This emerging specialty positions personal trainers well as a potentially strong conduit between healthcare providers and their patients.
We are already aware of the problem: Too many people are unhealthy—some obese, some with diabetes or hypertension, some who just don’t exercise. And the tricky thing is that it’s not necessarily that people don’t want to become healthy. Often they do, and will try different food plans or exercise strategies. The problem is that these solutions don’t stick and people end up feeling frustrated and alone.
Unhealthy individuals want lasting change, corporations want healthy workers, and healthcare providers want patients to get and stay healthy. Likewise, fitness pros want clients to succeed in making changes for the long term.
So what is the answer to the problem?
It may be health and wellness coaching. Some fitness industry experts believe this exploding field will help unhealthy people go from wanting to do something to actually getting it done. Coaching certifications emphasize a trio of skills—in behavioral, nutritional and physical training—that can holistically treat those struggling with poor health. Why do experts think health coaching can help, and how does it relate to you as a current or aspiring fitness pro? Health coaches and coaching experts share their viewpoints.
What Is Health and Wellness Coaching?
A health coach is not a personal trainer, a counselor or a dietitian.
“One of the game-changing dimensions to health coaching is the real emphasis on listening to the client and learning from her,” explains Cedric X. Bryant, PhD, FACSM, chief science officer for the American Council on Exercise, who is based in Redmond, Washington. “There’s a shift in focus from, 'I’m the expert to solve problems’ to, 'Let’s you and I go on the journey together to help you change your life.’”
Richard Cotton, MA, national director of certification and registry programs for the American College of Sports Medicine, believes that wellness coaching is an important new profession. “With respect to the subspecialty, it brings critical behavior-change services that heretofore have been lacking to exercise, nutrition, nursing and other health areas,” he says. “Coaching incorporates support strategies into . . . services that are dependent upon behavior change in order to achieve positive outcomes.”
Why Health Coaching Now?
Health coaching is actually not new. For instance, since 2002 Wellcoaches School of Coaching® has been focused on helping health professionals learn master coaching skills in collaboration with the American College of Sports Medicine and now the American College of Lifestyle Medicine, says Kate Larsen, MCC, a veteran fitness professional and executive coach in Eden Prairie, Minnesota, who is a National Board Certified Health and Wellness Coach (NBC-HWC), and a faculty member for Wellcoaches.
So why are so many people excited about health coaching at the moment? Because there’s a tremendous need for trained health coaches who can help people bridge the gap between medical recommendations and the behaviors required to implement them. “I think you’re going to see growing acceptance of behavior-change interventionists (i.e., health coaches) as part of the healthcare team,” says Bryant.
Leigh-Ann Webster, the executive director of the International Consortium for Health & Wellness Coaching, agrees. “With the arrival of National Board Certification for Health & Wellness Coaches, I anticipate significant growth over the next 4–5 years in the number of qualified people who provide health and wellness coaching services.”
How many coaches are there currently? Bryant estimates there are nearly 6,000 ACE-certified health coaches. Margaret Moore, MBA, CEO of Wellcoaches in Wellesley, Massachusetts, says there are 10,000 trained Wellcoaches coaches and 3,000 of them have completed the extra step required to become certified. Over 1,000 health and wellness coaches just passed the new National Board Certification for Health & Wellness Coaches.
Health Coaching Topics
Health coaching helps clients achieve health-related goals, with a focus on areas such as behavior change, exercise and nutrition, according to Natalie Digate Muth, MD, MPH, RD, FAAP, a community pediatrician, registered dietitian and ACE senior advisor for healthcare solutions, in the San Diego area.
Most health coach certifications cover a mix of coaching science and application. For example, the ACE Health Coach certification includes subjects such as coaching psychology, weight management psychology, the physiology of obesity, techniques for lifestyle coaching, and development of exercise programs.
pTopics in the Wellcoaches training program include core coaching skills like positive psychology, mindfulness, active listening, open inquiry and perceptive reflections; transtheoretical modeling in coaching; coaching mechanisms of action (including neurobiology); and coaching practice.
The new National Board Certification for Health & Wellness Coaches—developed by the nonprofit International Consortium for Health & Wellness Coaching and National Board of Medical Examiners—covers 140 competencies in the domains of coaching structure, process, ethics and professional development, as well as health and wellness knowledge.
