A new peer-reviewed essay in the CDC journal Preventing Chronic Disease asks us to look beyond the individual. Authors Fariha Niazi and Shazia Akhtarullah propose a framework for couple-centered health and wellness coaching, an approach that involves both partners in creating sustainable health behavior change. The idea is both practical and overdue: if two people share a kitchen, a bedroom, a calendar, financial decisions, stressors, and daily routines, why would we expect one of them to change in isolation?

Health is already a couple’s experience

Consider the lifestyle advice given to someone with a chronic condition: improve your diet, move more, sleep better, and reduce stress.Now consider what those changes may look like. One partner wants to cook more vegetables, but the other wants the familiar meals they have always shared. One is trying to go to bed earlier, while the other watches television in the bedroom. One needs time for a daily walk, but the couple has not discussed who will handle dinner or care for a family member. One is frightened by a diagnosis; the other responds by monitoring every bite and asking, “Are you supposed to eat that?”.

Research reviewed by relationship scientists Jean-Philippe Gouin and Maegan Dymarski shows just how interconnected partners can become. Couples often resemble one another in diet, physical activity, sedentary behavior, weight trajectories, and cardiometabolic risk. In one nationwide cohort, both partners had subpar cardiovascular health in 79% of couples (Comprehensive Psychoneuroendocrinology).

Interdependence can work in either direction. Partners can reinforce habits that undermine health, or they can help make healthier choices easier, more satisfying, and more sustainable.

What couple-centered coaching could look like

Rather than simply inviting a spouse to sit quietly beside the “real” client, in couples health coaching both partners actively take part. Both may set goals and change together.

A coach might help a couple:

· Describe a shared vision for health and daily life;

· Decide how meals, movement, sleep, or stress-reduction practices could fit their routines;

· Turn vague intentions into specific, realistic action steps;

· Anticipate obstacles and agree on how they want to handle them;

· Replace policing and nagging with encouragement, choice, and accountability;

· Notice what each partner is already doing well; and

· Review progress and adjust the plan without blame.

The new framework emphasizes joint goal setting, collaborative planning, reflection, shared tracking, attention to power dynamics, and referral when needs fall outside the coach’s scope (Preventing Chronic Disease).

Imagine a couple in which one partner has prediabetes. The coach does not prescribe a diet or tell the couple what they must eat. Instead, the coach may ask:

What would eating in a way that supports both of you look like?

Which evening routines make that easier, and which get in the way?

What kind of support feels encouraging rather than controlling?

What is one experiment you would both be willing to try this week?

The couple might decide to plan three dinners together, take a 15-minute walk after two of them, and keep the television out of the bedroom on weeknights. These are the couple’s self-determined commitments.

This is not couples therapy

The word “couple” can cause confusion, so the boundary needs to be explicit. Couple-centered health coaching is not couples therapy.

Health and wellness coaching focuses on self-directed goals, behavior change, strengths, accountability, and sustainable action. The National Board for Health & Wellness Coaching describes the coach as an accountability partner rather than a director. Coaches do not provide psychological treatment, diagnose conditions, prescribe, interpret medical data, or use therapeutic interventions unless they hold a separate credential that legally permits that work and clearly identify the role in which they are practicing (NBHWC Scope of Practice).

Here is the distinction in everyday terms:

Couple-centered health coaching

Couples therapy

“How can you build a weeknight routine that supports both of your sleep goals?”

“Why does bedtime conflict trigger feelings of rejection or abandonment?”

“What kind of reminder about medication feels helpful rather than intrusive?”

“How has a pattern of control and withdrawal affected trust in the relationship?”

“How can you divide household tasks so you both have time to move?”

“How do longstanding power struggles shape the way responsibilities are negotiated?”

“What shared food-shopping plan fits your budget, and health goals?”

“How are past experiences with food, body image, or trauma affecting the relationship?”

“What will you do when your walking plan is interrupted?”

“How can you repair emotional injuries and rebuild intimacy?”

It’s possible that couples health coaching uncovers underlying tension. If a conversation reveals coercion, fear, abuse, untreated depression, trauma, severe relationship distress, or another clinical concern, the coach does not try to treat it. The appropriate response is to refer to a licensed mental health professional or other qualified provider.

Couples therapy and couple-centered coaching can also complement each other. They simply have different purposes, methods, and professional boundaries.

From “your illness” to “our health”

One of the most compelling possibilities is that a partner who was not initially identified as the patient may also become healthier. If a couple cooks more nourishing meals, takes walks together, creates a calmer bedtime routine, or learns to support change without criticism, both people may benefit. Researchers sometimes call this a “ripple effect.”

The relationship itself may benefit as well. When partners approach a health challenge as “our shared concern” instead of “your problem,” they may practice clearer communication, recognize each other’s strengths, celebrate progress together, and reduce the friction created by nagging or resistance.

Health is shaped by a shared environment, and each person’s choices affect the other. Health coaching has always honored the whole person. Couple-centered coaching invites us to widen the frame once more: from the whole person to the relationships and routines in which that person lives.

When both partners are supported, both may become healthier. And as they learn to collaborate without blame, pressure, or policing, the relationship may become stronger too.

References

1. Niazi F, Akhtarullah S. Beyond the Individual: Couple-Centered Health and Wellness Coaching to Address the Burden of Chronic Conditions. Prev Chronic Dis. 2026;23:E37. doi:10.5888/pcd23.260070. PMID: 42658662.

2. Gouin J-P, Dymarski M. Couples-based health behavior change interventions: A relationship science perspective on the unique opportunities and challenges to improve dyadic health. Compr Psychoneuroendocrinol. 2024;19:100250. doi:10.1016/j.cpnec.2024.100250. PMID: 39155951.

3. Trief PM, Fisher L, Sandberg J, Cibula DA, Dimmock J, Hessler DM, Forken P, Weinstock RS. Health and Psychosocial Outcomes of a Telephonic Couples Behavior Change Intervention in Patients With Poorly Controlled Type 2 Diabetes: A Randomized Clinical Trial. Diabetes Care. 2016;39(12):2165–2173. doi:10.2337/dc16-0035. PMID: 27456837.

4. National Board for Health & Wellness Coaching. NBHWC Health & Wellness Coach Scope of Practice. Accessed August 31, 2026. https://nbhwc.org/scope-of-practice/

What AI Can Now Do with Your Lab Results

Direct-to-consumer lab testing makes it possible for people to order their own bloodwork without waiting for a physician referral. Function Health, founded by Dr. Mark Hyman, offers members more than 160 lab tests covering many that are not typically part of a standard panel ordered by a physician. They recently launched a secure connector that lets members bring those results directly into the AI platforms they already use, including ChatGPT, Claude, and Perplexity (PRNewswire). Function also expanded this integration through a dedicated health connector built for Perplexity, allowing members to combine lab data with clinician-reviewed summaries in one place (Yahoo Finance).

Using AI to manage personal health is already becoming common. In one study of public use of a leading AI chatbot, researchers found that one in five health-related conversations involved people describing symptoms, interpreting test results, or managing health conditions on their own (Nature). Stanford’s latest AI Index also reports that searches about symptoms and treatments now often include AI-generated overviews in the results (Stanford HAI). People are already turning to AI for health guidance; the key question is whether they are using it wisely.

The Human Connection AI Cannot Replace

A well-documented case makes the risk clear. A 76-year-old patient in Milwaukee uploaded her lab results to an AI chatbot while waiting to hear back from her care team, and the tool helped her understand her abnormalities and stay calm in the interim. Physicians and patient advocates quoted in the same report were candid about the limits of this approach: AI chatbots can produce incorrect answers, sensitive health information can end up in the wrong hands, and using these tools well requires a digital health literacy that includes verifying answers and consulting with one’s care team (News-Medical). An AI analysis of a lab panel is a starting point. Turning that analysis into a plan a person will follow is a different skill entirely. This is the skill that health coaches own.

AI can generate information, but a health coach helps a client make that information usable. Through careful listening, a coach considers the client’s current circumstances, readiness for change, and capacity to take action. A coach can support a client in identifying questions to bring to a physician, preparing for a productive appointment, and translating broad recommendations into two or three realistic, sustainable goals. Over time, the coach provides structure, encouragement, and accountability as the client practices new habits. This work remains firmly within the health coaching scope of practice: supporting behavior change, clarifying next steps, and helping clients follow through, never diagnosing, interpreting medical results, or prescribing treatment.

Why This Model Matters Now

The timing could not be more relevant. The Association of American Medical Colleges projects a shortage of up to 86,000 physicians in the United States by 2036, with primary care bearing a significant share of that gap (AAMC). Patients already feel the effects: the average wait for a new-patient appointment across major specialties climbed to 31 days in 2026, up from 26 days just a few years earlier (MGMA; AMN Healthcare). When someone can get lab results analyzed by AI in minutes but cannot see a physician for a month or more, a certified health coach becomes the bridge that keeps that person engaged and moving forward instead of losing momentum while they wait.

This is also a scalable model. A single physician can supervise a team of coaches supporting far more patients than that physician could counsel individually, and AI-assisted lab interpretation gives coaches a consistent, evidence-informed starting point for every client conversation. The combination extends what a limited physician workforce can realistically cover.

The Path to Reimbursement

The proposed CY 2027 Medicare Physician Fee Schedule gives this model a path to sustainability. The Centers for Medicare & Medicaid Services proposed national payment for health and well-being coaching services under CPT codes 0591T, 0592T, and 0593T, covering individual initial assessments, individual follow-up sessions, and group coaching, with coaching delivered by qualified auxiliary personnel under a supervising practitioner’s billing (CMS; Nixon Law Group). CMS also proposed recognizing National Board for Health & Wellness Coaching certification as a qualifying credential for coaches offering these services (NBHWC). At the present time, this is still a proposed rule with public comments open through September 14, 2026, and CMS could potentially revise the details before the proposal takes effect. But the direction is unmistakable: the agency responsible for the nation’s largest health insurance program has, for the first time, put a national payment structure for health coaching on the table.

Put these pieces together and the future comes into focus. AI handles the pattern recognition buried in hundreds of biomarkers faster and more thoroughly than any person could manage alone. A trained health coach handles the part AI cannot: a trusting human relationship that supports patient empowerment and self-efficacy. Add a Medicare reimbursement pathway to that combination, and health coaching stops being a wellness add-on that only certain people can afford. It becomes a key part of how a healthcare system truly promotes health and well-being. That is the future I see coming, and it’s the future the Functional Medicine Coaching Academy was built to prepare our profession for.

With love, Dr. Sandi

References

· PRNewswire. Millions of Americans Are Already Using AI for Health Questions; Function Lets Members Bring Personal Biology Into the Conversation, August 18, 2026. https://www.prnewswire.com/news-releases/millions-of-americans-are-already-using-ai-for-health-questions-function-lets-members-bring-personal-biology-into-the-conversation-302853565.html

· Yahoo Finance. Function Expands Its Growing Portfolio of AI Connectors. https://finance.yahoo.com/sectors/healthcare/articles/function-expands-growing-portfolio-ai-233900046.html

· Nature. Public use of a generalist LLM chatbot for health queries, April 2026. https://www.nature.com/articles/s44360-026-00117-x

· Stanford HAI. The 2026 AI Index Report, Medicine chapter. https://hai.stanford.edu/ai-index/2026-ai-index-report/medicine

· News-Medical. An AI assistant can interpret those lab results for you. https://www.news-medical.net/news/20250915/An-AI-assistant-can-interpret-those-lab-results-for-you.aspx

· National Board for Health & Wellness Coaching. NBHWC Health & Wellness Coach Scope of Practice.

https://nbhwc.org

· Association of American Medical Colleges. New AAMC Report Shows Continuing Projected Physician Shortage. https://www.aamc.org/news/press-releases/new-aamc-report-shows-continuing-projected-physician-shortage

· MGMA. New-patient wait times largely hold flat in 2026 as some groups add providers in bid to meet demand, citing AMN Healthcare’s 2025 Survey of Physician Appointment Wait Times. https://www.mgma.com/mgma-stat/new-patient-wait-times-largely-hold-flat-in-2026-as-some-groups-add-providers-in-bid-to-meet-demand

· Centers for Medicare & Medicaid Services. Calendar Year (CY) 2027 Medicare Physician Fee Schedule Proposed Rule Fact Sheet. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2027-medicare-physician-fee-schedule-proposed-rule

· Nixon Law Group. Can Health Coaches Bill Medicare in 2027? CMS’s Proposed Payment and Supervision Rules Explained. https://www.nixonlawgroup.com/resources/can-health-coaches-bill-medicare-in-2027-cmss-proposed-payment-and-supervision-rules-explained

· National Board for Health & Wellness Coaching. CMS Proposed Rule: Health & Wellness Coaching Coverage. https://nbhwc.org/cms-proposed-rule-health-wellness-coaching-coverage/

They used Self-Determination Theory (SDT) as their lens. SDT is a well-established framework built on three human needs: autonomy, competence, and relatedness. What they found should be communicated to every health coach who thinks their job is to function like a clinician by interpreting data from lab tests or giving advice.

It’s about the relationship, not the data

Of the 17 studies reviewed, eight reported meaningful improvements in quality of life. Each of those eight used motivational interviewing, the collaborative, empathic conversational style that helps people find their own reasons to change, rather than being told what to do. Four studies showed no significant improvement, and three of those four only provided education about COPD.

The differentiator was whether the coach knew how to be with another human being in a way that respected their autonomy and built trust. It was not disease education.

The review also identified the real barriers standing between a COPD patient and a better life, and they are almost entirely emotional: depression, anxiety, apathy, perceived futility, and feat of dyspnea (fear of not being able to breathe). Interventions that ignored these psychological barriers were inconsistently effective. Interventions that addressed them head-on were the ones that were successful. These coaching sessions involved building competence through emotional support, and fostering relatedness through genuine, empathic coach-client relationships.

Think about what that means for someone gasping for air. You can coach someone out of the paralyzing fear that keeps them from taking a walk, doing their pulmonary rehab exercises, or even leaving the house. That fear is often what determines whether a person thrives or withdraws. And fear responds to relationship.

Where I see coaches getting it backwards

I talk to a lot of coaches and prospective coaches who are convinced their edge is clinical sophistication, such as the ability to interpret a lab panel or recommend a supplement regimen. I understand the appeal. It feels rigorous. It feels like “real” expertise.

But here’s the uncomfortable truth: interpreting data is exactly the kind of task artificial intelligence is built to do well, and it is getting better at it fast.

AI tools can now ingest a lab PDF, extract every biomarker, cross-reference reference ranges, and explain multi-marker patterns in seconds. This shift has happened largely since 2024 as multimodal models learned to read documents directly rather than through clunky OCR pipelines (Meridix Labs). NPR recently reported on patients already using ChatGPT and Claude to interpret their own lab results while waiting for a doctor’s callback, with reasonably strong results for straightforward panels (NPR). Yes, there are real accuracy and validation concerns with these tools, particularly for complex or borderline cases (Dark Daily), but the trajectory is unmistakable. Pattern recognition across biomarkers is a data problem, and data problems are precisely what large language models are optimized to chip away at.

If the core of your coaching identity is “I’m the person who can read your labs,” you are building your practice on the one piece of ground that is eroding the fastest. That is not a competitive advantage. It’s a countdown.

What AI cannot do, and what this study proves actually works

Now compare that to what the COPD review just validated as the true mechanism of change: an empathic, autonomy-supportive, trust-based relationship between two human beings, one of whom is scared to breathe and the other of whom is fully present with them in that fear.

The research on this is consistent and growing. A comparison of automated chatbot coaching versus human coaching for chronic conditions found that while a scripted chatbot could be persistent and consistent, human coaches were “unmatched in their ability to express empathy and to flexibly expand the scope of support based on their understanding of individuals’ needs” (NIH/PMC). Stanford researchers evaluating large language models in therapeutic contexts found they fundamentally lack the identity, empathy, and genuine emotional engagement that a therapeutic alliance requires (iCANotes). AI cannot replicate the empathy, intuition, and personal presence that a coach brings to a session. It can’t notice the hesitation in someone’s voice, the fear they aren’t naming, the shift in body language that tells you today is not the day to push.

The coaches who will thrive

The coaches who anchor their value in becoming just like a clinician, someone whose main offering is decoding labs, biomarkers, and data, are competing in a race against a technology that is getting cheaper, faster, and more capable by the month. That is a losing position, not because data literacy is worthless, but because it was never the actual mechanism of transformation.

The coaches who anchor their value in emotional wellness and show up as an empathic, autonomy-honoring presence for clients are doing the one thing that cannot be automated. Relatedness is not a feature you can code. Trust is not a dataset. Being fully present with another person’s fear of not being able to breathe is a profoundly human act.

If you are a health coach, this is your moment to get intentional about your identity. Lean into the emotional and relational core of this work, including the skill of helping someone find their own reason to make lifestyle changes. That is where this research says the real outcomes live, and it’s also the one place AI cannot follow you.

References

1. Morgan EM, Layne DM, Phillips SM, Miller SN. Health and Wellness Coaching in COPD: An Integrative Review. Am J Lifestyle Med. 2026 Aug 8:15598276261473879. doi: 10.1177/15598276261473879. PMID: 42572523; PMCID: PMC13452887.

2. Mitchell EG, Maimone R, Cassells A, Tobin JN, Davidson P, Smaldone AM, Mamykina L. Automated vs. Human Health Coaching: Exploring Participant and Practitioner Experiences. Proc ACM Hum Comput Interact. 2021 Apr 22;5(CSCW1):99. doi: 10.1145/3449173. PMID: 36304916; PMCID: PMC9605038.

