John, a hypothetical middle-aged man, is told at his job about a new workplace wellness initiative that, among other things, offers two free sessions with a health coach. John immediately jumps at the chance — his primary care doctor had even suggested he consider working with a health coach. The health coach recommends a litany of lifestyle changes including diet, exercise, and supplements, which John conscientiously implements.
Everything is going well — until he suddenly experiences shortness of breath, heart palpitations, and sudden perspiration. He goes to the emergency room, where they immediately ask him about medications and supplements he’s taking. It turns out that one of the supplements recommended by the health coach has adverse reactions with a medication prescribed by his doctor. The health coach never asked John about his medications.
Health coaches are supposed to be the Next Big Thing in health care and public health. Consider a New York Times piece from 2021 about how health coaches are not widely available but offer great benefits. Similarly, in a 2020 post from a Harvard Medical School blog, a doctor touts the benefits of health coaches.
You can hire a health coach on your own for anywhere between about $50 and $150 per session. But many people, like John, connect with health coaches through popular workplace wellness initiatives. In 2021, one market research firm estimated the U.S. market to be worth $7 billion.
It’s easy to see why both clients and workplaces find health coaches appealing. In theory, they allow people to receive more personalized health care and health advice. When primary care doctors only spend an estimated 13-24 minutes with each patient, it’s obvious patients might appreciate meeting regularly with a knowledgeable person about their health concerns and goals.
But there’s a problem: Basically anyone can call themselves a “health coach” and start taking on clients.
Without adequate training, even well-intentioned people can cause real harm to another’s health. It’s also unrealistic and unfair to expect health coaching to fill the gaps within the health care system when there’s no standard of education, training, or care. Finally, without a body performing oversight, the profession is developing ethical gray areas, like a coach recommending supplements that they just happen to sell. Some people may act in bad faith and specifically attempt to exploit these areas. Others may again be well-intentioned but lack resources, knowledge, and training to navigate those murky waters.
There are no state or federal regulations around the term “health coach.” Nor is there an authoritative, widely accepted accrediting body with educational or training standards. As a result, people without proper training, education, or experience disguise themselves as qualified experts to oversee the health concerns, plans, and goals to address specific ailments, general complaints, or overarching worries that people may have.
It’s easy for the general public to assume that a health coach is a credentialed expert. Considering the press that health coaches have received, people can hardly be blamed for believing themselves to be making a good, informed choice for their health by consulting with one and listening to their guidance and advice.
Back in 2016, there was reason enough for cautious optimism about this new and burgeoning field. The excitement was precipitated by the National Consortium for Credentialing Health and Wellness Coaches and the National Board of Medical Examiners signing an agreement to work together to provide a national certification for wellness and health coaches. The certification currently requires an associate’s degree in any field, at least 50 sessions (of at least 20 minutes’ duration) conducting health/wellness coaching, completion of their training program, and passing their certification exam.
This was a necessary first step toward standardization and oversight. But since this agreement was put into place seven years ago, no more steps toward standardization and oversight have been taken. For example, in 2021 there were an estimated 128,000 health coaches in the United States. According to the National Consortium for Credentialing Health and Wellness Coaches, they have certified around 8,400. Assuming everyone certified is still working in the field, which is probably not the case, that’s just 6.6% of practicing health coaches. This puts the onus of researching and understanding a health coach’s credentials and background on those seeking to improve their health.
Even better would be state regulation of the term. In Colorado, for example, you can’t call yourself a doctor without having graduated from an accredited university with a doctorate degree such as an M.D. or Ph.D. Making “health coach” a protected title would be one way of safeguarding the public from unqualified people dispensing health advice. Health coaching should be similar to other regulated health care professions: it should require education in a relevant field (not just a degree in any field), supervised clinical hours (similar to physicians, nurses, etc., and not merely 20-minute sessions), and be subject to a licensing body responsible for the oversight of practice that can also address ethical violations.
People are constantly looking for new and better ways to improve their health and health care, but not all health and wellness offerings may be as they seem. Until there is standardization and oversight, through legislation and/or licensing board, accreditation councils, etc., it’s important for people to understand the limitations of this new field as they make health care choices for themselves and their family. Otherwise, the result could be the opposite of the health goals that people set for themselves.
Katie Suleta is a regional director of research in graduate medical education for HCA Healthcare. Her background is in public health and health informatics.
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