Fitness Pros as Health Coaches
With a background in exercise knowledge and proven ability to work with clients, fitness pros—especially personal trainers—are a natural fit to become health coaches. We know people need health coaches to help with behavior change, but why would you want to become a health coach?
It can provide new opportunities. “Health and wellness coaching is a natural career for trainers 45 and older,” says Moore. “It’s less of a physical strain, and trainers this age are a great fit as coaches. Most clients of health coaches are over 40. It’s harder for a younger person to navigate the complexity of the life of mature clients.”
Moore says fitness pros who become health coaches can get jobs in places like corporate wellness, clinical settings, community settings, spas and health clubs. Or they can go into private practice.
But what about the pay? “The compensation levels for ACE-certified health coaches tend to be in line with those of experienced personal trainers,” Bryant says, so trainers can diversify without losing income.
It creates another revenue stream. “Personal trainers can expand their current business with their own clients,” Bryant says. “In addition to offering personal training, they can also meet with their folks in person or on the phone to focus on the broader health-coaching activities. So they can work more frequently within their existing client base.” The more often you connect with your client base, the higher your odds of retention, he says. That, in turn, makes clients more likely to provide referrals.
Package deals also work well, says Sue D’Alonso, ACSM-certified personal trainer and ACE-certified health coach. “Many new clients want both services,” says D’Alonso, owner of SueD-Fit, in Pinole, California. “I offer 30 minutes of training and 15 minutes of health coaching. I generally work on health coaching with clients for 12–25 weeks, depending on the needs, commitment and stage of readiness.”
It helps you get corporate clients. Ellen Goldman, MEd, a National Board Certified Health and Wellness Coach (NBC-HWC) and Wellcoaches-certified professional health and wellness coach, created an employee wellness program for a small-sized corporation, where she works four times a year cycling all the employees through coaching, as well as present Lunch & Learns four times a year. “New and innovative opportunities are popping up as wellness coaching is becoming more popular and better understood,” says Goldman, personal trainer and founder of EllenG Coaching in Livingston, New Jersey.
It works well as a remote service. Health coaching can take place by phone, allowing you to reach clients beyond your own area. For example, Lee Jordan, ACE-certified health coach, personal trainer and co-owner of Fullest Living in Jacksonville Beach, Florida, works with obese clients as a health coach. “They pay a monthly fee, and I connect with them via phone and text messaging,” he says. “Working remotely lets me help more people,” says Jordan, who lost 275 pounds and can relate to clients’ weight loss journeys.
Goldman conducts group coaching sessions with five or six people via conference call. “I love seeing the camaraderie that forms when like-minded individuals who face similar challenges come together to get coached through the change process and to support each other,” she says.
Goldman adds that online learning is a fast growing industry with lots of opportunity for coaches to share their expertise. “I am in the process of creating courses on the many aspects of wellness that individuals can take at their leisure online, at a much more affordable rate than working privately with a coach. They will be ‘coaching style,’ meaning assignments with thought provoking questions, rather than straight lectures.”
It can provide a lower price point. “I’ve created coaching programs that give people the chance to work with me at a more affordable entry point by meeting with them only once a month for six months and sending email support and ‘homework’ assignments in between,” says Goldman. “I have been impressed with the positive results even occasional, powerful coaching conversations can have.”
It helps empower clients. Coaching changes the relationship dynamics found in personal training, says Larsen. “Personal trainers are often viewed as the expert by clients. Coaching puts less pressure on the coach, by putting the responsibility with the client. The client is an expert on himself and the coach has coaching skills expertise, so you work as a team.”
Getting the Results Clients Want
While health coaching can be a separate session, incorporating health coaching skills into personal training sessions can also be valuable. Moore says that getting certified as a health and wellness coach and using your coaching skills will significantly improve your clients’ results.
“The best personal trainers are very good at relationship skills,” she says. “Coaching competencies allow you to help someone build self-awareness, self-reflection and self-compassion to become more self-driven in terms of their health.”
In talking to lots of personal trainers, Moore has found that their success rate—measured as people being able to sustain the changes they make—increases. “While this is not peer-reviewed research, the success rate of many personal trainers grows from 15%–20% to 40%–60% from using their coaching skills.”
