RHR: The Future of Health Coaching, with Leigh-Ann Webster
In this episode, we discuss:
- What is a health coach?
- Why NBHWC was created
- The partnership between NBHWC and NBME
- The core competencies of health coaching
- Health coaching and behavior change
- How NBHWC approval works for health coach training programs
- Benefits of the NBC-HWC credential
- What’s next for health coaching
Show notes:
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Hey, everybody, it’s Chris Kresser. Welcome to another episode of Revolution Health Radio. This week, I’m really excited to welcome Leigh-Ann Webster as my guest on the show. Leigh-Ann is the executive director for the National Board for Health & Wellness Coaching. She has over 20 years of experience in marketing and communications and is also a National Board Certified Health & Wellness Coach and a certified personal trainer.
She is an active board member for the Palomar Family YMCA, she holds a sociology degree from the University of California, San Diego, and she received her health and wellness coach training from Real Balance and Well Coaches. In her spare time she enjoys spending time with family, being in nature, trail running, triathlons, healthy cooking, and travel. She resides in San Diego, California, and is also the owner of 52 Healthy Weeks.
So, I am really looking forward to talking with Leigh-Ann about health coaching in general as a profession, what the National Board for Health & Wellness Coaching credential has brought to health coaching as a profession, why it started as an organization, why it’s important, and what she sees as the future of health coaching. So let’s dive in.
Chris Kresser: Leigh-Ann, I’ve been looking forward to this for some time. Welcome to the show.
Leigh-Ann Webster: Thank you, Chris. I’m really excited to be here today. Thank you.
What Is a Health Coach?
Chris Kresser: So let’s start with the absolute basics here. A lot of people are listening to this. They hear the term “health coach,” they have probably some idea of what a health coach is. But maybe it’s not, we’re not all talking about the same thing when we say health coach. So what is a health coach, from your perspective?
Leigh-Ann Webster: So, I like to look at health coaches as people who help their clients with very client-centered behavior change, right? So client-centered, client-driven behavior change. So, health coaches really help people bring out their innate motivators and discuss their goals and help them figure out how to make the change that they’re looking for in their life. As health coaches, we really like to consider the people that we’re working with as experts in their own life.
Chris Kresser: Right. So, some people might think of when they hear coach, they actually maybe a vision of some gym teacher with a whistle around his neck comes to mind or maybe even someone who, like a nutritionist, who is extremely helpful, very legitimate and valid profession in its own right and prescribes comprehensive nutrition plans to someone based on their unique individual needs. We have nutritionists in our clinic. I’ve worked with them for years, and but a nutritionist is different than a health coach, isn’t it?
Leigh-Ann Webster: Definitely. So I like to use the example of nutritionist or even personal trainers. Because a lot of times when people hire nutritionists or personal trainers, they are really looking for education and information and a very guided prescription for what they can do. And a health coach is really someone who comes in and helps guide you. But we really like to see our clients do the work in terms of, like, figuring out what’s going to work best for them so that they own it, and then they actually make the behavior change and are successful.
So I think working with nutritionists and personal trainers is awesome. I actually am a certified personal trainer. But a health coach really helps bridge the gap between desire and action.
Chris Kresser: Right. And there’s a big gap there.
Leigh-Ann Webster: Yep. Yep, exactly.
Chris Kresser: We know, I’ve talked about this a lot on my show. But the CDC estimates that only about 6 percent of Americans consistently engage in the top five health behaviors. And we’re not talking about fancy stuff like intermittent fasting and meditating for an hour a day, we’re talking about:
- Not smoking
- Not drinking excessively
- Getting enough sleep
- Getting enough exercise
- Maintaining a healthy body weight
And yet 6 percent only of Americans consistently engage in those behaviors.
And it’s not because they don’t know that those things are healthy. People are confused about some of the specifics of, like, maybe, what diet is healthy. But they’re not, nobody thinks that smoking cigarettes at this point is healthy, or that being really overweight is healthy. It’s change is hard, right?
Leigh-Ann Webster: Right.
Chris Kresser: It’s really difficult to stick with.
Leigh-Ann Webster: Yep.
Chris Kresser: So, I confess that I was very confused about health coaches and health coaching for, until a few years ago. And as a practitioner, even so, my initial encounters with people who were referring to themselves as health coaches were not actually positive. I had a couple situations where patients came in to me and had been given some advice by health coaches that was downright dangerous in terms of labs that they had done and recommendations they had made based on those lab tests.
And I had some situations where people that actually changed their, what they were doing based on what a health coach told them versus what their practitioner that they were working with, their Functional Medicine practitioner, had recommended. And so I was, when I first started to hear more about health coaching, I was a little bit skeptical, because of the experience that I had had. And I looked around and I saw that there wasn’t really much of a standard for the education and training of health coaches. It was kind of the Wild West. Any person can call themselves a health coach. Just tomorrow, I’ll print out a business card that says health coach on it, and there was nothing stopping that or no regulations around that. And then any company or institution could just say, we’ve got a health coach program, here it is. It’s a one-day training, and now you’re a health coach. And so that troubled me as a practitioner.
