May 2015 Issue

Dietitians as Health Coaches
By Lindsey Getz
Today's Dietitian
Vol. 17 No. 5 P. 34

Becoming a certified health coach can enhance your RD credential and boost your effectiveness with clients and patients.

The concept of "coaching" no longer relates to just sports. These days, coaching has become part of health care in general. A health coach works with clients not only on their eating habits but also on their overall health habits. That can include encouraging clients to work out more regularly, quit smoking or another unhealthful habit, maintain a nutritious diet, and even give attention to their spiritual well-being.

A health coach isn't a regulated title with criteria specified and defined by a governing body. Because of this, many RDs don't like the term because it's perceived as a credential that refers to a group of unqualified health professionals providing nutrition advice to the public. "I find that health coaches are making nutrition even more of a gray area," says McKenzie Hall, RDN, cofounder of NourishRDs, a food and nutrition communications company. "People are having a hard time distinguishing among all these people offering nutrition services. As an RD, it can be a little bit worrisome, because people can offer nutrition advice that isn't always based on sound science."

Nevertheless, many nutrition and health care professionals think of the role of health coach as a supportive mentor, and it's something RDs are considering adding to their skill set. "A health coach helps a person to envision, plan for, and achieve health and fitness-related goals," says Natalie Digate Muth, MD, MPH, RDN, CSSD, FAAP, a physician with the Children's Primary Care Medical Group-Vista and the senior advisor for health care solutions for the American Council on Exercise (ACE). Many health coaches have broad expertise in the areas of behavior change, nutrition, and physical activity, and are skilled in communicating with clients in a way that's appropriate to their readiness for change. "The health coach isn't the expert, but more of a guide who helps the client make meaningful health changes," Muth says.

Muth says a health coach is not someone who prescribes or recommends specific diet or exercise programs. That's where physicians and dietitians come into play. But a health coach would be involved in referring clients to the appropriate professionals when necessary for developing a specific dietary or exercise program.
"Of course, in the case of an RDN/health coach, no referral would be necessary for the meal planning," Muth adds.

Perfect Match for Dietitians
There's no doubt that dietitians are a good fit for health coaching. They already possess many of the skills that make a health coach valuable, and the additional training that health coach certification brings may serve to boost their effectiveness with clients.

"RDNs can make excellent health coaches," Muth says. "First of all, they have solid background and training in the health sciences and are the most knowledgeable resources when it comes to nutrition. Secondly, many RDNs already have some training and expertise in behavior change principles. Gaining a certification for health coaching serves to endorse that knowledge and skill set when communicating with potential clients or other health professionals."

Gina M. Crome, MS, MPH, RD, of Lifestyle Management Solutions, says that being a health coach has helped make her a more complete resource with clients. Along with her personal training certification, it makes her the total package, and health coaching felt like a natural progression from what she was already doing.

"As dietitians, we know all the science," Crome says. "We can talk about getting daily whole grains and fruits and vegetables, and the reasons why that's so important. But the science isn't going to put those suggestions into practical use. That's where health coaching really shines."         

Health coach training also provides an opportunity for dietitians to become more business savvy. Marjorie Nolan Cohn, MS, RDN, CDN, ACSM-HFS, a national spokesperson for the Academy of Nutrition and Dietetics (the Academy), says that in addition to learning more about motivational coaching, dietitians may benefit from learning more about the business aspect of serving clients.

"As dietitians, we have that science base, but sometimes we're missing the business background," Nolan Cohn says. "As someone in private practice, I've had to learn those business lessons the hard way. But if a dietitian was able to find a training program for health coaching that also offered some business tools for working with clients, it could be very beneficial to a practice in general."

Will the Certification Make a Difference?
But is it really worth going through the extra training? Many say the health coaching certification does make a difference. Crome feels that it can change a client's perception. Instead of being the "food police" as dietitians are viewed at times, a health coach is viewed more as someone who's just there to help. She says that in many ways, a health coach is perceived in a more empathetic light.

"At the heart of health coaching is the fact that it's client focused," Crome says. "It's not as much about telling the person what to do as it's about being there for them—being empathetic to their needs and encouraging them along the way."

