Social connections: Could they be even more important than cholesterol?
Reviewed by Karin Nordin, PhD
Ever seen a health professional write that on a prescription note?
Though we’re often told to improve our health by eating right, moving regularly, sleeping well, and taking the recommended meds, it’s less common to be told to focus on our relationships.
That might be a mistake.
Because here’s what we’re discovering:
Social health is vital—and in some cases, it’s a bigger priority than exercise or nutrition.
The impact of poor relationships is so severe that some experts have argued physicians should screen for social isolation just as they screen for heart disease or diabetes.1
One study even found that satisfaction with relationships at midlife is a better predictor of long-term health than cholesterol levels.2 (Not to exaggerate the findings of one study, but it does illustrate the importance of social wellbeing.)
If you’re a health coach, relationships may impact your clients’ progress as much as how friendly they are with salad, or the daily steps they average.
The good news: We don’t need hundreds of new friends to improve social health. (And actually, a few quality relationships may be better than lots of weak connections.3)
In this article, we’ll provide three strategies you can use to help clients (and yourself) leverage quality social health—and health overall.
Read on, friend.
What does “social health” mean anyway?
Hope this doesn’t offend anyone but…
We aren’t that different from monkeys.
Okay, maybe you don’t pick through your mate’s back hair for snacks.
But much like our genetic cousins, we humans are social animals. So much so that it’s impossible to separate our physical health from our social health.
As the graphic shows below, the two are that intertwined. 4,5
What if your social group doesn’t encourage health?
Your nacho-loving beer buddies.
Your “just one more helping” family member.
The cast of Arrested Development that keeps you glued to the couch.
You’ve probably heard the advice: “If you want to be healthy, hang out with healthy people.”
The advice is well-meaning, based on results from the Framingham Heart Study that revealed just how impactful our social context is. (One finding: You’re more likely to be happy, depressed, or obese if your closest friend is happy, depressed, or obese.6)
Despite this, we love our beer buddies, sloppy and loud as they are. And Grandma’s pie-pushing comes from love. And no one wants to live in a world where dysfunctional family sitcoms don’t exist.
Our social circles often define our identities; we’re very attached to our familiar groups. This remains true even if the friend, family, or professional group we belong to isn’t necessarily good for us.2
For many, the idea of leaving a stressful or unhelpful social base is up there with being asked to live on a desert island… naked and alone… with snakes.
If someone suggests you swap an unhealthy social group for a healthy one, you’ll almost surely dig in and resist. (And your clients will do the same.)
That’s why when addressing clients’ social groups, coaches should listen more than they advise, and draw out a client’s own wisdom.
“Is this relationship still benefiting you?How does this relationship relate to your current goals, priorities, and values?”
After reflecting on those questions, a few clients might decide they need to find new friends or roomies.
But not usually.
And that’s okay—because as a coach, you still have three powerful strategies to help clients strengthen their existing social bonds, so they can improve their overall health.
Strategy #1: Amplify the coach-client relationship
You’re part of your client’s social network.
In fact, there’s a fancy-pants name for the coach-client bond: the therapeutic alliance. It refers to the level of trust and rapport between a practitioner and the person they’re helping.
A strong therapeutic alliance can help a person feel supported and understood while surfing the tides of change.
And get this:
Client results are up to 85 percent dependent on the therapeutic alliance.
The stronger that relationship, the better the results.
How do you strengthen this bond?
Highlight your clients’ awesomeness. Point out their strengths and what they’re doing right. As much as possible, try to see your client from a compassionate, non-judgemental, and positive perspective.
Embrace client-led coaching. Help clients identify their own limiting factors and propose their own solutions. You’re a knowledgeable guide, but only a client knows what’s best for themselves.
Listen and validate. When a client is suffering, they probably don’t need you to search PubMed for more evidence. More than facts, your clients often need understanding, support, and creativity to get them through the tough stuff.
(Want to build trust and connection with clients? Read: “I’m a coach, not a therapist!” 9 ways to help people change while staying within your scope)
Strategy #2: Create intentionally welcoming spaces
Take a critical look at the virtual and/or in person gathering spots you oversee as a part of your coaching practice.
Are they places where members feel welcome, championed, and safe?
Do clients want to hang out in these spaces?
If you decide your coaching community needs some work, consider this advice from Precision Nutrition super coach Jon Mills, PN2, who’s been building and maintaining successful coaching communities for years.
Know who you’re welcoming—and who you’re not.
Many coaches see themselves as the coach for everyone. That’s a mistake, says Mills. “When you welcome everybody, you by default welcome nobody,” he says.
Think deeply about the type of clients you want to attract and retain. Then consider what they might want from a community—and what might repel them.
For inspiration, consider what Valkyrie Western Martial Arts Assembly, the gym Mills runs in Vancouver, British Columbia did to cater to the queer community:
Posted a pronouns policyOffered non-gendered restroomsHung a pride flag in the front window
Those details helped clients know immediately whether the space was for them, Mills says.
Communicate your values and expectations.
Post a code of conduct. This helps clients know the rules that help keep your community safe and welcoming.
As an example, in our Precision Nutrition Facebook communities, our first rule is this:
And we explain what we mean by that.
Everyone wins: Members know what to expect, and how to behave.
Uphold your group rules.
