What should a trainer know to work with Obese clients?
I am hoping to open a discussion on what is needed to be qualified to work with an obese client. Training considerations, drug interactions, psychology, energy systems, biochemistry..etc. I know there are certifications that cover the basics of this stuff, but my opinion is that if a person is going to work with an obese client then that should be your niche and you should be dedicated to that. I train athletes and my personal library reflects that and so does my education.
I have a MS in Sports Science and 23 years of experience as a CSCS, and that’s how I got to a place of experience with so many different types of clients. There’s no magic formula and no number of extra certifications that will do the trick. Nothing can take the place of education and experience. I wasn’t capable of working with obese clients with multiple chronic diseases until about 10 years into my career, and that’s part of why it’s troubling to think of someone who has a BA in Marketing and a personal training certification as capable of handling a morbidly obese client safely. I answered a question about state licensure potential for our industry, and this is why I think it would be a step in the right direction if our industry was regulated. Standardized state testing for licensure in various fitness specialties would be ideal. If we want physicians to respect us and trust us enough to put their sickest patients in our hands and for insurance companies to pay for our services, we have to prove we’re a capable, professional, necessary part of a health care team that’s required to meet certain professional standards (just as they are). Otherwise, pills and surgeries will continue to be the answer to what seems like an easy question to me.
TTM is part of my methodology, and I use it during ever session with every client. When you see a client 2-3 times per week, it’s a slow process, but I also check in with clients via text or email between sessions to reinforce my strategy and encourage forward movement through the stages. I feel very strongly that people can’t be forced to change, and I’m not a babysitter. Some clients are more challenging than others and take more time to embrace change. I refuse to “want” the change more than the client does. I provide the foundation, expertise and encouragement, but they have to do the work and make the commitment. Part of my philosophy is also to teach clients the hows and whys behind the workouts so they’ll have the knowledge and tools they need to maintain their fitness level should they move, travel, or not be able to afford training in the future.
I agree with your statement that critical thinking and asking questions requiring evidence-based answers should be the basis of our field. While the internet is a helpful tool in many ways, it’s also filled with misinformation (not evidence-based) and videos demonstrating poor technique. This is another example of how the least knowledgeable in our industry hurt and devalue those of us who are providing quality services. What I think is really valuable is ideafit.com and this forum. It helps us share experiences, scientific research and opinions so we can all become better fitness professionals. I hope this helps.
this is a simple question the answer to which could fill books.
My comments here refer to morbid obesity which has already lead to a host of other problems such as high cholesterol, high blood pressure, diabetes and often arthritic conditions of the knees and hips and altered gait.
Needless to say, a physician's approval is always required. The assessment is also a challenge in that many obese clients do not even have the strength for most of them. Postural assessments are tricky because of the size of the person, and don't even try calipers. But even other non-invasive methods usually are highly inaccurate in the very overweight.
The greatest challenge is often just to find a starting point. The recommendation of 150 minutes of cardiovascular exercise may be along-term goal but is rarely possible initially. I find that strengthening to enable cardio is a good route but that needs some creativity because a lot of the 'traditional' exercises need to be severely modified. It is also imperative to change our perception of what an exercise is. From our fit condition, it is sometimes difficult to imagine that just lifting a leg a few times can be an exercise to build on.
Add to that the psychology of the situation. Once people come to see us, they have already recognized that exercise is part of the answer to their problems but that does not mean they enjoy exercise. I train in my own studio and am usually alone with my client which makes it a lot easier when situations become awkward because of the size of the client. In a health club, the awareness of not putting the client into embarrassing positions adds another layer of complexity.
While morbid obesity has certain common criteria, the individual situations are still different and cannot easily be extrapolated from one client to the other.
And I am not even talking about the entirely other side of the energy balance equation which is the food intake. Most overweight clients are quite well-educated about food and understand labels perfectly well. They may have already obtained life-time membership in weight watchers. In some clients, you cannot even talk about food without opening a floodgate of emotions. I found a very useful book called 'The End of Overeating' by Dr. Kessler which has opened a window into the psychology of the condition to me.
All of this is overlaid by medical problems. Textbooks can only go so far in preparing trainers for this.
But when you get that one person that can break through this prison, it was all worth it. It does not always have a happy ending, though.
I think Karin listed some good points. I think it’s up to each trainer how comfortable he or she feels when working with this type of clients. One can get more experience when spending more time training obese clients and/or also learn from others who work with these clients on a daily base. Of course doing your own research will provide you with a lot of the needed information as well. There are special population certifications which you can get and I think one at the top of the list is a Health Coach certification due to the information covered and the CE you will get. I know ACE offers a good one and it might worth your time and money to get it, if you want to get more into this category.
Each trainer approaches clients very differently as each and every client who comes to us has very unique issues. There is no one-size-fits-all approach. These clients have reached this point in their life for many different reasons. You have to understand those reasons in order to help them change their perspective and find the best way to help them. I'm not suggesting a special certification is needed in order to be able to get the job done, but I thought based on the phrasing of your question that you might be looking for a certification for non-athletes since you train only athletes. For those of us who have been in the field for many years, it’s probably easier to work with these clients than a trainer who is new to the business or doesn't have enough experience would find it to be.