"I do think clients notice additional certifications and training—particularly if you market it to them," Nolan Cohn adds. "Being a dietitian is a narrow scope of practice. It's very specific, and it's just about nutrition. But being a health coach encompasses more, and people may hire you not only to evaluate their diet but also their entire lifestyle. They want that coaching aspect."

According to Hall, pursuing certification to become a health coach is advantageous if RDs want more education on counseling and interpersonal skills to help them during educational sessions. "If getting a health coach certificate is helpful—if it makes you feel more confident as a professional or as an RD—then it can be beneficial."

However, many dietitians provide that coaching aspect without the official title. Torey Jones Armul, MS, RDN, CSSD, a national spokesperson for the Academy, says that she didn't go through any formal training but still considers herself a health coach. She personally considers all RDNs as health coaches.

"RDNs are the ultimate health coaches, in my opinion, because we're already talking with clients and patients about their health, and we follow evidence-based guidelines," Armul says. "Prevention is a major goal in health coaching, and dietitians have the added ability and credibility to address both prevention and treatment of chronic disease. Dietitians are still the experts in medical nutrition therapy."

However, if dietitians are willing to invest the time and money, Armul says some additional training certainly can be beneficial—particularly since health coaching has a slightly different focus than straight dietetics.

"Health coaching does place greater emphasis on an individual's 'whole health' or mind-body-soul health," Armul adds. "Health coaches may speak to nutrition, but they're also encouraged to address exercise, spirituality, interpersonal relationships, careers, and other factors that motivate health choices."

Armul says she likes the idea of more dietitians acknowledging the mind-body connection as a means of improving health and reducing chronic disease. "I think more dietitians can dig a little deeper into the internal motivations that influence their clients' food and health choices," she says. "And I like the idea of expanding the RDN's role to motivational coach rather than lecturer, disciplinarian, or academic."

Health coach training also can benefit RDNs by expanding their comfort zones beyond food and nutrition counseling, Armul adds. "It could spur more dietitians to speak comfortably, if they aren't already, about other aspects of physical and mental health that affect food, lifestyle, and health choices."

Pursuing Certification
If becoming a certified health coach is something dietitians want to pursue, they'll need to choose a good program. There are several different health coaching programs, each of which has its own unique strengths, Muth says. Before selecting one, do some research on what it has to offer (see sidebar for a short list of certification programs).

"The structure of training programs can vary considerably, and this is a field and profession that's rapidly evolving," Muth says. "Some programs are live training only. Others are through online training. Some are workbook and telephonic based, while others are self-study with a third-party administered online test. Currently, there's only one health coaching credential that has been accredited by a third party and that is the ACE Health Coach Certification, which is accredited by the National Commission for Certifying Agencies."

Some programs may require more prep work than others, but all will require at least some time and money. Crome, who went through ACE for her health coach credential, says she took several months to study for the exam. Crome also is a certified personal trainer through ACE so she was automatically attracted to its health coaching program. She says the emphasis of the program is based on a "total wellness concept."

The biggest challenge in pursuing a training program is finding the time. However, Muth says many programs are self-paced, giving RDs some flexibility in fitting it into their schedules. She feels the financial investment is relatively small when compared to the number of CPEUs, increased skills, and greater marketability that comes from earning this additional credential.

Nolan Cohn adds that beyond time and money, the other possible concern is unmet expectations. She met an individual who participated in a health coaching program and wasn't satisfied with the training received for the money spent. Many programs exist, and some are more credible than others.

"Since it's something you're investing in, take the time to research the program," Nolan Cohn says. "Ask for third-party opinions and find the program that really meets your needs and your expectations so you aren't disappointed."

As dietitians make the decision to formally pursue health coach training, they should think about how they'd market the certification to clients and how it'd benefit the type of work they do. For example, a dietitian in private practice would benefit more from health coach certification than one doing clinical work in a hospital. And even if RDs choose not to pursue training, Armul says all dietitians can benefit from thinking more about total body wellness.

"A special certification in health coaching isn't essential, but it's essential to remember that many factors—physical health, emotional health, stress, personal and professional relationships—affect food choices and eating behaviors and thus long-term health and risk of chronic disease," Armul says. "I'd encourage all dietitians to think of themselves as motivational health coaches and to consider the physical, mental, and social factors that go into our clients' food and lifestyle choices."

— Lindsey Getz is a freelance writer based in Royersford, Pennsylvania.