Don’t just pay lip service to values like helpfulness and respect.
You must actively reinforce them, Mills says. “It’s worse to have a code of conduct and not enforce it than to have no code of conduct at all,” he says.
Rule reinforcement is especially important if, like Mills, you coach clients who often feel unwelcome in typical spaces. When done right, you can create an atmosphere like the (now online) Valkyrie martial arts studio did pre-pandemic:
Valkyrie invited people to register for couch time—just as you’d register for sweating it out in a class. On any given day, you could find people chatting, laughing, and bonding.
For them, the studio was more than a gym. It was home.
Small group coaching: Where individualized attention and supportive group dynamics meet
For more than 21 years, Alwyn Cosgrove has gathered and stored data for every single training session with clients at Results Fitness, the gym he owns in Santa Clarita, California. That information—from roughly 40,000 yearly sessions—functions like an ongoing research study.
And it‘s led to a counterintuitive finding:
Clients do better when they train in small groups than when they work one-on-one with a coach or trainer.
This remains true even when clients are following different programs, Cosgrove says.
“You’d assume people would get better results when working only with a trainer because they’re getting more individualized attention,” says Cosgrove. “But the less individualized attention in a group setting seems to be offset by group dynamics.”
That might be because fellow clients “get” each other, allowing them to cheer one another on in ways friends and family may not be able to.
Strategy #3: Rally the support of family and friends
In coaching more than 100,000 clients, we’ve noticed something:
Most people focus on their shortcomings rather than their successes.
This negative focus tends to discourage and demotivate people.
That’s why, “at some point in virtually all of my clients’ journeys, we’ll have a conversation about building a cheer squad,” says Mills.
When friends and family support a client’s goals, values, and priorities, that client tends to be successful. There’s a sense of “we’re in this together,” says Precision Nutrition super coach Toni Bauer, PN2.
(Want to help clients get clear on the kind of support they need, and who to get it from? Use this FREE worksheet: Social Support Form)
But friends and family usually need a few pointers.
Because they can sometimes also be the people who (often unintentionally) sabotage a client’s progress by…
… Asking, “Hey, want some ice cream?” while scooping out two big bowls.
… Making comments like, “Wow, you’re eating less than usual. Are you okay?”
… Guilt-tripping, saying, “Oh come on, drink with us!” or “I made this cake just for you! Don’t hurt my feelings, now.”
As much as possible, try to allow the client to lead this solution-finding mission, says Bauer.
If you jump in with too many suggestions, your client will likely continually tell you, “No, that won’t work. You just don’t understand my friends/family.”
When brainstorming ways to overcome sticky issues with family and friends, Bauer suggests you ask questions like:
Has there been a time in your life when trying something new has worked smoothly in your household? If so, what was that like?
Could you tell me how you’ve communicated with your friends or family in the past? Let’s discuss what worked and what didn’t.
What’s the easiest, low-hanging-fruit change you can make that’s minimally disruptive to your friends’/family’s habits?
After contemplation, clients might come up with their own ideas.
If they get stuck, however, ask:
Do you need help with this? Are you interested in hearing some ideas that have worked for other clients?
If they say yes, you might tell them about that client with a nut allergy who asked her wife to only buy ice cream with nuts. The client knew she wouldn’t be tempted by nut-loaded ice cream, and it allowed her wife to keep a sweet treat in the house.
(For help navigating resistance from friends and family, read: 3 counterintuitive strategies for getting loved ones to support your healthy lifestyle.)
Our social circles don’t have to be perfect to benefit us.
It’s nice when goals align with with loved ones:
Your household sits down and EVERYONE wants to try your new kale loaf.
But really, whose life is that??!
In reality, just like us, our friends and family are a mishmash of virtues and vices.
But that’s not what defines us.
Instead, it’s our willingness to accept and support each other wherever we’re at, that makes relationships so life-giving.
Social groups may never be ideal, but they can usually be improved by building on what’s already working, and adding on as needed.
With this mindset, your beer buddies may continue to love their brews, but cheers to you even if you decide to opt for seltzer.
(And who knows, maybe seltzer pong could be a thing.)
Click here to view the information sources referenced in this article.
1. Larrabee Sonderlund A, Thilsing T, Sondergaard J. Should social disconnectedness be included in primary-care screening for cardiometabolic disease? A systematic review of the relationship between everyday stress, social connectedness, and allostatic load. PLoS One. 2019 Dec 19;14(12):e0226717.
2. Malone JC, Cohen S, Liu SR, Vaillant GE, Waldinger RJ. Adaptive midlife defense mechanisms and late-life health. Pers Individ Dif. 2013 Jul 1;55(2):85–9.
3. Umberson D, Montez JK. Social relationships and health: a flashpoint for health policy. J Health Soc Behav. 2010;51 Suppl:S54–66.
4. House JS, Landis KR, Umberson D. Social relationships and health. Science. 1988 Jul 29;241(4865):540–5.
5. Eisenberger NI, Lieberman MD, Williams KD. Does rejection hurt? An FMRI study of social exclusion. Science. 2003 Oct 10;302(5643):290–2.
6. Bzdok D, Dunbar RIM. The Neurobiology of Social Distance. Trends Cogn Sci. 2020 Sep;24(9):717–33.
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