Tricks of the Trade
Working with clients who have had gastric bypass surgery requires some extra caution and attention. I first met one such client about a year after her surgery. I asked her a ton of questions because I wanted to understand her motivation, why she decided to have the surgery, what her experience had been living with the result, what her restrictions and limitations were and how she was working within those limitations—her successes and challenges. One of the things I’ve learned about fitness and clients is that everything stems from their thinking process. Results depend on the clients, so I really wanted to have a great understanding of this client.
Once I understood her and how she was functioning at a nutritional level, we designed an exercise program that worked within the limitations and restrictions of her surgery. Her initial sessions were very basic as we discovered which areas needed to be modified. For example, lying flat on her back to do crunches caused discomfort if she still had food in her stomach. I left the planning of her nutritional needs to her dietitian and focused on getting her fit (not skinny!).
Communication was key in helping this client be successful and stay motivated on her journey. I was always “checking in” verbally and visually to ensure she wasn’t working outside of her abilities. Once we got the basics down and built up some fitness fundamentals, she totally kicked butt! It was amazing to watch her confidence rise as her waistline shrank.
It’s so important to approach these clients without judgment. Becoming part of their cheering squad is really important as well. Sometimes, as in this case, family members might not be supportive and might even think that surgery was too drastic a measure to take and that health goals won’t be achieved.
Working with a client who has had bypass surgery is definitely not a typical fitness coaching challenge, but it is most certainly an exceptional journey that I have had the privilege of sharing.
Owner/Coach, Achieve! Fitness
Over the years, I have trained quite a few clients who have had gastric bypass surgery of one form or another. There are many considerations to keep in mind when working with these clients. The first consideration is diet. A dietitian or a nutritionist who specializes in pre- and post-bypass clientele is the best person to handle their dietary needs. These clients may be restricted to less than 1,000 calories per day. They will often need to restrict the types of grains/rice they eat, as well as the types of protein. (For instance, steak can cause inflammation, yet ground beef does not. Chicken thighs may be better than chicken breast, owing to the dryness of breast meat.) Their food issues go way beyond our scope of practice and are best dealt with by a professional dietitian.
Physical issues are another consideration. People who have had gastric bypass have carried a significant amount of weight for a long time. This often causes premature wear and tear on joints and soft tissues, as well as problems with hips, ankles and, especially, knees. These physical issues are something to be conscious of when designing programs for these clients, especially if you want them to do any high-intensity or plyometric work (for many clients, this level of training may be unrealistic). Another physical issue may be laxity of ligament structures, especially in the sacroiliac joint (leading to low-back pain) and thoracic spine (leading to kyphosis). Once a ligament has grown lax, it doesn’t shrink back, so the muscles in these areas need a lot of stability. Also, these clients may not be capable of achieving perfect posture, so goals must be realistic.
Remember, just like with cars, it’s not the years . . . it’s the miles. Generally, this population has been wearing out its joints more than a similar but nonobese group would have done. Keep that in mind when planning exercise choice and intensity. Often gastric bypass clients will seem to be able to handle more than their connective tissue and joints will tolerate. Start slowly, and build a solid foundation first; then progress to more intense work if that is the client’s goal.
Brian Richey, MES
Medical Exercise Specialist
Owner, Fit 4 Life DC
I have worked with three female clients who have had the Roux-en-Y gastric bypass surgery. Each client weighed just over 300 pounds before surgery and had a weight goal of 145–155 pounds. They all lost weight rapidly, ranging from 100 to 160 pounds in 9–12 months. They lost approximately 3–5 pounds a week for the first 6 months and then 1–2 pounds a week for the remaining months. All of them have kept off the weight, with a fluctuation of approximately 5 pounds.
These women have experienced many postsurgery challenges, including difficulties with consuming enough protein and keeping hydrated, muscle weakness, excessive loose skin and hair falling out and/or breaking. Some have had medical problems, like developing gallstones caused by the rapid weight loss; this required gallbladder surgery.
I asked these clients, “What can a trainer do to keep gastric bypass clients positive?” They responded: Be positive, be encouraging, go slowly so that your client does not fear getting injured or being too sore, be flexible, modify where necessary, celebrate small victories and make sure your client does not get embarrassed. Look at the client’s body objectively. Recommend gradual and progressive weight training and show the client how to sculpt and tone his or her muscles. If the client is working with a doctor, make sure you understand the doctor’s recommendations for the most practical and beneficial progression.
What I have learned in training these clients is that listening carefully, without judgment, and allowing them to talk freely are essential parts of the workout. The clients wonder if they are going to have complications; they wonder what they are going to look like; they battle with body distortion even after they have lost an extreme amount of weight. One client told me, “Our bodies have been on a physical, mental and emotional roller coaster.”
As trainers, we also need to understand that people die just having the surgery, and that the client [in front of us] has survived and is now learning how to be “a whole person.” We have to understand that this is a “learning, testing and growing season” for people who have had this surgery and that each person has a unique set of fears and challenges.
Make sure you don’t hinder a client’s program by progressing too fast, which could cause a setback through injury or soreness, or by being negative and making the client feel inadequate.
Owner, Joy in Your Journey . . . To the
Glory of God Personal Training and
St. Charles, Missouri