A Biopsychosocial Approach to Women's Health Coaching

Traditional nutrition and fitness coaching (referred to simply as coaching from here on out) can often be reductionist, focusing primarily on biological or physiological factors when developing a program for clients. Many such programs are based on scientific research, much of which has historically been conducted primarily on men. This research trend stems from various reasons, including the perception that men have more “stable” hormonal profiles compared to women, whose hormonal cycles vary due to menstruation. As a result, researchers have often generalized findings from these studies on men to women, which we now know is not always accurate!

Conversely, a biopsychosocial approach to coaching integrates biological, psychological, and social factors to develop programs that promote overall well-being. It recognizes that health is influenced not only by physical aspects—such as genetics, hormones, and physiology—but also by mental and emotional states, as well as social environments, including relationships and community support. Wellness coaches using this approach work holistically with clients, addressing all these interconnected dimensions to create personalized strategies that foster balanced, sustainable health and sovereignty or ownership over their lives and health.

When coaching women, this approach allows a coach to move beyond the conventional, male-dominated research model. It also encourages coaches to consider the whole woman in their care. Let's examine the role each of these spheres of influence has on our health.

Biological Components

Biological Sex

One of the key components of coaching women is understanding that biological females have different hormonal profiles than biological males. While men and women both produce testosterone, estrogen, and progesterone, women have less testosterone and experience cyclical, variable patterns of estrogen and progesterone. Understanding how these hormones affect metabolism, weight, and fitness capacity throughout the cycle can significantly enhance a coaching approach.

Age

A female client’s age is another critical factor in coaching due to the continually changing hormonal environment. For instance, women aged 18-29 might focus on hypertrophy and building a strong foundation, while women aged 30-39 might prioritize strength training. As women enter perimenopause (typically in their early to mid-40s) and postmenopause (50+), declining estrogen levels necessitate a focus on strength training to maintain lean body mass and support bone health through weight-bearing exercises. Additionally, incorporating mindfulness practices for stress reduction becomes increasingly important with age as hormonal shifts can disrupt stress management.

Metabolism

Metabolism shifts across the female lifespan and throughout the menstrual cycle due to hormonal changes. Women typically use more fat as a fuel source during low to moderate-intensity exercise compared to men, who rely more on carbohydrates. This ability to oxidize fat more efficiently also varies throughout the menstrual cycle, with a greater ability to utilize fat as a fuel source occurring during the luteal phase (the second half of the menstrual cycle). During this phase, body temperature rises, as does the basal metabolic rate (BMR), which is the number of calories the body needs to maintain basic functions like breathing, circulating blood, and regulating body temperature while at rest.

Immune Function & Recovery

The menstrual cycle can impact a woman’s recovery from stressors such as exercise or dietary restrictions. During the follicular and ovulatory phases, higher estrogen levels enhance immune function, resulting in a stronger immune response. Conversely, during the luteal phase, progesterone levels rise, which has an immunosuppressive effect. This immunosuppression is thought to be a protective mechanism that prevents the body from attacking a potential embryo. These changes can lead to a generally lower immune response, making clients more susceptible to illness during the latter half of their cycle. Recovery is crucial during all phases of the cycle, but especially during the luteal phase, when deep sleep may be reduced, inflammation increases, and collagen production slows. During this phase, it’s essential to monitor a client’s perceived recovery status and incorporate more rest days or recovery methods if necessary.

Psychological Components

Thoughts, Feelings, & Perceptions

Our thoughts, feelings, and perceptions can profoundly impact our interaction with fitness and nutrition, and these can change daily, weekly, or monthly depending on the circumstances—or hormones—in our lives. Understanding a client as a whole person, beyond their biology, can influence adherence to a program and satisfaction with both the coach and the process. For female clients, it’s important to consider not only the menstrual cycle but also the common psychological burdens (or benefits) that women often face. Women are frequently exposed to harmful societal messages about their bodies and capabilities, which can affect their comfort in the gym or lead them to use food as a coping mechanism.

At the intersection of psychological and biological components are mindset shifts driven by fluctuating hormones during the menstrual cycle or during perimenopause/menopause. For instance, during the follicular phase, a client may experience mood improvements, increased energy, and enhanced cognitive function due to higher estrogen levels. Later in the cycle, during the luteal phase, progesterone may interfere with the brain’s feedback inhibition loops, potentially leading to increased anxiety, fear, mood swings, and anger.

Lastly, some clients may be affected by Premenstrual Dysphoric Disorder (PMDD), a severe form of premenstrual syndrome (PMS) that affects a small percentage of menstruating women. PMDD is characterized by significant emotional and physical symptoms during the luteal phase of the menstrual cycle, typically in the one to two weeks before menstruation begins. These symptoms can be severe enough to interfere with daily life, relationships, and work. PMDD is believed to be linked to the interaction between hormonal changes and neurotransmitters like serotonin. Treatment options range from lifestyle changes to medications and therapeutic methods, and these should be applied within a coach’s scope of practice.

Expectations & Goals

Expectations often impact women in various ways, which can affect their mindset. For example, expectations around what their bodies can do throughout different life phases (e.g., pregnancy, postpartum, perimenopause, menopause, injury) may lead to feelings of shame, disappointment, inadequacy, or—ideally—empowerment and pride. The dominance of social media in our culture often exacerbates these feelings through comparison. Encouraging clients to unfollow accounts that trigger negative feelings, focus on actionable steps towards their goals, and reconnect with their intuition can help mitigate the impact of these expectations.

