Health & Wellness Coaching: NBHWC Certification & Career Guide

Health and wellness coaching is a client-centered process that helps people make sustainable behavior changes around their physical health. You work with clients on nutrition, exercise, stress management, sleep, and chronic disease management — not by prescribing solutions, but by helping them find their own motivation and build habits that stick.

The approach is grounded in evidence-based methodologies: motivational interviewing, positive psychology, self-determination theory, and stages-of-change models. Unlike traditional health education (where an expert tells you what to do), coaching meets clients where they are and supports them in designing their own path forward.

This is one of the fastest-growing segments of the coaching industry. The global health and wellness coaching market is projected to reach $37.96 billion by 2034 according to Precedence Research. The Bureau of Labor Statistics projects a 12% increase in health education and community health worker positions from 2023 to 2033, which is significantly faster than the average for all occupations.

The growth is driven by a shift in healthcare: the system is moving from treating illness to preventing it. Employers, insurers, and healthcare systems are recognizing that behavior change coaching produces better long-term outcomes than one-time interventions — and they are hiring health coaches to deliver it.

This is the most important distinction you need to understand before entering health coaching. Your scope defines what you can and cannot do — and crossing those lines can put both your clients and your career at risk.

Health coaches support behavior change. You help clients set goals, identify barriers, build accountability, and develop sustainable habits around nutrition, exercise, stress, and lifestyle. You do not diagnose conditions, prescribe treatments, create meal plans for medical conditions, or provide psychotherapy. Your role is to help clients implement the changes they already know they need to make.

Registered Dietitians (RDs) are licensed healthcare providers who assess nutritional needs, diagnose nutrition problems, and provide medical nutrition therapy. They can create clinical meal plans for conditions like diabetes, kidney disease, and eating disorders. This is a protected title in most states — you cannot call yourself a dietitian or nutritionist (in states where that title is also protected) without the proper license. If a client needs a specific dietary protocol for a medical condition, you refer to an RD.

Therapists and counselors (licensed psychologists, LCSWs, LPCs) diagnose and treat mental health disorders. They work with clinical depression, anxiety disorders, trauma, eating disorders, and other diagnosable conditions. If a client presents with symptoms of a mental health condition — disordered eating, clinical depression, PTSD — you refer to a therapist. Coaching is not therapy, and attempting to treat mental health conditions without a license is both unethical and potentially illegal.

Where health coaches fit: You occupy the space between medical treatment and self-help. A physician diagnoses type 2 diabetes and prescribes medication. A dietitian creates a medical nutrition plan. A health coach helps the client actually follow through — building the daily habits, addressing motivational barriers, and providing ongoing accountability. You are the bridge between clinical recommendations and real-world behavior change.

The best health coaches know exactly where their scope ends and maintain strong referral relationships with RDs, therapists, and physicians. This is not a limitation — it is what makes you a trusted professional. Healthcare providers refer patients to coaches they trust to stay in their lane.

If you are serious about health coaching as a career, the NBHWC credential (NBC-HWC) is the certification that matters. It is the only health coaching credential administered through the National Board of Medical Examiners (NBME) — the same organization that administers the US Medical Licensing Examination. No other coaching credential carries this level of clinical legitimacy.

Here is what you need to earn it:

1. Complete an NBHWC-approved training program. There are 138+ approved programs as of 2026, ranging from university-based programs (Duke, Georgetown, University of Minnesota) to independent training organizations (Wellcoaches, IIN, Health Coach Institute). Programs vary from $2,000 to $10,000+.
2. Meet the education or experience requirement. You need an associate degree or higher from a regionally accredited institution, OR 4,000 hours of documented work experience in a health-related field. The degree does not need to be in health — any accredited degree qualifies.
3. Complete 50+ coaching sessions. Each session must be at least 20 minutes and follow NBHWC coaching competencies. Many approved training programs include practicum hours that count toward this requirement.
4. Pass the NBME-administered certifying exam. The exam is offered at Prometric test centers across the US and internationally. It covers health coaching competencies, behavior change science, ethics, and practical application.

Most people complete the entire process in 6-18 months. After certification, you must complete 36 continuing education units (CEUs) every 3 years to maintain the credential.

For a complete breakdown of requirements, costs, and exam preparation, see our full NBHWC certification guide.

Your training program choice shapes both your certification eligibility and your professional credibility. Here are the main categories:

University-based programs. Offered through schools of medicine, public health, or continuing education at institutions like Duke Integrative Medicine, Georgetown University, and the University of Minnesota. These programs carry the added credibility of a university name, cost more ($5,000-$10,000+), and often include supervised practicum hours. Best if you plan to work in healthcare systems or clinical settings where institutional credibility matters.

Independent training organizations. Schools like Wellcoaches, the Institute for Integrative Nutrition (IIN), and the Health Coach Institute offer NBHWC-approved programs at a wider range of price points ($2,000-$6,000). These tend to be more flexible with scheduling and often include business-building components. Best if you plan to build a private practice.

Dual-credential programs. Some programs are approved by both NBHWC and ICF, allowing you to pursue both health coaching and general coaching certifications simultaneously. This is valuable if you want to serve both health-focused and non-health coaching clients.

Critical step before enrolling: Verify that any program you consider appears on the current NBHWC-approved program list. Programs can lose approval, and completing a non-approved program means you will not be eligible for the certifying exam regardless of the training quality.