And this is kind of maybe a good segue into talking about the National Board for Health & Wellness Coaching and why it exists. Because when I first learned about NBHWC, I was really excited because I was, like, finally, now there’s a kind of an anchor where we can define these standards and have a way that when we say health coach, and someone has a certification, there’s an understanding of what that means. And a kind of level of training that we expect someone with that certification to have. So could you speak to the history of your organization, why it came into being and what your mission and purpose is now?
The National Board for Health & Wellness Coaching (NBHWC) sets the standards for health coaching. Find out how and learn what’s next for the profession in this episode of RHR. #changeagent #wellness #chriskresser
Why NBHWC Was Created
Leigh-Ann Webster: Sure. And I’ll start by saying that I too, when I decided I wanted to become a health and wellness coach, and it was back in 2007, just like you, I think I thought I was getting into one thing, which was way more education based.
Chris Kresser: Right.
Leigh-Ann Webster: And then within the first class, I was like, whoa, I love this. There is a lot of psychology here, there’s a lot of behavior change information. There’s a lot here. And it was a lot different for me than what I expected, but so much better than what I thought I was going to get.
So, that’s a good segue into the national board certification. Because when I became a health coach, the National Board for Health & Wellness Coaching did not exist. I happened to choose a program that had good education and high-quality standards in place. But our organization did not exist. So, when I found out that the organization was created, and that they were even looking for someone to work, to help them develop it, I jumped at it, because I was so excited that we were actually going to have standards in the field.
Chris Kresser: Right.
Leigh-Ann Webster: So, the organization first started as an idea, I guess, as all things do, in 2010. A couple of our board members, Margaret Moore, who’s the founder of Well Coaches, and Karen Lawson, from the University of Minnesota, were at the National Wellness Institute conference. And they started talking with other leaders in the field who really saw this growing as the Wild West. There was nothing in place to help standardize the profession or to create regulations within the training and education. And so they started talking to each other. That turned into meetings, which then turned into an actual nonprofit entity.
We formalized in 2012, with the goal to create training and education in the field of health and wellness coaching that would eventually lead to a national board certification. So we, the first couple of years, it was really just about formalizing and letting everybody know in the field that this was even happening. And then we had what’s called the creation of a job task analysis. And that is very common in any emerging profession. It’s when you develop the knowledge, tasks, and skills that somebody should know in that field as a practicing coach, in this case. That job task analysis was then validated by 1,300 coaches who were practicing, and that told us that we were definitely headed in the right direction. And based off of that, we were then able to create training and education standards for the industry.
And we launched what’s called program approval in 2015. And just to give you an idea of how big the field is compared to what we thought, at the time, we expected around 15 to 20 programs to apply for approval. And we had over 60 apply for approval in that first year.
Chris Kresser: Wow.
The Partnership between NBHWC and NBME
Leigh-Ann Webster: So, yeah, so that just kind of gives you a little bit of the history of how we came to be. And then we became partnered with the National Board of Medical Examiners in 2016 and launched our first exam for national board certification in September of 2017.
Chris Kresser: Okay, so, yeah, let’s talk a little bit about more about the partnership with NBME, the National Board of Medical Examiners. This is, for the listeners who aren’t familiar, the organization that determines the licensing requirements for medical doctors. And how did that come to be and what was the impetus behind that?
Leigh-Ann Webster: Yeah, so, in a lot of ways, it was a little bit of luck and a little bit of, like, who you know. But there was this one physician who was doing some contract work for the National Board of Medical Examiners and also some work with some of our subject matter experts that are on our board of directors. And one day, he said, “Hey, I think you guys should talk.” And so our organization started talking with the board at NBME, and it became very obvious that there was a clear path towards partnership there. Simultaneously, NBME was turning 100 years old and they had been tasked with finding other professions that they wanted to work within. And ours was on the list of professions they wanted to reach out to, unbeknownst to us when we reached out to them.
Chris Kresser: Right.
Leigh-Ann Webster: And so it just felt like a real positive relationship, and through a lot of legal negotiations, because as we all know, it’s very, it sounds great, but it’s very complicated to create these types of partnerships. But through a lot, we were, we like to say we were engaged for a while, and then we became married.
So we also look to NBME as real experts in exam creation and delivery. So on our side, we had the subject matter experts. We had excellent item writers and people that could work together to create the data for the exam. But what we really needed help with was actually having a good editorial team to look at the items and to put everything together into one robust exam. So we looked to NBME for a lot of that.
Chris Kresser: Right, yeah. They’ve got 100 years of experience doing this.
Leigh-Ann Webster: Yes.
