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Health Coaching Defined

Updated: Aug 12, 2023




Why Are Health and Wellness Coaches Essential?


Health and wellness coaches work closely with patients to help them achieve their health goals. Patient-directed health goals might include reducing stress, managing diabetes, or improving sleep. Coaches also work with mindset changes too. Coaches collaborate with patients on goal setting, which may include setting SMART goals, and help determine how to change habits and overcome barriers and obstacles to reaching one’s goals. This change process is focused on using the patient’s strengths, insights, and values.


Everyone Could Use A Health Coach


Most people have had some experience with chronic health issues. Changes are required and inevitable. Research shows that lifestyle changes (along with policy and structural changes) can prevent many of these chronic health issues, yet the modern healthcare system lacks the design to support people through adopting mindset and behavior change. Working with a health and wellness coach provides a positive alternative to the frustrating process of navigating a complex medical system without finding the connection and support needed. A healthcare provider gives advice and educates, yet beyond that point, for instance, they lack the time (and reimbursement incentives) to follow through with meaningful conversations to help patients or clients initiate the change process. A vast gap exists between knowing what to do and making daily changes.


Health and wellness coaching contains a unique approach to guiding mindset and behavior change. I define health and wellness coaching as a process in which health coaches co-create a nonjudgmental, safe environment with patients to help patients establish their own way of making long-term behavior and mindset changes.


Health and wellness coaching:


  • Provides a collaborative partnership between coach and patient

  • Focuses on health and wellness in the most holistic manner possible

  • Harnesses empowerment strategies while remaining non-judgmental

  • Provides a personalized, culturally and trauma-informed approach for the patient

  • Uses the patient’s preferences as a foundation for change and structures their goals accordingly

  • Contains an inherent belief in a person’s resourcefulness and self-management capacity

  • Works with a process of change, methods of self-awareness, identifying the patient’s obstacles, and reflecting on the continuum of change



Some tools a health coach may use, in conjunction with their personal mindfulness and emotional intelligence skills, include:


Motivational Interviewing

With the MI Spirit present, motivational interviewing guides patients through their desired change using foundational skills of open-ended questions, affirmations, reflections, and summaries and through a process of engaging, focusing, evoking, and planning.


Establishing accountability

A coach regularly follows up with a patient, often using technology to help patients remain on track with their goals.


Positive psychology

Health and wellness coaches support a mindset conducive to change, improving self-efficacy, and using positive psychology-based techniques.


Connecting Thoughts, Feelings, & Behavior

Health coaching supports the patient through a process of improved self-awareness and recognition of one’s ability to regulate emotions, creating space between the stimulus and the response.



The Future of Prevention Depends on Health Coaching


The pandemic highlighted underlying health conditions and increased mortality risks in marginalized socioeconomic populations. Research has shown that the future of preventive health depends upon health and wellness coaches supporting health maintenance strategies that will offer pandemic protection. Further evidence supports a wider range of preventive public health strategies that the coaching industry is in a prime position to facilitate. (Global Wellness Institute, Wellness Coaching Initiative White Paper, February 8, 2022, p. 30-31, taken from, Sforzo et al., 2017). Evidence supports health coaching as an intervention to improve health outcomes of those with chronic diseases such as type II diabetes, heart disease, hypertension, cancer, and high cholesterol (Sforzo et al., 2017, 2019). Similar positive outcomes appear in additional studies, including:


  • Nine out of twelve studies (75%) demonstrated that health coaches helped cancer survivors reduce pain levels


  • Health coaches helped 42% of patients reduce their cholesterol levels through health coaching


  • Nineteen studies on health coaching demonstrated statistically significant improvements in psychological variables such as self-efficacy and satisfaction


  • 78% of studies on health coaching intervention in diabetes revealed that health coaching positively affected A1C levels (Your Coach, pp. 22-4)


Health coaches play a unique, key role within an interdisciplinary healthcare team, utilizing various motivational, mindset, and behavior change techniques to help those manage and thrive even though they have chronic conditions. In addition, health coaches are key in preventing most chronic diseases. Yet, coaches must access more diverse populations suffering from the common chronic ailments listed above to expand the industry’s impact on social determinants of health, lifestyle behaviors, and chronic disease management.


Who Employs Health Coaches?


Health and wellness coaching opportunities are very diverse. More and more employers are requiring the National Board of Health and Wellness Coaching (NBHWC) certification, the NBC-HWC. Here are some potential employments paths:


Clinics, Hospitals, and Healthcare Provider Offices

Healthcare providers often do not have the time to address meaningful mindset and behavior change required to impact patient health outcomes long-term. That being said, healthcare providers' offices, wellness and integrative care centers, whole-person health practices, and hospitals increasingly recognize the vital benefits of health coaching and whole-person care. A coach can work alongside a medical doctor providing patients with lifestyle medicine and chronic disease management guidance and support. They can become an essential part of the interdisciplinary team.

Healthcare Insurers

Preventive care reduces insurance costs by decreasing benefits payouts and insurance premiums. Insurers can offer the service of health coaching to their customers to guide their health habits and help them remain on track. Often these customers receive health and wellness coaching through telemedicine modalities, and sometimes these services are offered through employee assistance programs.


