An Examination of Health Coaching as a Developing Profession

Abstract

Background

Health coaching is a field that is growing in popularity. Health coaching is not regulated and there is no standard for background, education, or training for those acting as health coaches. The purpose of this study was to investigate the burgeoning field of health coaching: who is performing it and common practices.

Methods

A total of 560 health coaching websites were reviewed to record educational backgrounds, recommendations for supplements, and the sale of supplements and/or other wellness products. Multivariable logistic regression was used to test associations between characteristics of health coaches and whether they recommend supplements, sell supplements, or sell other wellness products.

Results

The sample was mostly female without an applicable associate or bachelor’s degree listed practicing without national board certification. Twenty-nine percent recommended supplements, approximately 17% sold supplements, and 17% sold other wellness products. Of those without national board certification, nearly a quarter sold supplements. Multivariable logistic regression was used to identify associations between characteristics and supplement recommendations or selling supplements or other wellness products.

Conclusion

As health coaching develops, it is important to understand who is practicing as a health coach and common health coaching practices in the field.

Introduction

Health coaching is often defined as a patient-centered approach to goal setting and addressing health issues. It has been used to manage chronic conditions^1–3 as well as assisting patients with physical activity^4,5 and nutrition.⁴

While the concept of health coaching is not new, most of the research has focused on patient outcomes rather than how to effectively develop health coaching as a professional field. Additionally, the research on health coaching has often been restricted to health coaching as provided by healthcare providers.^6,7 Research has demonstrated that health coaching is effective, but how it should be done or who should be acting as a health coach remains uncertain.

In 2021, there were approximately 128 000 health coaches in the United States (US).⁸ Several organizations offer “health coach training” that vary widely in their requirements.^9,10 As a result, it is important to evaluate common training and practices as they exist in the field. Dispensing generic health advice and helping clients to set personal health goals are important aspects of health coaching. However, other practices, such as recommending supplements, selling supplements, and selling other types of wellness products (eg, essential oils, food allergy tests) are important to consider. The ability to prescribe medications is not required to recommend supplements or other wellness products. When considered in conjunction with the lack of standardization for the training of health coaches, supplements and other wellness products may be recommended and sold by anyone operating with the title of health coach. These supplement and wellness products recommendations could have deleterious effects on an individual’s health. In this study, we examined a sample of health coaches, evaluating their training and common practices.

Methods

We reviewed 560 health coaching websites for information about health coaches’ training and practices. To ensure a more representative sample of the US, health coaches from the 50 largest cities and the remaining states not represented in the largest cities were searched, ensuring that each state was represented. Google Maps was used with the search terms “health coach city” or “health coach state.” The first page of businesses included on Google Maps was then included in the sample. Only health coaches and wellness coaches were included in the sample. Those identifying solely as life coaches, personal trainers, executive coaches, and professional coaches were excluded. However, if someone identified as a health coach in any fashion (eg, both a health and life coach), they were included in our analysis. Those businesses without a website were excluded. Those websites lacking any information about the coach (eg, name, training) were also excluded. Data were collected from October 2023 to November 2023.

Data were collected on name, state, city (if known), gender, whether a relevant associate’s or bachelor’s degree was reported, whether a relevant graduate degree was included, and if the health coaches were registered dietitians, recommended supplements, sold supplements, sold other wellness products, or were certified by the National Consortium for Credentialing Health and Wellness Coaches. Relevant degrees included biology, kinesiology, exercise science, health sciences, public health, physicians, physical therapists, registered nurses, nurse practitioners, and pharmacists. Degrees deemed irrelevant to health coaching included but were not limited to business, marketing, psychology, and physics. Supplement recommendations were found in the blog portions of the websites or through offered services. Examples of other wellness products included but were not limited to essential oils and “diagnostic tests” such as food allergy tests.

Frequencies of health coach characteristics analyzed with chi-square or Fisher exact tests where appropriate are shown in Table 1. Multivariable logistic regression was used to test associations between the characteristics of health coaches and whether they recommended supplements, sold supplements, or sold other wellness products. Explored predictors were: National Board-Certified Health and Wellness Coach status, relevant undergraduate degree, relevant graduate degree, and gender. A random effect for state of practice was explored but not supported by Akaike information criterion. R version 3.6.3 and the lme4 package were used for analyses.