Just because the AMA decided to label obesity a disease does not mean a special certification is needed to have success with obese clients. This new label changes nothing. It certainly doesn’t change how I approach and train obese clients. The AMA’s decision shouldn’t change the foundations of proper training. That’s like if the NSCA decided to tell physicians how to treat their patients based on what we know to be true about exercise. It makes absolutely no sense.
Maslow’s Hierarchy doesn’t play into my equation. Mind over matter, period. But if you want to talk psychology, the Attachment Theory replaced Maslow’s Hierarchy.
Do I feel comfortable having a diabetic client check blood glucose before a workout and changing the workout, continuing it, or not continuing it based on the reading? Absolutely. In fact, I have them check during and after my workouts as well. Same thing goes for blood pressure. I don’t take any chances, and I’ve educated myself enough to feel comfortable working with special populations most other trainers wouldn’t work with. You’re right in saying the average trainer doesn’t have a clue about handling obese clients. We’ll never get to a place where every trainer seeks the knowledge to handle complex clients. The best thing we can do is educate people on how to choose the right trainer for their needs. I’ve been a trainer for 23 years and I was a NCAA athlete prior to that, so my experience speaks for itself. I’ve helped many obese clients become endurance athletes, and that requires not just programming for weight loss and conditioning, but also helping clients believe in themselves and want to reach their goals as much or more than I want them to. You’re right, that’s much tougher to do than to train an athlete for a record-breaking lift.
There are more unfit and more obese individuals than ever before.
As a fitness professional, I think it's essential to be as educated as our industry provides and to follow all guidelines and protocols geared towards specific populations
I think it's great that you have found your niche, I feel like I have expanded mine and am really feeling challenged
There are many things that have to be taken into consideration when working with obese clientele, from being aware of physical limitations, restrictive body motions, shame, embarrassment, metabolic disorders, physical limitations, joint issues, verbal cuing, proper gol settings to name a few.
I think it's imperative to work closely with the clients medical doctor even past medical clearance. I have requested many of my clients to check in with their doctors for a variety of reasons.
We must be professional and qualified no matter what niche we choose
I personally like the variety of work I have and I like the fact that I can offer both health coaching and personal training custom packages.
Great question and conversation starter. I've enjoyed the back and forth between you and Harris. I must say, I agree with all of what Harris has stated.
For me working with an obese client, means working with a team of professionals. Its a partnership approach. An obese client has a host of issues that have more to do than just weight. There are psycological, physical, medical and social issues to deal with. As such, there is no one path that works, nor is one person capable of dealing with all the issues. I often have obese clients working with a physician, psycologist or counselor to deal with food or emotional issues related to weight, a nutritionist or dietician and in cases where the weight has begun to effect their joints, a physical therapist or exercise physiologist. Most of the time, my obese clients have been referred to me by medical professionals who I've referred other clients to or are already working with other medical professionals who encourage them to work with a personal trainer.
I agree and have also been a proponent of licensure for fitness professionals. It has only been through hard work and demonstration of my skill and professionalism that those within the medical profession (gynocologists, family medicine practitioners and physical therapists) have started to refer clients to me. But it has taken time and in there words, "proving that I know what I'm doing and talking about." They trust their patients to me and vice versa. But we also do a lot of discussion back and forth, with the patient's sign off and HIPPA regulation follow through, to do what is in the best interest of the patient.
As for why I'm qualified to work with obese clients....I don't have an answer. I work specifically with women, especially those pre and post-partum. The obese clients that are referred to me more often are women who have had children and have issues related to their weight or child birth. This is the area I'm passionate about and the area I spend additional time getting CEUs in. I also take the opportunity to work with gynocologists and physical therapists as often as I can to learn more about this patient group. Not many others do this. As a result, the gynos and physical therapists I work with trust me, as they see me seeking out additional knowledge, from all areas. Staying up to date with medical journals, something I learned from years in pharmaceuticals, is also helpful.
Do I think there is a "fits" all training approach for the obese client? No. Do I think personal trainers should receive additional training or certification for this population? I'm not sure. I would hope, for any of my clients who are dealing with severe issues or medical concerns, that they would receive the same care. For mine they do.
We need to get inside the heads of former obese people. To do that is to work with and/or befriend them. This will then put the Health Coach training to better use. Is this not why Weight Watchers is successful?
Training the obese is more like working towards activities of daily living. We also need compassion, understanding, patience and most of all...love for our fellow man.
I can appreciate you making a distinction between client needs and desires and the value of having viable strategies, education, and experience in working with special populations.
And while professionals are now calling obesity a disease, it is a self created disease based on movement and eating behaviors. Like any other puzzle that is brought to personal trainers it takes at least two to formulate the solution, the trainer and the client. Often, it takes three or four, a RD and a therapist.
Drug interactions and psychology are not within the personal trainers calling, while certainly knowing the biochemistry of insulin, for those obese clients with this challenge is helpful.
But I am more curious about your concern with staying within one's niche. Perhaps, over the years niches can change.