In an industry that strives to help people improve health and fitness, there is still a significant amount of judgment and stigma toward people with obesity. A 2018 literature review found that weight bias was “pervasive” among health, fitness and nutrition professionals (Panza et al. 2018). Stigma and weight bias can negatively affect client outcomes and may even worsen mental health struggles and cause weight gain, the exact issues we are hoping to combat as health and fitness coaches.

Continuing to focus on ideal body types, strict diets and cut abs is not going to improve the health of the general population. Research shows that underlying biases are harmful and can worsen health outcomes in those who feel they are being judged. Specifically, weight stigma is associated with “obesity, diabetes risk, cortisol level, oxidative stress level, C-reactive protein level, eating disturbances, depression, anxiety [and] body image dissatisfaction and negatively associated with self-esteem among overweight and obese adults” (Wu & Berry 2018).

John Berardi, PhD, co-founder of Precision Nutrition, summed up weight bias in the industry in Change Maker, his recent book for health and fitness pros: “When I looked around, I saw a big disconnect between the people working in health and fitness and the people we were supposed to be helping. It seemed as if the entire field was set up to cater exclusively to people like me and my fellow fit friends. . . . We were putting all of our energy into serving a tiny percent of the population, the small segment of people who, ironically, needed our help the least” (Berardi 2019).

Shifting Our Own Perceptions

Considering that 42% of adults in the United States have obesity and many of the leading causes of death are due to preventable, lifestyle-related chronic diseases (CDC 2020), it’s time for the health and fitness industry to take a stand as a partner in improving health outcomes for all populations. This starts with understanding and combating the industry’s underlying weight stigma. With childhood obesity becoming even more prevalent, it’s estimated that half of the U.S. population will have obesity or be considered overweight by the year 2030, only one decade from now (Ward et al. 2019).

We need a paradigm shift in how we approach health and well-being. Our task is to destigmatize an industry that has focused on chasing a body ideal, glamorizing weight loss, and fixating on thin and muscular body types. Health and fitness coaches have the tools that can increase health, life expectancy and quality of life, but these tools are ineffective if we are saving them for people who are already healthy, while actively discriminating against those who may need the most support.

The health and fitness industry can begin to make changes to address weight bias and promote inclusivity by

  1. acknowledging weight bias and identifying and working to change personal biases
  2. understanding the complexity of the underlying causes of obesity and having empathy for all clients
  3. understanding how to effectively coach clients with obesity in a helpful and positive manner
  4. using inclusive messaging from the industry as a whole

See also: The Weight Debate: Obesity and Health Risks

What Is Weight Bias?

Weight bias in fitness

Weight bias can lead to psychological distress, weight gain, negative self-talk, decreased motivation and even binge-eating behaviors.

The Rudd Center for Food Policy and Obesity states, “People who have a higher body weight are vulnerable to stereotypes, bias, bullying, and discrimination in our society” (The Rudd Center 2020), adding that weight bias includes any underlying judgment or beliefs about others because of their weight.

Weight bias can cause psychological distress and create stress, anxiety, disordered eating and depression. Physical outcomes of weight bias can include weight gain, negative self-talk, decreased motivation and even binge-eating behaviors (Puhl, Moss-Racusin & Schwartz 2007). Puhl and Brownell (2006) found that eating more was a common strategy for coping with obesity stigma: Seventy-nine percent of study participants reported that they had used this strategy more than once.

The Impact On Client Success

A 2016 review of weight bias research found that, with rising rates of overweight and obesity, “weight discrimination in America has increased by 66% over the past decade and is equivocal to racial discrimination” (Fruh et al. 2016). This bias can severely hinder client outcomes. When clients feel stigmatized or discriminated against, they are at risk for low self-esteem, depression and lower quality of life (Phelan et al. 2015).

Considering that our industry is dedicated to helping people live higher-quality lives by improving their health and fitness habits, it’s unlikely that most trainers are consciously trying to alienate or offend people experiencing obesity. But we also need to recognize that it is, indeed, happening with our clients.

Weight stigma in the gym happens when fitness professionals encourage weight loss goals; make assumptions or judgments about people because of their weight (e.g., assuming, based on body type, that a client will want to lose weight); or make statements about dieting, “earning” cheat days, or achieving “a bikini body” or “six-pack abs” while teaching group fitness classes.

The outward expressions of judgment or “tough love” that coaches sometimes use to shame or blame clients can cause an increase in emotional or binge eating, perpetuating poor health habits and worsening health outcomes over time.

What’s more, clients are unlikely to return to a trainer or coach after feeling judged in a gym or coaching environment, and prospective clients who perceive judgment are unlikely to seek out the help they need.