Even women with healthy habits may express shame, guilt, or disappointment when they struggle to adhere to those habits. As a coach, it’s important to be a listening ear, provide compassion, normalize their feelings, and offer scenarios that can shift their perspective. Helping clients identify their values and set reasonable expectations, while cultivating presence and compassion for their current state, supports the creation of realistic and achievable goals.

To delve deeper into goals and goal-setting, it’s crucial to understand your client as a whole person. This enables you to identify where their goals are coming from and ensure they are rooted in positive motivations. If goals stem from external pressure, shame, or self-loathing, it’s important to compassionately explore these origins to help clients set goals that promote self-acceptance and well-being.

Disordered Eating History

In my coaching practice and conversations with women, I’m continually struck by how many have been affected by disordered eating or eating disorders. Disordered eating refers to a range of irregular eating behaviors that may not meet the criteria for a specific eating disorder but still involve unhealthy habits, such as chronic dieting, skipping meals, or obsessing over food. Eating disorders, on the other hand, are clinically diagnosed mental health conditions that include severe disturbances in eating behaviors, such as anorexia nervosa, bulimia nervosa, and binge-eating disorder. These disorders have specific diagnostic criteria and can lead to serious health complications.

Disordered eating habits are often normalized in our culture, and clients may not understand the implications of these habits on their bodies and physiology. If your client has a history of disordered eating, it’s important to recognize that they may be triggered by counting calories or macros, using a scale to weigh themselves, or restricting certain food groups. Identifying these triggers through open and compassionate conversation can help you tailor a nutrition or exercise program that isn’t based on restriction or numbers.

Social Components

Friends, Family, & Partners - Community

As mentioned earlier, a female client’s closest relationships can significantly impact their training and nutrition, either positively or negatively. On the positive end, friends, partners, or family members who share similar health goals can create a sense of accountability. Exercising together or sharing healthy meals can reinforce positive behaviors. Creating a supportive community where clients can share successes and challenges, such as a Facebook group or group chat, can foster positive reinforcement. When family members or partners prioritize healthy eating together, it becomes easier to maintain a nutritious diet. Cooking and eating healthy meals together can make healthy choices more accessible and sustainable. Lastly, emotional support from loved ones can help women manage stress, which is often a trigger for unhealthy eating or skipping workouts. A supportive environment that reduces the emotional labor women often assume in household, partnership, or work environments can lead to better emotional well-being, which in turn supports a healthy lifestyle. Helping clients set boundaries and seek positive influences in their lives is crucial for fostering a positive relationship environment.

Conversely, family members or partners who focus on weight or appearance can create pressure that leads to unhealthy dieting or excessive exercise. Negative comments about body image can contribute to low self-esteem and disordered eating behaviors. Friends or family members who don’t share health goals might unintentionally undermine efforts by encouraging unhealthy eating or discouraging exercise. For example, they might tempt a client with unhealthy foods or criticize the time spent on workouts. This may also occur within romantic partnerships where feelings of jealousy or control can lead to criticism, shaming, or subtle sabotage. Social events, such as family gatherings or outings with friends, can also present challenges when they involve foods that don’t align with a client’s dietary goals, leading to guilt or pressure to indulge. Teaching your client skills to navigate social situations, such as portion control, healthy communication strategies, and boundaries can allow them to participate in social functions while still adhering to habits that support their goals. These communication strategies are also vital for helping them set boundaries in relationships that may not currently foster a positive, supportive environment.

Job & Responsibilities

A female client’s job and responsibilities—particularly when combined with the emotional labor and disproportionate share of duties often shouldered at home—can create significant barriers to maintaining a healthy diet and fitness routine. Overcoming these challenges requires intentional time management, stress reduction strategies, and seeking support to ensure that nutrition and fitness remain a priority. Women frequently prioritize the needs of others—whether it’s family, coworkers, or friends—over their own, often resulting in the neglect of essential self-care practices like exercise, adequate nutrition, and rest. This self-neglect can lead to burnout and various health issues. When a client does prioritize herself, it’s often accompanied by feelings of guilt, adding psychological stress to an already challenging situation. Additionally, juggling work, home, and caregiving duties (for both children and adults) can lead to sleep deprivation, which negatively impacts energy levels, mood, and metabolism. Lack of sleep can also impair decision-making, leading to poor food choices and reduced motivation to exercise. Supporting your client in navigating these demanding work and home environments by connecting with them and holding space for their vulnerability is a powerful first step toward reducing shame and fostering empowerment and self-sovereignty.

Conclusion

Adopting a biopsychosocial approach to women’s health coaching allows for a more comprehensive and individualized plan that takes into account the complex interplay of biological, psychological, and social factors. This method recognizes that women’s health is influenced by more than just their physical bodies; it also includes their mental and emotional states, as well as their social environments. By understanding and integrating these factors, coaches can develop personalized strategies that promote not just physical health, but overall well-being, leading to more sustainable and effective outcomes for their female clients.

Whether you’re working with young women in their prime fitness years, supporting those navigating the challenges of perimenopause, or coaching clients through the complexities of postmenopausal life, a holistic, biopsychosocial approach provides a framework to empower women at every stage of life. It’s not just about achieving fitness goals; it’s about fostering resilience, self-acceptance, intuition, and long-term health in a world that often fails to recognize the unique needs of women.

If any of the above resonated with you and you’re ready to embark on a personalized, holistic journey to better health and well-being, I’m here to guide and support you every step of the way—let’s work together to achieve your goals and empower your life.