Michele is in her early 40s and, at 5 feet 7 inches, weighs approximately 265 pounds. She started Pilates for weight management, balance, core training and overall fitness, and became an instant fan. “I love the quiet strength it builds in my body through very subtle motions, but at the same time the workout is as tough as nails,” she says. “The more advanced I become, [the more I find] there’s another layer to address. As I lose weight, it becomes even more challenging as I continue to connect with my body.”

Michele’s Pilates instructor was kind and willing to make modifications. “For the full figure, the muscles are there below the fat, so the trainer has to have more patience,” says Michele. She worked twice a week—one session in a group class format and one session privately. She has been doing Pilates for 4 years now. “I am able to walk with more balance and clarity,” she says. “I look smaller than I did 4 years ago. I’m more compact. The sense of balance and strength is different from anything else I have ever done. The more I do it, the more I feel my body.”

Michele is one of many obese individuals in search of health, wellness and connection. Not all who are in her shoes think of Pilates as a primary path to their goals; nevertheless, plus-size people walk into Pilates classes and studios every day looking for help. As a Pilates professional, you have the opportunity to be part of the solution. The work of Joseph Pilates was developed more than 80 years ago, during a time when the population
included far fewer obese individuals. Today we have a chance to look at existing research on core training and apply Pilates techniques and principles to a demographic that desperately needs to be introduced to the powerhouse. This article reviews available research on Pilates and core training and explores possible solutions for training the obese client.

The Epidemic

It’s not new news. Our world is facing an obesity epidemic that has spread rapidly over the past two decades. More than 72 million people, or one-third of U.S. adults, are obese (BMI ≥ 30). There are an estimated 1 billion obese persons worldwide. Obesity rates among all groups in society—irrespective of age, sex, race, ethnicity, socioeconomic status, education level or
geographic region—have markedly increased (Centers for Disease Control and Prevention 2009; Kravitz 2005).

Obesity has physical, psychological and social consequences. Activities of daily living and quality of life are severely compromised. Sleep apnea and respiratory problems can leave the obese client feeling tired and less likely to engage in physical activity. Potential risk for type 2 diabetes may send the client an emergency signal to get active, but in some cases, the introduction of medication makes the person feel “safe” again, and no further intervention occurs.

For the purposes of this article, we are referring to the client in the weight range of 180–350 pounds. While some trainers work with clients above and below that range, please note that medical clearance is absolutely necessary when dealing with multiple risk factors. Some overweight clients may not consider Pilates a first choice for their movement program, so many self-screen.

Pilates and the Obese Client

While a great deal of research has focused on how mind-body teachings affect overall health (Ludwig 2008), at this time there is little research linking the successful impact of mind-body
techniques with the overweight or obese client. Emerging studies involving Pilates have looked at its influence on pain relief or injury rehabilitation, which are key issues for many obese people. Currently, however, there appears to be no research on the direct relationship between Pilates and obesity. One can presume that any movement introduced into the life of an obese individual could lead to an enhanced, active lifestyle. This area needs more evidence-based research. While body composition, cardiovascular health and glucose management (as it relates to Pilates) have not been studied, we know from practical experience that Pilates can have positive effects on quality of life, mood and self-confidence. We can also look at the research that does
exist and draw some parallels.

Aliesa George, president of Centerworks Pilates Institute in Wichita, Kansas, asserts in a WebMD article that while Pilates is not designed for weight loss, that outcome is often a byproduct. “Getting that mental focus to pay attention to what’s going on with the body helps you to get in touch from the inside out,” George says. “Once you get control of the body, and of finding the right muscles to put the body into the positions, you realize you can control other things in life” (Sarnataro 2007).

Pilates burns approximately 4.0–7.5 kilocalories per minute (Olson & Smith 2005). While performing Pilates does not lead to a significant caloric expenditure, many obese Pilates clients do lose weight. This may occur as a result of heightened body awareness and a new ability to listen to one’s body and let that voice be the authentic guide when it comes to good nutrition and movement.

Wing and Phelan (2005) defined a successful weight reduction program as intentional weight loss of at least 10% of body weight that is kept off for at least 1 year. They found that
engaging in high levels of physical activity assisted greatly in maintaining long-term weight loss. While the goal would be to increase activity level over a period of time, Pilates could be viewed as a gateway to a more active lifestyle.

Improved orthopedic health is another benefit that a Pilates program offers to the overweight individual. Without proper
orthopedic health, the client may be unable to progress to cardiovascular work. Many Pilates exercises are similar to those
designed by physical therapists for rehabilitating people with low-back problems. A study of 22 adults conducted at Florida Atlantic University found that a 12-week Pilates program reduced back pain (Graves et al. 2005). More studies need to be conducted before strong claims can be made regarding the role of Pilates in promoting back health. This issue is a particular concern for the overweight client with anterior pelvic tilt. It is important to note, however, that with large amounts of adipose tissue, especially around the torso and pelvis, locating neutral pelvis is challenging (but possible). [Editor’s Note: See “Mind-Body Research Update” by Ralph La Forge, MS, in this issue for more on Pilates and back pain.]