Chris Kresser: Like I said, they’re the organization that determines what you have to do to earn an MD in this country. So they have a ton of experience creating these credentials at the highest level and ensuring that there’s consistency in standards. So if, as we were saying before, like, with this credential, what’s phenomenal about it from my perspective as a practitioner, and now as the creator of an NBHWC-approved program, that there is just that common ground and common language.
That if we say yes, someone has this NBC-HWC credential, then I can assume if I’m an employer, if I’m a Functional Medicine practitioner hiring a coach with that credential, I can have a basic level of assumption of what skills and competencies they have. That they’ve demonstrated those skills and competencies in both a formal exam and also through a practical skills assessment, where they have to record a portion of their session and have that evaluated by an evaluator in the program. And then they’ve also taken the additional step of the formal NBHWC, or the NBC-HWC, exam.
So, to me, this really elevates health coaching from the realm of something that was certainly helpful and serving a lot of people. And I don’t mean at all here to disparage health coaches that don’t have this credential, or to say that health coaching hasn’t been phenomenally helpful for many millions of people around the world, and that I haven’t met fantastic health coaches, which I have in a variety of environments over 10 years. And I also saw the need to, like, if this is really going to move to the next phase of being a critical part of the solution to the challenges we face in the healthcare environment, it’s going to, there has to be this level of credibility and certification.
Leigh-Ann Webster: Right, absolutely.
Chris Kresser: So, you think, like, if I’m an insurance company, for example, and I’m thinking about whether I’m going to cover a session by a health coach at some point, I’m not probably just going to cover a session by anyone who calls themselves a health coach. Just as I wouldn’t reimburse a session from someone who’s calling themselves a doctor who doesn’t have an MD or the appropriate qualifications for that. And so to me, it just really opens it up for health coaching to start to be integrated into the conventional medical world, further integrated in the Functional and integrative medicine world and to provide, like, a totally legitimate and recognized career path for people who want to pursue this profession.
Leigh-Ann Webster: Exactly, yeah.
The Core Competencies of Health Coaching
Chris Kresser: So let’s talk a little bit more about these core competencies of a health coach.
Leigh-Ann Webster: Okay.
Chris Kresser: You’ve outlined, I forget the exact number, I should know, because we’re an approved school. Is it 17? Is that close?
Leigh-Ann Webster: Oh, the core competency? Oh, it, in the … Yeah, in the job task analysis, I believe it’s 22.
Chris Kresser: Okay. So there’s a number of competencies that you need to demonstrate to be, to show that you are functioning as a health coach. And we obviously are not going to go over all 22. But what are a few of these, just so people who are listening, who may not be as familiar with health coaching, have an idea?
Leigh-Ann Webster: I think the best way to talk about it is actually through what’s called our content outline. So we have the job task analysis, and then that developed into the content outline. And that serves as a, it’s actually a really interesting resource. Because what they did was they, they, as in the subject matter experts, basically took the job task analysis and then expanded that. And they broke it down into four different areas. So coaching structure, right? So how do you structure a coaching session?
Chris Kresser: Right. What do you do first, what do you next? What do you do at the end? How do you just logistically make it work?
Leigh-Ann Webster: Right, right. And why am I, I’m, like, totally blanking … coaching process, coaching structure, coaching process, right? So what’s the process that you’re going to go through, right? Are you going to ask a lot of open-ended questions? Are you going to show empathy? How are you going to approach this?
And then healthy lifestyles, which is actually a really key piece, because it kind of ties into the beginning of our conversation where we talk, we’re talking a little bit about education, and nutritionists and personal trainers.
And there isn’t a part of a health coaching session, or I should say, a piece to what a health coach needs to know, that very much needs to be about some standards in medicine, right? So we need to know about blood pressure, we need to know about cholesterol, we need to understand the language so that if a physician refers their patient to us as a health coach, we can actually interpret what the issues are and what needs to be done.
Chris Kresser: Yeah.
Leigh-Ann Webster: So that’s the third piece of the content outline, healthy lifestyles. And then the fourth piece would be ethics, right? So you definitely want to make sure that you’re walking into any coaching conversation with your ethics in place.
Chris Kresser: Integrity, morality, yeah.
Leigh-Ann Webster: Absolutely.
Chris Kresser: You understand your scope of practice.
Leigh-Ann Webster: Exactly.
Chris Kresser: You know what you should be doing and not doing. What red flags are that would lead you to refer your client to another professional perhaps. Yeah.
Leigh-Ann Webster: Yep.
Chris Kresser: It’s such an important point, and we often make this too to our students and prospective students that, on the one hand I think the history of health coaching has been that a lot of people who were initially trained as a health coach had maybe some good foundation in, like, nutrition and lifestyle modification. But they were just kind of telling their clients what to do and providing information and education. And we know that now through extensive research, and most of us just know through our own experience, that telling people what to do doesn’t work.
Leigh-Ann Webster: Right, right.
