A couple years ago I decided to take a short term position to continue developing and implementing the exercise component of a government funded obesity management program. Over that time frame almost 1,000 patients came through our program and I had an opportunity to work with many of them.
I learned a ton of stuff about dealing with those suffering from obesity that ultimately ended up changing my entire approach to personal training with all of my clients. Below are 5 valuable things I learned about clients with obesity that I think every trainer should know.
1. Obese people are not lazy or stupid
Contrary to how obese folks are portrayed in the media (lying on the couch in an undersized shirt with an open bag of chips beside them), most people with obesity are not lazy or lacking in intellectual capacity. In fact, the vast majority of obese folks I met in this program were gainfully employed, raising families, and living pretty much similar lives to most other people you'd expect to meet.
Of course, there are always those who didn't do anything, were lazy, and not the sharpest tool in the shed, but I think that can be said for people in general and not just those with obesity. A biased perception against obese people is called weight bias and, in my experience, health professionals and trainers are probably the worst.
2. The solution to obesity might not be education
As much as we as trainers would love to believe that all we need to do is teach people to eat well and exercise to solve their weight issues, this simply is not that case. The fact is that most people with obesity are subject to much of the same fitness and nutrition misinformation as the rest of the population, but generally speaking, they tend to know which foods they probably shouldn't be consuming and that they should be taking time to exercise regularly.
The key (along with the information we provide) is to be able to actually elicit change in our client's behaviors by partnering with them and eliciting change from within them instead of just instructing. Motivational Interviewing, Second Edition: Preparing People for Change is incredible for this and truly changed the way I work with my own clients.
3. Obesity is a chronic condition
Despite the fact that we tend to argue on internet forums about which diet and exercise combination is best for weight loss, the reality is that as long as you've created some sort of caloric deficit your obese client is going to lose weight. But that is the easy part. I would personally argue that getting any client to lose weight in the short term is far easier than keeping it off in the long term. Even with gastric bypass surgery, weight loss is rarely permanent and regain occurs in all but a few people.
Obesity is a lifelong condition and even if the client has lost their excess weight they must make great efforts to maintain their new lifestyle. Similar to those with diabetes, blood sugars may appear normal when treated with medication, but if you withdraw the treatment (exercise, nutrition, and behavior change in this case) the condition will come back. For this reason, it is imperative to consider options that provide long term solutions like habits rather than meal plans for all weight loss clients. This is, in large part, why I think 12 week weight loss challenges are useless for creating actual long term change.
4. Weight loss might actually be harmful
There are actually some data to suggest that mortality among hospital patients is actually lower for people who are overweight or even in class 1 obesity (BMI > 30).
Beyond that, there is some evidence to show that obese people with a greater number of more serious health conditions have a history of more previous weight loss attempts.
Does this mean that you should tell a client who comes in to lose weight that they shouldn't try to lose weight? Good luck with that. Does it mean that you should be primarily interested in trying to find ways to bring about lifelong change? Absolutely!
From a business perspective, the evidence showing that most people will regain weight following weight loss might actually help you convince clients to stay with you longer to maintain their results.
5. Exercise alone can be useful
Any trainer worth their salt should appreciate that meaningful weight change is going to require a change in nutrition. But the reality is that sometimes clients with obesity just want to be healthier and get control of some of their weight related issues. Of course, I would suggest using motivational interviewing to help them adopt nutritional changes over time, but if a client is resistant at first and just wants to exercise STAY WITH THEM.
We now know that even without a change in nutrition or even body weight change we can improve the health status of people who are obese just through exercise.
Perhaps with your coaching, patience, and initial results the client will gain enough trust to begin undertaking the difficult task of nutritional change. But if not, don't think you're not helping by way of exercise alone. You might be actually changing their life!