The Language of Lifestyle Choice
A survey indicates that doctors don’t know how to talk to kids and parents about obesity. What can fitness professionals do?
How do you tell children and teens that they are overweight or obese? This question is receiving new attention in light of the California Health Interview Survey’s recent results. The statewide review found that of 240 physicians, more than 90% admitted they needed to learn more about skills and strategies for communicating with kids and parents about weight issues.
IDEA member Monte Ladner, MD, is a “physician turned personal trainer” who made his career move after repeated frustrations with trying to treat patients he believed suffered primarily from lack of exercise, poor diet and ineffective stress management. He says he is not surprised by the survey findings and believes they signal fitness professionals to fill a need. “Obesity is a complex condition with multiple contributing factors,” he says. “However, I think most authorities agree that the biggest issue is one of lifestyle choices. Frankly, many physicians are unaware of the true impact of lifestyle on health outcomes. They have not embraced the notion that food and exercise are real—and powerful—medicine.”
Ladner believes that doctors may also have psychological reasons for not speaking up. “They may fear that the family will perceive the message as casting blame,” he says. “Doctors fear further stigmatizing children who already have a negative self-image.” Ladner goes on to say that even if a doctor is willing to practice a little wellness coaching, people typically don’t make office visits often enough for the message to really sink in. This is where fitness professionals can make inroads.
Fitness professionals may be in a much better position to offer health advice to overweight and obese children and teens, but it’s still a touchy subject. Jim Gavin, PhD, professor of applied human sciences and graduate program director at Concordia University in Montreal, says a delicate approach is best. “Obese children stand a good chance of having obese parents, so sensitivity is of the essence,” he says. “I think our current politically correct language sometimes goes too far by obscuring the message. Yes, it’s wrong to call a kid ‘fat,’ but obesity is a relatively sanitized descriptive term that is used throughout the medical literature. I don’t think the issue is [about] avoiding the term obese, but rather [about] how you engage in a dialogue with parents to determine how they perceive matters, how well informed they are and where they stand in terms of commitment to action. Clearly, in dealing with a child, it’s a family matter, and the fitness professional needs to consider the client to be the family, rather than the child alone.”
IDEA member Karen Jashinsky is the founder and chief executive officer of O2 MAX, a fitness concept exclusively for teens, based in Los Angeles. She agrees that working with a child is a family matter, but she also thinks it’s important to relate to the child or teen as an individual and in a way that is motivating and uplifting. “You have to first build trust,” she says. “If [kids] don’t trust you and feel comfortable, it is going to be a tough battle. They need to feel that you are on their side and you are working for them and with them, not with the parent or for the parent.”
The commitment to change varies, however, depending on the context. “Clearly, when parents bring their child to you, getting their personal involvement is easier,” says Gavin. “If it is you who brings the ‘bad news’ to the parents, be prepared to meet resistance. I think it’s reasonable to ask parents whether they are open to having a conversation about their child’s physical status. If they are, and if you present clear indicators of the child’s obesity, your best tactic after a brief presentation is to ask, ‘Does this raise any concerns for you?’ If they say yes, I would ask what their concerns were, rather than launch into an informational piece about obesity.”
Ladner, who offers a free fitness podcast (www.fitness rocks.org), sees the communication chasm as something that fitness professionals can help bridge. “The ideal scenario is for the medical community and the fitness community to come together and solve this problem,” he says. “If physicians and personal trainers worked together to create community programs that promote healthy eating and exercise, I think we could turn the obesity epidemic around.”
More than 90% admitted they needed to learn more about skills and strategies for communicating with kids and parents about weight issues.
“It is an awesome privilege and responsibility to train others, especially with the state of our healthcare system. This is a terrific way to inform and influence people—to let them know they can take more control and responsibility for their health. An interesting aspect of this whole journey is that all the studying and training you do to keep your mind active motivates you. It’s better than any healthcare plan you can buy, because you have to stay physically, emotionally and mentally fit in order to stay involved.
—IDEA member and personal trainer Linda Smibert, St.Marys, Ontario
So you’ve had this idea for years. It’s either a program you’ve spent many hours developing or a product or piece of equipment that could turn you into an instant inventor. You’re sure this idea has true potential, if only you could mass-market it. But that takes money, and your bank account is woefully inadequate.
Don’t let that stop you. IDEA member Tony Findlay, who conceived the idea of a DVD game that would educate children about the dangers of obesity, turned his concept into reality by finding an investor (read his story in the July–August issue of IDEA Fitness Journal). He shares his success tips with other fitness professionals:
- Know your material. Constantly refine your research and hone your skills. No project will be developed overnight.
It’s fun to design new programs and routines for clients and participants. Exercise options are many—and multiplying daily, it seems. But don’t forget about the simple joys of perambulation. According to the 2005 “Sports Participation” report from the National Sporting Goods Association, exercise walking grew 1.5% in 2005, and remains number one—a position it has held since 1990.
Other “classic” fitness activities in the survey also showed healthy growth in 2005. Weightlifting ranked ninth and was the fastest growing, increasing by 35.4% to 35.5 million participants. Working out at a club ranked 10th with 34.7 million participants (+9.2%); aerobic exercising 11th with 33.7 million (+14.4%); and running/jogging 14th with 29.2 million (+9.5%).
