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In Part I of this series I described the categorization and classification of obesity, in Part II I shared some resources and very important concepts about obesity management, in Part III I discussed how I could go about training those with a BMI greater than 35.  Today I want to talk a little bit about training people with obesity whose BMI is less than 35, but still over 30 which is pretty much the standard criterion for obesity in most places in the world (except for a few places that I mentioned in Part I).

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Within this category I find that there are often two different types of people.  The first are those who are inactive, have less than average muscle mass, and are generally out of touch with all that is fitness.  The second type I generally see within this category are those who are regularly active, lift weights, and are fairly muscular.  They are often everyday gym rats, off season bodybuilders, and even trainers and coaches.

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While those in the first group tend to accept that they are obese, those in the second group often having difficulty truly accepting this and often  point out that BMI does not take into account their muscle mass.  For this reason, it is important to remember that while you CAN have a BMI greater than 30 and not be over fat, males with a body fat percentage over 20% and females with a body fat percentage over 30% are considered obese regardless of their BMI.

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I won’t get into it too much here, but you can see how working with those who are already active could warrant more intense training programs and different exercise variations.  However, I find that these people are most difficult to reach in terms of establishing long term realistic behavior changes as they tend to see themselves in the different category than those who are starting from ground zero.  In my experience, this group tend to think that they are able to handle more “hardcore” dieting and training practices to bring about rapid fat loss and they struggle to come to terms with the fact that while they certainly train hard, they need to address the root causes of their excess weight in much the same way as those who are less experienced with training.  In short, carb and calorie cycing, refeeds, and all of the other advanced nutritional practices are secondary to slow, progressive behavioral change.

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I would also add to this discussion the importance of remembering a point I made in Part I.  It isn’t as important to know the classification of obesity (how heavy you are) as it is to know about how obesity is impacting your health.  In short, you could have class 3, stage 0 obesity (BMI over 40, but no obesity related health problems) or you could have class 1, stage 2 obesity (BMI over 3o with significant obesity related health problems).  So weight (over even body fat percentage) doesn’t give us the whole picture anyway.  If you exercise you MAY be in better health because of the simple fact that exercise is medicine, or you may be suffering from metabolic changes associated with obesity despite the amount of exercise you’re getting.  So whether you exercise or not, I think the two groups here both need to consider changes to their behaviors in the interest of long term health.

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Goals

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Before we go forward I want you to consider something before you outright reject it.  What if we suggested to people that instead of losing weight that they just focus on maintaining weight?  I’m not body composition change or anything fancy.  There is no trick here.  But what if instead of working towards fat loss, we just stopped the gain?  Is that success?

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The basic premise is that each of us tends to slowly gain weight as the years go by and that if we could just stop the gain we’d be miles ahead.  I’m not suggesting that you’ll have an easy time convincing clients that this is the way to go, but sometimes perspective is the key here.  How many times have you (or someone you know) pulled out a picture from 10 years ago and thought “Damn…I used to look like that?  And I thought I was fat?  I would KILL to look like that again!!!”.  Hindsight is 20/20.  Add to that the physiological and psychological effects of losing and regaining weight repeatedly and you can see why maintaining weight might be a good option.  In this case, I think many would do well to maintain their current weight and work towards preventing future gain.

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I’m not saying that you’re going to get clients to buy into this off the bat.  But if you’ve worked with a client for a long time and they’ve failed change their behaviours to the point where they’re able to lose weight (if you’ve been in the industry for a while you know you’ve seen this even if you’re unwilling to publicly admit it) it might be a good time to reiterate this point so that they can see the smaller version of success that they ARE achieving.  Further, I find it helps in cases like these to reiterate successes like adding exercise and the benefits it provides to keep the client motivated to maintain the changes that they have made.  At one point in my career I used to “fire” clients for being non-compliant and failing to get results with weight loss.  Had I had this perspective then I certainly wouldn’t have made this embarrassing mistake and they’d probably be healthier for it.

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Back to reality though.  If a client comes in and you tried to sell them on this they’d be out the door before you could blink.  I think that mentioning the concept is a good idea, but suggesting a weight loss of no greater than 1-2 pounds per week is probably a good idea.  Truthfully, we all know that when starting a program it’ll come a little faster at first anyway (business tip: under promise, over deliver), but if the weight loss keeps moving much faster than this it could be a good sign that you’re overly depriving your client and that the changes won’t stick.  You don’t have to take my word for it, but I’m right. 

