In wellness push, a new job: Coach.

The tools of the trade for Janet Kennon are simple, but powerful:

A telephone. Time to listen. And the ability to break hefty goals - such as losing 20 pounds - into small steps, like eating more salad or buying a pedometer.

Kennon works for Sentara Optima, and she spends her day coaching people to be healthier.

Employers, insurance companies, doctors' offices and hospitals are increasingly hiring health coaches like Kennon to educate and motivate people. They come from many walks of life. Some, including Kennon and the other Sentara coaches, are nurse case managers. Others in the field are dietitians, licensed clinical social workers, pharmacists. Some hail from new programs set up specifically to train health coaches.

The coaches are tasked with checking in periodically, often by phone, with people who are recovering from surgery, or suffering from chronic conditions like diabetes and asthma, and those who are at high risk of developing disease. They educate, answer questions, offer resources, set goals and follow up.

It's a sprawling field, and for now largely unregulated, but it's expected to keep growing.

Insurers are trying to keep health care costs in check by helping people avoid expensive hospital stays and from developing disease in the first place.

And hospitals are working harder to keep people from being readmitted. A health care overhaul provision that goes into effect in October will penalize hospitals with smaller Medicare reimbursements for avoidable readmissions.

Health coaches are seen as the bridge between time-starved doctors and patients. They can make the difference between sticking to medical advice and falling off the wagon. While some coaches meet with clients regularly, phone contact also is a big component. Coaches also are making use of mobile devices - for apps and texting - and social media as a way to keep people on track.

An organization called the National Consortium for Credentialing of Health & Wellness Coaches, started in 2009, is bringing some order to the field by conducting a survey in January that will try to nail down statistics for the field and gauge interest in establishing standards and credentialing.

Kennon is one of about 40 nurse case managers Sentara Optima employs to help coach its insurance members across the state. Anthem Blue Cross and Blue Shield also employs health coaches, about 70, according to spokesman Scott Golden, who said the number is on the upswing.

New training programs are springing up in the field. Margaret Moore, co-director of the Institute of Coaching in Massachusetts, is also the founder of a company called Wellcoaches, which went from training 100 health coaches in 2003 to more than 1,000 this year.

At Sentara Optima, the coaching idea goes back to the late 1990s with nurses who helped people manage chronic disease, according to Janis Sabol, who coordinates the team. They educated patients with diabetes, asthma and heart disease and encouraged them to take their medications, follow doctors' advice and keep medical appointments. That role has evolved to include people who have health conditions such as obesity, high cholesterol or high blood pressure that put them at risk for developing disease.

The idea is to make people more proactive about their health, and lead them to self-sufficiency. That involves educating them, answering questions, helping them set goals, and creating a plan of small steps that leads to long-term changes.

Then the coaches call periodically - weekly, monthly, quarterly - to monitor progress and talk about setbacks or successes.

Each nurse case manager at Optima coaches 150 to 250 people. Lynne Jonas works mainly with people who have diabetes.

"We're not here to judge or condemn," she said. "We're here to encourage and support them. We're like cheerleaders - we're here to praise them when they lose one pound or when their blood sugar drops by one point."

Sometimes stress might be exacerbating their health problems and Jonas will help them resolve that.

Kennon said just knowing someone is going to call to ask about their weekly action plan makes people feel more accountable, and therefore more likely to stick to their goals. It's a fact of human behavior that companies see as key to changing unhealthy habits. A Kaiser Family Foundation survey of employer health benefits in 2011 found that 27 percent of companies are offering employees access to health coaches, with some giving financial incentives for working with one.

This time of year can be challenging. There's the holiday season, when special foods and the flurry of celebration often get in the way of good nutrition and exercise.

And sometimes people have unrealistic New Year's resolutions.

Setbacks will happen, but people should aim to have more good days than bad, rather than giving up their goals altogether.

The health coaches don't want their clients to wince when they hear their voice on the line.

"Most people appreciate the calls," Kennon said. "But sometimes I do sense people are overwhelmed with life at the moment, so I'll be brief and just tell them I'm here when they need me. We are not all ready to change. And if it's not self-motivated, it's not going to happen."

Elizabeth Simpson, (757) 446-2635, elizabeth.simpson@pilotonline.com