For guidance on choosing between online and in-person options across all coaching credentials, see our certifications hub.

Where do health coaches actually work? According to NBHWC data, NBC-HWC holders are distributed across several distinct career settings:

Private practice (41% of NBC-HWCs). The most common path. You build your own client base, set your own rates, and work with clients directly — either in person or virtually. Private practice health coaches typically work with clients on weight management, nutrition habits, stress reduction, fitness goals, and chronic disease lifestyle management. The advantage: you control your schedule and income. The challenge: you are responsible for marketing, client acquisition, and business operations.

Healthcare systems (22% of NBC-HWCs). Hospitals, clinics, and integrated health systems hire NBC-HWC coaches to work alongside physicians, nurses, and dietitians. You help patients with chronic conditions like diabetes, hypertension, and obesity build sustainable behavior changes. Hospital systems value the NBC-HWC specifically because of its NBME-backed rigor — general coaching credentials typically do not meet their standards. This path offers more income stability than private practice, with salaried positions and benefits.

Digital health (10% of NBC-HWCs). Health tech companies hire coaches to deliver coaching through apps, telehealth platforms, and employer wellness programs. Companies like Noom, Virta Health, and Omada Health employ health coaches at scale. Digital health positions often offer flexibility (remote work, asynchronous coaching) and exposure to technology-enabled coaching models.

Corporate wellness. Companies contract or hire health coaches to support employee wellness programs. You work with employees on stress management, nutrition, physical activity, and work-life balance. Larger employers increasingly specify NBC-HWC certification when hiring wellness coaches. These roles are often part-time or contract-based, making them a good complement to private practice.

Community health and nonprofits. Public health departments, community health centers, and nonprofits employ health coaches to work with underserved populations on preventive health. These roles are mission-driven and often grant-funded. The NBC-HWC credential signals the competency in evidence-based behavior change that funders and administrators require.

Insurance-reimbursable coaching. Some health insurance companies and integrative medicine practices are beginning to recognize and reimburse for health coaching services — but typically only when provided by an NBC-HWC certified coach. As insurance coverage for health coaching expands, this credential becomes increasingly important for private practice coaches who want to accept insurance.

Health coaching income varies widely depending on your setting, location, experience, and whether you hold the NBC-HWC credential.

Private practice. Session rates for health coaches typically range from $75 to $200 per session. NBC-HWC holders can command higher rates than non-credentialed coaches. Many private practice health coaches also offer packages (e.g., 12-week programs at $1,500-$3,000) rather than per-session pricing. Full-time private practice income varies widely — from $40,000 to $100,000+ depending on client volume and pricing strategy.

Healthcare and corporate positions. Salaried health coaching positions in hospitals, clinics, and corporate wellness programs typically pay $45,000-$75,000 per year, with variation based on location and employer. Senior or leadership roles in wellness programs can reach $80,000-$100,000+. The BLS reports a median salary of $62,860 for health education specialists (the closest comparable occupation category), with the top 10% earning over $102,000.

Digital health platforms. Digital health coaching positions typically pay $50,000-$80,000 for full-time roles, with some senior positions exceeding $90,000. Contract and part-time digital coaching can supplement other income streams.

The credential premium. NBC-HWC holders consistently earn more than non-credentialed health coaches. The credential opens doors to institutional employment (healthcare, corporate, insurance-reimbursed) that is simply not available without it. If you are investing in a health coaching career, the NBHWC certification pays for itself through higher rates and access to better-paying settings.

For broader context on coaching income across all specializations, see our life coach salary data.

If you choose the private practice path (as 41% of NBC-HWCs do), here is how to approach building your business:

Define your niche within health coaching. "Health coach" is already a specialization within coaching, but you can go narrower. Coaches who focus on a specific population or condition — diabetes management, postpartum health, executive stress, menopause wellness — can differentiate themselves more effectively and charge higher rates. Your background matters here: a former nurse has credibility in chronic disease coaching; a former athlete connects naturally with performance-focused wellness.

Build referral relationships. Physicians, dietitians, therapists, and physical therapists are your referral partners. When a doctor tells a patient to "eat better and exercise more" but has 15 minutes per appointment, you are the professional who provides the ongoing support. Make it easy for providers to refer to you: a one-page summary of your services, your credentials, and your scope of practice. Knowing and respecting your scope boundaries is what earns trust from healthcare providers.

Consider your delivery model. Health coaching works well virtually — which means your geographic market is not limited to your city. Many successful health coaches offer a combination of one-on-one sessions (in person or video), group coaching programs, and digital resources (courses, meal planning guides, accountability apps). Group programs in particular can increase your income without proportionally increasing your hours.

Get liability insurance. Professional liability insurance is essential for health coaches, especially those working with clients on health-related goals. Policies typically run $200-$500 per year and protect you in case a client claims harm from your coaching.

Pursue insurance reimbursement. As more insurers recognize the NBC-HWC credential, the ability to accept insurance becomes a significant competitive advantage. Research which insurers in your area cover health coaching services and what credentialing requirements they have. Being able to tell prospective clients "we can bill your insurance" removes a major barrier to enrollment.

For a comprehensive guide to the business side of coaching, see our how to start a coaching business guide. For step-by-step guidance on entering the profession, see how to become a life coach.