Wanted to ask some of the more advanced trainers here on the board a question. I was curious how you would handle someone coming to you looking for advice on weight loss when they are 425+ lbs and 5'8. There is an obvious need for medical clearance of course. However, suppose they were cleared, how would you handle the client?
The reason I ask is this: a woman recently emailed me. She has seen me on the web, I am not sure where. I post in multiple forums, websites, and have my own website. She is very heavy and mobility is not the greatest. There is not much out there in terms of research on what is effective for someone in this situation.
I am well aware of the need to help her mentally first. You can feed her all the fitness and nutrition jargon in the world, but it is not going to help one bit if she is not mentally focused and goal oriented on losing weight.
I am more interested to hear how some of you would handle designing a program for someone in this situation.
When you have someone of this size and health status, throwing the old "get your booty in the gym and bust out some compound exercises coupled with some HIIT coupled with a small caloric deficit" just does not work.
It is obvious that she is going to have to take small steps, naturally due to her size. Even walking long distances for her is difficult. I also want to do some research on some basic, body weight programs that can be done at home..... if anyone has any recommendations, I would be interested in hearing them.
Lastly, with nutrition, there is tons of room for improvement. Just switching her eating habits to clean foods from where she is today will make a drastic difference. We all know, without scientific equipment, when you are dealing with someone who is hyper-obese, you can't really determine a "maintenance level" of caloric intake. None of the equations will work! I think the best plan of attack for someone in this situation is to simply get a daily average estimate of food intake and look to see if they have been gaining or losing weight the last year or so. If they have been remaining the same, which she has, than simply reducing calories slightly and cleaning up the foods should be the key. However, again, open to suggestions.
I have ideas of how I want to handle the situation, but I wanted to hear how some of you may handle it.
I am thinking that too Cynic. I am sure the nutrition will have the largest role in her success/survival! I am very interested to hear about training ideas that she can do though. That is where I am lacking knowledge/information.
Diet will be the main culprit, you don't get that big without putting a lot of calories in your mouth. I agree with the walking for starters idea, anything else and it will most likely be too strenuous.
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And make us lose the good we oft might win
By fearing to attempt.
I'm not one of the advanced people you're looking for, but I'd say one thing I'd be curious about right away is if she's always been overweight, or if she used to be normal, or even an athlete (doubtful, but possible). Is her family obese... and then, what triggered the cry for help? Doctor's orders (so maybe she's scared), friends and family (so she's going through the motions for them), or a personal desire to better herself (best case, obviously)? All of these could factor significantly in how you attack it from the mental aspect, or even expectations physically.
Ed, lol, I am sure she is glad that she did not contact you. HA!
stroutman, You already know what to do. The principles remain the same. She just has to start where she is and do what she can do. I agree that diet and emotional/mental persepctive are going to be key to any successful program.
Many times really heavy clients actually have a pretty good bit of muscle under all that fat. They've been lifting heavy with every step for a long time.
If she doesn't have joint issues that would prevent it, start her with walking as has been suggested. She can, after just a week or so, do a very modified HIIT, just walk faster for a designated time and then walk slower as recovery. Then increase intensity slowly over time from wherever she had to start.
When it comes to lifting, she might be able to do more than you think, or she might have trouble just getting down on her hands and knees. So start her with whatever she is capable of. Begin with mobility work on a mat: birddogs, planks, glute bridges, pushups to a wall or high incline, scap pushups from her knees, and maybe rowing with a band. See how hard that is for her or if she says it's easy. Work up from there.
I think my approach would be to start too easy so that each workout is a success and she can have some areas where she can "move up." I also think it's going to be very hard to help her from a distance (if your only contact with her is the internet). She really needs someone who can watch her.
By default, Alco should not post in this thread :p
I had a guy who was 400+ and got down to 280 over the course of a year.
Basically I brought order to their diet, nothing special, just cut the crap, eat more protein, veggies, and better fat ratios. Something basic around 2500 cals or so. At that point you can do almost anything and have them lose fat.
As far as training, I wanted to do mobility work and stuff, but at that size, you can move much at all, so even getting them to be on all fours or even on the ground was a challenge.
So I had them walk on off days, starting with steady state work for a few weeks and then modified things as I saw fit. So one day they had an HIIT setup where they walked at a regular pace and then just slightly speed it up, another day they did hill work where they walked on a flat treadmill and then increase the incline for intervals (no drastic changes of course but enough to challenge them), and then a 400m setup where they walk briskly for 400m and then rest of 90s.
As far as weights, they cant squat, lunge, DL, etc. but they can drag things. So I had them either drag a sled or hold onto some ropes on the cable station and then walk back and forth from a low pulley. You can go for time, distance, weight, whatever, Steups were good too, again starting low and gradually working up. Leg presses were ok as well.
Upper body work was cable, free weight, or machine based presses and rows, but I could use the sled here too and do some foward presses, row walks, rotation walks, etc. Got really creative with the sled.
Bands could be good too for some limited traction work looking back in hindsight, but I didnt think about that at the time.
