The National Consortium for Credentialing of Health & Wellness Coaches (NCCHWC) and the National Board of Medical Examiners (NBME) signed an agreement last month for the launch of a national certification for individual health and wellness coaches in the U.S. According to a joint press release, the agreement is a landmark in the efforts of a dedicated group of individuals who have been working for years to establish professional practice and educational standards for health and wellness coaching.

What is “health and wellness coaching?” According to NCCHWC’s website:

Health and Wellness Coaches partner with clients seeking self-directed, lasting changes, aligned with their values, which promote health and wellness and, thereby, enhance well-being. In the course of their work health and wellness coaches display unconditional positive regard for their clients and a belief in their capacity for change, and honoring that each client is an expert on his or her life, while ensuring that all interactions are respectful and non-judgmental.

This includes, according to a Job Task Analysis, helping the client set her own health and wellness goals and then helping her get there through various techniques, such as behavior tracking and providing “basic healthy lifestyle recommendations by credible sources.”

Again according to the press release, both the NBME and the NCCHWC,

envision a professional community that is dedicated to high quality and continuous improvement and an advocate for the development and certification of high-quality coaching skills across healthcare, academia, and industry.

Beginning next year, health and wellness coach training programs will have to meet certain standards for accreditation by the NCCHWC. They must have qualified faculty who must have graduate degrees in a health field, described as “MPH, MSW, MD, PhD, MSN, DrPH, etc.” Students must complete minimum hours in both clinical and classroom training, including  “Healthy Lifestyle Basics,” with a curriculum based heavily on the CDC’s “robust, evidence-based website that provides valuable resources for the coaching process.” After this, the candidate will have to pass the certification exam administered by the NBME.

I am cautiously optimistic that this endeavor could turn into a positive contribution to improvement in the nation’s health. Physicians could refer patients with, for example, chronic diseases and weight problems, to certified health and wellness coaches. They could help these patients set and meet goals to improve their health. In fact, I have thought about (and meant to write a post about), science-based alternatives to the false claims of CAM providers that they somehow hold the key to health promotion and disease prevention. Health coaching could become an evidence-based tool in the health care armamentarium and actually help patients avoid turning to CAM.

Some qualms

That said, I see trouble on the horizon for this nascent field.  With all good wishes and great hope for their success as a positive addition to the science-based health care field, I feel compelled to offer some friendly advice.

To their credit, some big names in “integrative medicine” were involved in getting health and wellness coaching to this point in its evolution toward professionalization.  These include Karen Lawson, MD, ABIH, University of Minnesota Center for Spirituality and Healing, a member of the Academic Consortium for Integrative Medicine, and David Eisenberg, MD, who was apparently involved in negotiating the deal between NCCHWC and the NBME. I also heard a mention of Dr. Oz in one of the videos explaining the organization’s formation. (The video was from 2014, hopefully before he was disgraced by Sen. Clare McCaskill for supplement shilling.)  Others from Integrative Medicine programs are also on the Board of Directors and Council of Advisors, as is someone connected to the American Holistic Nurses Association.

We at SBM (myself included) have often been quite critical of so-called Integrative Medicine (formerly known as “CAM”) which we see as an excuse to lower the evidence standards for medical practice, in part by incorporating quackery like homeopathy and reiki. We have also criticized IM for their championing of “CAM providers,” who don’t feel any allegiance to science and evidence at all, such as naturopaths.   One of our gripes has been the fact that IM co-opts exercise and diet as its own. In fact, evidence-based diet and exercise advice, including referring patients to other professionals, such as Registered Dietitians and physical therapists, have long been a part of “conventional” medical practice. I don’t back down from any of those criticisms one bit.

I hope the NCCHWC will think long and hard about its association with “integrative medicine.”  If health and wellness coaching is trying to establish itself as an evidence-based profession, then tying your future to an ideological movement in medicine that lowers the bar for evidence is not the best solution. For example, the website of Dr. Lawson’s own University of Minnesota Center for Spirituality and Healing contains an uncritical article on craniosacral therapy, an egregious form of quackery. It refers patients to an article criticizing scientific research and promoting anecdote-based evidence. It also contains a link to the Upledger Institute, which teaches and promotes this form of pseudoscience.  This is moving medicine back into the 19th century, not moving it forward.

Even integrative medicine’s most ardent proponents admit that integrative medicine has no set definition and that there is much about it we do not know, such as:

  • Whether IM really offers the best of conventional medicine and CAM.
  • Whether IM produces better outcomes.
  • Whether IM is effective in the area of prevention, including obesity and cardiovascular risk.
  • Whether IM has anything to offer preventive medicine.
  • Whether future IM research will yield beneficial results.
  • Whether IM has a positive impact on utilization clinical preventive services, smoking cessation, diet and physical activity.
  • Whether IM is cost effective.

Is that a movement you want to be associated with as you work to establish your credibility? It may well be that those who promote IM have the best of intentions, but, as Peter Rosenbaum, MD, wrote in an article critical of the “CAM” being offered to children with cerebral palsy,

Good intentions are no substitute for good evidence.

I wholeheartedly agree.

Let me mention another cause for concern. Right now, some health and wellness coach training organizations have received what is called “Transition Phase Approval” from the NCCHWC. This means they are authorized to train coaches during a transitional phase while the NCCHWC gets its full program up and running.  Sometime next year, more stringent requirements will be in place for training programs and all must apply and be accredited (even those with Transition Phase Approval) every three years.

I see some organizations on the Transition Phase Approval list that give me pause.  While I do understand the need for a transitional program to get things started, one would hope that more stringent requirements would bring these programs under greater scrutiny and allow NCCHWC to reassess their qualifications for accredited status. A few examples:

Integrative Women’s Health Institute: Offers some highly questionable advice on women’s health issues. (For example, if your testosterone is too high and you have PCOS, eliminate dairy and sugar and use lots of cinnamon, among other things.)

Functional Medicine Coaching Academy, Inc.:  This is another outlet for the Functional Medicine brand, now helmed by Mark Hyman, MD, which includes courses in practicing so-called functional medicine as well as an outpost at the Cleveland Clinic. The most measured thing I can say about functional medicine is that there is insufficient evidence for its underlying principles (which are themselves pretty vague) as well as no evidence that it improves health outcomes.

Institute for Integrative Nutrition: I mention this website as an example of a training outfit that provides insufficient evidence about its program to permit an appropriate evaluation by a potential student. There is no information on, for example, cost, faculty, financial aid or curriculum without having to contact the company. I suggest that NCCHWC require all accredited schools to provide this type of information in a standardized format on their websites, as is common with colleges.  I am also concerned about faculty who promote their own particular “brand” of nutrition, as opposed to evidence-based information.

The choice is yours

I think evidence-based health and wellness coaching offers a wonderful opportunity to improve the nation’s health, one patient at a time.   NCCHWC’s association with the NBME and incorporating CDC recommendations in its curriculum are steps in the right direction. But health and wellness coaching is a rich target for those who want to promote their personal brand of “wellness” or incorporate pseudoscience into their training and practice regimens. An early effort on the part of NCCHWC to guard against these inroads would go a long way towards establishing itself as a credible and valued addition to health care.

Posted in: Nutrition, Public Health