Table 1.

Characteristics of Health Coaches

		Recommends supplements			Sells supplements			Sells other
	Overall	No	Yes	P	No	Yes	P	No	Yes	P
N (% yes)	559	398	161		465	94		466	93
Female	510 (91.2%)	361 (90.7%)	149 (92.5%)	.594	42 (9.0%)	7 (7.4%)	.767	42 (9.0%)	7 (7.5%)	.793
Relevant associate or bachelor degree	111 (19.9%)	77 (19.3%)	34 (21.1%)	.72	92 (19.8%)	19 (20.2%)	.999	94 (20.2%)	17 (18.3%)	.783
Relevant graduate degree	80 (14.3%)	60 (15.1%)	20 (12.4%)	.498	65 (14.0%)	15 (16.0%)	.735	68 (14.6%)	12 (12.9%)	.793
Registered dietitian	10 (1.8%)	5 (1.3%)	5 (3.1%)	.161	5 (1.1%)	5 (5.3%)	.015	6 (1.3%)	4 (4.3%)	.068
National board-certified-health and wellness coach	69 (12.3%)	55 (13.8%)	14 (8.7%)	.127	66 (14.2%)	3 (3.2%)	.002	63 (13.5%)	6 (6.5)	.086

Results

The sample was 91% female and approximately 80% without an applicable associate or bachelor’s degree listed. The vast majority, nearly 88%, were practicing without national board certification. Twenty-nine percent recommended supplements, approximately 17% sold supplements, and 17% sold other wellness products (Table 1).

The only significant (P < .05) or nearly significant (P < .10) adjusted predictor of recommending supplements, selling supplements, or selling other wellness products was a National Board-Certified Health and Wellness Coach certification. The odds of recommending supplements were reduced in those with certification but not significantly so, odds ratio (OR) = 0.58 (95% confidence interval [CI] 0.30 – 1.06) P = .09. Likewise, persons with certification had reduced odds of selling supplements, OR = 0.19 (95% CI 0.05 – 0.54) P = .006, and nearly significantly reduced odds of selling other products OR = 0.44 (95% CI 0.17–0.97) P = .07.

Discussion

This topic, while not entirely novel, to our knowledge, has not been examined in a similar fashion. The overwhelming majority of health coaches in the sample were women who did not list a relevant degree and were not National Board-Certified Health and Wellness Coaches. Many of the websites included personal stories for becoming a health coach and, anecdotally, many included stories of diagnoses that are much higher in or specific to women, such as endometriosis, breast cancer, and Hashimoto’s thyroiditis.

The vast majority of health coaches in the sample did not list a relevant degree. The lack of credentials in health-related fields is concerning given the strict regulations in most healthcare professions. Without relevant education, the dispensed advice may not be accurate. Furthermore, many of the health coaches included in the sample went to non-accredited organizations for a certificate in health coaching (eg, the Institute for Integrative Nutrition, Dr. Sears Wellness Institute). While these institutes may be a viable training and educational route for the future of health coach training, they are not a substitute for a relevant degree and likely vary in educational content quality.

Credentials may have important implications. Approximately one-quarter of the sample (28%) recommended the use of supplements and about 16% sold supplements. Health coaches certified through the National Board for Health and Wellness Coaching had reduced odds of recommending and selling supplements or other wellness products compared to those without the certification. This is important to consider because, although supplements are not FDA-regulated, they may have interactions with other medications or other deleterious effects.

Limitations

These results should be interpreted cautiously. Personal trainers and life coaches were not included in our analysis unless they also identified as health coaches. Additionally, only health coaches with websites were included, and we did not consider social media pages as websites. Future studies should investigate the social media accounts of those identifying as health coaches, especially in the era of social media influencers. Finally, there is a potential for bias as the health coaches included in the sample were the top choices suggested by search engines.

Conclusion

Health coaching is growing in popularity. Little attention has been given to who is acting as a health coach. Since it is not a regulated field, anyone can identify and act as a health coach. These findings demonstrate that there are people without relevant credentials or training acting in the space. Further research is needed to assess how the field is growing and potential policy implications.

Funding Statement

This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare-affiliated entity.