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Wanted to ask some of the more advanced trainers here on the board a question. I was curious how you would handle someone coming to you looking for advice on weight loss when they are 425+ lbs and 5'8. There is an obvious need for medical clearance of course. However, suppose they were cleared, how would you handle the client?
The reason I ask is this: a woman recently emailed me. She has seen me on the web, I am not sure where. I post in multiple forums, websites, and have my own website. She is very heavy and mobility is not the greatest. There is not much out there in terms of research on what is effective for someone in this situation.
I am well aware of the need to help her mentally first. You can feed her all the fitness and nutrition jargon in the world, but it is not going to help one bit if she is not mentally focused and goal oriented on losing weight.
I am more interested to hear how some of you would handle designing a program for someone in this situation.
When you have someone of this size and health status, throwing the old "get your booty in the gym and bust out some compound exercises coupled with some HIIT coupled with a small caloric deficit" just does not work.
It is obvious that she is going to have to take small steps, naturally due to her size. Even walking long distances for her is difficult. I also want to do some research on some basic, body weight programs that can be done at home..... if anyone has any recommendations, I would be interested in hearing them.
Lastly, with nutrition, there is tons of room for improvement. Just switching her eating habits to clean foods from where she is today will make a drastic difference. We all know, without scientific equipment, when you are dealing with someone who is hyper-obese, you can't really determine a "maintenance level" of caloric intake. None of the equations will work! I think the best plan of attack for someone in this situation is to simply get a daily average estimate of food intake and look to see if they have been gaining or losing weight the last year or so. If they have been remaining the same, which she has, than simply reducing calories slightly and cleaning up the foods should be the key. However, again, open to suggestions.
I have ideas of how I want to handle the situation, but I wanted to hear how some of you may handle it.
Thanks!
I have had a client like this before and I will tell you exactly what I would do with your situation. At 425 pounds and with difficulty walking, I would recommend simple steady state cardio vascualr activity until a substantial amount of weight is lost. I don't recommend HIIT or weights or bands. HIIT is an overused word and most of the programs I have seen labeled "HIIT" are your basic intervals. At her weight, she will have mobility problems due to her weight ( the extra mass), so you need to concentrate on getting her on a dedicated walking program. The mental aspect of this is the toughest, as her committment level will be challenged.
Once she has lost a good 15-25lbs, begin incorporating bodyweight exercises:
Squats
1/4 Lunges
Mod. Push-ups
Chair exercises (dips, presses, squats)
Boxing (uppercuts, hooks)
Mod. calisthenics
You simply have to get her moving...jumping jacks in a corner is perfect.
With heavy people, you have to be careful because they are emotinoal eaters and will resort to food. Education is paramount and suggesting ways to find alternate means of pleasure (rather than eating)--like reading, drawing, hobby, etc.
At her weight, she may have some risk factors that you should look into. Other than that...it becomes a committment on both of your parts.
Good luck!
Other than that...it becomes a committment on both of your parts.
That is the most poignant thing on this subject that I think can be said. As others have indicated, you probably have a good handle on what exercises to do. She's not equipped to do much, so you are pretty limited.
It will really take some straight talking and committment though. I won't take on more than one client like this at a time due to the emotional drain on me. Be aware of your own limits and don't get too emotionally wrapped up in her success or failure. Be supportive and stable, but keep your professional distance and articulately lay out your plan of action, getting her to agree to each step as you go.
That is the most poignant thing on this subject that I think can be said. As others have indicated, you probably have a good handle on what exercises to do. She's not equipped to do much, so you are pretty limited.
It will really take some straight talking and committment though. I won't take on more than one client like this at a time due to the emotional drain on me. Be aware of your own limits and don't get too emotionally wrapped up in her success or failure. Be supportive and stable, but keep your professional distance and articulately lay out your plan of action, getting her to agree to each step as you go.
Great points JP....
Committing youself to others is what this line of work is...and some of new trainers that come out haven't grasped that. One of my teaching anchors is "Their goal becomes your goal". And it is true.
fwiw, i'm not advanced by any means, but what i would do is:
get her diet in order. This is first and foremost, because we all know how shitty a shitty diet can make you feel. If she's drinking lots of pop/soda, that means major sugar spikes. A major problem with people trying to lose weight with a diet that's far from perfect is that they view the food choices as boring. Find out what she's eating in the day, and then give her healthy alternates, and change her diet to a caloric deficient one. You need to make sure her "clean" foods taste good too. If you have her eating plain chicken breast every day with veggies, the chances are that she is not going to stick to it. Seriously, look at how hard it is for people who have been in the weight and nutrition game for awhile to stick to a strict diet.
You don't want anything high impact. Get her up and moving. I would actually focus mostly on weight gain for awhile until she loses a significant amount of weight. I don't think a lot of people realize how large 425 pounds is. It puts a huge stress on your joints, and even doing brisk walking would be rough. Even at 400 pounds, i would not have her doing chair dips or squats. She probably would not have the mobility, or the strength to do these.
basically what everyone else said, but you want to make what she is doing as far from generic as you can, starting with the diet.
Thanks everyone for the great comments. I am in uncharted territory here and def. appreciate all of the feedback and opinions. I will keep you all up to date once we dive more into this.
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