Chris Kresser: If you have a kid or a partner, or whatever, you’ve probably figured that out. We don’t even like to tell ourselves what to do. We’ve got this internal dialogue going all the time. So it seemed like the nutrition and wellness piece has historically been there. And what was missing was core coaching skills and competencies, like we’re talking about. Motivational interviewing and stages of change and positive psychology, empathy, building trust and rapport, all of these things. On the other hand, what you’re saying, and I agree with, is that core coaching skills are not enough on their own—
Leigh-Ann Webster: Right.
Chris Kresser: If you plan to be a health coach. And that’s maybe the difference between, like, a health coach and a life coach, or an executive coach or something like that, right?
Leigh-Ann Webster: Yeah, yeah.
Chris Kresser: They would have those same core coaching skills—
Leigh-Ann Webster: Right.
Chris Kresser: That they could use, but they’re applying them in a really different environment.
Leigh-Ann Webster: Absolutely.
Chris Kresser: They don’t need to know about those things. And so, like, in our program, we train people in not only in health and basic medical knowledge, but in Functional Health and medical knowledge, because of course that’s my lens and where I’m coming from. As a practitioner myself, I just thought like, thought about it like, what would I want a coach, our coaches, to know when I’m referring patients. I don’t need them to know how to interpret labs and prescribe treatment based on that, because that’s what I do. And that’s outside of the scope of their practice. But I do, if I prescribe a certain treatment protocol that includes diet changes and lifestyle changes, I want them to know what I’m talking about.
Leigh-Ann Webster: Absolutely.
Chris Kresser: Not just be like, “What? What is this stuff?” And even just to understand the labs and why I’m using them and what they mean, without interpreting. And that’s a different, that’s an important line there for me. So it sounds like this: it’s a combination of both the Functional or the nutrition, medical knowledge, and then also the core coaching skills.
Leigh-Ann Webster: Absolutely. I mean, I think you really need to be able to walk into a physician’s office, or even into a corporate environment, and help people interpret the information that they’ve been given, right? Because a lot of times when people are in their doctor’s office, they’re nervous.
Chris Kresser: Right.
Leigh-Ann Webster: They’re not necessarily retaining information. And they don’t necessarily understand it. I was just thinking about this earlier today, it’s so easy for us in healthcare, and I mean, our vernacular every single day is about all of this, right? And of course, we’re going to be conscious about exercise and fiber, because it’s what we’re passionate about. But I think that when a coach walks into the room, they have to come in, first of all, nonjudgmental, right? Ready to really help somebody feel like they can accomplish things and interpret the information that they’ve been given. So I do think that the healthy lifestyle piece of this is critical.
Chris Kresser: Yeah, that’s such a good point. I mean, we know the average time in the conventional model that a patient spends with a physician is between 10 and 12 minutes. So there’s no time for patient education and really explaining fully why a medication was prescribed or why a recommendation was made, or any of that. And so the health coach in that situation could be an important liaison between the doctor or the nurse practitioner and the patient. And in a Functional Medicine model, we have almost the opposite problem, where there’s too much information provided.
A patient has an hour-long case review with me, they might leave with 15 pages of, maybe that’s an exaggeration, but a huge amount of recommendations. Everything from supplements that they’ll be taking as part of their SIBO protocol to the special diet that we want them to follow to lab kits for follow-up tests that they have to do in a certain way and take at a certain time. And it’s enormously complex and there’s so many moving parts, and people get super overwhelmed. And these are often very sharp, high-functioning people. And so in our situation, the health coach serves as, again, as the liaison between me and the other practitioners. Helps walk the patients through all the various steps that they need to take. And then if they bump up against some kind of difficulty or challenge or ambivalence moving forward, then a health coach can be an incredible resource in that situation.
Leigh-Ann Webster: Definitely.
Health Coaching and Behavior Change
Chris Kresser: Let’s talk a little bit more about that. I mean, that ambivalence is this term, that I think my understanding of ambivalence is having equal reasons for changing and not changing. And so you can have a patient, let’s say, most of my patients are really motivated who come to see me. But even there, we had a patient the other day who I hadn’t, I prescribed a protocol, he was really excited about it. I didn’t see him for a year. And he came back to the office this week and said, “I’m really excited. I think this will help me, but I just can’t get over the hump. I can’t take the step. I don’t know what to do.” So that was like a perfect health coach scenario.
Leigh-Ann Webster: Oh, absolutely.
Chris Kresser: Yeah. So how would a health coach approach that kind of situation?
Leigh-Ann Webster: So I mean, it’s interesting, because the first thing I’m thinking about is the transtheoretical model for change, right? So taking somebody from precontemplation all the way into action and eventually mastery, at least that’s the goal. I think that one of the best places to start, and of course, I’m going to give my personal, how I would do it.
Chris Kresser: Yes.
Leigh-Ann Webster: And I think everybody, I like to say it’s like we all have our own flavor how we do this. But I think that one of the best things that a health coach can do is really taking a deeper dive into the person’s life and figure out like what their intrinsic motivators are and what’s really at the core of what they want for themselves. And what’s it going to take, like, really being able to ask those difficult questions. I think that’s one thing that health coaches become very good at, is getting comfortable in uncomfortable situations.