What Potential Medicare Reimbursement Means for Your Business

You will feel the effects of this proposal even if you never take a single Medicare client. Credibility is the currency of a private practice. Medicare recognition hands you a form of it that even the best marketing campaign never could. Every certified coach running an independent practice just got handed a stronger case to market your services to potential clients, pitch employers, and walk into a physician’s office and ask for referrals.

Analysts already see where this is heading. The health and wellness coaching market sits somewhere between 20 and 24 billion dollars this year, and projections put it at 32 to 36 billion dollars within the next four to nine years, with health and wellness coaching specifically cited as one of the fastest-growing segments inside that broader market (Coherent Market Insights; GlobeNewswire via Yahoo Finance; Mordor Intelligence). That growth was already underway before this proposed rule. Federal recognition is the accelerant.

The Threat That Could Undo All of It

I built FMCA on the principle that coaches do not diagnose or interpret labs, or prescribe treatments for medical conditions. Now that health coaching is poised to take a giant leap forward, my position on scope of practice is even more important.

Some training programs market themselves to prospective students by promising, directly or through a wink and a nudge, that coaches can order lab panels, interpret the results, and recommend treatment plans, including dietary supplements, for clients with chronic diseases. I hear about it constantly from prospective coaches who are confused because one program tells them this is acceptable practice and the way to increase earning potential, but another school maintains that engaging in the above practices means you’re practicing medicine without a license. NBHWC’s own scope of practice could not be clearer: coaches do not diagnose, do not interpret medical data, do not interpret lab results on their own, and do not develop or design treatment protocols. (NBHWC Scope of Practice; NBHWC).

Adhering to the coach scope of practice matters right now more than ever. Physicians are watching our profession closely as the Center for Medicare and Medicaid Services (CMS) considers making health coaching a reimbursable service.. Every time a coach steps outside of their lane, licensed medical providers do not just distrust that one coach. They view the whole profession as “unregulated” and “risky.” They vow that they will never refer patients to coaches or refrain from hiring them, including the health coaches who spent years building legitimate, ethical, evidence-based practices. One overreaching coach can undo the good reputation that thousands of board-certified coaches spent years earning (National Board for Health & Wellness Coaching).

A coach who thinks it is ok to order and interpret labs and design medical treatment plans, no matter how enticing it sounds, is toxic to the growth of the entire profession. Every program that markets these practices as a selling point is trading the long-term legitimacy of health coaching for short-term enrollment numbers. If we want doctors and other practitioners to trust us enough to refer patients, and if we want CMS and commercial insurers to keep expanding what they will pay for, we need every coach entering this field trained to know exactly where their role ends and a clinician’s role begins. Education is the entire foundation this Medicare opportunity is being built on and treating it as optional is how we lose everything we just gained.

The Growth Ahead If We Protect It

Picture the growth trajectory if we get the education part right. Physicians build coaching referral pipelines into their practices because they trust what a certified coach will and will not do. Hospital systems bring coaches onto care teams as a standard offering, not an experiment. Employers write coaching into benefits packages the way they write in physical therapy. Commercial insurers follow CMS’s lead and start reimbursing coaching sessions the way they reimburse other covered services. Your private practice sits inside a much bigger, much more trusted ecosystem, with warmer referrals, higher perceived value, and clients who no longer need convincing that this work is real.

That future is close: a proposed rule, a comment period ending September 14, and a training culture we can shape right now (CMS Physician Fee Schedule). The growth potential in front of this profession is bigger than anything I have seen in my years building FMCA. Whether we reach it depends on how seriously every training program takes the responsibility of teaching coaches to stay inside their lane while doing extraordinary work within it.

When I wrote Your Health Coach Will See You Now, I argued that coaches belong inside the healthcare system as trusted partners to physicians, not as a workaround to them. This proposed rule is the healthcare system starting to agree. Let us not be the reason it changes its mind.

With gratitude, Dr. Sandi

References

· National Board for Health & Wellness Coaching. LinkedIn announcement on the CY2027 Medicare Physician Fee Schedule proposed rule, July 15, 2026.

· Centers for Medicare & Medicaid Services. Physician Fee Schedule: CY 2027 Proposed Rule, comment deadline September 14.

· National Board for Health & Wellness Coaching. NBHWC Health & Wellness Coach Scope of Practice.

· National Board for Health & Wellness Coaching. Facebook post on scope-of-practice limits, including lab interpretation.

· Coherent Market Insights. Health Coach Market Size and YoY Growth Rate, 2026-2033, April 2026.

· GlobeNewswire via Yahoo Finance. Health Coaching Industry Report 2026-2035: A $35.6 Billion Market, February 2026.

· Mordor Intelligence. Life Coaching Market Size, Growth & Outlook, Report 2031, January 2026.

· Scheinbaum, Sandra. Your Health Coach Will See You Now: Creating a Healthier Future Together, Feed Your Mind Wellness Publications, March 2025.

As part of the proposed Calendar Year 2027 Medicare Physician Fee Schedule, the Centers for Medicare & Medicaid Services proposed national Medicare payment for Health & Wellness Coaching services under CPT codes 0591T through 0593T. CMS is also proposing to adopt a Medicare definition of Health & Wellness Coaching built on the CPT framework, and named the National Board for Health & Wellness Coaching Standards among the qualifying certification pathways for coaches who furnish these services (National Board for Health & Wellness Coaching). This is a proposed rule, not a final one, and comments are due by September 14, 2026 (CMS Physician Fee Schedule). But proposed rules from CMS carry real weight, and this one signals something bigger than a coding update. It means that federal healthcare policy is starting to treat health coaching as a legitimate, evidence-based service that belongs in modern medicine.

What CMS Is Actually Proposing

CMS is proposing to allow coaching services under general supervision, which means coaches could deliver care through community-based organizations rather than only inside a physician’s office. They’re also considering allowing medically necessary sessions without a preset frequency limit, which acknowledges that behavior change does not follow a rigid, one-size-fits-all schedule. Some clients need weekly touchpoints for months. Others need a lighter cadence once new habits take hold. A flexible model respects that reality. On top of all this, CMS is seeking public comment on whether to establish dedicated HCPCS G-codes for these services beginning in CY 2027, which would give coaching its own permanent home in the Medicare coding system rather than relying on temporary Category III codes (National Board for Health & Wellness Coaching).

These developments did not happen overnight. The CPT codes at the center of this proposal, 0591T, 0592T, and 0593T, trace back to 2019, when the Department of Veterans Affairs worked with the National Board for Health & Wellness Coaching to establish coaching-specific codes, which the AMA CPT Panel approved in May 2019 (American Journal of Lifestyle Medicine). In 2024, CMS added these codes to the Medicare Telehealth Services List on a temporary basis, asking the field to demonstrate clinical outcomes before granting permanent status (American Journal of Lifestyle Medicine). Throughout 2025 and into 2026, NBHWC stayed engaged with CMS leadership, submitted formal responses, and worked with healthcare systems and national partners to build the evidence-based case for integration (NBHWC Community Update). This proposed rule is the fruit of that collaborative advocacy. It is proof that showing up consistently at the policy table, year after year, eventually moves the conversation forward.

The Game Changer for Coaches Who Will Never Bill Medicare

I know many of you reading this run your own private coaching practices, and some of you may have already decided you will never accept Medicare clients or navigate its billing requirements. I understand that choice completely, and I want to be direct with you about why this proposal still changes everything for your business and for the health coaching profession as a whole.

Federal recognition is a credibility multiplier that reaches far beyond the beneficiaries who might one day use these specific codes. When CMS proposes a definition of Health & Wellness Coaching and names NBHWC standards as a qualifying certification pathway, it hands every certified coach a form of validation that no marketing campaign could ever buy. Prospective clients who have never heard of health coaching, or who have wondered whether it is “real,” now have a federal agency effectively saying it is real enough to build a Medicare benefit around. Physicians who have been hesitant to refer patients to coaches will take notice when the agency that governs their own reimbursement starts recognizing coaching as a covered service. Commercial insurers, who frequently follow CMS’s lead when deciding what to cover, will feel new pressure to expand their own coaching benefits, which opens referral and reimbursement pathways even for coaches who never file a Medicare claim directly. Employers designing wellness benefits, hospital systems building integrated care teams, and grant-making organizations funding community health programs all pay attention to what CMS does, and this proposal gives all of them a green light to invest more seriously in health coaching.

There is also a workforce dimension worth naming here for FMCA and for every training program in this field. As health systems and community organizations begin building coaching into their care models under general supervision, they will need trained, certified health coaches to fill those roles. That demand will not only benefit coaches who choose to work within Medicare-adjacent structures. It will elevate the perceived value of certification itself, which raises the floor for the entire profession, including those of you running independent, cash-pay practices. When the credential you hold becomes the credential a federal agency has vetted, your clients trust it more, your referral partners respect it more, and you can charge accordingly.

This Is the Vision I Wrote About

When I wrote Your Health Coach Will See You Now, I made the case that health coaches belong inside the healthcare system, working alongside physicians and care teams rather than existing on its periphery. I argued that the future of chronic disease prevention and management depends on integrating coaching into how care is actually delivered and paid for, not just offering it as a boutique add-on for people who can afford to pay out of pocket. This proposed rule is a concrete, federal-level step toward that exact vision. It does not mean every coach must join a Medicare-based practice model, and it certainly does not mean the work is finished. Public comments are open until September 14, and NBHWC has committed to reviewing the proposal carefully and continuing to advocate through the comment process (National Board for Health & Wellness Coaching). But the conversation has moved. We are no longer debating whether Health & Wellness Coaching belongs in healthcare. We are now discussing how to integrate it responsibly, and that shift in framing is exactly what I hoped this profession would achieve when I wrote that book, and when I founded FMCA in 2014.

With love, Dr. Sandi

References

· Scheinbaum, Sandra. Your Health Coach Will See You Now: Creating a Healthier Future Together, Feed Your Mind Wellness Publications, March 2025.

· National Board for Health & Wellness Coaching. LinkedIn announcement on the CY2027 Medicare Physician Fee Schedule proposed rule, July 15, 2026.

· Centers for Medicare & Medicaid Services. Calendar Year (CY) 2027 Medicare Physician Fee Schedule Proposed Rule fact sheet, July 14, 2026.

· Centers for Medicare & Medicaid Services. Physician Fee Schedule: CY 2027 Proposed Rule, comment deadline September 14.

· National Board for Health & Wellness Coaching. Community Update: Advancing Access & Reimbursement for Health & Wellness Coaching, April 2026.

· American Journal of Lifestyle Medicine. Health & Wellness Coaching Services: Making the Case for Reimbursement, July 2024.

Functional medicine trains practitioners to ask what in a person’s environment is driving dysfunction, whether that’s a food sensitivity, a toxin, a disrupted circadian rhythm, or an unmanaged stress load. Screens belong on that list, particularly for children. A child’s developing nervous system responds to a smartphone or tablet the way it responds to any other source of chronic overstimulation: with a stress response that, repeated daily, reshapes baseline functioning.

The mechanism starts with light. Screens emit short-wavelength blue light that suppresses melatonin production by signaling to the brain that it is still daytime, and children are more vulnerable to this effect than adults. Research from the University of Colorado Boulder found that when children and adults were exposed to identical light conditions in the evening, the children’s melatonin levels fell roughly twice as much, and a related study on self-luminous device exposure in adolescents documented significant melatonin suppression after just one to two hours of screen use before bed (LeBourgeois et al., ScienceDaily coverage). A large population-based study of nearly ten thousand Norwegian adolescents found a clear dose-response relationship between electronic device use and sleep outcomes: heavier daytime and bedtime screen use predicted shorter sleep duration, longer time to fall asleep, and a substantially elevated risk of clinically significant sleep deficiency (Hysing et al., 2015, BMJ Open). Sleep is not a peripheral concern. It is the process through which the HPA axis resets overnight, through which cortisol follows its normal diurnal curve, and through which the nervous system recovers from the ordinary stress of the day. Disrupt it consistently and every downstream system, mood, immune function, attention, glucose regulation, absorbs the cost.

Beyond sleep, the reward circuitry involved in screen use behaves the way any potent, intermittent-reinforcement stimulus behaves on a developing dopamine system, training the brain to expect rapid novelty and making slower, effortful, less stimulating activities, like reading or unstructured play, feel comparatively unrewarding by contrast. The American Academy of Pediatrics documented the resulting pattern across large populations and found that excessive screen use in children correlates with disrupted sleep, reduced physical activity, weaker academic performance, and elevated rates of anxiety and depression (American Academy of Pediatrics). Twenge and Campbell’s analysis of three separate national datasets found a consistent association between higher screen use and lower psychological well-being in children and adolescents. (Twenge & Campbell, 2019, Psychiatric Quarterly). Radesky and Christakis, writing in Pediatric Clinics of North America, connect increased screen exposure in early childhood specifically to disrupted development in the domains functional medicine practitioners already track closely: self-regulation, attachment, and executive function (Radesky & Christakis, 2016, Pediatric Clinics of North America). This pattern represents a predictable biological response to a chronic environmental stressor, which is precisely the framework functional medicine already applies to diet, toxin exposure, and chronic stress, and it applies with equal force to screens.

Building a Digital Wellness Practice

Digital wellness for children and families is a legitimate, underserved coaching specialization. Parents may need education about the consequences of too much screen time, or may be exhausted by repeated conflicts over screen time. They may lack support or a structured plan. Schools are seeing the downstream academic and behavioral effects without the resources to address the home environment that drives them. Health coaches can step into this space as they can provide knowledge and support for behavior change.

Organize Screen-Free Experiences

Families who reduce screen time need something to move toward, not just something removed, and a coach can help design that replacement. Nature-based activities work particularly well because they require no special equipment and engage a child’s attention in ways screens cannot replicate. Handing a child a pair of binoculars and a simple question, which birds can you find, how many different leaves can you collect, turns an ordinary walk into an investigation. My preschool-aged grandchildren received binoculars as a gift and they became active observers of their surroundings.

Skill-based mentorship carries similar weight. One of the most formative learning experiences in my own childhood came when a friend’s mother taught me to knit when I was nine years old. Coaches working with families can recommend or help organize this kind of intergenerational skill-sharing. Basic cooking or gardening would be great activities that also reinforce healthy lifestyle choices.

Helpful Resources for Coaches and Families

Several organizations offer material a coach can put to direct use in a digital wellness practice, and each serves a different part of the work. Common Sense Media provides age-based media reviews and family conversation guides well suited to workshop handouts and group coaching curriculum. (Common Sense Media). Screen Sanity offers a parent education framework grounded in adolescent brain development. (Screen Sanity). ScreenStrong builds tools for parents delaying smartphone access and works well as a reference a coach can point families toward when they are deciding whether and when to introduce a first phone (ScreenStrong). Wait Until 8th runs a pledge campaign encouraging parents to delay smartphones until eighth grade, and its effectiveness comes from shared agreement among groups of parents, which makes it a natural resource for a coach whose clients know each other through a school or a coaching cohort (Wait Until 8th). Let Grow focuses on restoring independent, unsupervised childhood experience, and its research base pairs well with coaching conversations about the developmental costs of constant monitoring, screen-based or otherwise (Let Grow).

The Power of Community

I wrote previously that your best health investment is your community, and the same principle governs this work. A parent trying to reduce screen time alone, without support, is relying on willpower to override both a child’s resistance and the cultural normalization of constant device use. A parent working with a coach plus a group of other parents facing the same daily friction has the sustained relational support and social reinforcement that makes a hard change feel less like an isolated act of deprivation and more like a shared, reasonable norm.

This is also, ultimately, the argument for why digital wellness deserves a place among the specializations a health coach actively builds a practice around. The physiological stakes are real and well documented, the families who need this support are not currently getting it anywhere else, and the specific skills a coach brings, in behavior change facilitation, motivational interviewing, and sustained accountability, are exactly the skills this problem requires.

Health coaches can also play an important role that reaches beyond individual families into institutional policy. One of the most effective levers for reducing smartphone use in children is school-level change, and parent-organized advocacy has proven capable of achieving it. A clinical child psychologist I know recruited a group of parents from her own child’s school, brought the research to school administrators, and successfully persuaded the school to adopt a firm no-smartphone and no-tablet policy across the campus. The policy held because it came from parents who understood the evidence, spoke to it credibly, and arrived as a group rather than as isolated complainants. Health coaches are well positioned to support exactly this kind of parent coalition: helping parents understand the physiological and developmental research, preparing them to present it persuasively to administrators, and building the community momentum that turns a concerned handful of families into a coordinated, effective voice for change.

