Deep Dive: Case Study—First 90 Days with a New Client¶

Reading time: ~7 minutes
Prerequisite: Chapter 1.6 (The Longevity Coaching Process)

The Big Picture¶

Theory is nice, but what does longevity coaching actually look like in practice? Let's walk through a realistic case study covering the first 90 days with a new client.

This composite case is based on typical patterns. The details are illustrative, not prescriptive. Every client is different, and you'll adapt your approach accordingly.

Meet Sarah¶

Background:
- 52-year-old marketing executive
- Recently elevated blood pressure (138/88) and borderline HbA1c (5.9%, a measure of average blood sugar; 5.7-6.4% indicates prediabetes)
- BMI 29, mostly sedentary
- Sleeps 5-6 hours ("I'll sleep when I'm dead")
- High stress from demanding job
- Recently lost her father to a heart attack at 78
- Motivation: "I don't want to end up like my dad"

Sarah represents a common longevity coaching client: high-achieving professional with emerging health markers, lifestyle gaps, and a recent wake-up call.

Days 1-14: Discovery and Foundation¶

Initial Session (90 minutes)

The first session is about understanding, not fixing.

Deep Health Assessment:

Key Findings:
- Sleep is her biggest vulnerability (affects everything else)
- Exercise is genuinely non-existent, not just underreported
- Eating is erratic: skipped breakfast, late dinners, stress snacking
- Strong support at home (husband is on board)
- Identity tied to productivity; rest feels like weakness

Biomarker Review:
I asked what her doctor said about her labs. She shared:
- BP trending up over 3 years
- Fasting glucose 108 mg/dL
- LDL 145 mg/dL
- Doctor mentioned "lifestyle changes" but no specific guidance

I didn't interpret these. I asked what they meant to her and what her doctor recommended.

First Two Weeks Focus:
- One thing only: protect sleep
- Goal: In bed by 10:30 PM at least 5 nights/week
- Why: Sleep affects everything: stress, eating, motivation, cognition. It's the keystone.

Days 15-30: Building Momentum¶

Week 3-4 Check-ins

Sarah hit her sleep target 4 out of 7 nights the first week, 5 out of 7 the second. She reported:
- "I didn't realize how bad I felt until I started feeling better"
- Energy improved noticeably
- Less afternoon snacking (she was eating to stay awake)
- Still anxious about work, but coping better

Adding Movement

With sleep improving, we added one thing:
- 15-minute walk after dinner, 4x/week
- Why: Low barrier, fits into existing routine, doesn't require equipment or planning
- Secondary benefit: Helps with glucose (post-meal walks improve glycemic response)

Addressing Resistance

Sarah pushed back: "15 minutes seems too easy. Shouldn't I be doing more?"

This is common with high achievers. My response:
- "Your nervous system has been in overdrive for years. We're rebuilding from the ground up."
- "The goal isn't to burn calories. It's to build a sustainable habit."
- "When 15 minutes is automatic, we'll add more."

Days 31-60: Deepening the Work¶

Month 2 Progress

Sleep: Now averaging 6.5-7 hours most nights
Walking: 5x/week consistently, enjoying it
Eating: Still erratic, but less stress snacking
Stress: "Better, but work is still crazy"

Adding Nutrition Structure

We introduced one change: eating breakfast within an hour of waking.
- Why: Stabilizes blood sugar, reduces late-day cravings
- What: Something easy. Greek yogurt with berries, or eggs
- Not tackling dinner timing yet (one thing at a time)

Exploring the Emotional Dimension

In week 6, Sarah got emotional discussing her father. Key themes emerged:
- She never saw him as unhealthy until suddenly he wasn't
- She's afraid of "waking up one day and it's too late"
- Work feels safer than facing these fears

I listened and reflected. I didn't try to fix. I noted that some of this might benefit from working with a therapist and asked if she'd considered it. She said she'd think about it.

Referral Decision Point

Her anxiety seemed within normal range—grief plus work stress—but I flagged it for monitoring. Clear criteria for referral:
- If anxiety interferes with daily function
- If sleep problems persist despite good habits
- If she shows signs of depression

Days 61-90: Consolidation and Progress¶

Month 3 Achievements

By 90 days, Sarah's behaviors had meaningfully shifted:

Functional Improvements

• Energy: "I'm not crashing at 3 PM anymore"
• Mood: "Less irritable, my husband noticed"
• Focus: "Better at work, ironically"

Introducing Strength Training

With walking established, we discussed adding resistance training:
- Started with 2x/week bodyweight routine at home (15 minutes)
- Used a simple program: squats, push-ups (modified), rows, planks
- Goal: Build the habit before optimizing the program

Planning Ahead

End of 90 days, we outlined months 4-6:
- Continue building strength training consistency
- Address dinner timing (she often eats at 9 PM)
- Explore social connections (friendships have faded)
- Recheck biomarkers at 6-month mark with her physician

What Made This Work¶

1. Starting With Sleep

Trying to fix everything at once would have failed. Sleep was the leverage point. It improved energy, reduced cravings, and made other changes feel possible.

2. One Thing at a Time

Each month focused on one behavior change. This felt "too slow" to Sarah initially, but led to sustainable progress.

3. Respecting Her Pace

High achievers want to sprint. Coaching Sarah meant repeatedly redirecting her toward sustainable progress over quick wins.

4. Staying in Scope

I didn't interpret her labs, didn't diagnose her anxiety, didn't prescribe supplements. I asked questions, encouraged provider follow-up, and focused on behavior change.

5. Building on Success

Each win built confidence for the next. Walking led to feeling better, which motivated breakfast changes, which improved energy for strength training.

What This Means for Coaches¶

• Discovery takes time: Don't rush to intervention. Understand first.
• Keystone habits matter: Find the one change that unlocks others.
• Slow is fast: Sustainable change takes patience. Resist the urge to overload.
• Stay in your lane: Support, don't diagnose. Refer when appropriate.
• Celebrate progress: Small wins build the momentum for bigger changes.

Key Takeaway¶

Effective longevity coaching isn't about implementing a perfect program. It's about meeting clients where they are, starting with one keystone change, and building sustainable momentum through consistent small wins over months, not days.

References¶

1. Precision Nutrition. The Coaching Process. PN Coaching Framework. 2024.
2. Prochaska JO, DiClemente CC. The Transtheoretical Model of Change. Am Psychol. 1992.
3. Clear J. Atomic Habits. Avery. 2018.
4. Fogg BJ. Tiny Habits. Houghton Mifflin Harcourt. 2020.
5. National Board for Health & Wellness Coaching. Scope of Practice. NBHWC. 2025.
6. ACSM. Guidelines for Exercise Testing and Prescription. 11th ed. 2022.