Because a lot of times the client is having to really do some deep thinking about what’s going on and really examine their life, right? So helping somebody examine their life, and then figuring out why they’re motivated to change, and helping them draw that out in themselves and thinking through, helping them think through what challenges are going to get in their way the minute they leave the office.
Chris Kresser: Right, preparing for failure.
Leigh-Ann Webster: The minute they leave your office something’s going to try to throw them off track.
Chris Kresser: Yeah, absolutely.
Leigh-Ann Webster: And so helping them figure out like, “Okay, I’m contemplating. I’ve been told that this is a problem. Now, I’m kind of thinking about it. Okay. I do want to change, I do. All right. Okay. Yeah, I am going to start doing this, I am going to start exercising, I am going to try to whatever, walk three times a week for 30 minutes.” And drawing upon, like, what is it? What is it going to take for you to really get there and do that?
Chris Kresser: Yeah, yeah, that’s such a great point. And I mean, I think of a, I think I wrote about this patient I had in my most recent book, Unconventional Medicine, where she was a middle-aged woman, pre-diabetic, verging on fully diabetic blood sugar. Actually, she would kind of go back and forth. And her doctor and her nurse practitioner had been telling her for years to eat a healthier diet, exercise more, like, to address this. And she just wasn’t really able to, and couldn’t find the, just from being told to do that, it wasn’t enough. You won’t be surprised by that.
But it’s interesting to me that that’s still the default approach, despite all of the research we have and educate. That’s another topic. She ended up working with a health coach who was trained in these modalities, and through that process, was able to make the change. And for her, it was really getting in touch with her deep desire to see her grandchild who had recently been born graduate from college and to really connect with that. Her love for her granddaughter, and her desire to be part of her life and to be able to play with her and feel good and be present for her childhood and her graduation from college.
That was a goal that she felt like she could really get behind. And as soon as she connected with that motivation, it was just like, the floodgates opened, and she was totally able to stick with the program.
Leigh-Ann Webster: That’s cool. That’s great.
Chris Kresser: I mean, to me, that’s such a good example of what we’re talking about here, where we could have gone on, me, her other doctors, whatever, could have gone on telling her to eat healthy and exercise more for years with no change. But it was actually just the process of someone asking her the right questions that ended up making the difference for her.
Leigh-Ann Webster: Yeah, and I think a lot of times people are embarrassed, right? Because they’ve been failing. They haven’t been able to reach their goals, maybe they keep putting on weight, or they’re not losing the weight, whatever it is. And so they’re embarrassed in front of their physician. And really, when they meet their health coach and start working with their health coach, they need to feel like that’s such a safe space.
Chris Kresser: Right.
Leigh-Ann Webster: It’s nonjudgmental, and no matter what you say, I still am going to hold you in the highest regard and do whatever I can as a health coach to help you succeed.
Chris Kresser: That’s so powerful. I mean, and of course, that’s why empathy and building trust and rapport are among the competencies that you need to demonstrate as a coach. Because without that, you can’t build that trust and relationship and create that safe space. And I think it’s likely that for some people, that kind of interaction with a health coach might be the first and only relationship they’ve ever had where they felt that.
Leigh-Ann Webster: I agree.
Chris Kresser: What an incredible gift to offer someone. Especially when they don’t have that in any other area of their life.
Leigh-Ann Webster: Yep. Yeah, I agree. And it takes practice too. I mean, I think we all kind of have an edge to us. And that’s why I love talking to health coaches and that I love being a health coach, especially as a parent.
Chris Kresser: Yeah.
Leigh-Ann Webster: Because it takes practice, it takes time. And that’s why like the practical skills assessment and doing this and having buddy coaching and mentorship, it matters. Because you, as a coach, you also progress as a human.
Chris Kresser: Yeah.
Leigh-Ann Webster: And you become less judgmental and much more open to hearing somebody’s story and really helping them.
Chris Kresser: Yeah, we hear that so often from our students, and we even, we have a little internal saying, better coach, better human. It’s just the skills that you learn when you train to be a coach are skills that are just life skills. Being able to communicate effectively, being a good listener, being able to reflect and back what someone is saying in a way that makes them feel heard and understood. And helping people to achieve their goals. I mean it’s like, what profession or relationship are those skills not going to be helpful in?
Whether you’re a parent, or you’re working in a totally different field, or you’re a teacher, an educator, it just, it’s sort of, I mean, sort of, I often feel like this should just be like part of general education. It should be part of school, period. Starting in elementary school and going through high school and college.
Leigh-Ann Webster: I very much agree. Yes.
How NBHWC Approval Works for Health Coach Training Programs
Chris Kresser: Yeah, yeah. So let’s talk a little bit about the requirements for schools.