The International Health, Racquet & Sportsclub Association (IHRSA) announced that more than 10 organizations that offer personal training certifications are currently accredited or in the process of receiving accreditation from the National Commission for Certifying Agencies (NCCA).
IHRSA’s board of directors adopted a resolution in March 2005 recommending that as of January 1, 2006, IHRSA clubs hire personal trainers holding at least one current certification from a certifying organization/agency that has begun third-party accreditation from an independent, experienced and nationally recognized accrediting body. IHRSA identified the NCCA as an appropriate accreditation organization.
The following personal training certification organizations have either earned accreditation or are in the process of receiving accreditation from the NCCA:
- American College of Sports Medicine
- American Council on Exercise
- The Cooper Institute
- International Fitness Professionals Association
- National Academy of Sports Medicine
- National Council on Strength & Fitness
- National Exercise & Sports Trainers Association
- National Exercise Trainers Association
- National Federation of Professional Trainers
- National Strength and Conditioning Association
- Pilates Method Alliance® Bullying: Barrier to Exercise for Overweight KidsBullying: Barrier to Exercise for Overweight Kids
Researchers studied 100 overweight or at-risk-for-being-overweight children between the ages of 8 and 18. About one-quarter of the children reported significant problems with bullying during the 2 weeks leading up to the study. Findings showed that bullying was linked to depression, loneliness and anxiety, further explaining why exercise rates were low.
“When you think about it, it makes intuitive sense, when you consider the hallmark signs of depression—sadness, fatigue, lack of interest in things you used to like,” Storch said. “When kids are having a tough time with peers, and struggling with depression, then this can translate to reduced rates of physical activity.”
Are you including outdoor drills in your functional training for older adults? Given the results of a study published in the May 30 online issue of the American Journal of Public Health, maybe you should. The study found that outdoor falls among adults aged 45 and older are more common than indoor falls, which seem to receive more attention.
Researchers looked at 2,193 falls that resulted in injury and found that 73% of the outdoor falls were caused by the environment: slippery sidewalks, uneven surfaces, or objects on curbs or streets. Walking was the most common fall-related activity, accounting for almost 50% of the outdoor falls reported. While you may not have much control over the outside environment, you can help prepare older adults for outdoor hazards by designing sessions with “obstacles” that mimic what clients might encounter on a walk.
Obesity in the workplace is becoming more troublesome. Employers are concerned not only about the healthcare costs and lost time associated with obesity but also about the rapid and dramatic increase in obesity over the past few years. Leade Health, a company that specializes in health coaching in the areas of weight management, stress management and tobacco cessation, recently released a white paper called The Business Case for Weight/Obesity Management Using Health Coaching Interventions. Here are some of the key elements from the report:
- Medical costs for obese employees are 77% higher than for healthy-weight employees; obesity-related disabilities cost employers up to $8,720 per claimant a year.
If your clients ask you which sport might be a good choice for their adolescent daughters, you can feel confident in recommending soccer. Since it combines weight-bearing exercise with repetitive impact from running and jumping, soccer significantly increases bone density, thus reducing the risk of osteoporosis. This study conclusion appears in a recent issue of Pediatric Physical Therapy (2006; 18 , 19–22).
Researchers compared bone mineral density (BMD) in three groups of adolescent female athletes: 29 swimmers, 16 soccer players and 19 weightlifters. Of the three groups, the soccer players had the highest BMD levels. Bone density was somewhat higher in weightlifters than in swimmers, although the difference was not significant.
The differences in BMD reflect differences in the three sports. Soccer and weightlifting are weight-bearing activities. The extra load placed on the skeleton promotes bone development. In contrast, swimming is a non-weight-bearing activity, since the body’s weight is supported by the water. Soccer also places repetitive impact on the skeleton, further promoting bone development. In association with this extra stimulus, the soccer players in the study had average BMD values higher than the normal values for adult women, even though the girls weren’t yet fully mature. Weightlifters had BMD values similar to those of adult women, while the BMD values in swimmers were below adult norms.
Helping young people lose weight takes on an added urgency when you look at a recent study out of Norway. Relying on national data from 1.2 million adults, researchers found that those who were overweight or obese were at greater risk of eventually needing a total hip replacement due to severe arthritis. Men and women who were heavy before the age of 25 were especially at risk. The report was published in the journal Arthritis & Rheumatism.
The threat of hip replacement rose along with body mass index (BMI). People who were overweight or obese based on BMI were two to three times more likely than normal-weight adults to need a hip replacement. The effect of BMI was less pronounced, however, among women whose weight was measured when they were in their 50s or 60s. Researchers looked only at hip replacements performed due to osteoarthritis. Researchers note that it’s possible that the hip-joint cartilage is more vulnerable to damage earlier in life.
It takes a village . . . to help people with metabolic syndrome, and a recent study from the Medical College of Wisconsin in Milwaukee underscores the importance of personal fitness trainers working with allied health professionals. Specifically, this study’s team clinic approach included an endocrinologist, a dietitian, a psychologist, a diabetes educator, a clinical pharmacist, a physical therapist and an exercise physiologist.