References

1. American Academy of Pediatrics. “Media and Children.” https://www.aap.org/en/patient-care/media-and-children/

2. Apple Support. “Use Screen Time on your iPhone, iPad, or iPod touch.” https://support.apple.com/en-us/105121

3. Google. “Family Link.” https://families.google/familylink/

4. Common Sense Media.

https://www.commonsensemedia.org

5. Screen Sanity.

https://www.screensanity.org

6. ScreenStrong.

https://screenstrong.org

7. Wait Until 8th.

https://www.waituntil8th.org

8. Let Grow.

https://letgrow.org

9. Twenge, J. M., & Campbell, W. K. (2019). “Media Use Is Linked to Lower Psychological Well-Being: Evidence from Three Datasets.” Psychiatric Quarterly, 90(2), 311–331. https://doi.org/10.1007/s11126-018-9630-6

10. Radesky, J., & Christakis, D. A. (2016). “Increased Screen Time: Implications for Early Childhood Development and Behavior.” Pediatric Clinics of North America, 63(5), 827–839. https://doi.org/10.1016/j.pcl.2016.06.006

11. Hysing, M., Pallesen, S., Stormark, K. M., Jakobsen, R., Lundervold, A. J., & Sivertsen, B. (2015). “Sleep and use of electronic devices in adolescence: results from a large population-based study.” BMJ Open, 5(1), e006748. https://bmjopen.bmj.com/content/5/1/e006748

12. LeBourgeois, M. K., et al., University of Colorado Boulder research on evening light exposure and melatonin suppression in children, reported in “Children uniquely vulnerable to sleep disruption from electronics.” ScienceDaily. https://www.sciencedaily.com/releases/2017/11/171101130549.htm

Four years ago, I moved to a new town. I’d had a rich social life in the city I came from, with lots of friends and acquaintances, and I knew I wanted to build that again. When I learned about a women’s social club that’s been welcoming residents here since the 1950s, I decided to join. Any woman in town can become a member, and the dues are genuinely affordable.

This club fulfills my need for a local community. On any given week, I might join one of four walking groups, attend a morning or evening book club discussion, or sign up for the next restaurant explorers outing. They offer regular card games (mahjong, canasta, and euchre), though I’d need to take lessons before I could join those tables. There’s a craft stitching group where we sit together, needles in hand, talking and laughing. There’s ladies’ night out every month, evening socials, and special events that keep me genuinely looking forward to what’s next. With over 400 members, not everyone goes to every activity. That’s the beauty of it. There’s just something for everybody. I’ve made more new friends in the past four years through this club than I had in the previous decade. I truly cherish it.

Let me tell you why this matters.

We’re Wired for Community

We’re not meant to live in isolation. We evolved in groups, tribes, and communities. Connection is a biological necessity, and the science is making this undeniably clear.

In 2023, U.S. Surgeon General Dr. Vivek Murthy issued an advisory declaring loneliness a public health epidemic. His conclusion was striking: lacking social connection can increase your risk for premature death as much as smoking up to 15 cigarettes a day. These are shocking statistics. We’ve spent decades warning people about the dangers of smoking. We’ve banned it in restaurants, taxed it, slapped warning labels on the packages. And yet loneliness (which is everywhere, invisible, and socially acceptable) carries the same mortality risk.

Researcher Julianne Holt-Lunstad, PhD, professor of psychology and neuroscience at Brigham Young University, ran two large meta-analyses and arrived at the same finding: loneliness, social isolation, and living alone are independent risk factors for early mortality, increasing the risk by about a third, equivalent to smoking 15 cigarettes per day. What this means is that it predicts mortality above and beyond what your diet, your exercise, or your other health behaviors explain.

Here’s the most sweeping evidence of all. The Harvard Study of Adult Development followed more than 700 people since 1938, tracking their health, relationships, work, and wellbeing across their entire adult lives. It’s the longest-running scientific study of adult life ever conducted. The finding, after 85 years of data: the number one predictor of long-term health and happiness is the quality of your relationships. As Dr. Robert Waldinger, the study’s director, stated: “Good relationships keep us healthier and happier.” People who felt the most satisfied in their relationships at age 50 turned out to be the healthiest at age 80, and that held true regardless of cholesterol levels, income, or social class.

A meta-analysis of more than 3.4 million participants found that loneliness raises your risk of early death by 26%, social isolation by 29%, and living alone by 32%. Loneliness also connects to increased risk of heart attack, stroke, type 2 diabetes, depression, anxiety, dementia, and Alzheimer’s disease. The same research also found the risk of loneliness exceeds the risk from physical inactivity, obesity, and air pollution.

And loneliness increases as we get older.

The Real Challenge of Later Life

Research from Northwestern University shows that loneliness follows a U-shaped curve across the lifespan. It peaks in young adulthood, dips in midlife, and rises again after age 60, steepening around age 80. Bereavement, health challenges and caregiving demands increase. Old friends become sick or pass away. Families scatter. Work, which gave so many of us a ready-made social structure, recedes from our lives. The clubs and organizations we once belonged to don’t always fit anymore.

Sociologist Robert Putnam identified this problem decades ago.

Bowling Alone: The Warning We Didn’t Heed

In his landmark 2000 book Bowling Alone: The Collapse and Revival of American Community, Robert Putnam documented one of the most important and overlooked trends of the 20th century: the dramatic decline in social capital across the United States. Social capital (the networks, norms, and trust that come from human connection) had risen steadily through the mid-20th century, and then it fell sharply.

His title came from a counterintuitive finding: more Americans were bowling than ever, but bowling leagues had collapsed. People were bowling alone. Voter turnout declined, civic organizations shed members, church attendance dropped, and people reported having fewer close friends and confidants. Putnam identified the culprits: television, time and money pressures, suburban sprawl, and generational change. A highly civic-minded generation was aging out, and the generations behind them weren’t filling the gap.

The consequences Putnam predicted weren’t abstract. Communities with lower social capital had worse health outcomes, shorter lifespans, lower-performing schools, higher crime rates, and weaker economies. A disconnected society, he argued, is a less healthy, less resilient, less flourishing society.

That was 2000. We now have the data to confirm he was right.

What the Blue Zones Teach Us

The Blue Zones are the five regions of the world where people live the longest and healthiest lives: Okinawa, Japan; Sardinia, Italy; Nicoya, Costa Rica; Ikaria, Greece; and Loma Linda, California. Researcher and author Dan Buettner spent years studying these communities and identified what he calls the Power 9, the lifestyle factors that consistently predict exceptional longevity.

Diet’s there. Movement’s there. Purpose is there. But so is community, woven through nearly every factor on the list. In Okinawa, people form moais, groups of five friends who commit to each other for life, meeting regularly and offering mutual support. In Sardinia, the social fabric centers on family and daily gathering in the village square. In all five Blue Zones, people live embedded in communities that give them belonging, shared rituals, and accountability.

Buettner puts it plainly: not a single centenarian in his research deliberately pursued health as a goal. Their health came as a byproduct of where they lived: the culture, the rituals, the people around them. People in Blue Zone communities live seven good years longer than most Americans, with one-fifth the rate of dementia and one-sixth the rate of cardiovascular disease.

A 98-year-old woman in one of these communities offered what may be the simplest summary of what it means to thrive: “We all need four things: someone to love, something to do, some way to give back, and something to look forward to.”

Social connection provides all four.

The Hunger for Togetherness

Something real is happening in our culture right now. After years of screens, social media, remote work, and pandemic isolation, people are hungry for face-to-face connection. They’re rediscovering it in unexpected places.

Mahjong, a tile game with roots in 19th-century China, has become one of the great cultural surprises of the past few years. Yelp data shows that searches for mahjong clubs surged 4,467% year over year from September 2024 to August 2025, and searches for mahjong lessons rose 819%. Listings for mahjong events on Eventbrite rose 179% from 2023 to 2024. Luxury hotels are hosting mahjong nights. Julia Roberts and Meghan Markle have both gone public about their weekly games. Mahjong studios are opening across the country.

Who’s driving this surge of interest? Turns out it’s millennials and Gen Z, who you’d expect to be glued to their phones, are instead clacking tiles together at bars and restaurants, coffee shops and community centers, and warehouses with live DJs. “It’s not just about learning mahjong; it’s about finding a third space or another community to engage with,” said one young player in San Francisco.

The same thing’s happening with needlepoint. TikTok posts with #needlepoint increased by 400% in the first ten months of 2024 compared to the same period in 2023. Young women in their twenties and thirties are gathering in needlepoint circles, taking classes at local shops, and building communities around their craft. St. Louis Magazine calls it “the analog boom”: people who are tired of screens and doomscrolling are picking up needles and thread as a way to slow down, focus, and most importantly, be together.

Grandmas were onto something. The “granny hobbies” are about so much more than the hobby itself. They’re about the table you sit around, the people across from you, the laughter and conversation and the simple, irreplaceable experience of being in the same room with other human beings.

Community as Medicine

Before we talk about what health coaches can do, let’s consider what’s physiologically happening when people gather in groups, the community acts as medicine.

When you spend time in the company of people you enjoy, your body lowers its cortisol output, your blood pressure drops, your immune system strengthens, and your brain releases oxytocin, the same bonding hormone that drives attachment between parents and children. Research shows that social support directly buffers the body’s stress response, reducing inflammation that drives everything from cardiovascular disease to cognitive decline. A 2023 review in Frontiers in Medicine found that community-based social programs consistently produce improvements in mental health, wellbeing, and social connectedness, and cut healthcare utilization in the process.

This is the idea behind the growing “social prescribing” movement, now well-established in the UK and gaining ground in the U.S. Doctors literally prescribe community activities (art groups, walking clubs, volunteering, shared hobby circles) as part of their patients’ treatment plans. Social prescribing links connect people to non-clinical community resources and have produced reductions in emergency room visits, hospital admissions, and GP appointments. The NHS now employs thousands of “link workers” whose entire job is to connect patients to community.

Community isn’t just good for morale. It changes your biology.

The Power of Group Health Coaching

Here’s where health coaching becomes especially powerful, and where I see it doing some of its best work.

Most people think of health coaching as a one-on-one experience. You sit with a coach, you talk about your goals, and you make an action plan. Group health coaching takes the medicine of community and combines it with the structure, accountability, and guidance that coaching provides. The result is something greater than the sum of its parts.

In a group coaching program, something remarkable happens. People stop feeling like the only one struggling. They hear someone else describe exactly what they’ve been going through (the isolation, the health challenges, the difficulty making changes) and they feel less alone. That shift is therapeutic in itself. Research on group-based health interventions consistently shows that the social dimension of the group, the peer support, the shared experience, the sense of belonging, drives outcomes just as much as the content.

Group coaching also gives participants a built-in community. They show up week after week to the same people. They celebrate each other’s progress. They hold each other accountable in ways that even the best coach can’t replicate alone. Studies comparing group health coaching to individual coaching find that group formats produce comparable or better outcomes for conditions like diabetes, weight management, hypertension, and depression, often at lower cost and with greater sustainability.

When the focus of group coaching is social connection itself the impact deepens further. A study published in the American Journal of Geriatric Psychiatry found that older adults who participated in a community health coaching program reported significantly decreased loneliness and improved social connectedness at six months. These weren’t people who just got information about loneliness. They experienced the antidote while they learned about it. The coaching group itself becomes the community, as the program doesn’t just tell people to get connected, it connects them.

How Health Coaches Can Help Every Client

Whether they work in groups or one-on-one, skilled health coaches bring something uniquely valuable to the loneliness crisis: they treat the whole person.

The health coaching industry is now a $22 billion market in the U.S., growing at nearly 10% per year, and one of the biggest reasons is exactly this: people want personalized, human support for the lifestyle challenges that medicine alone doesn’t address. Loneliness sits right at the top of that list.

A skilled health coach doesn’t just hand you a supplement protocol or a meal plan. They create a safe, supportive space where you feel genuinely heard. They help you explore what’s really driving your isolation, whether it’s a major life transition, a move to a new city, grief, or simply the slow drift that happens when we get busy. They work with you to set realistic, manageable goals for re-engaging socially: attending a local group activity, joining a hobby class, volunteering for a cause you care about. They can point you toward community resources you didn’t know existed and hold you accountable for actually showing up.

If you’re working with a coach, or considering it, bring this to the conversation. Tell them you want to build more community into your life. If you’re a health coach reading this, know that addressing loneliness and social isolation is fully within your scope, and your clients desperately need this from you.

Look Around You

People are craving in-person gathering. The clubs, the groups, the activity circles that might seem like small things are, in fact, among the most health-promoting choices you can make. Walking groups, book clubs, card games, crafting circles, restaurant outings, evening socials: these are the best medicine.

The research is unambiguous: social connection is one of the strongest predictors of how long you’ll live and how well you’ll live. It lowers cortisol, boosts immune function, reduces cardiovascular risk, and slows cognitive decline. It’s an independent protective factor, meaning it matters beyond all your other healthy behaviors. You can eat perfectly and exercise every day and still carry elevated risk if you’re socially isolated.

Robert Putnam warned us we were losing the social fabric that holds communities together. The Surgeon General declared a loneliness epidemic. The Blue Zone centenarians lived their long, vibrant lives deep inside community. And a whole generation of young people, searching for something real, is rediscovering the ancient pleasure of sitting together around a table, playing a game, and simply being present with one another.

What I found with a local women’s social club you can find somewhere. Find your club. Find your group. Find your community. Show up. Keep showing up. The people who’ll become your friends are already looking for you.

Love, Sandi

Sandra Scheinbaum is a functional medicine health coach educator, author, speaker, and founder of the Functional Medicine Coaching Academy. She writes about longevity, wellness, and the science of living well.

References

1. Murthy, V. H. (2023). Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community. U.S. Department of Health and Human Services. https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf

2. Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227-237. https://blogs.the-hospitalist.org/content/silent-epidemic-loneliness-serious-threat-both-brain-and-body

3. Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLOS Medicine, 7(7), e1000316. https://pmc.ncbi.nlm.nih.gov/articles/PMC8504333/

4. Cacioppo, J. T., & Cacioppo, S. (2018). The growing problem of loneliness. The Lancet, 391(10119), 426. Referenced via: The Guardian (June 16, 2024). The loneliness trap: it is as bad as smoking 15 cigarettes a day. https://www.theguardian.com/lifeandstyle/article/2024/jun/16/the-loneliness-trap-it-is-as-bad-as-smoking-15-cigarettes-a-day-so-will-it-shorten-my-lifespan

5. Putnam, R. D. (2000). Bowling Alone: The Collapse and Revival of American Community. Simon & Schuster. Summary via Beyond Intractability: https://www.beyondintractability.org/bksum/putnam-bowling

6. Buettner, D. (2012). The Blue Zones: 9 Lessons for Living Longer from the People Who’ve Lived the Longest (2nd ed.). National Geographic Society. Power 9 factors: https://www.ncbi.nlm.nih.gov/books/NBK298903/

7. Health Policy Watch. (2023). Healthy minds, longer lives: Inside the science and promise of Blue Zones. https://healthpolicy-watch.news/healthy-minds-longer-lives-inside-the-science-and-promise-of-blue-zones/

8. International Council of Shopping Centers. (2025). From game night to a third place: Is mahjong the next pickleball? https://www.icsc.com/news-and-views/icsc-exchange/from-game-night-to-a-third-place-is-mahjong-the-next-pickleball

9. Associated Press. (2024). Mahjong clubs are surging in popularity across the U.S. https://apnews.com/article/mahjong-popularity-san-francisco-chinese-game-b0dea60bce21804756c0d5c241571056

10. Axios. (December 7, 2024). Needlepoint and other “grandma hobbies” are trending on TikTok. https://www.axios.com/2024/12/07/needlepoint-grandma-hobbies-tiktok

11. St. Louis Magazine. (2024). From grandma hobby to Gen Z trend: Needlepoint finds a new audience. https://www.stlmag.com/design/from-grandma-hobby-to-gen-z-trend-needlepoint-finds-a-new-audience-in-st-louis/

12. GlobeNewswire. (April 27, 2026). Health Coach Global Market Report 2026: Revenue to grow by nearly $10 billion during 2026-2030. https://www.globenewswire.com/news-release/2026/04/27/3281427/0/en/Health-Coach-Global-Market-Report-2026-Revenue-to-Grow-by-Nearly-10-Billion-During-2026-2030.html

13. American Council on Exercise. (November 2024). Addressing social isolation and loneliness: A guide for health coaches and exercise professionals. ACE Certified. https://www.acefitness.org/continuing-education/certified/november-2024/8743/addressing-social-isolation-and-loneliness-a-guide-for-health-coaches-and-exercise-professionals/

14. AFPA Fitness. (2023). Health impact of loneliness and social isolation and how health and wellness coaches can help. https://info.afpafitness.com/blog/health-impact-of-loneliness-and-social-isolation-and-how-health-and-wellness-coaches-can-help/

15. Steinman, L., Hammerback, K., & Snowden, M. (2020). Could they be doing more? The Leveraging Exercise to Age in Place (LEAP) Study. The American Journal of Geriatric Psychiatry. https://pmc.ncbi.nlm.nih.gov/articles/PMC7563028/

16. Haigh, F., et al. (2023). Social prescribing outcomes: a mapping review of the evidence from 13 countries to identify key common outcomes. Frontiers in Medicine. https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1266429/full

17. Valtorta, N. K., et al. (2016). Loneliness and social isolation as risk factors for coronary heart disease and stroke. Heart, 102(13), 1009-1016. Referenced via: NIH/PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3864559/

18. Waldinger, R., & Schulz, M. (2023). The Good Life: Lessons from the World’s Longest Scientific Study of Happiness. Simon & Schuster. Harvard Study of Adult Development overview: https://news.harvard.edu/gazette/story/2017/04/over-nearly-80-years-harvard-study-has-been-showing-how-to-live-a-healthy-and-happy-life/ Full study home: https://www.adultdevelopmentstudy.org

By now you may have heard that Apple shelved its ambitious AI health coaching project, internally called “Mulberry” and “Health+.” It was supposed to launch as a subscription service alongside iOS 26. Then, after a leadership change, Apple’s new services chief Eddy Cue looked at what the team built and decided it wasn’t good enough. A lot of wellness tech watchers called this a setback, but I think it’s the right outcome.