D’Alonso obtained several new clients since obtaining her health coach certification. “All have been successful,” she says. “One lost 80 pounds this year. Being a health coach has benefited my career in that I am much more versatile. I think being a personal trainer and health coach together is much more powerful than being one or another.”
A Word of Caution
Fitness pros need to understand the critical distinction between being an expert and being a coach, says Larsen. “One thing I’ve learned in training health professionals in coaching skills since 2002 is that it takes lots and lots of practice. Learning the skills to taking a coach approach is one step, and practicing consistently is another.
“Masterful coaches make it seem easy to do with clients. However, people who have been through training will tell you that staying out of ‘expert’ mode is surprisingly challenging at first. Yet the client benefits are amazing! Coaching skills are tools that help us have trusting, respectful conversations with others. Who wouldn’t benefit from that?”
The Medical Arena
One reason for the excitement about health coaching is that fitness pros see it as a way to truly connect with healthcare practitioners. “The fitness community has been talking about working with the healthcare industry for decades, but it hasn’t happened on a broad-scale basis,” says Bryant, who views health coaching as the bridge to health care. “The healthcare landscape is changing, and providers are more open to having people such as health coaches help their patients.” Here’s why.
A better name. Doctors may look more kindly on a “health coach” than on a “personal trainer.”
Though thousands of qualified, certified personal trainers provide excellent service to their clients, medical practitioners may have seen patients injured by the “go hard or go home” approach of some so-called “professional” trainers, says Jordan. “That mentality has cast a shadow on personal training for many in the medical profession.”
Health coaches do not have that association. “When you’re a health coach, medical people think that you’re ‘one of us,’” says Jordan. “They view you as working on their team and seeking a solution of patient health together.”
Changes in health care. Medical practitioners find they don’t have time to help patients struggling with obesity and other serious health issues make the step-by-step changes required for long-term success.
Bryant says the Prescription for Activity (PfA) Task Force is trying to broaden the definition of a “healthcare provider” because doctors are dealing with so many people who require profound changes in their lifestyles in order to prevent or treat a variety of ailments. “We are working to encourage and enable physicians to refer patients to professionals such as health coaches,” says Bryant, who serves on the Executive Committee of the PfA Task Force. “We are also striving to ensure that all members of a patient’s healthcare team are appropriately educated on how they can most effectively collaborate to drive the best possible patient outcomes.”
Also, Medicare approved a reimbursement for obesity counseling in 2011, says Muth, ACE senior advisor for healthcare solutions. “However, this hasn’t been adopted across the board. There are stipulations that the coaching had to be conducted in the primary care doctor’s office and had to meet evidence-based guidelines. When Medicare starts to pay for something, it’s likely that other insurance companies will start to pay, too. This may be a future opportunity for health coaches.”
In addition, “the Affordable Care Act requires insurance companies to pay for preventive services recommended by the U.S. Preventive Services Task Force with no cost sharing to the patient,” explains Muth. “Obesity screening and intervention and nutrition and fitness counseling for people with cardiovascular disease risks are included in these services, but the actual implementation of this rule varies significantly on a state-by-state and an insurance-company-by-insurance-company basis.”
Opportunities With Healthcare in the Future
Muth is cautiously optimistic about the opportunities for health coaches in the medical field. “Are there possibilities there?” she asks. “Definitely. But are they well defined and easily available now? Not really. I think of them as emerging opportunities rather than current opportunities.”
Cotton also takes a conservative viewpoint. “There are funds available for prevention services, but I suggest caution,” he says. “A fundamental goal of the Affordable Care Act is to lower healthcare costs, and the only way to do that is to actually lower healthcare costs. If health and wellness coaches can prove their services can support that goal, there is a greater chance of revenue for expanded coaching service.”
Muth explains that the Affordable Care Act encourages primary-care doctors to create “patient-centered medical homes” that integrate different professionals into their practices. To be certified as a patient-centered medical home, a doctor’s office needs to help patients develop goals and eventually engage in health coaching. “Typically someone within the doctor’s office—like the medical assistant—is trained to be the coach, but some locations have used outside coaches to fill that gap,” Muth says.