Leigh-Ann Webster: Okay.
Chris Kresser: I mean, I, of course, am familiar with them as we are now an approved school, but for listeners who are not familiar, what does a school have to demonstrate, just at, starting at a 30,000-foot view, in order to become approved? Because it’s quite a rigorous process, in order to get this approval.
Leigh-Ann Webster: It is, it is. So I think the biggest thing that people are surprised by is that a school needs to show that they have a certain number of hours. And I believe it’s 40 hours of synchronous training. So a lot of people don’t even know what the word synchronous means. And I like to describe it as live and interactive. What you and I are doing right now is synchronous. If I was reading what you wrote online, by myself, that is not synchronous. That’s asynchronous.
Chris Kresser: Watching a recording of this conversation on your own time is asynchronous.
Leigh-Ann Webster: Yeah. We’re learning from each other right now. We’re talking. It’s back and forth. So that’s probably the biggest piece, obviously. And, of course, the biggest piece is teaching in terms of the content outline, right? But the part that a lot of people don’t necessarily get when they call us is the synchronous component. So it’s 40 hours of live, synchronous training. And then there’s an asynchronous component, which is 20 hours.
So that can be self-paced, reading on your own, listening to a recording. And then another piece would be the minimum of 15 hours of healthy, what we call healthy lifestyle basics. And that’s like what we were talking about earlier, just knowing about cholesterol, blood pressure, just some basic terms. And then another big piece that we often have to go into detail with people about is the practical skills assessment. Because we really believe that you learn by doing. And you, there’s a lot of parts about coaching that you don’t get until you’re actually doing it, like how to sit in the room when someone is crying across the table from you, and how to sit there comfortably, but still with a lot of empathy. So like, we really believe in the practical skills assessment and in coaching practice before you actually are assessed.
Chris Kresser: Yeah.
Leigh-Ann Webster: So those are the biggest pieces of what we’re looking for when a program comes to us for approval. Now, of course, there’s many, many more details in there.
Chris Kresser: Oh yeah, yeah.
Leigh-Ann Webster: But we don’t want to get into that, because let me tell you, I don’t even want to get into it.
Chris Kresser: I think our application was 325 pages, if I recall.
Leigh-Ann Webster: Oh my gosh.
Chris Kresser: Something like that.
Leigh-Ann Webster: Well, let’s not scare people. It’s not that bad.
Chris Kresser: No. But it was well worth it.
Leigh-Ann Webster: Yeah.
Chris Kresser: And I just feel strongly, as you know, I mean we’ve talked about this before, in the vision here and what we need to do in order to advance coaching as a profession. I put my stake in the ground in my book saying that health coaching is critical to the future of medicine. And in fact, we can’t, I don’t think we have a hope of preventing and reversing chronic disease without health coaches playing a much more significant role. Because we already have a shortage of primary care doctors that’s expected to get worse by 2030. There’ll be a shortage of 50,000.
The visits even now are 10 to 12 minutes per patient, they’re getting shorter. Doctors don’t have time to talk about the important diet, lifestyle, and behavior change. And as we’ve been talking about the whole show, they don’t have the training that’s actually required to support people in making those successful changes, motivational interviewing, stages of change, etc. They have incredible training and doctory kind of things that we need them to focus on. And so, and also it takes seven years and tens of thousands, hundreds of thousands of dollars to train a new physician. Whereas someone can earn a health coach certification from a program like ours in one year.
Leigh-Ann Webster: Yeah.
Chris Kresser: And be already ready to make a big difference and help people. So, I’m a huge believer in that. And it just, I know you have recently moved. When you first started, there was some transitional process for approving programs. And then you’ve recently updated the process now for new programs. So tell us a little bit about the shift that happened there and what the differences are. Because I know some people have been confused about that as well.
Leigh-Ann Webster: And it is confusing unless you’ve been there since the beginning, which I have. So anytime, if you’re taking the proper steps, when a profession is trying to advance, you usually have to do it in stages. Because you have to have time for the people practicing in that profession to catch up and for the educators in the profession to essentially catch up to where you ideally would like to end up, right? So when we launched what we call “program approval” in 2015, we started with the very, very basic core competencies. And at the time, I believe that was 30 hours of training and education. So we essentially then stayed dormant in terms of program approval for two years, actually, while all the programs, including the programs that applied for approval, back in the transition phase in 2015, all of them had to catch up.
Chris Kresser: Right.
Leigh-Ann Webster: And it’s still quite an effort for programs because we have advanced so much in terms of what we’re asking for. But everybody is catching up. And so in September of 2018, so actually it was a year ago, because it was September first of last year, we launched program approval now in this new phase, and we call that the 2018 standards. Personally, I’d like to have a different name, but we haven’t had a chance to develop that yet, because we’ve been so busy. But now programs are applying under those standards. So people who attended one of the programs under the first phase, they’re still eligible to sit for the exam through February of 2021. Because like I said, we’re catching up education and training. And then anybody who’s sitting for any of the newly approved programs is in a good spot because they have that much more education.