Where Bias Shows

Weight bias against people with obesity can be explicit or implicit. Explicit bias means there is conscious discrimination. Implicit bias is automatic and often occurs outside of awareness; it can result from the collective ideology of the fitness industry, stereotypes, or lack of personal experience or understanding of the complex etiology of obesity. It can also come from the media, which has been shown to “portray overweight and obese individuals in a stigmatizing manner” (Ata & Thompson 2010).

Examples of collective ideology are gym marketing materials showing only fit body types; fitness facilities promoting weight loss programs with “before-and-after” images, implying that a smaller body is the ultimate outcome; and health and fitness pros holding themselves to a certain hard-to-maintain standard for weight or physical appearance.

But bias can also be more overt: for example, mocking new gym-goers who sign up in January; making judgmental comments to other trainers in the gym about people with certain body types; or perpetuating the idea that individuals with obesity are simply lazy or lack dedication.

So what can be done? A 2005 study noted that beliefs held by a valued group of peers influenced people’s perceptions of individuals with obesity (Puhl, Schwartz & Brownell 2005). This suggests that by focusing on one’s own weight biases, it’s possible to begin to influence peers in the industry.

Acknowledging Personal Biases

“Experts suggest that preventing weight stigmatization and bias is essential to effective obesity treatment efforts” (Fruh et al. 2016). Preventing weight bias and stigma starts with identifying your own personal biases as a health and fitness coach. This can include judgments actively made toward others due to their weight status, as well as behaviors stemming from subconscious ideology—like using specific photos or verbiage on your marketing, website or social media accounts.

Acknowledging your own biases and even your own use of stigmatizing language or coaching tactics can be challenging; admitting that you may have your own underlying personal beliefs is uncomfortable. But it’s worth it. When we learn better coaching techniques, we become better coaches and ultimately help clients have better outcomes.

Working to be more inclusive presents the opportunity to help more people and to have a greater influence on the health of the population as a whole.

Understanding The Complexity Of Obesity

Understanding the complexity of obesity

Oversimplification of weight loss can lead to weight bias among health and fitness pros and alienate clients with obesity.

The first step in removing stigma and weight bias from the health and fitness industry is understanding that obesity is a complex disease with many underlying factors and causes. The oversimplification of weight loss that many coaches and trainers subscribe to (“move more and eat less”) tends to blame clients for lacking self-control, being lazy or having “no motivation.” This can lead to weight bias among health and fitness pros and alienate clients with obesity.

The path to improving strength, making dietary changes or losing weight may seem clear to those who have never personally struggled with weight challenges. The common approach to weight loss—“calories in, calories out”—fails to consider the complexity of metabolism, set-point weight and the hormonal impact of dieting over a long period of time.

Factors That Influence Weight

The underlying causes of obesity include a combination of psychological, emotional and physical factors.

Socioeconomic Status

A 2018 study found that low socioeconomic status (SES) was a direct link to developing type 2 diabetes mellitus, due to “restricted autonomy and opportunities that could lead to more stress and consequently [an] increase in stress hormones . . . which might ultimately change fat deposition, increasing visceral fat and increasing the risk of T2DM development” (Volaco et al. 2018). Socioeconomic factors include access to food and opportunities or safe spaces for exercise.

Psychological Factors

Underlying psychological factors can have a big impact on nutritional habits. Clients who grew up with food insecurity (or were raised by parents who experienced food insecurity) can develop eating habits based on a food scarcity mentality. Obeying a food rule like “clear your plate” or eating quickly to make sure you get your share are habits that can develop in childhood and be very challenging to break later in life. Even when there is no shortage of food, underlying psychological factors can be difficult to overcome.

Other psychological factors include emotional eating, binge eating and having been raised by a parent who suffered from emotional eating habits.

Physical Factors

Underlying physical causes of weight gain include hormonal and metabolic function, genetics, habits, and ethnicity. Research has linked a history of dieting to weight gain, owing to both the impact of hormonal control of appetite and the role of weight loss in reducing metabolic rate (Dulloo, Miles-Chan & Schutz 2018). Simply put, after weight loss, appetite may increase, whereas metabolism has decreased; this can lead to renewed weight gain.

Sleep has also been linked with weight gain. Shift work can influence weight gain through the disruption of sleep cycles (Sun et al. 2018). Stress can also influence weight, since stress hormones disturb sleep, enhance appetite, trigger cravings and reduce motivation for physical activity (Geiker et al. 2018).

Of course, current nutritional and exercise habits are important, but having empathy for the life experiences of your clients, their deeply rooted habits and their past attempts at weight loss can build rapport and begin to remove weight stigma, improving the coach-client relationship.