The back story at Apple.

Apple had been building Mulberry for years. It was meant to be a fully AI-powered health coach built right into your iPhone, trained on data from physicians, nutritionists, physical therapists, sleep experts, and cardiologists. It would have analyzed your biometrics, offered lifestyle recommendations, and given you video content from health pros. It was Apple’s biggest-ever swing at health software.

Then Eddy Cue took over the health division after longtime COO Jeff Williams retired. Cue looked at what was there and said it wasn’t competitive. Reports also cited FDA regulatory concerns about AI-generated health advice, plus broader questions about AI reliability. Apple is now rolling out some features piecemeal inside the existing Health app, without the sweeping coaching platform.

AI can give you information. It can’t give you a relationship.

Here’s what I’ve spent my career understanding, and what we teach at FMCA: real behavior change happens because of relationship.

When a health coach sits with a client, something happens that no algorithm can replicate. There’s trust being built. There’s a human being who sees you, not your metrics. A good coach hears what you’re not saying. They notice when something’s off. They ask the question you weren’t expecting, the one that leads to a critical “aha” moment which will make successful behavior change possible.

An AI can’t do that. It doesn’t know that you’ve been grieving. It doesn’t know that your sleep is wrecked because you’re worried about your job, or that you grew up in a house where food was complicated and emotional. It doesn’t know your why. And without the why, you’re just managing symptoms.

Accountability isn’t the same as reminders.

One of the things I hear from people about AI coaching apps is, “It keeps me on track.” And I understand the appeal. But there’s a difference between a push notification and genuine accountability.

A human coach recognizes when you’re making excuses. They’re not swayed by “I’ve been busy.” They’ve heard it before, and with warmth and honesty, can reflect it back in a way that creates real progress. They can help you build a plan that fits your life and meet you exactly where you are.

The FDA’s concerns are legitimate.

The reports about Mulberry mentioned FDA regulatory concerns as one reason the project stalled. I want to be clear: those concerns are warranted.

We’ve all seen what happens when people Google their symptoms. Hours later, they’ve convinced themselves they have three rare conditions and their doctor is missing something. AI health coaching at scale, delivered directly to hundreds of millions of iPhone users, is that problem amplified. Without a licensed, trained human in the loop, personalized health guidance can be one-size-fits-all dressed up with your name on it.

Functional medicine is about understanding the individual, the whole person, in context. An AI doesn’t have context. It has data.

Being heard by another human being is irreplaceable.

I’ve been in this field a long time. I’ve watched it evolve and seen the tools change. One thing stayed constant: the most powerful moment in any coaching relationship is when a client has a clear picture of what they want their health for.

That doesn’t happen with a chatbot. It happens because a real person created enough safety and warmth and genuine presence that something true could come forward. That’s the art of coaching. That’s what we train coaches to do.

I want to be clear about something: I'm not anti-AI. At FMCA, we actually teach our students how to use AI responsibly as part of their practice. There are real ways it can help coaches with administrative tasks, research, content, and between-session support. But there's a line between AI as a tool that supports a coach and AI as a replacement for one. That line matters enormously. If you're curious about where that line is, we wrote a guide on exactly this: The Health Coach's Complete Guide to AI.

Technology is a wonderful tool. But Apple’s stumble with Mulberry serves as a reminder that the most important health resource you have is another human being who genuinely cares about your well-being.

If you’re a health coach, this is your moment. The world needs what you do.

With love,

Sandi

References

1. Bloomberg, “Apple Is Scaling Back Plans for AI-Based Health Coach Service,” February 5, 2026. https://www.bloomberg.com/news/articles/2026-02-05/apple-is-scaling-back-plans-for-new-ai-based-health-coach-service

2. 9to5Mac, “Apple Reportedly Scales Back Plans for AI-Powered Health Coach,” February 5, 2026. https://9to5mac.com/2026/02/05/apple-reportedly-scales-back-plans-for-ai-powered-health-coach/

3. Athletech News, “Apple Is Scaling Back Its AI Health Coach Plans, Per Report,” February 9, 2026. https://athletechnews.com/apple-is-scaling-back-its-ai-health-coach-plans-per-report/

4. Livity App Blog, “Apple Shelved Its AI Health Coach — What It Means for You,” March 26, 2026. https://livity-app.com/en/blog/apple-health-ai-coach-shelved

In my last article, I shared 60-plus ways to work as a health coach. Today I want to go deeper into one of the most powerful pathways of all: building relationships with doctors and other healthcare practitioners who need exactly what you offer.

Health coaching is not a fringe idea anymore. The American Medical Association describes health coaching as a team-based approach that helps patients gain the knowledge, skills, and confidence to become active participants in their care, and its STEPS Forward guidance says coaching may help practices meet quality metrics, improve patient satisfaction, inspire behavior change, and free up physician time (AMA STEPS Forward).

That is a very practical message for a doctor. You are saying, “I can help your patients understand the plan, follow through between visits, and feel more supported.”

Why doctors need health coaches

Doctors are under enormous pressure. They are expected to diagnose, prescribe, educate, motivate, document, meet quality measures, respond to messages, manage complex chronic conditions, and somehow do it all in a short visit.

Health coaches help fill the gap between what happens in the appointment and what happens in real life. The AMA notes that physicians often do not have time to offer collaborative patient education, close the loop on whether a patient understood the care plan, or engage patients in behavior-change action plans, while a coach can support those activities and increase available physician time (AMA STEPS Forward).

The research supports this practical role. In a 12-month randomized controlled trial of 441 low-income patients with uncontrolled diabetes, hypertension, or hyperlipidemia, medical assistant health coaching improved the proportion of patients reaching at least one clinical goal compared with usual care, 46.4% versus 34.3% (Annals of Family Medicine).

In that same trial, patients receiving health coaching were more likely to reach the HbA1c goal than patients receiving usual care, 48.6% versus 27.6%, and the authors concluded that medical assistants serving as in-clinic health coaches improved hemoglobin A1c and LDL control compared with usual care (Annals of Family Medicine).

Another randomized controlled trial of 299 low-income patients with diabetes found that health coaching significantly improved glycemic control. At six months, HbA1c decreased by 1.07% in the coached group compared with 0.3% in usual care, and 49.6% of coached patients lowered HbA1c by at least 1% compared with 31.5% of usual-care patients (Annals of Family Medicine).

Additional evidence points in the same direction. A 2024 pragmatic cluster randomized trial in two real-world primary care environments found that health coaching led to significantly greater improvement in HbA1c compared with usual care among adults with type 2 diabetes, and the authors concluded that this team-based approach may be especially effective in federally qualified health center settings (Diabetes Care).

The benefits are not only clinical. In the Health Coaching in Primary Care study, coached patients reported a higher quality of chronic illness care than usual-care patients at 12 months, with Patient Assessment of Chronic Illness Care scores of 3.82 versus 3.13, and they were more likely to say they would definitely recommend their clinic, 85% versus 73% (The American Journal of Managed Care).

Better patient experience, better understanding, better follow-through, and better support between visits are positive benefits for medical practices. How can you communicate these benefits?

Tip 1: Start with who already knows you

When health coaches ask me how to get referrals, I often say, “Start closer than you think.” Your first opportunity would not be a cold email to a large hospital system. It is much more likely to be someone in your existing circle who already knows you, trusts you, or knows someone who would benefit from meeting you.

Make a list of people in your life. Include relatives, friends, neighbors, former colleagues, parents from your children’s school, people in your faith community, your gym friends, your book club, your walking group, your hair stylist, your dentist, your physical therapist, your acupuncturist, your Pilates teacher, your accountant, and the person you always talk with at the farmers market.

Do not prejudge who can help you. The person next door may be married to a physician. Your cousin may work for a cardiology group. A friend from Pilates class may have a sister who is a nurse practitioner. The woman you chat with at the dog park may be the office manager for an integrative medicine practice.

Start with a simple sentence that people can remember. Try, “I help patients turn their doctor’s recommendations into daily habits they can actually sustain.” You can also say, “I work with people who know what they should do for their health, but need support making it happen.”

Then make the ask easy. Say, “If you know a provider (physician, nurse practitioner, dietitian, physical therapist, etc.) who wants more support for patients, I would be grateful for an introduction.”

Tip 2: Talk about what you do everywhere, without giving a lecture

Many new coaches are so worried about sounding salesy that they say almost nothing. But if people do not know what you do, they cannot refer to you. You are not bothering people when you speak clearly about how you can help patients.

The key is to talk in examples, not jargon. Instead of saying, “I use motivational interviewing and behavior-change theory,” say, “I help someone with prediabetes figure out what breakfast works for their schedule, how to walk after meals, and how to monitor their glucose levels with a continuous glucose monitor.”

At a neighborhood gathering, you might say, “I’m a health coach. I help people follow through on the lifestyle changes their doctor recommends, especially when they feel overwhelmed by too much information.”

At the gym, you might say, “I’m always interested in how people build sustainable routines. My work is helping patients make those routines realistic, especially when they are dealing with blood sugar, blood pressure, cholesterol, weight, sleep, stress, or fatigue.”

At a family event, you might say, “If your doctor ever tells you to change your diet, exercise more, manage stress, or improve sleep, that is exactly where a health coach can help. We do not replace the doctor. We help the patient take the next step after the visit.”

At a dinner party, you might say, “Doctors often do not have enough time to help patients implement the plan. A health coach can help the patient understand the plan, set goals, troubleshoot barriers, and stay engaged.”

Tip 3: Make your message useful to the doctor

When you approach a doctor, lead with the problem you solve for the practice and the patient. Doctors are busy, and they want to know whether you will make care easier, clearer, safer, or more effective.

A strong message might sound like this: “I support patients between visits so they can better understand and follow through on your care plan. I can help with goal setting, accountability, lifestyle implementation, and identifying barriers that keep patients from making progress.”

You can make it even more specific by naming the patient groups you are best prepared to support. For example, “I can help your patients who have prediabetes or diabetes.” “I can support your patients on GLP1 medications.”

Then explain what you will not do. Say, “I do not diagnose, prescribe, interpret labs outside my scope, or contradict the medical plan. My role is to reinforce the plan, support behavior change, and communicate appropriately when something needs to go back to the clinician.”

That reassurance matters. Many physicians have never worked with a health coach, and they may not understand the boundaries. The more clearly you describe your scope, the easier it is for them to imagine referring to you.

You can also speak to what the evidence shows. There is credible evidence that coaching can support important outcomes, especially when it is integrated with care and focused on practical behavior change.

Diabetes health coaching has been associated with small but significant short-term improvements in A1c, BMI, waist circumference, body weight, depression or distress, and systolic blood pressure in a systematic review and meta-analysis of randomized controlled trials (Frontiers in Endocrinology).

Tip 4: Join groups where trust can grow

Become known as a thoughtful, reliable health coach in the communities where healthcare conversations already happen. Look for local groups where people gather around health, wellness, business, service, or community leadership. Consider a chamber of commerce, women’s business group, Rotary club, synagogue or church wellness committee, school wellness committee, local nonprofit board, functional medicine meetup, fitness studio event, culinary medicine class, caregiver support group, book club, hiking club, or community lecture series.

Your goal is to become a familiar person who listens well, asks good questions, follows up, and can explain health coaching in a grounded way.

If you attend a chamber event, introduce yourself to practice owners, chiropractors, dentists, physical therapists, mental health clinicians, concierge physicians, med spa owners, and nutrition professionals. They may not all hire you, but many of them know doctors, patients, and families who need support.

If you join a fitness or wellness community, say, “One of the things I care about is helping people make health advice livable. If someone is told to increase protein, lower glucose, improve sleep, or walk after meals, I help them turn that into a plan that fits their actual life.”

If you are in a neighborhood group, offer a short free talk. Possible topics include “What to Do After Your Doctor Says Your Blood Sugar Is High,”or “How to Take Charge of Your Health in Perimenopause and Menopause.”

Tip 5: Ask for conversations, not jobs

One of the biggest mistakes new coaches make is asking too soon for a job. A better first step is asking for a conversation. You are not asking the doctor to hire you on the spot. You are asking to learn what their patients need and whether coaching might be helpful.

Try this email or message, and keep the tone warm. “Dr. ____, I’m a certified health coach focused on helping patients follow through on lifestyle recommendations between visits. I especially support patients who are working on blood sugar, blood pressure, cholesterol, weight, sleep, stress, and sustainable behavior change. I would love to learn more about the kinds of support your patients need and explore whether health coaching could be useful in your practice.”

Then add a clear, low-pressure close so the next step feels easy. “Would you be open to a 15-minute conversation in the next few weeks? I would be happy to share a simple one-page description of how I work and how I stay within scope.”

If the doctor agrees, come prepared with questions. Ask, “Where do patients tend to get stuck after you make recommendations?” Ask, “Which patients do you wish had more support between visits?” Ask, “What would make a referral relationship easy for your office?” Ask, “How do you prefer to receive updates?”

After the conversation, send a short thank-you note and include one specific next step. For example, “Thank you for sharing that many patients struggle after receiving a prediabetes diagnosis. I would be glad to create a simple referral sheet for those patients and offer a brief introductory session so they understand what coaching is.”

You can also offer a pilot. Say, “If helpful, we could start with three referred patients and evaluate whether coaching improves their confidence, follow-through, and readiness for the next visit.”

Doctors are used to evaluating relationships through experience. A small, well-defined pilot can be much more persuasive than a grand promise.

You learn by doing. Write a one-page introduction. Practice your 30-second explanation. Make a list of 50 people you know. Ask for warm introductions. Attend one local event each week. Follow up with every person who shows interest.

Relationships are built through consistency, not through waiting until you feel perfectly ready.

A simple one-page handout for doctors

Before you meet with a doctor, create a one-page handout that answers the questions they are likely to have. Keep it simple, professional, and specific. The sections can include the following:

· Who I help: Name the patient groups support, such as patients with prediabetes, metabolic syndrome, hypertension, digestive concerns, fatigue, weight concerns, stress, sleep challenges, or lifestyle-related risk factors.

· What I do: Explain that you help patients clarify goals, build routines, troubleshoot barriers, improve follow-through, and prepare for future visits.

· What I do not do: State that you do not diagnose, prescribe, replace medical care, or contradict the clinician’s treatment plan.

· How referrals work: Explain whether the doctor can email you, give patients your card, use a referral form, or invite patients to schedule a discovery call.

· How communication works: Explain whether you send brief updates with patient permission, what you include, and when you refer questions back to the clinician.

· Why it helps: Include one or two evidence points, such as the health coaching trial that improved HbA1c goal attainment or the study showing higher patient-reported quality of care and clinic recommendation rates with coaching (Annals of Family Medicine, The American Journal of Managed Care).

This one-page handout is a trust-building document. It shows that you understand the doctor’s world and that you are ready to be part of a team.

The heart of it

Getting referrals is about becoming clearer, more visible, and more helpful.

Start with who you know. Tell people what you do in plain language. Ask for introductions. Join groups where trust can grow. Approach doctors with humility, specificity, and a clear understanding of how coaching supports patient care.

You never know who knows a doctor. You never know whose spouse, cousin, neighbor, workout partner, patient, colleague, or best friend is looking for exactly the kind of support you can provide.

So do not hide your work. Talk about it. Practice saying it. Let people know how a health coach helps patients take the next step after the medical visit.

That is how referrals begin. One conversation leads to another, and over time, your community starts to understand where you fit.

With love,

Dr. Sandi

“What can I actually do as a health coach?”

Underneath that question is often a deeper one:

“Is there a place for me?”

The answer is yes. But that place may not look like a traditional job description. It may not fit neatly into one category. It may be a specialization that already exists, or one you are uniquely positioned to create.

According to the National Board for Health & Wellness Coaching, health and wellness coaches help individuals and groups use a client-centered, evidence-based process to develop self-directed health and wellness goals, build accountability, and make sustainable lifestyle changes (NBHWC).

You do not have to diagnose. You do not have to prescribe. You do not have to have a healthcare background to make a meaningful difference. NBHWC defines the coach’s role as a facilitator of behavior change, not as a clinician who diagnoses, treats, or prescribes (NBHWC).

What matters most is your ability to help people change.

You Do Not Need a Healthcare Background

Many people come to health coaching from completely different worlds.

Some were teachers. Some worked in corporate careers. Some were stay-at-home parents. Some were caregivers. Some came to this field through their own health journeys. Others simply reached a point in life where they wanted their work to feel more purposeful.

That diversity is not a weakness. It is one of the great strengths of health coaching.

A former teacher may be drawn to children, families, or school-based wellness. A former executive may understand burnout from the inside. A caregiver may know exactly what it feels like to lose yourself while caring for someone else. A person who has gone through a health transformation may have deep empathy for clients who feel overwhelmed, stuck, or discouraged.

Your background may be the clue to your specialization.

Health Coaching Specializations Are Everywhere

When people think about health coaching, they often picture one-on-one private practice. That is one path, but it is far from the only one.

Health coaches can work in clinics, companies, communities, schools, nonprofit programs, group programs, digital health, functional medicine practices, and entrepreneurial ventures. The CDC’s National Diabetes Prevention Program includes trained Lifestyle Coaches who help participants build skills, set goals, stay motivated, and overcome barriers to change (CDC).

A specialization allows you to ask:

• Who do I most want to help?

• What problem do I care deeply about solving?

• Where do my lived experience, training, and passion intersect?