Corporate Health Coaching

Due to absenteeism from illness and injury, U.S. companies paid $575 billion in 2019. (Blackman, 2020). Mercer Global reports that the per-employee health benefit cost is more than $13,000 per employee, a 3% increase since 2018. (Mercer, October 2019). Corporations are turning towards empowerment strategies and behavior change coaching to help lower costs. Technology-focused solutions such as telemedicine programs have the potential to decrease costs.


Schools and Universities

Schools are understanding that increasing student well-being helps students reach their potential. Coaches can help students improve their overall health, manage stress levels, and achieve deeper sleep. Physical activity can be used to improve study habits, improve memory, and cognitive function. Student self-efficacy, as it relates to academic performance, can also improve through coaching.


Local Organizations

Health coaches who enjoy personal interaction and group dynamics can foster relationships with local organizations, non-profits, faith-based institutions, and senior centers and focus on coaching underserved populations or target groups who need coaching for a particular condition. Often these programs involve group coaching to decrease costs.


Online Programs

Virtual coaching greatly expanded during the pandemic. Self-employed coaches can partner with online coaching platforms to provide coaching services, HIPAA-compliant communications, and paying/billing features, all included. Online coaching programs can offer virtual classes, membership offerings, or subscription programs in a variety of niches and sliding payment scales.


Health and Wellness Coaching Opportunities Are Expanding


Fortunately, more and more companies are providing employees with free Health and Wellness Coaching. Insurance companies in the future will likely increase access to insurance reimbursement. Reimbursement could provide a combined total of 190 million lives with coaching. (Global Wellness Institute, Wellness Coaching Initiative White Paper, February 8, 2022, p. 30-31, taken from, Opier, 2020). It is staggering if one considers the potential impact of health coaching in the corporate sector. Moreover, CPT codes could increase access and make coaching more affordable. Industry professionals believe the Department of Labor will recognize health and wellness coaching within the next 5 years.


While corporations and insurance are increasing access to health coaching, vast pieces of the healthcare access puzzle are missing. The Kaiser Family Foundation points out that one out of every five adults in ten states that did not adopt Medicaid expansion in 2023 are without healthcare. (Kaiser Family Foundation, 2023)


Millions of Americans are at the “working poor” level, have fewer healthcare benefits, and have significantly decreased opportunities for screenings such as blood pressure, diabetes, and cholesterol. (Robert Wood Johnson Foundation, 2013)


An Inclusion Health Coach Certificate will give you the tools and knowledge to serve more diverse and marginalized populations based on:

Race,

Ethnicity,

Gender,

Age,

National Origin,

Religion/No Religion,

Ability,

Sexual orientation,

Size,

Socioeconomic status,

and Education,

Marital status,

Other identities.

Increased efforts are needed to educate the general public and clarify what a health and wellness coach is trained to do, especially when working in healthcare. The potential for reimbursement is promising, but it also means that states will ultimately regulate the profession. Moreover, digital technology is recalibrating the coaching industry at large, increasing the potential for accessibility and also monitoring patients. Healthcare systems across the board are recognizing the coaches' unique contribution to deeply understanding a patient's mindset and behaviors and applying goal-oriented strategies. The National Board of Health and Wellness Coaching (NBHWC) is leading the way through its approved program and board-certification process.


Overall, the coaching industry has become more tightly interwoven with the healthcare and mental health industries. Margins have shrunk by over 20% in the healthcare industry due to labor costs and clinical staff shortages. The health coaching industry can leverage their expertise to help ease workforce burdens allowing clinicians and nurses to operate at the top of their scope of practice while health coaches can focus on long-term mindset and behavior change that is a prerequisite for optimal patient health outcomes.

Overall, the health and wellness coaching industry is poised to impact patient outcomes in a more personalized way positively. Who wouldn’t want to become or be supported by a health or wellness coach?


Blackman, Melanie, “Employees Poor Health Cost Employees Employers $575B in 2019” Health Leaders, December 8, 2020


Rudowitz, Robin, Patrick Jake, and Jennifer Tolbert, “How Many Uninsured Are in the Coverage Gap and How Many Could be Eligible if All States Adopted the Medicaid Expansion? Kaiser Family Foundation, March 31, 2023,

https://www.kff.org/medicaid/issue-brief/how-many-uninsured-are-in-the-coverage-gap-and-how-many-could-be-eligible-if-all-states-adopted-the-medicaid-expansion/


Olsen JM. “Health coaching: a concept analysis.” Nurs Forum. 2014 Jan-Mar;49(1):18-29. doi: 10.1111/nuf.12042. Epub 2013 Jul 8. PMID: 24456550.


Global Wellness Institute, Wellness Coaching Initiative White Paper, February 8, 2022, p. 30-31, taken from, Sforzo et al., 2017


Mercer Global, “Mercer Survey Finds US Employers Shifting to Innovative Strategies to Make Healthcare More Affordable for More Employees,” October 28, 2019, Seen on: https://www.mercer.com/newsroom/mercer-survey-finds-us-employers-shifting-to-innovative-strategies-to-make-healthcare-more-affordable-for-more-employees.html



Your Coach, Health Coaching Industry Report: At the Front Lines of Health, 2022




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