See also: Undoing Weight Bias Within Yourself

7 Strategies For Effectively Coaching Clients With Obesity

Coaching clients with obesity

Take a broadened approach to coaching clients with obesity in order to focus on overall health habits.

Blüher’s 2019 report on the epidemiology and pathogenesis of obesity noted, “Lifestyle and behavioural interventions aimed at reducing calorie intake and increasing energy expenditure have limited effectiveness because complex and persistent hormonal, metabolic and neurochemical adaptations defend against weight loss and promote weight regain.” It’s therefore crucial to take a broadened approach to coaching clients with obesity, focusing on overall health habits as opposed to weight.

Here are seven strategies you can use to coach clients using a healthy approach.

1. Deemphasize Weight

Overemphasizing weight loss is ineffective at best and can potentially be detrimental to a client’s physical and mental health and well-being. Health and fitness pros can promote inclusiveness by concentrating on health habits, using neutral language about weight and minimizing emphasis on weight loss goals. While it’s perfectly acceptable for clients to want to lose weight, goals should focus on habits the client is able to control—including nutrition, physical activity, sleep and stress management—as opposed to a weekly weight loss target.

Using weight loss challenges or making weigh-ins the sole method for tracking progress promotes the idea that weight is the most important metric to track. Moreover, monitoring progress becomes a challenge when clients face the inevitable plateaus.

In reality, it takes a host of healthy habits to successfully manage outcomes like blood pressure, glucose, cholesterol and so on. And for those who have obesity, beginning with even a small weight loss goal has been shown to improve these health markers. A 2016 study found that losing as little as 5% of body weight “improved adipose tissue, liver and muscle insulin sensitivity” (Magkos et al. 2016).

Forming new habits is key, as research shows that weight maintenance is even more challenging than weight loss. “While the dominant discourse attests that people can lose weight and keep it off, evidence informs us that maintenance of weight loss is unlikely” (Kasten 2018). A majority of people who lose 10% of their body weight end up gaining it back within 5 years (Montesi et al. 2016).

Tracking weight monthly or biweekly may be helpful in monitoring the trend over time, but it’s best to avoid daily weigh-ins, especially for clients who are hyperfocused on the scale or who have experienced unhealthy dieting behaviors in the past.

The bottom line is that, by deemphasizing weight, coaches can promote practices that help people improve health, not just reduce their clothing size.

2. Use People-First Language

Inclusive language is people-first language. Saying “people with obesity” versus “obese people” avoids defining people by their weight status. Kyle & Puhl (2014) note, “AMA [American Medical Association] advises authors to refer to persons with diabetes, rather than diabetics. However, although people-first language has been widely adopted for most chronic diseases and disabilities, it has not been adopted for obesity.” The words you choose can reduce bias and discrimination.

3. Adopt Inclusive Marketing Techniques

Inclusive marketing involves using imagery of all body types on websites, on social media, and in gyms and health centers. Showing only thin or muscular body types can alienate clients (or potential clients) who may not fit that mold. By rejecting the idea that people must look a certain way to be healthy, the health and fitness industry can begin to focus more on total health rather than aesthetics.

4. Identify NonWeight Benefits of Improved Nutrition and Activity

Regardless of weight status, improving nutrition and physical activity habits has endless benefits. Helping clients to see those benefits—immediate and long-term—can aid them in accomplishing long-lasting, healthy behavior change instead of simply making a temporary change as a means to an end (weight loss).

For example, increasing fiber in the diet through fruits, vegetables, whole grains and beans can improve cholesterol levels, digestion and satiety. Incorporating more exercise can enhance sleep, mental well-being, cholesterol levels and overall energy.

5. Help Clients Make SMART Goals

Clients are more likely to achieve their goals if they are SMART (specific, measurable, attainable, relevant and timely). If clients want to focus on weight loss, understanding their motivational why can help them link their habit goals to their ultimate desired outcomes. When people figure out their top health priorities (i.e., better sleep, more energy, better focus) and adopt healthy habits to support those priorities, it becomes easier to stick to the new habits and enjoy “small wins” from the beginning.

Here are some whys your clients might have:

  •            being able to play with grandkids
  •            wanting to look fit for a special event
  •            going through a big life change like divorce, childbirth or the loss of a loved one
  •            recovering from a health event, such as a heart attack
  •            responding to a diagnosis or managing a lifestyle-related disease
  •            wanting to feel strong

In the end, the underlying reason for weight loss is often related to the desire to “feel better.” When clients understand that improving their fitness and nutrition is what will help them feel better, even the most weight-focused clients begin to pay attention to their daily habits.