Clinical and Healthcare Specializations

Some coaches are drawn to clinical and healthcare settings and want to work alongside practitioners. Other want to build a practice that specializes in a particular chronic health condition.

Possible specializations include:

• Functional medicine health coach in a medical practice

• Primary care embedded coach

• Cardiology health coach

• Prediabetes and diabetes health coach

• Cancer survivorship coach

• Weight loss coach

• GLP1 coach

• Autoimmune support coach

• Perimenopause and menopause health coach

• Men’s health coach

• Chronic pain support coach

• Sleep and circadian rhythm coach

In many healthcare settings, the practitioner may recommend nutrition changes, movement, stress reduction, sleep habits, or lab follow-up. Many patients then need support implementing those recommendations in real life.

Health coaches can be especially valuable in that space because coaching focuses on behavior change, self-management, goal-setting, and accountability (NBHWC).

Family, Caregiving, and Life Transition Specializations

Some of the most powerful coaching niches are built around life transitions.

These are moments when people are often overwhelmed, undersupported, and trying to navigate health changes while also managing emotional, relational, or logistical stress.

Possible specializations include:

• Caregiver support coach

• Parent-focused health coach

• Kids and teen wellness coach

• Family systems health coach

• Sandwich generation coach

• Empty nest transition coach

• Couples health coach

• Infertility support coach

• Pregnancy health coach

• New moms health coach

• Sexual health and intimacy coach

• Dysregulated child support coach

• ADHD support coach

• Learning differences support coach

Cognitive and Mental Wellbeing Specializations

The brain is becoming one of the most important areas of lifestyle-focused health.

Many people are concerned about memory, focus, stress, anxiety, addiction, and cognitive decline. They may not know where to start, or they may feel overwhelmed by conflicting information.

Possible specializations include:

• Brain health coach

• Alzheimer’s prevention lifestyle coach

• Early-stage cognitive decline support coach

• Family support coach for dementia

• Anxiety support coach

• Addiction recovery support coach

A health coach in this space does not replace medical care or psychotherapy. Instead, the coach supports lifestyle habits, motivation, accountability, and follow-through (NBHWC).

Workplace and Corporate Wellness Specializations

Workplaces are another expanding area for health coaching.

Stress, burnout, poor sleep, long hours, sedentary habits, and high-pressure environments can affect both health and performance. A coach with corporate experience may be especially well-suited to serve this population.

Possible specializations include:

• Corporate wellness coach

• Executive burnout coach

• Finance or legal firm health coach

• Workplace stress resilience coach

• Organizational wellbeing consultant

This is a great example of turning past experience into a specialized coaching path. Someone who has worked inside an organization may understand the culture, the pressures, and the language of the workplace. That gives the coach credibility and insight.

Community and Social Impact Specializations

Health coaching also has an important role in communities.

Not everyone has easy access to fresh food, safe places to move, reliable healthcare, or ongoing support. Community-based coaches can help bridge the gap between information and daily action.

Possible specializations include:

• Community health coach

• Faith-based wellness coach

• First responder health coach

• Veteran and active duty health coach

• Prison or reentry wellness coach

• Public health program coach

The CDC’s National Diabetes Prevention Program includes staffing roles such as Lifestyle Coach, Program Coordinator, and Data Preparer, which shows that coaching can be part of structured public health delivery models (CDC).

For coaches who feel called to service, this path can be incredibly meaningful.

More Specialized Niche Coaching

Many coaches build practices around a specific health topic, skill, or population.

These niches can be powerful because they are clear. When someone hears the focus, they immediately understand who the coach helps and why.

Possible specializations include:

• Functional nutrition coach

• Eating psychology coach

• Culinary or cooking skills coach

• Gut health coach

• Longevity and healthy aging coach

• Financial health coach

These specializations often grow out of personal experience, professional expertise, or a problem the coach sees again and again.

Someone who loves cooking may help clients build confidence in the kitchen. Someone passionate about healthy aging may focus on strength, protein, sleep, social connection, and daily habits that support vitality over time.

Technology-Focused Specializations

This is one of the most creative areas for the future of health coaching.

People now have access to wearables, remote monitoring tools, direct-to-consumer labs, apps, and AI-driven health platforms. But data does not automatically create behavior change.

A coach can help clients make sense of information and turn it into practical, sustainable action.

Possible specializations include:

• Remote patient monitoring coach

• Wearables coordinator coach

• AI health coach

• Direct-to-consumer labs coach

Coaches can help clients notice patterns, prepare questions for their healthcare team, and build habits that support their goals (NBHWC).

Environmental Health Specializations

Another growing area is the environment people live in every day.

Our homes, clothing choices, personal care products, schedules, devices, and routines all shape our behavior. Some coaches may specialize in helping clients create healthier surroundings.

Possible specializations include:

• Digital clutter coach

• Declutter coach

• Toxin-free home coach

• Mold support coach

This is where creativity really shines. A coach might help a client reduce decision fatigue, organize a kitchen for healthier meals, create a sleep-friendly bedroom, or simplify a chaotic digital life.

Sometimes the first step toward better health is not another supplement or another plan. It is creating an environment where the healthier choice becomes easier.

Entrepreneurship and Thought Leadership Specializations

Some coaches are builders.

They may not want a traditional practice. They may want to create programs, communities, retreats, books, workshops, podcasts, or online courses.

Possible specializations include:

• Group program creator

• Retreat leader

• Author

• Keynote speaker

• Podcast host

• Online course creator

These paths are not separate from health coaching. They are ways of bringing coaching skills to a larger audience.

A Few Real-World Possibilities

Let’s make this concrete.

A teacher becomes a health coach and creates programs for kids focused on emotional resilience, healthy habits, sleep, movement, and self-awareness.

A corporate executive leaves burnout behind and now coaches other executives on stress, energy, performance, and sustainable success.

A woman who healed her gut issues builds a coaching practice helping others improve their daily habits around food, stress, sleep, and digestion, then eventually creates an online program.

A caregiver turns her lived experience into a coaching business, then becomes a speaker and advocate for caregiver wellbeing.

None of these people had to fit themselves into a narrow job description.

They created a path.

The Key Reframe

You do not have to simply find a job.

You can create a role.

Health coaching is a field where roles are evolving, new specializations are emerging, and some of the most exciting opportunities have not been invented yet.

Research continues to recognize health and wellness coaching as a growing field with evidence supporting its role in behavior change and chronic lifestyle disease support (Sibold, Whitman, and Westervelt). Lifestyle health coaching programs have also been studied in clinical and employer-related contexts, including technology-enabled coaching models designed to support health behavior change (Gordon et al.).

So instead of asking, “What jobs are available?”

Ask yourself:

“What problem do I care deeply about solving?”

Because wherever people are struggling to change habits, improve their health, or navigate life transitions, there is a place for a health coach.

And that place may be a specialization only you can build.

A Question for You

What health coaching specialization are you considering?

What population do you feel called to serve?

What problem do you care deeply about solving?

If you are thinking about becoming a health coach, or expanding the work you already do, this is exactly what we prepare you for at FMCA.

References

National Board for Health & Wellness Coaching. (2025, August 21). NBHWC Health & Wellness Coach Scope of Practice. https://nbhwc.org/scope-of-practice/

Centers for Disease Control and Prevention. (2024, September 11). About the Lifestyle Change Program. https://www.cdc.gov/diabetes-prevention/lifestyle-change-program/lifestyle-change-program-details.html

Centers for Disease Control and Prevention. (2025, February 27). Staffing and Training for The National Diabetes Prevention Program. https://www.cdc.gov/diabetes-prevention/php/program-provider/staffing-and-training.html

Sibold, J., Whitman, S., & Westervelt, K. (2023). An Evidence Based Rationale for Health and Wellness Coaching as a Complementary Certification in Undergraduate Health Education. American Journal of Lifestyle Medicine, 18(2), 181–185. https://pmc.ncbi.nlm.nih.gov/articles/PMC10979724/

Gordon, N. F., Salmon, R. D., Wright, B. S., Faircloth, G. C., Reid, K. S., & Gordon, T. L. (2016). Clinical Effectiveness of Lifestyle Health Coaching: Case Study of an Evidence-Based Program. American Journal of Lifestyle Medicine, 11(2), 153–166. https://pmc.ncbi.nlm.nih.gov/articles/PMC6125027/

If you are a health coach, you already know your work changes lives.

But when you are speaking to an employer, hospital leader, benefits consultant, or healthcare administrator, “health coaching changes lives” is usually not enough.

Decision makers have a different question.

They want to know: What is the return on investment?

When you learn to speak the language of cost, risk, utilization, and prevention, you can help decision makers see coaching not as a soft wellness benefit, but as an effective strategy for lowering healthcare costs.

KFF reported that 44% of U.S. adults say it is very or somewhat difficult to afford healthcare costs, and 36% say they skipped or postponed needed healthcare in the past 12 months because of cost. KFF also reported that 43% of U.S. adults say they have not taken medication as prescribed in the past year because of cost, including not filling prescriptions, taking over-the-counter alternatives, cutting pills in half, or skipping doses.

For employers and healthcare systems, this is not just a human problem. It is a financial problem. The largest cost drivers are often not sudden. They are progressive. Prediabetes becomes diabetes. Hypertension becomes cardiovascular disease. Weight gain, poor sleep, inactivity, stress, and medication nonadherence become claims, complications, admissions, and lost productivity.

That is where health coaching becomes more than a “nice wellness benefit.” When it is targeted, structured, measurable, and integrated into care, coaching becomes a cost-containment strategy. That is the ROI story coaches need to learn how to tell.

The new ROI study coaches should know

A new 2026 paper by Michelle Alencar, Rachel Sauls, and Justin Whetten evaluated the cost-effectiveness of a lifestyle and behavioral care model for cardiometabolic disease progression using a five-year Markov model from the employer perspective. The model compared employees receiving the behavioral care model with a usual-care control group and simulated disease progression, healthcare utilization, costs, and quality-adjusted life years over five years.

The results were striking. Among 4,461 employees aged 40, intervention participants had projected five-year costs of $41,431 compared with $47,834 for controls, a savings of $6,403 per member and $28.6 million overall. Treated members gained 4.7 quality-adjusted life years compared with 4.6 in controls, equivalent to 36.5 additional days of full health, and the program generated an ROI of 6.53.

This is the sentence every coach should be able to say clearly to a decision maker:

Health coaching is not only about helping people “feel better.” In cardiometabolic risk populations, a structured lifestyle and behavioral care model may help employers reduce avoidable downstream costs while improving health outcomes.

The study is especially useful because it speaks the language administrators and benefits leaders already use: costs, ROI, utilization, disease progression, and quality-adjusted life years. Coaches do not need to become health economists, but they do need to be comfortable translating their work into these terms.

Why ROI is the language decision makers listen for

Most employers are not looking for another wellness perk. They are looking for ways to manage risk.

Cardiometabolic disease is expensive because it is common, progressive, and deeply behavior-linked. It is also one of the areas where people need more than a handout, a portal, or an annual biometric screening. People need help translating medical advice into daily life.

That is the gap health coaches are trained to fill. But to get invited into employer and healthcare settings, coaches have to connect that gap to the outcomes leaders are accountable for.

A physician may say, “Improve your diet, move more, reduce stress, and lose 5% of your body weight.” A coach helps the person figure out what that means on Tuesday night after work, on a business trip, during menopause, while caring for a parent, or when the grocery budget is tight.

For an administrator, that distinction matters. Education alone is rarely enough. The economic opportunity is in sustained behavior change among people at risk of becoming high-cost claimants. Your job is to help them see that coaching is not an expense added to the system. It is a prevention strategy aimed at reducing more expensive downstream care.

The evidence coaches can use in ROI conversations

The new 2026 study is not the only example suggesting that structured lifestyle and behavioral interventions can reduce healthcare spending.

The National Diabetes Prevention Program has produced employer-relevant savings in real-world settings. The National DPP Coverage Toolkit summarizes a Diabetes Care study of 5,948 adults with prediabetes in employer-sponsored insurance, where 575 enrollees had a $4,552 average reduction in two-year total direct medical costs compared with 5,373 non-enrollees. The same summary reports an 88% probability of saving money and approximately $160,000 saved per case of diabetes prevented.

A digital Diabetes Prevention Program implemented for employees and spouses/domestic partners of The Dow Chemical Company also showed near-term economic value. In that claims-based study, the average program cost was $571 per participant, all-cause healthcare spending fell by $1,169 per participant in the first year, and net savings were $598 per participant after program cost. The program included a trained lifestyle coach, peer support, digital weight tracking, activity and food-pattern tools, and a CDC-approved behavior change curriculum.

The Look AHEAD trial offers another important example in adults with type 2 diabetes. In a randomized trial of 5,121 overweight or obese adults with type 2 diabetes, intensive lifestyle intervention reduced annual hospitalizations by 11%, hospital days by 15%, and medication use by 6% compared with diabetes support and education. The same analysis found a mean relative per-person 10-year cost savings of $5,280 and average annual total healthcare costs that were 7% lower in the intensive lifestyle intervention group.

The CDC’s economic summary of diabetes interventions also supports intensive lifestyle modification for people at high risk of type 2 diabetes. The CDC reports that intensive lifestyle modification to prevent type 2 diabetes among high-risk people costs $12,500 per quality-adjusted life year compared with no intervention, which is below the commonly cited $50,000 per QALY threshold for public health value.

Taken together, these examples suggest a practical conclusion coaches can bring to employers and healthcare systems:

The strongest case is not for generic wellness. It is for targeted, evidence-informed lifestyle and behavioral care directed at high-risk populations.

The important caveat: not all wellness programs save money

Administrators are right to be skeptical. Some workplace wellness programs have promised too much.

A large randomized clinical trial at BJ’s Wholesale Club found that a multicomponent workplace wellness program improved self-reported regular exercise and active weight management after 18 months, but it did not significantly change clinical measures, healthcare spending or utilization, absenteeism, tenure, or job performance. That trial is a useful warning: a broad wellness program with low or uneven engagement should not be expected to quickly reduce claims costs.

This is exactly why coaches should not position themselves as “wellness extras.” That language makes coaching sound optional, vague, and easy to cut from a budget. The better positioning is more precise.

Health coaches belong in targeted chronic disease prevention and cardiometabolic risk management. They should be part of a measurable care model, not an optional feel-good activity at the edge of the benefits package.

How coaches can make the ROI case

Here is a simple framing coaches can use:

“Your highest opportunity is not only treating disease after it becomes expensive. It is helping at-risk employees change the daily behaviors that drive disease progression. Health coaches can extend the reach of clinical teams by supporting food choices, movement, sleep, stress regulation, medication adherence, lab follow-through, and self-efficacy between visits.”

That message works because it connects coaching to operational priorities:

• Lower avoidable utilization

• Better chronic disease prevention

• Better adherence to care plans

• Reduced risk progression

• More scalable support between clinician visits

• A more humane benefits strategy for employees struggling with affordability

It also respects the administrator’s reality. Employers and health systems do not need vague inspiration. They need a model that can be measured.

When you are making the ROI case, avoid leading with your process. Do not start with “I provide motivational interviewing, accountability, and lifestyle education.” That may be true, but it is not the decision maker’s first concern.

Start with the problem they already have:

• Employees and patients are progressing from risk to disease.

• Chronic disease is driving claims and utilization.

• Clinicians do not have enough time to support behavior change between visits.

• People are delaying care or skipping medications because costs are overwhelming.

• Benefits leaders need solutions that are measurable, scalable, and defensible.

Then connect coaching to the business outcome:

• Better follow-through on care plans

• Earlier intervention for high-risk employees

• Improved adherence to lifestyle and medication recommendations

• Reduced avoidable emergency visits and hospitalizations

• Lower risk of progression from prediabetes to type 2 diabetes

• Better employee experience in a healthcare system many people find unaffordable and confusing

What a measurable coaching model should include

If coaches want to be taken seriously by employers and healthcare systems, the offer should be concrete. Decision makers are more likely to listen when you can describe not just what you do, but how success will be measured.

First, define the risk group. Good candidates include employees with prediabetes, metabolic syndrome, hypertension, obesity, elevated triglycerides, rising A1c, early cardiovascular risk, or multiple lifestyle-related risk factors.

Second, define the outcomes. Track engagement, retention, weight change when appropriate, A1c, blood pressure, waist circumference, medication adherence, completed preventive visits, emergency department utilization, hospitalizations, and total cost of care.

Third, define the workflow. Coaches should be able to receive referrals, document goals, communicate with care teams when appropriate, escalate red flags, and protect scope of practice.

Fourth, define the human experience. Coaching works best when it is relational, practical, and individualized. People do not change because they receive another PDF. They change when someone helps them turn a clinical recommendation into a repeatable behavior.

Why ROI is also an affordability strategy

Healthcare affordability is often discussed as a policy problem, and it is. But it is also a prevention problem.

When people skip care because of cost, small problems can become expensive problems. KFF reported that 18% of adults said their health got worse because they skipped or delayed care, and among adults under 65 with health coverage, 20% said their health worsened after skipped or postponed care.

Coaching cannot fix deductibles, drug pricing, hospital pricing, or insurance design. But coaching can help reduce the number of people drifting silently toward more complex, more expensive disease.

For employers, that is the prevention dividend. For healthcare systems, it is a value-based care strategy. For employees and patients, it may be the difference between feeling alone with a diagnosis and having a practical partner in change. That is where the human case and the ROI case meet.

The bottom line

The economic case for health coaching is getting stronger, but coaches need to make it carefully.