Benefits of the NBC-HWC Credential
Chris Kresser: Yeah, yeah, that’s great. And yeah, I’m very familiar with the need to do that when you are starting off a new, you’re really advancing a new profession and credibility there. On that note, I know that the National Board has been involved in a number of kind of advocacy efforts for advancing the profession of health coaching and the recognition of health coaching within the conventional medical world and the entire medical world in general. Including, exploring the potential for future insurance reimbursement and things like that. So what can you tell us, just in broad terms about your goals and vision there and what’s going on?
Leigh-Ann Webster: Well, we would love to get to a place where health and wellness coaching has what’s called a Category I CPT code so that it’s an automatic in healthcare that a physician could prescribe health and wellness coaching. And that there was a reimbursable code for it. As of today, we do have what’s called a Category III CPT code. CPT codes are provided by the American Medical Association after you complete an application and then go in front of a review board and really present all of the information.
So on July 1st of this year, 2019, we were granted a Category III code. And it’s technically for health and well-being coaching. And that code will become effective January 1, 2020. The Category III codes are not generally reimbursed. They’re generally used for data collection. And that data collection, or the data is then, the hope is that you collect enough data across all demographics, across all regions in the country, so that you then can present that information to the American Medical Association within a couple years. That’s the goal. So that you can move to Category I CPT code.
Chris Kresser: So yeah, it sounds like it’s a stepping stone on the process to hopefully getting insurance reimbursement for health coaching sessions at some point.
Leigh-Ann Webster: It’s huge, actually. It’s huge. We’ve been working on this, it’s been a big topic of conversation. It’s probably one of my number one questions.
Chris Kresser: Yeah.
Leigh-Ann Webster: And it’s huge that we have this. It might not feel huge, because it’s not reimbursed yet. But it is huge. And we will get there.
Chris Kresser: It’s huge and it’s a game changer. I mean, that’s going to open up so many opportunities for health coaches. If insurance reimbursement is available, it’ll increase its accessibility, and that’s when it really gets exciting. Because it does then start to fulfill its promise of being able to scale up and really reinvent medicine and prevent and reverse chronic disease. Because if you’re a physician, you’re working in a conventional primary care practice, again, you only have 10, 12 minutes. You know that your patient needs to work, change their diet, exercise, and work on their lifestyle.
Almost every doctor I know wants to provide that support, but they just don’t have the infrastructure to do it. And in many cases, they’re not going to, referring their patients who might be low income to a private health coach, is not even feasible for their patient populations. But if they can refer, if they’re on Medicare and they can refer them and Medicare will pay or a private insurer will pay, that’s a completely different story. And really, really exciting development. Do I understand that, I read a little bit of information that you sent me, in the way that a health coach is defined in this, what do we call it, in the CPT code approval process, as someone who has the National Board credential?
Leigh-Ann Webster: Yes, yes. So in the actual language written by the AMA, it states that the health and well-being coach needs to either be a National Board Certified Health & Wellness Coach or CHES certified, which would be a health educator.
Chris Kresser: Right. Okay, so the AMA is actually defining a health coach as someone that has one of those two certifications. So someone who does not have one of those two certifications will not be eligible for their clients to get reimbursement for health coach sessions. Is that right?
Leigh-Ann Webster: Well, given that there’s no reimbursement yet, I would say that they wouldn’t be eligible to provide the data as a result of that Category III CPT code.
Chris Kresser: Right. And then we don’t know yet what the definition will be if it progresses to Category III, or will it probably stay the same?
Leigh-Ann Webster: Well, I would imagine that since the original language is for the stage three, Category III, with the eventual goal to move to Category I, which would be reimbursed, that I would assume that the language would remain the same.
Chris Kresser: It would have to be the same.
Leigh-Ann Webster: Yeah, because the data.
Chris Kresser: The data would change.
Leigh-Ann Webster: Exactly, exactly.
Chris Kresser: You would have to be sure that someone who doesn’t have one of those credentials will get the same or similar results, which is the whole point of the credential in the first place.
Leigh-Ann Webster: Right, exactly. And I think actually, our conversation right now is a perfect example of the complexity of the system. Because we’re figuring it out too, right? And you can tell just by our conversation, that it’s like Category I, Category III, I mean, we’re just like, wow, this is complicated. But we’re getting there.
Chris Kresser: Yeah, I mean, it is and it isn’t. It goes back to what we were talking about before. If you’re the AMA, now I certainly don’t agree with the AMA on everything. But put yourself in the shoes of a policymaker or someone who makes these kind of decisions at the AMA or at Medicare or a private insurer. You’re not going to pay for a session that happens with someone who has no, without knowing what their credentials are and their training is.
Leigh-Ann Webster: Right.
