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Clients Not Sticking With the Program? Here’s Help!

Tough clients. Every fitness professional has them. You know, the ones who make you think, “What is wrong with you? Why can’t you follow simple instructions or do what’s good for you?” Don’t take it personally. When prescribed life-saving medications for cancer, heart disease and diabetes, patients take them a shockingly low 55% of the time, according to a World Health Organization estimate. If almost half of people can’t spare 10 seconds to pop a pill, how can we expect them to exercise and to eat a healthy diet?

Odd though it is, there is an explanation. Most of us assume human beings base decisions on the rational deliberations of the logical left brain. However, behavior studies suggest otherwise. What really drives most of our decision-making (whether we’re willing to admit it or not) is our emotional, empathetic, image-oriented right brain. Research shows that breaking down tasks supports the brain and makes goals easier to reach.

Ask, Don’t Tell
One reason people fail to comply with doctors, dietitians and fitness professionals is that far too often we don’t ask—we tell:

  • “Eat two servings of this every day.”
  • Exercise 5 hours this week.”

Research shows that both animals and humans react defensively when they perceive a strong threat to their freedom of choice. Also, deeply forbidden things are more appealing than requirements. Tell a client, “Don’t do that!” and you’ll get a primal-brain-fueled rebellion.

Luckily, as humans we will tolerate a mild threat to our choice as long as we feel it was our idea and/or that it matches our own priorities. Begin with identifying what is truly important for a client—it may not be what you presume.

To get into our clients’ heads, we use the “5 Whys” exercise, originally developed for the Toyota production process. It’s a way to get at root causes and effects by asking “Why?” For example:

Client: “I just can’t eat a healthy diet.”
You: “Why?”
Client: “I don’t feel I was cut out for it.”
You: “Really, why so?”
Client: “Well, um, it’s just hard for me to do, with all the planning.”
You: “Why is the planning hard for you?”
Client: “It seems hard to juggle with all my work demands and stuff.”
You: “Why so?”
Client: “I feel there’s no time to go shopping, with my commuting, and the kids, and Bob working longer hours.”

Now you’re getting somewhere. You can start to see where you as the coach or trainer can intervene at critical junctures; for example, by helping the client work on time management, food preparation strategies and ways to eat healthy meals on the run. You also get a sense of other priorities (e.g., work and family) that are competing for the client’s attention.

Shrink the Change
Usually clients don’t ignore suggestions out of spite. Most simply think some actions are impossible or not sufficiently meaningful. A die-hard carnivore might find “eating five vegetables a day” as momentous a task as climbing Mt. Everest. Why not ask for a client’s feedback before deciding what advice to give? When was the last time you asked the following:

  • “What’s truly important to you right now?”
  • “In what ways do you feel ready to change?”
  • “On a scale of 1-10, how confident are you that you can do what I am asking?”

In our practice, we ask this last question of each client. It not only helps us shape our advice but also enlists the client in the change process. For example, if the answer is less than a 9 or 10 on a given task, we know the client won’t do what we’re asking. So we make the task easier. In fact, we keep simplifying, clarifying and reducing the difficulty until we get a heartfelt 9 or 10 on the confidence scale.

Research shows that people always want to feel they have choice and to feel in charge of their own lives. View your clients as collaborators and yourself as a guide or facilitator rather than an expert. Highlight where they feel confident and start there to achieve compliance.

For more in-depth information, see the complete article, “The Compliance Solution,” in the online IDEA Library or in March 2012 IDEA Fitness Journal.

John Berardi, PhD

John Berardi, PhD, and Krista Scott-Dixon, PhD, are part of the Precision Nutrition team, a group of nutrition, exercise and lifestyle professionals dedicated to helping people achieve lasting personal change through diet and exercise. To gather more tips on coaching clients and improving adherence, check out www.preci sionnutrition.com/course-for-fitness-professionals.

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