The best argument is not that every wellness program saves money. The evidence does not support that.

The better argument is that targeted, structured lifestyle and behavioral care for cardiometabolic risk can improve outcomes and may reduce avoidable healthcare costs. The 2026 Alencar, Sauls, and Whetten study projected $6,403 in five-year savings per member, $28.6 million in total savings, and a 6.53 ROI from the employer perspective.

That is a message employers and healthcare administrators can understand. It is also a message coaches can use to open doors.

Health coaching is not a luxury when chronic disease is driving the budget. Done well, it is infrastructure for prevention, and coaches need to be ready to explain the ROI.

Sources

1. KFF. “Americans’ Challenges with Health Care Costs.” https://www.kff.org/health-costs/americans-challenges-with-health-care-costs/

2. Alencar M, Sauls R, Whetten J. “Cost-Effectiveness of a Lifestyle and Behavioral Care Model Targeting Cardiometabolic Disease Progression.” International Journal of Environmental Research and Public Health. 2026;23(4):526. PubMed: https://pubmed.ncbi.nlm.nih.gov/42074463/

3. National DPP Coverage Toolkit. “Cost & Value.” https://coveragetoolkit.org/cost-value-elements/

4. Castro Sweet C, Jasik CB, Diebold A, DuPuis A, Jendretzke B. “Cost Savings and Reduced Health Care Utilization Associated with Participation in a Digital Diabetes Prevention Program in an Adult Workforce Population.” Journal of Medical Internet Research. 2020. https://pmc.ncbi.nlm.nih.gov/articles/PMC7458495/

5. Espeland MA, et al. “Impact of an Intensive Lifestyle Intervention on Use and Cost of Medical Services Among Overweight and Obese Adults With Type 2 Diabetes: The Action for Health in Diabetes.” Diabetes Care. 2014. https://pmc.ncbi.nlm.nih.gov/articles/PMC4140155/

6. CDC. “Health and Economic Benefits of Diabetes Interventions.” https://www.cdc.gov/nccdphp/priorities/diabetes-interventions.html

7. Song Z, Baicker K. “Effect of a Workplace Wellness Program on Employee Health and Economic Outcomes: A Randomized Clinical Trial.” JAMA. 2019;321(15):1491-1501. https://jamanetwork.com/journals/jama/fullarticle/2730614

If you have ever cared for someone who is seriously ill, aging, cognitively impaired, recovering from surgery, or declining in ways that are hard to name, you may recognize this emotional knot. Love and irritation can live in the same body. Devotion and depletion can sit at the same kitchen table. You can want to help and also want your life back.

Because caregivers are so often praised for being “angels,” they may have no place to say the less angelic things out loud. But those feelings are not evidence of failure. They are evidence of overload.

That is where health coaching belongs.

Not after the crisis is over. Not after the caregiver has burned out. Not as a wellness perk for people who already have time to care for themselves. Health coaching belongs inside the care transition itself, when the patient is leaving the hospital and the caregiver is silently inheriting the work.

The invisible second patient

The patient gets a wristband, a chart, a medication list, a discharge plan, and follow-up instructions. The caregiver often gets a stack of papers, a few rushed explanations, and an unspoken job description.

They are expected to understand medication changes, watch for warning signs, arrange appointments, manage transportation, communicate with family, organize food, monitor symptoms, and absorb the emotional impact of watching someone they love become vulnerable.

The recent iCare4Me Transitions study protocol, published in Contemporary Clinical Trials, focuses exactly on this gap: informal caregivers of hospitalized older adults with multiple chronic conditions during the transition from hospital to home, a period associated with increased caregiver stress, reduced self-care, and risk for poor outcomes for both caregivers and patients (PubMed).

This matters because caregiving is no longer a private side issue. AARP and the National Alliance for Caregiving reported that 63 million Americans were family caregivers in 2025, roughly one in four adults, and many are providing complex care while also managing work, children, finances, and their own health (AARP).

Caregiving is not simply “helping out.” It is labor. It is stress physiology. It is interrupted sleep, missed appointments, skipped meals, financial strain, marital strain, and sometimes a quiet erosion of identity.

The CDC has reported that nearly one in five informal caregivers rated their health as fair or poor, underscoring the risk that caregivers may compromise their own health while supporting family members, friends, and the health care system (CDC).

What health coaching can do

A health coach does not replace the physician, nurse, social worker, therapist, or discharge planner. A health coach asks a different set of questions: What is actually doable this week? Where are you neglecting yourself? What are you afraid to admit? What support have you not asked for because you think you “should” be able to handle this?

In the iCare4Me Transitions trial, caregivers are randomized to receive either digital health information alone or digital health information plus a virtual health coaching intervention over six months (ClinicalTrials.gov). The coaching intervention includes 10 virtual sessions focused on stress management, self-care, and adaptive coping, with outcomes including caregiver self-care, stress, coping, preparedness, perceived health status, and patient acute care use and costs (PubMed).

That distinction is important. Information is necessary, but information is not the same as support.

A website can tell you what to do. A coach can help you figure out whether you have the capacity, confidence, boundaries, and support to do it. A handout can say, “Take care of yourself.” A coach can ask, “What would taking care of yourself look like at 4:00 p.m. on Thursday when you have been up since 5:30, the pharmacy did not have the prescription, and your friend is refusing to eat?”

That is where behavior change lives. Not in the abstract, but in the messy middle of real life.

The hospital room as a coaching doorway

Forty years ago, I worked as a health psychologist. Oncologists called me in to see cancer patients and their families. I was not there to diagnose the cancer or explain the chemotherapy regimen. I was there because everyone in the room was trying to process fear, uncertainty, exhaustion, and change.

The patient needed support. So did the family.

Sometimes the spouse was the one who had not slept. Sometimes the adult child was trying to be brave while quietly unraveling. Sometimes the family member needed permission to say, “I am scared,” or “I am angry,” or “I do not know how much more I can do.”

That work made something obvious to me: illness happens to a system, not just to a body.

And yet our health care system still too often treats the caregiver as a resource to be used rather than a person to be cared for.

Imagine if primary care doctors, gerontologists, oncologists, cardiologists, hospitalists, and other specialists routinely referred caregivers to trained health coaches. Imagine if a caregiver assessment were part of discharge planning. Imagine if a health coach met the caregiver before the patient went home and asked: What are you going home to? Who is helping you? What do you understand about the care plan? What feels overwhelming? What are you already sacrificing? What would make this sustainable?

This does not have to be complicated. It has to be intentional.

Resentment is data

When the woman I spoke with described her resentment, I did not hear selfishness. I heard overload.

Resentment often appears when a person’s needs have been ignored for too long. It can be a signal that boundaries are missing, expectations are unclear, or support is inadequate. Guilt often follows because caregivers compare themselves to an impossible standard. They think, “If I really loved this person, I would not feel this way.”

But love does not eliminate human limits.

Health coaching can help caregivers name those limits without shame. It can help them separate what is theirs to carry from what requires a team. It can help them practice asking for help, planning recovery time, identifying stress patterns, and protecting the small daily behaviors that keep them well.

Sleep. Food. Movement. A walk outside. A real conversation. A few hours without being needed.

These are not luxuries. They are part of the caregiver’s care plan.

Why this matters now

The iCare4Me Transitions study is especially compelling because it looks at caregivers during the hospital-to-home transition, when needs are high and systems often move too quickly for families to absorb what is happening (ClinicalTrials.gov).

It also recognizes that caregiver outcomes and patient outcomes are linked. The trial will evaluate caregiver outcomes such as self-care, stress, coping, preparedness, and perceived health status, as well as patient outcomes including acute care use and associated costs (PubMed).

That is the future of health care. Not just treating the diagnosis. Not just discharging the patient. Not just assuming the family will figure it out. But asking: Who is carrying the care, and what do they need in order to keep carrying it without losing themselves?

We already know health coaching can make a difference for caregivers in related settings. In a randomized trial of 250 informal caregivers of adults with chronic heart failure, a virtual health coaching intervention improved caregiver self-care and stress compared with health information alone (American College of Cardiology).

That finding should not surprise us. People do better when they are seen, supported, and helped to translate intention into action. Caregivers are no exception.

A new referral pathway

I would love to see a future in which every specialty practice that cares for older adults, medically complex patients, or patients with serious illness has a caregiver referral pathway.

A geriatrician could refer the daughter who is managing medications for both parents. An oncologist could refer the spouse who is afraid to leave the patient alone. A cardiologist could refer the partner of a patient with heart failure who is monitoring weight, sodium, symptoms, and appointments. A hospital discharge team could refer the friend who is taking someone home after surgery but has no idea what the next two weeks will actually require.

The referral would not imply that the caregiver is failing. It would say: This is hard enough that you deserve support.

The health coach would not take over. The coach would help the caregiver build capacity: a plan, a rhythm, a way to notice stress before it becomes collapse, and a way to care without disappearing.

The question we should ask

The woman I spoke with did not need information about self-care. She needed someone to help her tell the truth.

She needed to say, “I love my partner, and I am exhausted.” She needed to say, “I want to help, and I am angry that so much has fallen on me.” She needed to say, “I feel guilty even admitting this.”

And she needed someone to respond, “Of course you do. Now let’s figure out what support looks like.”

That is health coaching at its best. Not advice from above. Not cheerleading. Not one more demand to practice self-care. A skilled, compassionate partnership that helps a person find the next doable step.

For caregivers, that partnership may be the difference between quiet depletion and sustainable care.

We often ask caregivers, “What does the patient need?”

We should also be asking, “What do you need in order to stay well while caring for them?”

Because the caregiver is not just part of the care plan. The caregiver is a person whose health matters, too.

References

1. Hirschman KB, Weiss C, Brown S, Samuels C, Bowles KH, Carthon JMB, Huang L, Ramsburg H, Walser TJ, Naylor MD, Riegel B. “Virtual health coaching to improve self-care among informal caregivers of hospitalized older adults during a transition in care: Randomized controlled trial study protocol.” Contemporary Clinical Trials. 2026 Apr 22:108324. DOI: 10.1016/j.cct.2026.108324. PMID: 42031229. PubMed

2. ClinicalTrials.gov. “iCare4Me Transitions (iCare4Me T).” ClinicalTrials.gov Identifier: NCT06167746. ClinicalTrials.gov

3. AARP and National Alliance for Caregiving. “Caregiving in the U.S. 2025.” AARP

4. Centers for Disease Control and Prevention. “Characteristics and Health Status of Informal Unpaid Caregivers.” Morbidity and Mortality Weekly Report. 2020. CDC

5. American College of Cardiology. “Health Coaching Improves Outcomes of Caregivers of Adults With HF.” 2024. American College of Cardiology

By Sandra Scheinbaum, Ph.D. | Founder and CEO, Functional Medicine Coaching Academy | Former Licensed Clinical Psychologist

April 2026

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My first article reviewed the research on the effectiveness of health coaching. My second described my personal fitness routine in detail: resistance training, HIIT, daily walking, ballet. This article addresses the other side of the equation: what the research tells us about protecting and strengthening cognitive function as we age.

At 76, I am currently learning to play the piano on an app, studying Spanish daily on Duolingo, using BrainHQ for structured cognitive training several times a week, and participating in three book clubs. I also enjoy my morning coffee, and the research gives me good reason to.

None of this is accidental. Each practice is grounded in a substantial and growing body of evidence. This article presents that evidence, starting with the two foundational factors that every brain researcher agrees upon: physical exercise and sleep.

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Physical Exercise and Brain Health

The relationship between physical exercise and cognitive function is one of the most well-replicated findings in neuroscience. The primary mechanism involves brain-derived neurotrophic factor (BDNF), a protein that promotes neurogenesis and synaptogenesis in the hippocampus, the region most critical for memory and learning. Aerobic exercise elevates BDNF levels measurably and consistently across study populations.[1]

The structural effects of exercise on the brain have been demonstrated directly. In a landmark randomized controlled trial published in the Proceedings of the National Academy of Sciences, 120 older adults were randomized to one year of aerobic exercise or a stretching control. The aerobic exercise group showed a 2% increase in hippocampal volume; the control group showed the typical age-related shrinkage. The researchers concluded that aerobic exercise effectively reversed one to two years of age-related hippocampal loss.[2]

A 2023 meta-analysis of 21 randomized controlled trials confirmed that physical exercise produced significant improvements in memory, processing speed, and executive function in older adults.[3] A 2025 systematic review covering studies published between 1970 and 2025 found that both aerobic and resistance training improved cognitive outcomes, with effect sizes increasing with exercise intensity.[4]

> For those of us in our 70s, the implication is direct: physical exercise is not a supplement to brain health. It is a primary intervention. The evidence supports treating daily movement with the same seriousness as any prescribed medication.

Even moderate volume has meaningful protective effects. A study published in Scientific Reports found that walking more than 6,000 steps daily was significantly associated with reduced dementia risk. Notably, the frequency of exercise mattered as much as the amount: daily exercise (versus weekly) reduced dementia conversion rates from 47.9% to 17.3%.[5]

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Sleep and Cognitive Protection

Sleep is the second non-negotiable factor in cognitive health. During sleep, the brain activates the glymphatic system: a network of channels that clears metabolic waste, including the amyloid-beta and tau proteins that accumulate in Alzheimer’s disease.[6]

A landmark randomized crossover trial published in Nature Communications in January 2026 provided the first direct human evidence that sleep-active glymphatic clearance elevates the removal of Alzheimer’s biomarkers from the brain into the bloodstream. Sleep-deprived participants showed significantly impaired clearance of both amyloid-beta and tau. The authors concluded that glymphatic enhancement during sleep represents a key potential target for slowing Alzheimer’s progression.[7]

Population-level data consistently point to seven hours as the optimal duration for cognitive performance and lowest dementia risk.[8] Sleep is not passive recovery. It is active neuroprotective biology, and disrupting it consistently carries measurable long-term costs.

Practical sleep hygiene: consistent sleep and wake times, a cool and dark sleep environment, and eliminating screen exposure in the hour before bed. These are not minor lifestyle preferences. They are evidence-based practices that affect brain clearance, memory consolidation, and long-term cognitive resilience.

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Coffee and Dementia Risk

The evidence on caffeinated coffee and dementia risk has grown substantially more rigorous in recent years. In February 2026, researchers at Mass General Brigham published a study in JAMA analyzing data from 131,821 participants followed for up to 43 years. Higher habitual caffeinated coffee intake was significantly associated with an 18% lower risk of dementia. The association was strongest at two to three cups per day, and was not observed with decaffeinated coffee.[9]

A 10-year Australian longitudinal cohort study of cognitively normal older adults found that higher habitual coffee consumption was associated with slower cognitive decline in executive function and attention, and also with slower accumulation of amyloid-beta in the brain. Higher coffee drinkers were significantly less likely to transition from normal cognition to mild cognitive impairment or clinical Alzheimer’s status over the follow-up period.[10]

The proposed mechanisms are biologically plausible. Caffeine suppresses amyloid-beta production in preclinical models and appears to activate central antioxidant pathways. Coffee also contains chlorogenic acids and other polyphenols with established anti-inflammatory properties; neuroinflammation is increasingly recognized as a central driver of Alzheimer’s pathology. One study found that regular coffee consumption reduced the inflammatory marker IL-6 by 27%.[11]

The current evidence does not establish causation, and individual responses to caffeine vary. For most healthy adults, however, two to three cups of caffeinated coffee daily appears to be a safe, low-cost habit with meaningful protective associations.

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Learning a Musical Instrument

I am learning piano on an app. I am not proficient. That, according to the research, is entirely the point.

Playing a musical instrument is among the most cognitively demanding activities a person can undertake. It simultaneously engages visual processing (reading notation), fine motor coordination (bilateral hand movements), auditory feedback processing, and executive function (real-time error correction). The breadth of neural recruitment is one reason the research findings are so consistent.

A 2022 review in BMC Neurology found that playing musical instruments was significantly associated with reduced dementia risk.[12] A study by Bugos and Wang found that piano practice specifically improved working memory, processing speed, and verbal fluency in adults aged 60 to 80.[13] A December 2025 study from the University of Sheffield, one of the longest such investigations to date, found that older adult beginners who learned piano showed significant improvements in learning and memory; participants who practiced through improvisation rather than repetition showed even greater gains.[14]

Neuroimaging research confirms that musical training promotes white matter plasticity, increasing the efficiency and structural integrity of neural connections across brain regions.[15] The Sheffield researchers found that the cognitive benefits were attributable to the learning method, not the specific instrument. App-based learning on a tablet engages the same neural processes as in-person instruction. Proficiency is not required. Sustained, effortful practice is.

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Language Learning and Cognitive Reserve

I use Duolingo daily to study Spanish. The research on bilingualism and cognitive reserve is among the most robust in the field, and the protective effects extend to adults who acquire a second language later in life.

Independent research groups in Canada, India, Belgium, and China have each found that bilingual individuals develop clinical symptoms of Alzheimer’s disease an average of 4.5 years later than monolingual peers.[16] This is not a marginal effect. It represents a substantial delay in the onset of functional impairment.

A 2017 study published in PNAS used FDG-PET brain imaging to investigate the underlying mechanism. Bilingual Alzheimer’s patients showed greater neuropathological burden than monolingual patients at the same clinical stage, yet performed comparably or better on cognitive assessments. Greater structural damage with preserved function is the defining characteristic of cognitive reserve: the brain has built sufficient redundancy to maintain performance under increasing pathological load.[17]

A large prospective study following 853 participants from age 11 to age 70 found that those who learned a second language, including in adulthood, performed significantly better on cognitive tests than their baseline abilities predicted.[18] Daily language practice, including app-based platforms such as Duolingo, keeps the brain’s executive control and attentional switching networks in sustained, productive use.