6. Use Appropriate Caloric Intake Guidelines

Nutrition for Clients with Obesity

An extreme caloric deficit can lead to weight gain over time.

For people who want quick results, it’s easy to fall into the trap of wanting a quick fix. However, research shows that taking a moderate approach—losing weight slowly and starting with a 5%–10% weight loss—can lead to better long-term outcomes (Magkos et al. 2016). A balanced approach means avoiding super-low caloric intake or strict dietary plans, as these methods can be challenging to maintain. Extreme caloric deficits, especially combined with increased physical activity, can lead to disordered eating, yo-yo dieting and binge eating, which can quickly undo progress and worsen health and metabolism.

A 2019 review of studies on weight loss and yo-yo dieting concluded that “weight loss by calorie restriction is associated with increased hunger and a strongly increased reward value of food” (Contreras, Schriever & Pfluger 2019); thus, an extreme caloric deficit can lead to weight gain over time because related metabolic and hormonal changes influence hunger cues. Instead of significantly decreasing caloric intake, it can be beneficial to choose satiating foods, like protein and low-calorie, high-fiber fruits and vegetables, while eating fewer highly processed foods. Ultraprocessed foods (like fast food, packaged chips, baked goods, etc.) have been shown to be neither satiating nor nutritious and can lead to overeating and raise caloric intake overall (Hall et al. 2019).

Many calorie calculators or apps like MyFitness Pal give daily targets that are too low, especially for active adults. As an alternative, the Dietary Guidelines for Americans indicate caloric ranges by age, sex and physical activity levels (USDHHS & USDA 2015).

7. Build Confidence With Small Wins

Many people think that once the scale hits a certain number, they will feel better, happier or more confident, but it’s important to help clients understand that weight loss will not “fix” any negative body image or lack of confidence they may currently be experiencing. Focusing on building positive skills and following through on short-term goals can boost confidence and body image more effectively than losing weight.

Clients can begin feeling more confident now (at any weight) by practicing self-compassion and following through on their short-term mini goals. After all, the confidence that comes from sticking to a goal for any amount of time is significantly greater than any confidence that could come from losing a few pounds.

Help clients identify negative thought patterns about their body and begin to shift their self-talk by avoiding self-deprecating comments. Encourage them to think about parts of their life, body or personality that they love and to focus on those things instead. Chances are good that they’re successful at something (in their career, parenting, accomplishments, hobbies, etc.). Even noting their commitment to show up week after week can be a way to redirect conversations toward client progress.

Focusing on fitness improvements is also a great opportunity to help clients build confidence. Increasing speed, mileage, reps or weight can be an excellent way to mark progress week to week.

See also: It’s Time to End the Stigma of Obesity

Practice Questions

Here are a few sample questions to help you gain perspective about your own weight biases.

  • What “type” of person is your ideal client? Whom do you usually work with?
  • What type of imagery is visible on your own marketing/website or in the gym or health center you work in?
  • Do you encourage weight loss goals, require frequent weigh-ins, or have weight loss transformation contests?
  • Consider your own internal conversation or commentary when you see or coach a client who is overweight or obese. What are you saying?
  • How do you critique your own body? What expectations have you placed on yourself to look a certain way as a health and fitness pro?
  • What assumptions have you made about how “simple” or “easy” it may be to lose weight?

Alternative Methods for Tracking Client Success

  • Track compliance with habit-based goals (i.e., if the goal is to work out 30 minutes four times a week, how much did the client actually do?).
  • Measure body fat percentage or body measurements on a monthly basis.
  • Use progress photos (biweekly or monthly).
  • Monitor bloodwork over time (A1C, glucose, cholesterol).
  • Monitor blood pressure.
  • Track qualitative factors—such as the client’s emotional well-being, sleep quality, energy level, confidence and stress level—on a Likert scale weekly or biweekly. Use this information to measure progress related to changes in nutrition or fitness habits.
  • Try new approaches. Eating new fruits or vegetables, cooking at home, or trying different workouts, etc., can be beneficial, especially for clients who may have had picky tendencies or were hesitant to try new things in the past. People may find they enjoy the healthy new foods or unfamiliar activities. When health and fitness habits are enjoyable, it’s easier to maintain habits and make progress.

The Difference You Can Make

Health and fitness coaches have a responsibility to understand the reality and impact of weight bias. This means acknowledging personal biases, understanding the complexity of obesity, and starting with small changes to shift awareness and promote inclusivity in the health and fitness industry. Then a ripple effect can follow, beginning with improvements in individual client outcomes and spreading to the health of the wider population.

Redirecting Weight Loss