Metabolic syndrome is a cluster of risk factors that include abdominal obesity, insulin resistance (with or without type 2 diabetes), unhealthy lipid levels and hypertension. (Authorities differ slightly on how many factors must be present for a diagnosis.) People with the syndrome are vulnerable to cardiovascular diseases caused by plaque deposits. There is also an increased risk of blood clotting.
Data on approximately 480 patients revealed that, after 6 months of treatment, their collective BMI dropped by 4.4%, their waist size decreased by 4.3%, their triglyceride levels fell by 13.1% and their HDL (healthy) cholesterol level rose by 6.2%. As a result, their 10-year risk of developing cardiovascular disease was reduced by 19.5%.
If your female clients are having a hard time both losing weight and finding time to sleep, there may be a connection. A study presented at the American Thoracic Society International Conference on May 23 posited that women who sleep 5 hours or less per night weigh more on average than those who sleep 7 hours.
The study began in 1986 and included 68,183 middle-aged women enrolled in the Nurses Health Study. They reported their weight and typical night’s sleep every 2 years for 16 years. Researchers found that women who slept 5 hours per night were 32% more likely to experience major weight gain (defined as an increase of 33 pounds or more) and 15% more likely to become obese over the course of the study (compared with women who slept 7 hours). Women who slept for 6 hours were 12% more likely to have major weight gain and 6% more likely to become obese. On average, women who slept 5 hours or less per night weighed 5.4 pounds more at the beginning of the study than those sleeping 7 hours and gained an additional 1.6 pounds more over the next 10 years.
“That may not sound like much, but it is an average amount—some women gained much more than that, and even a small difference in weight can increase a person’s risk of health problems such as diabetes and hypertension,” said lead researcher Sanjay Patel, MD, assistant professor of medicine at Case Western Reserve University in Cleveland, Ohio, in a press release.
The researchers looked at the women’s diets and exercise habits to see if these could partly account for the findings; however, neither factor accounted for the weight gain. “We don’t have an answer from this study about why reduced sleep causes weight gain, but there are some possibilities that deserve further study,” Patel said. “Sleeping less may affect changes in a person’s basal metabolic rate (the number of calories you burn when you rest). Another contributor to weight regulation that has recently been discovered is called non-exercise-associated thermogenesis, or NEAT, which refers to involuntary activity, such as fidgeting—or standing instead of sitting. It may be that if you sleep less, you move around less, too, and therefore burn up fewer calories.”
If you do online personal fitness training or communicate regularly with clients via e-mail, beware of unintentionally creating a touchy situation with a quick reply. In fact, you might want to wait 24 hours before responding, especially if it involves a controversial or emotional situation, says Jennifer Cochrane, who directs the online teaching and learning program for the department of communication studies at Indiana University–Purdue University in Indianapolis.
The issue is that e-mail messages can be very ambiguous and many things get lost in translation. An e-mail doesn’t convey tone of voice, gestures and other nonverbal messages, which are said to make up as much as 65%–90% of communication. So what should you do if a client sends an upsetting message about her lack of weight loss? Wait 24 hours or until you can see her in person. “Some things should never be said in an e-mail, because your message may not be interpreted just exactly the way you intended,” Cochrane says. “When precision, nuance and personal intent [are] paramount, e-mail may not be the communication method of choice.”
If you know or work with a U.S. military veteran who is overweight or obese, he or she may be eligible to participate in a special program called MOVE! (Managing Overweight and/or Obesity for Veterans Everywhere). MOVE! is a Department of Veterans Affairs (VA) national weight management program with a “comprehensive focus on behavior, nutrition and physical activity.” According to the VA, more than 70% of veterans receiving medical care are overweight or obese. Of those, 20% have diabetes. To find out more about this program and whether it is available in your area, visit www.move.va.gov.
You may be working with clients who have diabetes and are in the dark about it. According to recent data from the National Institutes of Health and the Centers for Disease Control and Prevention, about 2.8% of U.S. adults—one-third of those with diabetes—still don’t know they have the disease. The prevalence of diagnosed diabetes in U.S. adults aged 20 and older rose from about 5.1% in 1988–1994 to 6.5% in 1999–2004. The study, published in June 2006 of Diabetes Care, notes that type 2 diabetes accounts for up to 95% of diabetes cases and virtually all cases that are undiagnosed.
. . . a cordless jump rope with weights inside the handles that “simulate the feel of a rope moving”; . . . Nike’s Air Zoom Moire, a new lightweight running shoe with a built-in sensor that tracks distance, time, speed and calories burned. The data can then be fed through a wireless receiver that attaches to an iPod (IDEA veteran presenter Jay Blahnik consulted on this project); . . . J-Mat™, an interactive wireless fitness mat, used with the XaviXPORT™, that allows users to dodge and leap over on-screen obstacles, à la Jackie Chan; . . . a 16,000-pound treadmill specifically built for Alaska Zoo’s own reluctant-to-exercise Maggie the elephant; . . . NYC RUN, an organization that offers individual or group guided running tours of New York City.
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