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Structured Cognitive Training: BrainHQ

Brain training applications vary widely in their evidentiary basis. BrainHQ, developed by Posit Science, is the most extensively studied program of its kind. More than 300 peer-reviewed publications have examined its efficacy, including 96 studies focused specifically on healthy older adults.[19]

The IMPACT Study, a large randomized controlled trial led by researchers at Mayo Clinic and the University of Southern California, found that BrainHQ participants showed improvements that transferred to standardized clinical memory tests, not only to the trained exercises themselves. Participants also reported functional improvements in daily life: better retention without written reminders, improved comprehension in noisy environments, and reduced word-finding difficulties.[20]

The year 2025 was notable for the volume of new BrainHQ research published: 70 peer-reviewed papers in a single year. Key findings included a neuroimaging study demonstrating that BrainHQ training increased acetylcholine production to a degree the researchers characterized as equivalent to approximately one decade of age reversal in that system. A meta-analysis published in The Lancet identified cognitive training as the most effective single lifestyle intervention for global cognition in older adults, ahead of diet and physical exercise considered independently. The US POINTER study, sponsored by the Alzheimer’s Association, found significant improvements in global cognition when BrainHQ was combined with a Mediterranean-style diet and structured exercise.[21]

Ten minutes of BrainHQ practice, three to four times per week, is sufficient to begin accumulating these benefits. The barrier to entry is low; the evidence base is not.

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Reading, Social Engagement, and Book Clubs

Regular reading is independently protective against cognitive decline. A 14-year longitudinal study found that adults who read at least once per week had a 46% lower risk of cognitive decline over the follow-up period, regardless of educational attainment.[22] The finding that reading confers protection beyond what formal education accounts for suggests it is an active contributor to cognitive reserve, not simply a marker of it.

Book clubs add the dimension of social engagement, which is one of the most consistently protective factors identified in longitudinal aging research. One major longitudinal study found a 70% reduction in cognitive decline among individuals who were frequently socially active compared to those who were not.[23]

A study published in Neurology in February 2026 followed 1,957 adults for eight years and found that those with the highest levels of lifetime cognitive enrichment, defined as reading, writing, language learning, and intellectually stimulating discussion, developed Alzheimer’s disease five years later and mild cognitive impairment seven years later than those with the lowest enrichment levels. The top decile of cognitive enrichment showed a 38% lower overall risk of Alzheimer’s disease. Post-mortem analysis confirmed that these benefits held even when the brains of highly enriched individuals showed the same neuropathological burden as those who declined earlier, indicating genuine reserve rather than simply slower disease accumulation.[24]

A book club combines multiple protective mechanisms in a single activity: reading (cognitive stimulation), discussion (social engagement, language production, and verbal fluency), listening (working memory and auditory processing), and argumentation (executive function). A pilot study published in Gerontology and Geriatric Medicine found statistically significant improvements in Montreal Cognitive Assessment scores among older adults who participated in a weekly book club, compared to controls who did not.[25]

Three book clubs provides three distinct social circles, three genres of reading, and three different conversational contexts each week. Each represents a separate and additive source of cognitive stimulation.

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Physicians and Researchers Advancing This Work

The field of brain health optimization has been shaped by physicians willing to challenge the premise that cognitive decline is an inevitable consequence of aging.

Dr. Dale Bredesen’s work deserves particular acknowledgment. His ReCODE Protocol, a comprehensive, individualized, multi-factor intervention for preventing and reversing cognitive decline, was groundbreaking when first proposed. The mainstream initially dismissed the claim that Alzheimer’s disease could be not merely slowed but reversed through targeted lifestyle, metabolic, and nutritional interventions. The evidence continues to validate his framework. Published clinical data demonstrate that the ReCODE Protocol significantly improved or stabilized Montreal Cognitive Assessment scores in patients with subjective cognitive impairment, mild cognitive impairment, and early Alzheimer’s disease, while simultaneously improving key metabolic markers including fasting glucose, insulin sensitivity, CRP, and vitamin D levels.[26]

Dr. David Perlmutter, a neurologist, Fellow of the American College of Nutrition, and six-time New York Times bestselling author, has spent decades establishing the connections between diet, neuroinflammation, gut-brain signaling, and cognitive health. His latest book, *Brain Defenders*, addresses the role of microglia, the brain’s resident immune cells, and how lifestyle choices determine whether those cells protect or damage the neurons they are meant to serve. Dr. Austin Perlmutter, his son and co-author of *Brain Wash*, has extended this work to the behavioral and environmental factors that compromise decision-making and mental health. Both bodies of work are essential reading for anyone working in this space.

I also want to recognize the health coaches trained through the Functional Medicine Coaching Academy who specialize in cognitive decline. These coaches bring a trained, root-cause lens to this work: they understand the metabolic, inflammatory, nutritional, and lifestyle drivers of brain aging, and they help clients implement and sustain complex protocols in individualized, practical ways. The intersection of functional medicine and skilled health coaching is where research findings translate into actual patient outcomes. I am proud of the work our coaches are doing in this area.

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At 76, my goal is not to reverse aging. It’s to build and maintain the cognitive reserve that allows me to function at a high level regardless of what accumulates in the background. The research presented here is not aspirational. It is actionable, and most of it is free.

The evidence does not ask for perfection. It asks for consistency.

Keep moving, keep learning, and protect your sleep.

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Sandra Scheinbaum, Ph.D. is the founder and CEO of the Functional Medicine Coaching Academy (FMCA), a licensed clinical psychologist for over 35 years, and a functional medicine educator and curriculum developer. Her work focuses on translating health and longevity research into practical application for coaches and the clients they serve.

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References:

[1] BDNF and Neuroplasticity: Exercise Review (PubMed, 2025): https://pubmed.ncbi.nlm.nih.gov/41206250/

[2] Aerobic Exercise Increases Hippocampal Volume: PNAS Randomized Controlled Trial: https://pmc.ncbi.nlm.nih.gov/articles/PMC3041121/

[3] Exercise for Cognitive Function in Older Adults: Meta-Analysis, IJERPH 2023: https://pmc.ncbi.nlm.nih.gov/articles/PMC9858649/

[4] Physical Activity and Age-Related Cognitive Decline: Sports Medicine Open 2025: https://pmc.ncbi.nlm.nih.gov/articles/PMC12085549/

[5] Exercise Frequency and Dementia Conversion Rates: Scientific Reports 2023: https://www.nature.com/articles/s41598-023-42737-3

[6] Glymphatic Clearance and Alzheimer’s Disease Pathology: https://www.explorationpub.com/Journals/ent/Article/100491

[7] Sleep-Active Glymphatic Clearance of Amyloid-Beta and Tau: Nature Communications 2026: https://pmc.ncbi.nlm.nih.gov/articles/PMC12847902/

[8] Sleep Duration and Cognitive Health: The Neuroscientist 2025: https://pmc.ncbi.nlm.nih.gov/articles/PMC12426325/

[9] Caffeinated Coffee and Dementia Risk (131,821 Participants): JAMA 2026: https://pubmed.ncbi.nlm.nih.gov/41661604/

[10] Coffee Consumption and Cognitive Decline in Older Adults: Frontiers in Aging Neuroscience 2021: https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2021.744872/full

[11] Coffee, IL-6, and Cognitive Performance: Journal of the American Heart Association 2024: https://www.ahajournals.org/doi/10.1161/JAHA.124.034365

[12] Musical Instrument Playing and Dementia Risk: BMC Neurology 2022: https://creyos.com/blog/how-playing-an-instrument-benefits-your-brain

[13] Piano Practice and Working Memory in Adults 60-80: Bugos and Wang, 2022: https://creyos.com/blog/how-playing-an-instrument-benefits-your-brain

[14] Piano Learning and Cognitive Outcomes in Older Beginners: University of Sheffield / Royal Society Open Science 2025: https://sheffield.ac.uk/news/learning-play-music-can-improve-older-peoples-brain-function-study-suggests

[15] Musical Training and White Matter Plasticity: Cerebral Cortex Communications 2021: https://pmc.ncbi.nlm.nih.gov/articles/PMC8213952/

[16] Bilingualism and Delayed Alzheimer’s Onset: American Journal of Alzheimer’s Disease 2022: https://pmc.ncbi.nlm.nih.gov/articles/PMC10581104/

[17] Bilingualism as Cognitive Reserve: FDG-PET Evidence, PNAS 2017: https://www.pnas.org/doi/10.1073/pnas.1610909114

[18] Second Language Acquisition and Late-Life Cognition: Clinical Interventions in Aging 2017: https://pmc.ncbi.nlm.nih.gov/articles/PMC5656355/

[19] BrainHQ Efficacy: 300 Peer-Reviewed Studies, Posit Science: https://www.brainhq.com/news/press-releases/hundreds-of-studies-show-efficacy-of-one-particular-brain-fitness-program/

[20] The IMPACT Study: BrainHQ, Mayo Clinic, and University of Southern California: https://www.brainhq.com/world-class-science/information-researchers/impact-study/

[21] BrainHQ Research Summary 2025: Posit Science: https://www.brainhq.com/better-brain-health/article/better-brain-health/brain-news/how-an-avalanche-of-science-buried-brain-exercise-skeptics-in-2025/

[22] Reading Frequency and 14-Year Cognitive Decline Risk: International Psychogeriatrics: https://pmc.ncbi.nlm.nih.gov/articles/PMC8482376/

[23] Social Activity and Cognitive Decline in Aging: Gerontology and Geriatric Medicine 2023: https://pmc.ncbi.nlm.nih.gov/articles/PMC9869223/

[24] Lifetime Cognitive Enrichment and Alzheimer’s Disease Onset: Neurology 2026, Rush University: https://www.rush.edu/news/lifelong-learning-may-decrease-alzheimers-risk

[25] Book Club Participation and Montreal Cognitive Assessment Scores: Gerontology and Geriatric Medicine: https://pmc.ncbi.nlm.nih.gov/articles/PMC9869223/

[26] ReCODE Protocol: Clinical Outcomes in Cognitive Decline: Biomedicines 2021: https://pmc.ncbi.nlm.nih.gov/articles/PMC8533598/

Vibrant at 76: Move More, Think Better, and Don’t Go It Alone

What the science says about resistance training, joyful movement, and positive psychology; and why having someone by your side changes everything.

By Dr. Sandra Scheinbaum  |  April 2026

The research on healthy aging has never been clearer, or more encouraging. We now know that the major threats to vitality in our 70s and beyond, muscle loss, cognitive decline, reduced bone density, low mood, and social isolation, are not inevitable. They are, in large part, modifiable. And the interventions that work best are simpler than most people expect.

In my first Substack article, I shared the science behind health coaching and why having a trained partner matters for lasting change. In this article, I want to walk through three pillars of vibrant aging that the evidence consistently supports: progressive resistance training, varied movement, and the practice of positive psychology. And I want to close with the most important point: you do not have to do any of this alone.

As a licensed clinical psychologist who spent over 35 years in practice before leaving to train health coaches, and as someone who is personally committed to putting these principles into action every day, I find the convergence of science and lived experience genuinely exciting.

Pillar One: Resistance Training Is Non-Negotiable

One of the most consequential facts in aging science is also one of the most underappreciated: after age 30, adults lose 3% to 8% of their muscle mass per decade, and that rate accelerates sharply after 60.¹ By our 70s, sarcopenia, the clinical term for age-related muscle loss, affects roughly 10% of adults over 60 and rises to approximately 30% by age 80.² The consequences go well beyond appearance. Sarcopenia erodes balance, slows metabolism, reduces bone density, and is one of the strongest predictors of loss of independence in later life.

The good news is that resistance training is among the most well-documented interventions in all of longevity medicine. A landmark randomized controlled trial published in BMJ Open Sport & Exercise Medicine found that just one year of heavy resistance training at retirement age produced measurable strength benefits that persisted four years later, even among participants who had subsequently stopped training.³ One year of committed effort. Four years of residual benefit.

Harvard researchers confirm that combining adequate protein intake with progressive resistance exercise produces the most meaningful improvements in muscle mass and functional strength in healthy older adults.⁴ The combination matters; neither nutrition nor exercise alone produces the same result.

"The evidence is clear: it is possible to get stronger in your 70s and beyond. Muscle is not lost simply because of age; it is lost because of disuse."

Progressive Overload: The Principle Behind Lasting Gains

The mechanism that drives continued improvement in strength training is called progressive overload: the practice of incrementally increasing the challenge placed on a muscle over time. The increases do not need to be dramatic. In fact, the most sustainable approach is often almost imperceptibly small.

A personal example: I use dead hangs as a progressive overload practice, which consists of hanging from a bar and holding a few seconds longer each session. Over time, this has built grip endurance and upper body stability I could not have predicted when I started. Grip strength, it turns out, is one of the most powerful predictors of longevity and functional independence in older adults.⁵ I also apply the same slow-build principle to other forms of strength training. Working up gradually over many months, I reached a 165-pound deadlift from an initial starting point of 115 pounds. Not through any exceptional athletic background, but simply by adding a little more, consistently, over time. That is progressive overload in practice.

The key insight here is that the starting point is irrelevant. What matters is the trajectory.

Exercise Snacking: Movement in Every Margin

Not all resistance training needs to happen in a dedicated gym session. Research supports the concept of "exercise snacking”: short bouts of movement distributed throughout the day that accumulate into a meaningful training stimulus. I keep kettlebells by my desk and fit in squats and swings between Zoom calls. I do 30 air squats while waiting for my coffee to brew each morning, do some push ups during breaks, and work at a treadmill desk to get in steps. Several times a day I practice dead hangs and attempt an unassisted pull up (a work in progress). These brief doses of effort add up, and the evidence suggests they produce real physiological benefits, including improved blood glucose regulation and maintained muscle protein synthesis.⁶

Pillar Two: A Movement Menu, Not a Movement Mandate

Resistance training provides the structural foundation. But the research on longevity consistently points to movement variety as an additional and independent contributor to healthy aging. Different modalities train different systems; balance, coordination, cardiovascular capacity, bone density, and cognitive function all respond to different inputs.

The evidence supports a broad movement menu. For me, it includes the following:

• Dance and rhythmic movement: A meta-analysis of dance interventions lasting 10 weeks to 18 months found consistent links to maintained or improved cognitive performance in older adults, including memory, attention, and executive function.⁷ Ballet, in particular, combines balance, proprioception, spatial memory, and musical timing in a way that few other activities can match. I’ve taken ballet classes for years, and while I’m often the least accomplished dancer in the room, skill level doesn’t matter. The physical, cognitive, and social returns are well worth it.

• Inversions and balance work: Handstands, headstands, and other inverted positions challenge the vestibular system, core stability, and spatial orientation. Regular balance training is one of the most evidence-based interventions for fall prevention, which remains a leading cause of injury and death in adults over 65.⁸ I practice a handstand against the wall every morning; it takes less than a minute and serves as a daily reminder that the body remains capable of remarkable things at any age.

• High-intensity interval training: Short, maximal-effort intervals produce cardiovascular and metabolic adaptations that longer moderate-intensity sessions often do not. Research by Dr. Stacy Sims and others highlights that women in particular benefit from higher-intensity protocols rather than extended moderate-effort cardio.⁹ My own practice is two 20-second all-out sprints on a Carol Bike three times a week. It takes under ten minutes total and consistently delivers.

• Daily walking: Thirty to forty minutes of outdoor walking delivers a consistent return on investment: improved mood, better circadian rhythm regulation, reduced cardiovascular risk, and meaningful daily step accumulation. Weather permitting, I love to walk outside daily; the light exposure and connection with nature make it non-negotiable. Both are independently associated with wellbeing.¹⁰

• Jumping for bone health: Repetitive jumping, whether via jumping jacks, a trampoline, or rope skipping, generates multi-directional mechanical loading on the skeleton that stimulates osteoblast activity; the bone-building cellular response. For women especially, this kind of impact training is a practical complement to resistance work for maintaining bone density.¹¹ My daily practice is 100 jumping jacks, 100 jumps on a rebounder, and 5 minutes of jumping rope: simple and remarkably effective.

• Isometric holds: Wall sits, planks, and dead hangs build functional strength in positions the body regularly uses, and research supports their role in blood pressure management and joint stability as well.¹²

"Movement variety is not just more interesting; it is more effective. Different modalities train different systems, and the research supports building a broad movement practice rather than a narrow one."

Pillar Three: Positive Psychology Is Not Just a Nice Idea

The behavioral and psychological dimensions of aging are as well-studied as the physical ones, and the findings are striking. Yale researcher Becca Levy followed 660 adults aged 50 and older for up to 23 years and found that those with more positive self-perceptions of aging lived an average of 7.6 years longer than those with more negative views, after controlling for age, gender, socioeconomic status, loneliness, and functional health.¹³ The effect size exceeded that of quitting smoking.

A major NIA-funded study of over 150,000 women found that the most optimistic participants lived approximately 4.4 years longer than the least optimistic and were significantly more likely to reach age 90, with effects consistent across racial and ethnic groups.¹⁴

These are not soft findings. They are robust, replicated results with large samples and long follow-up periods. The mechanism appears to involve both behavioral pathways, optimistic people engage more consistently in health-promoting behaviors, and biological ones, including lower levels of inflammatory markers and better stress hormone regulation.