The idea that one day insurance companies may directly reimburse health coaches for their services is exciting. “However, we’re not quite there yet,” says Muth.
For example, Muth notes that there is a growing movement to offer diabetes prevention programs for those diagnosed with prediabetes. “In fact, Medicare and some private insurances now covers CDC-certified Diabetes Prevention programs. It is likely that this opportunity will continue to grow.”
Can a fitness pro who is also a health coach waltz into any doctor’s office and get reimbursed through insurance for offering this type of program? No.
“However, an entrepreneurial, proactive health coach could develop a CDC-certified diabetes prevention program, or work with a program that is already certified. Down the road, insurance may pay for other health coaching services, but for the most part it isn’t happening yet.”
The good news is that leaders in the health and wellness coaching industry are working to change that. “The American Medical Association now has guidelines for health coaching in primary care and a coaching handbook for medical students,” explains Moore. “Our new national board just met with the CDC to work on codifying group coaching competencies, integrating into the national standards, and upgrading the Diabetes Prevention Program coaching standard. The board is also trying to get the national board certified coach into wellness/prevention reimbursement codes and capitated payments.
“The new American Board of Lifestyle Medicine just certified the first cohort of around 300 physicians, most of whom are integrating health coaches using existing reimbursement codes including the annual wellness visit introduced by Obamacare,” Moore adds.
Just because insurance reimbursement isn’t a reality yet doesn’t mean doctors aren’t interested in outside health coaches. “Doctors want to do more to help patients who have lifestyle-related diseases be more active and eat healthier,” says Muth. “I would recommend health coaching to my patients if it was the right fit.”
Jordan says doctors have not been interested in his services as a personal trainer. But “they do see health coaching as viable. Once doctors feel they can trust you and know that you are competent and certified, they will refer to you.”
Some exercise and coaching experts and pioneers think that the future of health and wellness coaching is going to flourish, including earning reimbursement by healthcare payers now that there is a National Board Certification for Health and Wellness Coaches. (The first group of coaches took the exam in September 2017.) One reason this new certification is likely to receive positive notice by the medical industry is that it is co-sponsored by the National Board of Medical Examiners (NBME), which has been responsible for physician licensing exams for 102 years.
Self-Funded Health Insurance: A Game Changer?
Another societal change may also pave the way for the use of health coaches. The trend of some corporations moving to the self-funded insurance model may mean more work for health coaches, explains Jordan.
“Why is the self-funded insurance model such a big deal?” Jordan asks. “It’s important because it is a movement propelled by the marketplace and not legislation. That means that more businesses are seeing the self-funded (self-insured) route as an advantage due to its positive impact to the bottom line.
“Self-funded corporations are financially incentivized to provide tools to their employees that will facilitate their wellness. Chronic diseases, such as diabetes and obesity, by their nature are progressive and therefore progressive in cost. They often lead to high cost catastrophic conditions.
“Highly qualified and certified health coaches will be needed and fit perfectly into the self-funded model. As employees are impacted through health coaching and biometrics reflect progress and medications are no longer needed or are decreased, the company actually makes money. There is a difference between a company not having their rates raised (a lot), as in the traditional model, and a company actually recording bottom line dollar gains due to healthier employees.”
Wellness for All
Health and wellness coaching is not for everyone; it has pros and cons like any other career. IDEA Fitness Journal will explore the topic more in the future, so look for further articles. But health coaching is definitely an up-and-coming career.
“Health coaching is going to become a necessary part of a successful fitness professional’s essential toolkit,” says Mary Bratcher, MA, DipLC, co-owner of The Biomechanics Method. The days where trainers simply tell clients what to do to achieve a fitness goal are falling by the wayside because people are realizing that such an approach only brings about temporary results. Coaching techniques enable trainers to help clients realize the power of their own unique coping and decision-making skills. It also helps clients take personal responsibility for the success (or failure) of their programs.”
Goldman also feels strongly that coaching is the direction the fitness industry is heading.
“Helping individuals tap into their own inner motivation and create programs that work for their unique lifestyles is what health coaching is all about,” she says. “If I can help clients come to their own realization about what will work for them and actually follow through and start to transform, I can’t imagine that there is any more rewarding work to be done.”