Chris Kresser: That just doesn’t make sense, so they don’t want to spend taxpayer money to, even if the person is very skilled and competent, if they’ve just done that learning on their own, there’s no way of demonstrating that. And so it makes total sense to me that the AMA would define a health coach as someone who has the national board credential. Because that is currently nationally, and even internationally, as far as I understand right now, the highest level of training and education that a health coach can get.
Leigh-Ann Webster: Yes. That’s right.
Chris Kresser: And so if you’re the AMA and you want to study health coaching and its effectiveness, which is what this Category III CPT code is about, with an eye towards potentially providing reimbursement later, then yeah, you’re going to define a health coach as someone who has evidence-based training and shares a certain basic level of skills, which is why credentials exist in every single profession, not just in medicine.
Leigh-Ann Webster: Yeah, exactly.
Chris Kresser: So kudos to you and the organization. I have had a little bit of interaction with the, with that system, and it’s a large bureaucratic organization, and nothing happens quickly. And I think it’s quite an accomplishment and I’m super excited about it.
Leigh-Ann Webster: Yeah. And from what I’ve been told, too—I wasn’t personally at the meetings in Chicago—but from what I’ve been told, they’re very excited too.
Chris Kresser: That’s great.
Leigh-Ann Webster: And receptive.
Chris Kresser: That doesn’t surprise me.
Leigh-Ann Webster: That’s good.
What’s Next for Health Coaching
Chris Kresser: Like, the CDC has endorsed health coaching. This is not something that’s just like integrative and Functional Medicine. These mainstream conventional health organizations have seen the writing on the wall. They know as well as anybody that the current system is not working. I mean, that’s not a news flash. Like, it’s a major issue in political campaigns. The Congressional Budget Office has predicted that if we don’t get healthcare spending under control, the U.S. could be bankrupt by the year 2040.
This is a big deal. And everybody, I think, everybody recognizes that diet and lifestyle change are critical and they’re the missing piece. Like, we spent 90 percent of our healthcare dollars on treating chronic disease and 3 percent on public policy and education and things that might fall under, like where health coaching might fall under that. And if we spent even 20 percent on paying for health coaches for people, I’m convinced that we would have a dramatic impact on the burden of chronic disease. And I think everybody knows that and agrees with that at this point.
Leigh-Ann Webster: Yeah, and I think if health coaches became more mainstream, then we would reach a tipping point where people working with health coaches would start talking about their experience. People in healthcare would start relying more on health coaches to bridge the gap. And I think it would really help us get to a place where it tips and it’s just part of the healthcare system.
Chris Kresser: Yeah, that’s what I’m looking forward to. And also, as the awareness grows in all different environments, people will get exposed to health coaches in many different ways. Like maybe through their corporate wellness program, for example. And maybe through their Functional Medicine practitioner, or maybe they sign up for, there’s a growing number of companies, like, we call them doc-in-the-box companies, like Vida Health, that do individual wellness programs and utilize health coaching.
Or Noom, which is a weight loss coaching app that offers, it does health coaching. And actually one of our students was hired by Noom even before she finished the program and is still working with them. And so there’s a growing, I just think, like, health coaching awareness in the public sphere is growing in part due to your efforts. And just because out of necessity.
Leigh-Ann Webster: Right, right. Yeah, in fact, today we just did a big session with, we actually had 900 people on the Zoom session today and we had people from Vida Health and people from Noom.
Chris Kresser: There you go. Yeah, yeah. So it’s definitely an exciting time to be a health coach, to be considering a health coaching career, to be a practitioner that benefits from working with health coaches, like myself. And I definitely want to thank you and your colleagues at the National Board for all the hard work that you’re doing. And excited that we’re now a fully approved school. That was definitely a worthwhile process to go through. And I feel so confident in our program and its ability to prepare people for a successful career, and having that NBC credential is a big part of that.
Leigh-Ann Webster: Yeah, we’re happy that you’re now an approved program. And I’ve had a lot of fun talking to your coaches, who are reaching out all the time. So yeah, thank you.
Chris Kresser: Awesome. Okay, so where can people learn more about the national board and learn about the exam process and all that stuff? What’s the website?
Leigh-Ann Webster: So the website is N as in Nancy, B as in boy, HWC, so NBHWC.org.
Chris Kresser: Great, yeah. Lots of useful resources there. And then for those of you who are thinking of a career as a health coach, at the time of this recording, we’re in an enrollment for our fall program. And if you want to learn more, the best way to do that is go to Kresser.co/info and there you can download our full info packet, 47-page guide with everything you ever wanted to know about the program and how to schedule a call with an enrollment advisor to talk about whether it might be the right fit for you.
So thanks, again, everyone for listening. Thank you, Leigh-Ann, for being here today. It was a pleasure.
Leigh-Ann Webster: Anytime.
Chris Kresser: And keep sending your questions in at ChrisKresser.com/podcastquestion. It helps me to understand what’s on your mind and choose guests and topics for the show. And we’ll talk to you next time.