Applying Positive Psychology: Practical Tools

Positive psychology is not the same as positive thinking. It is a scientific field focused on the conditions that allow individuals and communities to flourish. Applied to aging and behavior change, it offers several evidence-based strategies:

• Start with values and meaning: Identifying why a health behavior matters to you personally produces more durable motivation than external goals. Research on self-determination theory consistently shows that intrinsically motivated behavior change is more sustained than externally driven compliance.¹⁵ My own anchor is a question I ask every morning: What will bring me joy today? I also tell myself: Today will be a good day. These small cognitive shifts direct attention toward possibility.

• Use small, achievable goals: Goal-setting research shows that specific, proximal, and achievable goals produce more consistent behavior than large aspirational ones. I started several years ago with five push-ups; proper military form, no modifications. That was the only goal. Then six, then ten, and now 100 each day. The number grew because the identity was already in place. Starting small is not a compromise; it is a scientifically sound strategy for building momentum.

• Build identity before habits: What we believe about ourselves shapes what we do more powerfully than willpower or motivation. The research on identity-based behavior change suggests that framing exercise as an expression of who you are, rather than something you must do, produces more resilient patterns over time.¹⁶

• Reframe setbacks as information: Cognitive reframing, a core tool of both cognitive behavioral therapy and positive psychology, reduces the psychological cost of setbacks and maintains forward momentum. The question is not "why did I fail?" but "what does this tell me about what to adjust?"

• Adopt a pro-aging rather than anti-aging frame: The language of anti-aging positions age itself as the enemy, which research suggests is counterproductive. A pro-aging orientation, which views aging as an opportunity for continued growth and wisdom, is associated with better health outcomes and greater psychological wellbeing.¹³

You Don't Have to Do This Alone

There is a common pattern in behavior change that deserves direct attention: people who understand the science, who have read the research, know what they should do, and still struggle to make lasting changes. This is not a failure of knowledge or willpower. It reflects the well-documented gap between intention and behavior, one of the most studied phenomena in health psychology.

Health coaching is one of the most effective interventions for closing that gap. A 2025 study in Clinical Interventions in Aging found that health coaching was significantly associated with improved self-management behaviors in older adults (standardized coefficient = 0.42, p < 0.001), with patient activation, meaning the individual's confidence in their own capacity to manage their health, serving as the key mediating factor.¹⁷

Research published in the Journal of Community Medicine & Public Health confirms that social support is among the strongest predictors of sustained exercise behavior in older adults, often outweighing individual motivation.¹⁸ And a study in Innovative Aging found that accountability relationships, including coaches, peer leaders, and mentors who monitor progress, provide feedback, and model healthy behavior, are among the most effective strategies for maintaining physical activity in middle-aged and older adults.¹⁹

"The gap between knowing and doing is not a willpower problem. It is a support problem; and that is precisely what a skilled health coach addresses."

What a Functional Medicine Health Coach Does

A functional medicine health coach is not a personal trainer, dietitian, or physician. They are a trained partner who works alongside your existing healthcare team. Specifically, a well-trained health coach helps clients:

• Identify the root-cause barriers to behavior change and address them with evidence-based tools

• Set personally meaningful, achievable goals calibrated to current capacity rather than ideal outcomes

• Navigate the often-overwhelming landscape of nutrition, movement, sleep, and stress management with a personalized lens

• Maintain accountability in the gap between medical appointments, where most behavior change actually happens or fails

• Build the psychological foundation, including identity, self-efficacy, and resilience, that makes healthy choices sustainable over the long term

The research consistently shows that behavior change is more durable when it is supported by a skilled, consistent relationship. This is not a luxury; it is a well-documented component of effective health intervention.

A Final Thought

The science of vibrant aging points in a clear direction: progressive resistance training, movement variety, a positive psychology orientation, and social support are not merely beneficial add-ons. They are core pillars of healthy longevity with robust evidence behind each of them.

The barriers to starting are rarely physical. They are usually psychological and structural; uncertainty about where to begin, lack of accountability, and the isolation that makes it easy to postpone. Those are exactly the barriers a good health coach is trained to help you work through.

You do not need to be starting from a position of strength. You need only to start; and ideally, to start with someone in your corner.

With love,

Dr. Sandi

Sandra Scheinbaum, Ph.D., is the founder and CEO of the Functional Medicine Coaching Academy, a licensed clinical psychologist, author of Your Health Coach Will See You Now, and host of the Health Coach Talk podcast.

References

1. CNN Health (2025). Even modest strength training can counter age-related decline. https://www.cnn.com/2025/12/05/health/muscle-loss-strength-training-longevity-wellness

2. University of Nebraska — Honors Thesis (2024). Sarcopenia and the Importance of Resistance Training. https://digitalcommons.unl.edu/honorstheses

3. Bloch-Ibenfeldt M et al. (2024). Heavy resistance training at retirement age induces 4-year lasting beneficial effects. BMJ Open Sport & Exercise Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC11191791/

4. Harvard Health Publishing (2024). Muscle loss and protein needs in older adults. https://www.health.harvard.edu/healthy-aging-and-longevity/muscle-loss-and-protein-needs-in-older-adults

5. Bohannon RW (2019). Grip strength: an indispensable biomarker for older adults. Clinical Interventions in Aging. https://pubmed.ncbi.nlm.nih.gov/31814700/

6. Betts JA et al. (2020). The causal role of breakfast in energy balance and health: a randomized controlled trial. American Journal of Clinical Nutrition. [exercise snacking review] https://pubmed.ncbi.nlm.nih.gov/32936868/

7. Qi M et al. (2023). Effects of dance therapy on cognitive and mental health in older adults. BMC Geriatrics. https://pmc.ncbi.nlm.nih.gov/articles/PMC10601250/

8. Sherrington C et al. (2019). Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. https://pubmed.ncbi.nlm.nih.gov/30703272/

9. Stacy Sims / ROAR (2016). Research on female-specific exercise physiology and HIIT protocols. https://www.drstacysims.com

10. White MP et al. (2019). Spending at least 120 minutes a week in nature is associated with good health and wellbeing. Scientific Reports. https://www.nature.com/articles/s41598-019-44097-3

11. Kato T et al. (2006). Effect of low-repetition jump training on bone mineral density in young women. Journal of Applied Physiology. https://pubmed.ncbi.nlm.nih.gov/16339346/

12. Howden EJ et al. (2018). Isometric exercise training for blood pressure management. Hypertension. https://pubmed.ncbi.nlm.nih.gov/29084835/

13. Levy BR et al. (2002). Longevity increased by positive self-perceptions of aging. Journal of Personality and Social Psychology. https://pubmed.ncbi.nlm.nih.gov/12150226/

14. NIH National Institute on Aging (2022). Optimism linked to longevity and well-being. https://www.alzheimers.gov/news/optimism-linked-longevity-and-well-being-two-recent-studies

15. Deci EL & Ryan RM (2000). Self-determination theory and the facilitation of intrinsic motivation. American Psychologist. https://pubmed.ncbi.nlm.nih.gov/11392867/

16. Fogg BJ (2020). Tiny Habits. Houghton Mifflin Harcourt. [identity and behavior change framework]

17. Alharbi M et al. (2025). Assessing the impact of community health coaching on self-management in older adults. Clinical Interventions in Aging. https://pmc.ncbi.nlm.nih.gov/articles/PMC11874956/

18. Chen WL et al. (2023). Effects of exercise behavior, social cohesion, and social support on health behaviors in older adults. Journal of Community Medicine & Public Health. https://www.gavinpublishers.com/article/view/effects-of-exercise-behavior-social-cohesion

19. Lachman ME et al. (2018). Behavioral strategies to increase physical activity in sedentary adults. Innovation in Aging. https://academic.oup.com/innovateage/article/2/1/igy007/4962182

I’ve Watched This Profession Fight for Credibility

For years, health coaches were the best-kept secret in healthcare. We knew that a skilled coach could help someone reverse their trajectory on diabetes, find the motivation to actually exercise, or finally find their meaning and purpose in life. We knew coaching worked based on the turnaround in clients’ lab values. We heard countless reports of individuals taking charge of their health because they engaged with a health coach.

But knowing it and proving it are two different things. We needed data. We needed randomized controlled trials, effect sizes, follow-up periods. The health coaching profession needed the kind of evidence that earns a seat at the table with physicians and hospital systems and insurance companies.

Well, here it is. Pull up a chair.

The Flagship Study: 8,662 Patients. 30 Trials. One Clear Answer.

If you need a single study to bookmark, save, and share with every doubter in your life, it’s this one.

In 2023, Boehmer and colleagues (https://doi.org/10.1016/j.pec.2023.107975) published a landmark systematic review and meta-analysis in Patient Education and Counseling. They looked at 30 randomized controlled trials with 8,662 participants, asking one direct question: does health and wellness coaching make a meaningful difference in patient-important outcomes?

The answer was unambiguous. Health coaching significantly improved quality of life at three months (SMD 0.62, p=0.002). It significantly improved self-efficacy, that critical sense of “I can actually do this,” at just six weeks (SMD 0.38, p=0.033). And it delivered some of its most striking results in depression outcomes: significant improvement at three months (SMD 0.67), six months (SMD 0.72), and twelve months (SMD 0.41), all with p-values well under 0.05.

These aren’t small effects. These are clinically meaningful changes, replicated across thousands of patients, across dozens of trials. This is the kind of evidence that moves medicine.

Moving Bodies and Lifting Spirits: The Vanderbilt Finding

One of my favorite studies in recent years came out of Vanderbilt, led by Dr. Ruth Wolever, a researcher who has spent her career making the case for health coaching in clinical settings.

Her team studied 200 active-duty and retired Air Force beneficiaries who were at elevated risk for coronary heart disease, type 2 diabetes, or both. Participants received just 10 sessions of health coaching. Six months after the intervention ended, the coached group was 3.6 times more likely to report moderate-to-vigorous physical activity(https://news.vumc.org/2022/07/21/study-shows-benefits-of-health-coaching-for-chronic-conditions/) compared to inactivity or light activity. Not just during the program, but six months after it wrapped! At one year out, they were still 2.9 times more likely to be exercising.

And the depression scores? Significantly lower in the coaching group at six months.

What I love about Dr. Wolever’s description of the coaching approach is how precisely it captures what we teach at FMCA: “Coaching is not about diagnosing or directing behavior. It is about facilitating change from one’s intrinsic motivation.” That’s the whole thing, right there. That’s why it works and why it sticks.

The Breadth of the Evidence: 480+ Studies and Counting

Here’s the scope of what we’re dealing with.

The 2023 Compendium of Health and Wellness Coaching (https://www.linkedin.com/pulse/latest-evidence-health-coaching-impact-disease-main-tuma-phd-nbhwc-wlp1c), including its addendum, now documents over 480 published studies on health coaching, including more than 160 randomized controlled trials. Across those studies:

- 79% of diabetes studies measuring HbA1c reported positive reductions

- 11 of 12 studies on coaching for heart disease showed significant improvements

- 28 of 32 studies found positive effects on weight reduction and/or BMI

- 13 of 14 cholesterol studies reported favorable outcomes

That’s not a trend. That’s a pattern. And when you see a pattern like that across hundreds of independent studies, you stop asking “does this work?” and start asking “how do we make sure every person who needs this has access to it?”

The Heart of the Matter: Coaching and Cardiovascular Health

Heart disease remains the leading cause of death worldwide, responsible for 20.1 million deaths in 2021 alone (https://www.acc.org/latest-in-cardiology/articles/2025/02/01/42/prioritizing-health-journey-of-the-health-and-well-being-coaching-profession), largely driven by modifiable lifestyle factors. This is precisely where health coaching shines.

The COACH Program is a powerful example. Patients with established coronary heart disease who were coached by trained dietitians and nurses achieved a [21 mg/dL greater reduction in total cholesterol](https://www.uspharmacist.com/article/health-coaching-for-cardiovascular-risk-reduction) compared to usual care at six months, along with improvements in LDL cholesterol, body weight, BMI, and dietary patterns. Those results were sustained at 18 months post-program. And perhaps most striking: a 5.08% absolute reduction in all-cause mortality in the coaching group.

The American College of Cardiology took notice (https://www.acc.org/latest-in-cardiology/articles/2025/02/01/42/prioritizing-health-journey-of-the-health-and-well-being-coaching-profession) in a February 2025 article documenting how health and wellness coaching is now being integrated into cardiovascular care in physician practices and health systems nationwide — with CPT billing codes established and Medicare coverage expanding.

The health coaching profession has arrived in cardiology. That’s remarkable.

Quality of Life and the Mind: Mayo Clinic’s Contribution

We can talk about cholesterol numbers and HbA1c all day, but what about the whole person? What about stress, depression, the lived experience of health?

A 2014 Mayo Clinic study (https://www.mayoclinic.org/medical-professionals/physical-medicine-rehabilitation/news/study-finds-wellness-coaching-benefits-last-over-time/mac-20431166) published in Mayo Clinic Proceedings followed 100 employees through a 12-week wellness coaching program. By the end, participants showed statistically significant and clinically meaningful improvement in all five domains of quality of life: physical, social, emotional, cognitive, and spiritual. Perceived stress dropped from a mean of 14.3 to 11.0. The number of participants reporting troubling depressive symptoms was cut in half. Every single domain improved.

And those improvements held at the 24-week follow-up.

What strikes me about this study is the word the researchers themselves used: “meaningful”. Not just statistically significant. Meaningful. That’s the word that matters to clients.

The Business Case: Real Dollars, Real Lives

For those who need to make the case to health systems, employers, or insurers, the cost data is equally compelling.

A study of 1,161 high-risk individuals enrolled in health coaching for at least four weeks found decreases across inpatient, emergency department, outpatient, and prescription claims. The predicted average monthly savings? $286 per person in outpatient costs alone, and $412 per person in total savings (https://www.uspharmacist.com/article/health-coaching-for-cardiovascular-risk-reduction).

Health coaching doesn’t just help people feel better. It reduces the burden on an overtaxed healthcare system. It saves money. And the healthcare world is beginning to notice. FMCA documented [100+ studies on our own evidence page](https://functionalmedicinecoaching.org/about/health-coaching-studies/) for anyone who wants to go deeper.

What This Means for Health Coaching, and What Comes Next

We are living through a pivotal moment in the health coaching profession. The evidence is no longer accumulating quietly in academic journals that few people read. It’s showing up in the American College of Cardiology. It’s influencing Medicare policy. It’s driving the integration of health coaches into physician practices and hospital systems across the country.

This is what we’ve been working toward. And if you’re a health coach, a practitioner, or someone who has felt the impact of coaching in your own life, you are part of this story.

My invitation to you: share this evidence. Use it in your conversations with skeptical physicians, with hospital administrators, with the client who isn’t sure coaching is “real medicine.” Because the research is clear, and the outcomes are real, and people deserve to know that this kind of care exists.

We are not a footnote in healthcare. We are a solution to some of its most intractable problems. And we’re just getting started.

- Dr. Sandra Scheinbaum is the founder and CEO of the Functional Medicine Coaching Academy (https://functionalmedicinecoaching.org/ and author of Your Health Coach Will See You Now. A licensed clinical psychologist for over 35 years, she left her practice to train health coaches in 2015 and has since trained thousands of them. She is a passionate advocate for integrating health coaching into mainstream medical practice.

Sources referenced in this article:

- Boehmer KR et al. Patient Education and Counseling. 2023. [https://doi.org/10.1016/j.pec.2023.107975](https://doi.org/10.1016/j.pec.2023.107975)

- Vanderbilt University Medical Center, July 21, 2022. [https://news.vumc.org/2022/07/21/study-shows-benefits-of-health-coaching-for-chronic-conditions/](https://news.vumc.org/2022/07/21/study-shows-benefits-of-health-coaching-for-chronic-conditions/)

- Tuma, PhD, NBHWC. Compendium of Health and Wellness Coaching, 2023 Addendum. [https://www.linkedin.com/pulse/latest-evidence-health-coaching-impact-disease-main-tuma-phd-nbhwc-wlp1c](https://www.linkedin.com/pulse/latest-evidence-health-coaching-impact-disease-main-tuma-phd-nbhwc-wlp1c)

- U.S. Pharmacist, “Health Coaching for Cardiovascular Risk Reduction,” Feb 12, 2025. [https://www.uspharmacist.com/article/health-coaching-for-cardiovascular-risk-reduction](https://www.uspharmacist.com/article/health-coaching-for-cardiovascular-risk-reduction)

- Mayo Clinic, Mayo Clinic Proceedings,*2014. [https://www.mayoclinic.org/medical-professionals/physical-medicine-rehabilitation/news/study-finds-wellness-coaching-benefits-last-over-time/mac-20431166](https://www.mayoclinic.org/medical-professionals/physical-medicine-rehabilitation/news/study-finds-wellness-coaching-benefits-last-over-time/mac-20431166)

- American College of Cardiology, February 2025. [https://www.acc.org/latest-in-cardiology/articles/2025/02/01/42/prioritizing-health-journey-of-the-health-and-well-being-coaching-profession](https://www.acc.org/latest-in-cardiology/articles/2025/02/01/42/prioritizing-health-journey-of-the-health-and-well-being-coaching-profession)

- Functional Medicine Coaching Academy, Health Coaching Studies. [https://functionalmedicinecoaching.org/about/health-coaching-studies/](https://functionalmedicinecoaching.org/about/health-coaching-studies/)