How Health Coaching Could Help Close the Behavior-Change Gap in Pediatric Obesity

Childhood obesity is currently one of the most persistent and costly public health challenges in the US, affecting more than 1 in 5 children nationwide and increasing the risk of chronic conditions including type 2 diabetes, hypertension, and mental health disorders.¹

Yet despite decades of research demonstrating the effectiveness of intensive behavioral interventions, many families receive little more than brief counseling about diet and exercise during routine pediatric visits. The problem is not a lack of knowledge about how to treat pediatric obesity but a lack of access to sustained behavioral support.

“We know intensive lifestyle behavior change works; 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 [and] it’s also part of the child obesity guidelines from the American Academy of Pediatrics,” said Thea Runyan, DrPH, MPH, NBC-HWC, cofounder and CEO of the Pediatric Health Coach Academy, in an interview with The American Journal of Managed Care® (AJMC®). “We know this, but we have a coverage gap.

Runyan and Arielle Levi, PhD, NBC-HWC, PCC, chief science officer and cofounder of the Pediatric Health Coach Academy, argue that expanding pediatric health coaching could help address this gap by providing continuous behavior-change support to children and families—something the traditional health care system often struggles to deliver.

“The programs and services we’re promoting through the Pediatric Health Coach Academy, including one-on-one health coaching, are not covered, so we have this huge gap in that space,” continued Runyan. “Long-term, we’re really talking about chronic disease prevention in youth, which is going to be a huge cost to society in the future.”

Their white paper, Pediatric Health Coaching: A Workforce Strategy for Pediatric Obesity and Chronic Disease Prevention, discusses the current challenges in pediatric obesity, and provides clinicals with proven workforce strategies to overcome these care obstacles.

Pediatric Diabetes Is Rising—Especially Among Vulnerable Children

A recent national analysis of Medicaid and Children’s Health Insurance Program (CHIP) enrollees found that pediatric diabetes prevalence rose steadily between 2016 and 202, and overall diabetes prevalence among children increased from 2.73 to 3.04 cases per 1000 enrollees, representing an 11.4% relative increase.²

What’s even more concerning is the surge in type 2 diabetes, historically considered an adult disease. During the same period, type 2 diabetes prevalence increased by 24.3%, from 0.74 to 0.92 per 1000 children, whereas type 1 diabetes rose more modestly by 6.5%.

The data also revealed troubling disparities. Children living in rural areas had higher overall diabetes prevalence, while urban populations experienced faster growth. Boys and children living in the Western US also showed particularly steep increases in type 2 diabetes.

These findings matter because Medicaid and CHIP cover a large share of American children. Roughly 37 million children—about 49% of the US pediatric population—are insured through these programs, meaning trends in this population reflect broader national health patterns.³

Obesity and Chronic Disease Begin Long Before Diagnosis

Moreover, current health care model struggles to address behavior-based conditions effectively.¹ Many families receive only brief advice during clinical visits—often limited to recommendations such as eating healthier or exercising more—without the sustained guidance necessary to implement lasting change.

The result of this is an implementation gap between medical knowledge and real-world behavior change. Frontline health care workers, such as nurses, care coordinators, and community health workers, regularly interact with families and could help bridge that gap, the white paper suggest. However, these workers often lack specialized training in behavior change counseling, motivational interviewing, and family-centered health coaching.

Without that support, families are left to navigate complex lifestyle changes on their own.

Why Lifestyle Change Is Harder Than It Sounds

In the interview, both authors emphasized that the difficulty of treatment often lies not in the science but in the daily realities of family life.

Medical providers may know what interventions are needed—improved nutrition, increased physical activity, better sleep, and mental health support—but translating those recommendations into everyday routines is far more complicated.

Behavior change is shaped by a web of social and environmental factors. Family schedules, financial stress, food access, school environments, and cultural norms all influence a child’s health behaviors.

“Health coaching as a practice is looking not just how to encourage behavior change, but it goes even deeper for sustained behavior change,” said Levi. “We're looking at mindset and the stories that families carry, and we're looking at family dynamics. We’re coaching the child, but we're actually coaching the entire family unit.”

Addressing such complexity often exceeds the time available in a typical clinical appointment. Primary care visits may last only 15 minutes, leaving little room for deeper conversations about barriers to healthy eating, emotional relationships with food, or strategies for integrating physical activity into daily life.

Health coaching, however, is designed specifically to address these challenges.

The Role of Pediatric Health Coaches

Health coaching is a structured approach to behavior change that focuses on goal setting, accountability, and ongoing support. Coaches work collaboratively with patients and families to identify realistic goals, develop strategies, and maintain motivation over time.

Unlike traditional education-based interventions, coaching emphasizes partnership rather than instruction. Families are encouraged to define their own priorities and solutions, guided by evidence-based behavior change techniques.

In pediatric settings, this approach often includes:

• Motivational interviewing
• Family-centered goal setting
• Habit-building strategies
• Ongoing check-ins between clinical visits
• Coordination with health care providers

Trained pediatric health coaches could become a key workforce solution for chronic disease prevention.