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But here is the real key.  Measure multiple things and create goals for each.  Track weight, measurements, body fat percentage, health markers (get their physician on board and make sure to educate them on obesity), cardiovascular fitness, and so on.  That way, if there is little progress on one, there will be others to highlight at any given time.  And MOST importantly, define weekly BEHAVIORS that you want to change (no more than 1-2 at a time) and focus most heavily on these goals.  Behaviors become habits which lead to outcomes.  Even if the client is able to deviate from plan and lose weight, the reinforcement should be focused on the behaviours as opposed to the outcome.  Because, in the end, if the behaviors don’t change, the results will eventually come undone.  So…the instead of behaviors leading to the goals…the behaviors ARE the goals.  Or to phrase it another way, the results are YOUR goals, the behaviors should be the goals of your client.

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Training

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I was thinking I’d write a detailed explanation of the training I use for people in this category, but frankly, it isn’t really much different than the training I outlined in Part III with only a few exceptions.

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I will do a full movement assessment on people in this category provided that they are not overly limited in any specific way.  Most are not so I proceed with a full breakdown of posture, mobility, stability, flexibility, and strength on this crowd.  If the client can, we do foam rolling.  And I certainly don’t have any issues with doing mobility work specific to the needed determined in the assessment for this group either.

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In terms of resistance training, I’ll generally follow the same template as I would do with heavier folks with the exception of the fact that this group will probably be able to handle (both physically and psychologically) more volume so I might do 2-3 set of each exercise instead of starting with 1.  That said, in the beginning pretty much anything you do will bring about results so I don’t push the envelope too much.  Make the person enjoy exercise and they’ll come back.  Of course, if I get one of those I mentioned earlier who already trains like a beast I’ll make them hurt.    Let’s be honest, they’ll enjoy that.  But they’re still going to have to make behavior changes too as this is the component upon which long term results are dependent.

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For cardio with this group it all comes down to what they prefer to do.  Now that doesn’t mean that if they prefer to sit on the couch and watch television that they aren’t going to do cardio.  But if they would rather do moderate intensity cardio for a longer time I’m good with that.  I don’t think cardio is that important for fat loss when combined with a solid diet anyway.  I use it for health and other benefits so I don’t care how they get it.  If they prefer more intense stuff, they can do that.  Of course, the idea is always to be increasing in intensity over time regardless, but I don’t freak out if people don’t want to do intervals.

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Summary

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In short, I think the biggest difference between these folks and those with a BMI greater than 35 is how you frame their goals.  The training is simply a matter of matching the level of exercise progression/regression to meet their needs and not making them hurt so bad that they don’t want to come back.  While this group is often easier to work with in terms of what they are physically capable of doing, their nutritional shortcomings are often just as difficult to overcome as those at higher body weights.  In the next article of this series, I’ll be talking about nutrition and how it applies to these groups.

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If you have any specific thoughts or questions about these articles, please drop them below.  And don’t forget to follow me on Twitter and Facebook if you’re not already.

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Check out Part V of this series HERE.

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I hope this has been of help to you.  If so, please “like” or share this article so we can spread the word.

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Recently an old friend contacted me on Facebook and asked me the following question:

“What are your thoughts on the 5/3/1 Program? I ask because I’m thinking of completely changing my program to focus on strength, and I’ve read some rave reviews about that program. “

Now honestly, I own the 5/3/1 Program, but have yet to read it so I can’t really make a fair assessment of the program (although I hear it is really good).  I have some degree of ebook ADD and I tend to purchase a lot of them and it takes me a long time to read them all.

However, after reading this question it got me thinking about how people go about choosing programs and it occurred to me that a lot of people have it ass backwards.  They pick a method or program first and set goals from there.

When someone decides to work with me I do the opposite.  I ask them to set out their goals from the very beginning to help me with the overall direction and design of the program.  Instead of choosing a type of training and then setting goals to suit the method, I like to define the goal and select the training methods that are best suited to helping the person reach them.

If strength training happens to be necessary to achieve the goal then I’ll include it as a block of training. However, if it is not necessary to produce the goal, it won’t appear in my client’s program no matter how good the material out there is at at time. Instead of being focussed on the method, I think it is important to focus on the results you want to obtain and select the ideal methods to bring those about.

One question I always ask new clients is ”Where do you want to be in a year from now?” The answer to that question tentatively dictates all blocks of training up until that point. If you’re training primarily to look better, then doing a strength block for no reason other than because a program sounds good, probably isn’t the best way to go.  That is not to say that there is no place for strength training in a physique based program, but you need to plan it accordingly.

Now that it is officially 2010 I urge you to look ahead to where you want to be next year at this time.  Pull out your calendar and work backwards by tentatively planning training blocks all the way through.  And whenever you include something all you have to ask is “does this take me closer to my stated long term goal”?  If the answer is no, your time would be better spent on something else.