The effectiveness of various abdominal exercises was previously studied by Juker and colleagues and by Willett and associates (Juker et al. 1998; Willett et al. 2001). Olson and Smith used this information in conducting their research in 2005. They placed electromyography (EMG) electrodes on the rectus abdominis and external obliques and measured electrical output from these muscles during a Pilates workout. Exercises performed were double leg stretch, crisscross, roll-up, teaser and the hundred. A gym crunch was used as the control. For the rectus abdominis, only the hundred elicited less electrical intensity than the gym crunch. All exercises scored higher than the crunch in activating the external obliques. Roll-up and teaser activated the obliques to the level that researchers from San Diego State University reported for the gym crunch on a stability ball (Anders 2001). While this is great information, each of the Pilates exercises used in the study would need to be modified for the obese client. It is also important to note that roll-up and teaser may overuse the hip flexors, causing pelvic misalignment.

Another study assessed activity levels of the transverse
abdominals and internal obliques during roll-up, the hundred and leg circles (Endleman & Critchley 2008). The conclusion: a selection of classic Pilates exercises activates the transverse
abdominals and internal obliques. The results differed only slightly between reformer and mat, with the transverse abdominals being more activated on the reformer during a harder version of the hundred. What is interesting to note here for the obese population is that the hundred and leg circles would need to be modified for the larger body, and a roll-up is nearly impossible to perform—let alone with excellent technique—for the beginner overweight client. While the outcome may not be the same, letting the client know what is possible may inspire her.

Research also shows that a brief relaxation exercise led to subjects having significantly lower levels of salivary cortisol as well as increased levels of self-reported relaxation (Pawlow & Jones 2002). A relaxation exercise at the end of a Pilates session could have significant benefits. Other obvious benefits of Pilates that are apparent in everyday fieldwork include improvements in posture, balance, stability, flexibility and respiration; easing of aches and pains; stress reduction; and an increase in one’s ability to perform activities of daily living.

Applying Pilates Principles to the Obese Client

The following six principles have been distilled from Joseph Pilates’ work, and while their order and definitions vary among practitioners, the basic concepts remain constant in scope and style. In this article, the principles are being applied to the overweight and obese client.

Centering. Movements originate from the center of the body—the powerhouse—located between the lower ribs and the pubic bone. In the overweight client, there may be mass covering the pubic bone, even in a prone position. Initially, therefore, it might be a challenge for the client to “find center,” but visualization should help her make the connection. This can be a good time to introduce the location of internal organs in the body. Empower your overweight client with the knowledge and kinesthetic wisdom of where the stomach, liver and kidneys are located. (Often, the overweight woman, when asked, will point to the area of her uterus as the location for the stomach.) Centering, paired with visualization, may eventually allow the other five principles to occur.

Concentration. At first, concentration may be incredibly challenging for the overweight client. This client is generally not connected to his body, so encouraging full-body awareness can be frustrating, overwhelming and overloading to the central nervous system. Begin by asking your client to be aware of the moving body part. If that is too much, ask him to become aware of what is working in his body. In the beginning it may be nothing, or he may feel nothing. If so, break the question down even more. Try asking, “Is there one molecule engaged/working in this exercise?” Slowly the central nervous system will get on track, as well as the client’s ability to arrive fully in his body, one molecule at a time.

Control. Initially, control may be interesting to monitor. The overweight body is amazing in its ability to adapt. It compensates by engaging different muscle groups to perform an action instead of using the appropriate biomechanics and firing the accurate muscles. Teach your client awareness so that she isn’t “muscling” movements, but instead is using control and exertion specific to the action.

Precision. While precision is important, it may be more beneficial to focus on what is working for the client rather than what is not working. When you build on the positives, step by step, the body and mind begin to work in sync. Until your client gains a better grasp of the work, too much detail may be overwhelming. You must understand how the client learns best—kinesthetically, auditorily or visually. A kinesthetic or visual person may not integrate auditory cues. Use a blend of all of the approaches, notice which ones resonate with the client, focus on what is working and refine precision from there.

Breath. Many Pilates instructors teach very full breathing,
using the lungs as “bellows.” Most Pilates moves coordinate with the breath, and it is a key aspect of the practice. You can teach your client how to palpate the collarbone and lower ribs to help her “feel” the breath. Touching the bones, even deep behind the flesh, will let her sense the lungs’ potential to expand. As with
internal organs, bringing awareness to the location and capacity of the lungs is empowering. Also, your obese client may have been told to “suck it in” on the inhalation, so natural diaphragmatic breathing may need to be re-established within the body.

