My greatest attribute is enthusiasm, pathological enthusiasm rather than anything else. But yeah, I hope so. yeah, I hope if one person moves more than it's a job, well done, I suppose.

Tim Williams: Great, lovely, Cal. Thanks for your time today.

Callum: Yeah, pleasure. Hope you get in the water soon, Won't be that cold anymore. Nice and warm. Yeah.

Tim Williams: Yeah, don't you worry. Don't you worry. Thanks so much. OK, bye.