“All health care leaders need to help cover the cost of these services that we know benefit kids and families; that's the bottom line,” said Runyan. “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, is getting that funding to do that and that support to do that.”

This workforce model could also expand the reach of pediatric health care systems without placing additional burdens on already overstretched physicians.

Addressing Health Equity Through Coaching

By working directly with families over time, coaches can help identify barriers that clinicians might not see during brief appointments. These might include transportation challenges, financial constraints, cultural dietary patterns, or mental health stressors.

In the interview, both experts emphasized that effective coaching must acknowledge these realities rather than simply repeating standard lifestyle advice.

“We’re really moving [clients] forward with supportive accountability from a health coach,” said Runyan. “We're really trying to provide that consistency and motivation [and] it's a very different relationship than one might have with a traditional medical provider, and it's very forward thinking, action oriented, but most importantly, client-centered, where we're really trying to understand what the client goals are.”

Integrating Coaching Into Health Systems

Broader implementation will require several structural changes, including:

• Training and certification pathways for pediatric-focused health coaches.
• Reimbursement mechanisms allowing coaching services to be covered by insurers.
• Integration with clinical teams, ensuring coaches collaborate with physicians, nurses, and dietitians.
• Research evaluating outcomes, particularly in chronic disease prevention.

Some health systems have already begun experimenting with these models, embedding coaches within primary care clinics or population health programs.

Early findings suggest that coaching may improve engagement, adherence to treatment plans, and lifestyle changes—though large-scale evidence is still emerging.

Medication Alone Will Not Solve the Problem

Importantly, the rise of new pharmacological treatments for obesity and diabetes, such as GLP-1 receptor agonists, has generated excitement in both adult and pediatric medicine. But the experts caution that medication alone cannot address the behavioral and environmental factors driving childhood chronic disease.

Even when medications are effective, they often require lifestyle changes to achieve lasting results. Without support systems to maintain those changes, long-term outcomes may remain limited. Therefore, health coaching could complement medical treatment by helping families sustain healthier behaviors over time.

Prevention as a Workforce Strategy

Chronic diseases that begin in childhood often persist throughout adulthood, driving decades of health care costs. Early prevention and intervention could reduce long-term complications such as cardiovascular disease, kidney failure, and severe metabolic disorders.

Pediatric health coaching is not just a clinical intervention but a workforce strategy designed to expand the health care system’s capacity to prevent disease before it becomes irreversible.

Instead of relying solely on physicians and specialists, health care systems could deploy trained coaches who focus specifically on behavior change and family support.

“[What] we know with health coaches is that when they're properly trained and they have the right skills and qualities and characteristics, they're magnetic, and kids cannot wait to meet with their coach, and so we need health care leaders to be thinking in a way that's not only just going to get results, but that kids want to do because they're going to get results through doing it,” said Levi.

This shift would allow clinicians to concentrate on diagnosis and medical management while coaches address the day-to-day challenges of implementing healthier lifestyles.

Economic and System-Level Implications

Beyond clinical outcomes, the researchers argue that pediatric health coaching could represent a cost-effective workforce strategy.

Childhood obesity is associated with higher health care spending across the lifespan, in which early intervention may reduce long-term costs by preventing disease progression. Health systems also face growing demand for services related to pediatric metabolic disease. Without additional workforce capacity, clinicians may struggle to provide the level of behavioral support recommended by clinical guidelines.

Behavioral interventions for children with obesity—particularly those recommended by the USPSTF—often require intensive, multicomponent programs with at least 26 contact hours over several months.⁴ Yet such programs are rarely available in routine clinical settings.

A Critical Moment for Pediatric Health

The steady increase in pediatric diabetes and obesity suggests that traditional approaches to chronic disease prevention may no longer be sufficient. Although medical science continues to advance, the gap between knowledge and behavior remains one of the largest barriers to improving child health.

Health coaching represents one attempt to bridge that gap. As researchers, clinicians, and policymakers grapple with the rising burden of chronic disease among children, the question is no longer whether behavior change matters but how the health care system can realistically support it. The answer may lie in building a new workforce designed specifically for that task.

References

1. Runyan T, Levi AJ. Pediatric Health Coaching: A Workforce Strategy for Pediatric Obesity and Chronic Disease Prevention. Pediatric Health Coach Academy. Accessed March 9, 2026. https://www.pediatrichealthcoaching.com/healthcare-providers/

2. Steinzor P. Rising pediatric diabetes trends in US Medicaid, CHIP enrollees. AJMC. March 2, 2026. Accessed March 9, 2026. https://www.ajmc.com/view/rising-pediatric-diabetes-trends-in-us-medicaid-chip-enrollees

3. AAP analysis: 49% of children insured by Medicaid or CHIP. American Academy of Pediatrics. February 27, 2025. Accessed March 9, 2026. https://publications.aap.org/aapnews/news/31491/AAP-analysis-49-of-children-insured-by-Medicaid-or

4. Addressing Childhood Obesity. CMS. Accessed March 9, 2026. https://www.medicaid.gov/medicaid/quality-of-care/quality-improvement/addressing-childhood-obesity