Flow. The overweight person tends to hurl his body through space without being aware of the “how” involved in locomotion. Using Pilates equipment can help your client find flow in movement, which may be different from his experience in day-to-day living. Explain that even the space between one movement and another can flow seamlessly. Teaching the concept of flow will add a sense of grace to a body that often feels cumbersome and weighted down. Simple observation by the client can facilitate curiosity and acceptance in a once fearful body and allow for the possibility of safe, flowing, precise movement.

Anatomical Approach

The obese client’s body adapts remarkably well to moving through space; however, anatomically, it is most likely misaligned. Typically, an obese body presents with poor balance, biomechanics and proprioception. Also, keep in mind that the bony landmarks may not be visible in the overweight body. With trust and respect, you can teach the client how to palpate her own body so she gains a deeper awareness that there are bones beneath all the flesh.

The obese client is often forward-shifted in her posture, from the feet to the top of the head. Structurally, this places pressure on the small bones of the feet, knee joints, low back, shoulders and neck. Obese clients tend to be very strong in their legs and sometimes even in their arms, so it is easy to be deceived about the body’s needs.

Another common issue is that plus-size people will “hang out” in their joints, meaning there is a lack of muscular support for the knees, hips and back. The transversus abdominis needs to be “turned on” to provide stability and to support the lumbar pelvic girdle. Joint integrity is weak in the knees, hips,
lumbar spine and shoulders. Strength is needed so that the muscles can hold the joints properly. Building strength in the knees, hips and lumbar spine will bolster alignment, allowing the client to move on to other activities. (See the sidebar “Anatomical Approach: Sample Exercises” for more details.)

Practical Field Experience

Pilates instructors working with overweight clients are passionate about their work. As with any special population, there needs to be a deep sense of compassion and understanding, great patience and a willingness to shift one’s approach to meet the client’s needs. Instructors must be able to walk their talk by staying grounded, present and attentive during their work, and must create an energetic connection to the client that assures her that she is safe.

Kristi Anderson, STOTT PILATES® certified trainer, in San Diego, says that working with the obese population can be an incredibly rewarding experience. “If we are honest, society disempowers overweight and obese people,” she says. “Clients feel they are judged every moment of the day, by strangers and loved ones, but worst of all, by themselves. The most fundamental commitment in working with an obese client is nonjudgment. Extend total acceptance and encouragement for the courage they have to walk into your space and move their body. Make and hold eye contact, and give the client your undivided attention.”

Marshall Ekland, MA, STOTT PILATES instructor trainer and owner of Marshall Ekland Pilates Studio in San Diego, says that first and foremost, it is important to approach the client as a wellness professional—not as a fitness trainer. “Stress the benefits of Pilates training—structural strengthening that will create better joint health, especially in the knees, hips and lumbar spine,” Ekland says. “With more awareness, the client is able to move her body with more appreciation.”

Zoey Trap, MSc, Peak Pilates master trainer and educational director, and principal instructor at The InnerSpace in Avon, Connecticut, has a lot of experience working with the obese population. “Working with the overweight client is a challenge, an adventure and a real opportunity,” she says. “I have learned so much from my clients. As [wellness] professionals, we need to be part of the solution. We must clean our own house first by letting go of our perceptions and becoming comfortable working with this population. The client may have had a negative previous experience, and you need to guide the client to a healthier
relationship with the training and with her body.”

Alicien Cisco, MS, exercise specialist at Structure House, Durham, North Carolina, has observed that overweight people seem to do better on equipment. “In mat class, [these clients] may be at the mercy of their body weight and gravity,” she says. “They feel empowered using the apparatus. Pilates appeals to women more than weight training, while men enjoy the strength gains of Pilates without using weights. Pilates allows the client to stay focused and present [more easily] than yoga. In yoga, you hold the pose for a series of breaths. In Pilates, there is a more dynamic approach, and that helps to keep the client present. I have felt very encouraged by how empowered the clients become.”

Adriene Ingalls, of Premiere Pilates, New York City, approaches her overweight and obese clientele from a “whole-body” perspective. “In the classical system, you go through the order, irrespective of who you are dealing with,” she says. “Verbal cuing is where you go first, and then you make the adjustment. Today, I move more to treat the whole body—who is in front of me, and what do they need? I have always had overweight clients, and many are opting for one-on-one sessions for the individualized attention and privacy. The teacher must help the client in developing his or her mind-body awareness through the Pilates practice.”

A Big Challenge, a Big Opportunity

The challenge for Pilates professionals is to empower the obese population even to consider a Pilates practice in the first place. A method which, on the surface, targets one of their most psychologically vulnerable regions—the abdominal area—can be intimidating. We need to re-educate our clients, the public and healthcare practitioners in our referral network about the
effectiveness of Pilates. When done correctly, it can address an obese body’s structural imbalances and posture; enhance respiration and coordination; and improve how the client views his or her body, which may be the most powerful benefit of all.