5 Things to Know About Pediatric Health Coaching and the Obesity Care Gap

Childhood obesity and related metabolic conditions continue to rise in the US, yet many families lack access to sustained, effective support.¹ Thea Runyan, DrPH, MPH, NBC-HWC, cofounder and CEO of the Pediatric Health Coach Academy (PHCA), and Arielle Levi, PhD, NBC-HWC, PCC, chief science officer and cofounder of the PHCA, share expert perspectives, suggesting that pediatric health coaching may help close a critical gap between clinical recommendations and real-world behavior change, in an interview with The American Journal of Managed Care^® (AJMC^®).

Here are 5 key things health care stakeholders should know.

1. Pediatric Obesity Is Not a Motivation Problem

Pediatric obesity is often misunderstood. Although it is commonly framed as a result of poor choices or lack of education, Runyan and Levi argue the real issue is limited access to effective interventions. Intensive, family-based behavioral programs are recommended and known to work, but many families never receive them.

Moreover, there exists an implementation gap between what clinicians know is effective and what patients actually receive in practice, as highlighted in recent reporting from AJMC.² Both experts reinforced this point, noting that the challenge is not whether families understand what to do, but whether they have the support to actually do it consistently.

“We know intensive lifestyle behavior change works,” said Runyan. “It is recommended by the USPSTF [US Preventive Services Task Force] Grade B recommendation for kids with obesity to participate in intensive lifestyle behavior modification programs. It's part of the child obesity guidelines from the American Academy of Pediatrics. We know this, but we have a coverage gap.”

2. Most Families Receive Limited, Episodic Support

Although clinical guidelines recommend intensive, ongoing behavioral interventions, most children receive only brief counseling during routine visits. This is largely due to time constraints and system limitations in pediatric care.

Fewer than half of children who need obesity-related support receive it, and when they do, care is often limited to short interactions rather than sustained engagement, and this episodic approach is insufficient for addressing complex lifestyle changes.

“Pediatricians are limited in time, so that really kind of led us around to who can we upskill in their workforce with these skills if it's not going to be a standalone pediatric health coach in the practice,” said Runyan.

3. Behavior Change Requires Continuous, Family-Based Support

Effective pediatric obesity interventions must go beyond individual behavior and address the broader family system, according to both experts. Health coaching should focus on long-term, relationship-based support that helps families build sustainable habits over time.

“The behavior change isn't just about what habit we can do this week; it becomes a much more long-term plan because we're creating change in the way that individuals and families think about themselves,” said Levi.

Health coaching focuses on sustained engagement, helping families build habits over time rather than relying on one-time counseling. This approach also incorporates mental health, stress, sleep, and social factors—areas often overlooked in traditional care but critical to long-term outcomes.

4. Health Coaching Could Expand the Pediatric Workforce

One of the most significant opportunities is using health coaching as a workforce strategy. Rather than relying solely on physicians, experts suggest training existing professionals—such as nurses, community health workers, and care coordinators—to deliver behavior-change support.

“Who are the people that are working with these families on a regular basis?” asked Runyan. “We’re looking at the FQHCs [federally qualified health centers] and the CHWs [community health workers] who are working closely with the families.”

This aligns with broader workforce trends, as health systems face shortages in pediatric and behavioral health providers and increasing demand for services.³ Upskilling the existing workforce could extend care beyond clinic visits and improve access in community settings such as schools and local programs.

5. Closing the Gap Could Improve Outcomes and Reduce Costs

The long-term implications of pediatric obesity are substantial, both clinically and economically. Childhood obesity contributes to over $3 billion in annual health care costs, with projected societal costs reaching $49 billion annually by 2050.¹ At the same time, family-based behavioral interventions can deliver strong returns on investment, with some programs generating more than $3 in savings for every $1 spent.

Health coaching may offer a cost-effective way to deliver these interventions at scale.

“We believe in implementing the health coaching model, because if you have a child who's overweight or obese and they have to go to a doctor or a nurse to be monitored weekly, that's going to cost a lot more than to hire a health coach into the clinical setting,” said Levi. “The health coach is well trained, but they're not as expensive as a nurse or a doctor to pay, and to actually see more behavior change progress, because they have time.”

However, reimbursement remains a key barrier.

“There have to be more reimbursement pathways and mechanisms to cover the cost of these programs, because we know that they work, and that's the biggest gap: getting that funding to do that and that support to do that,” said Runyan.

As pediatric obesity and diabetes rates continue to rise, experts say addressing the behavior-change gap will require more than clinical guidance alone. Expanding access to continuous, family-centered support—through models like pediatric health coaching—may be essential to improving outcomes and reducing long-term costs.

References

1. Runyan T, Levi AJ. Pediatric Health Coaching: A Workforce Strategy for Pediatric Obesity and Chronic Disease Prevention. Pediatric Health Coach Academy; February 2026. Accessed March 20, 2026. https://www.pediatrichealthcoaching.com/wp-content/uploads/go-x/u/b11e22d4-19fd-4e67-9ed6-ec647ea56ede/Pediatric_Health_Coaching_workforce_strategy.pdf

2. Steinzor P. How health coaching could help close the behavior-change gap in pediatric obesity. AJMC. March 10, 2026. Accessed March 20, 2026. https://www.ajmc.com/view/how-health-coaching-could-help-close-the-behavior-change-gap-in-pediatric-obesity

3. Smith H, Gould Z. Assessing and expanding the capacity of the pediatric health care workforce. National Academy for State Health Policy. January 20, 2026. Accessed March 20, 2026. https://nashp.org/assessing-and-expanding-the-capacity-of-the-pediatric-health-care-workforce