Obesity: Top Three Concerns
By Geoffrey B. Miller

The top three concerns for working with the obese population are a caloric balance, screening/identification, and treatment or lifestyle modification.

Caloric Balance

The main objective for this population is to create a negative caloric balance [kcal] for a weight loss 1-2 lbs per week or long term goals of 5-10% of body mass reduction (Reimers, et al. 2000). This reduction of weight will be achieved through a combination of both an increase in energy use and caloric restrictions. The goals of kcal expenditure are 200-300 per day or a minimum of 1,250 per week with a goal of working up to 2,000 kcal per week (Clark, et al. 2008). The kcal intake restrictions for sedentary individuals should not drop below 1,200 for women and 1,500 for male. (Reimers, et al. 2000) With this information identified, it would be highly suggested that the fitness professional refer the obese client back to their primary care manager for a later referral to a registered dietician — in most cases and states, the trainer would be limited to the area of basic nutrition education.

Screening/Identification

Screening and identification go hand in hand as obesity in itself is a risk factor for coronary heart disease (Armstrong, et al. 2006). There is an additional risk of association with the chronic diseases of hypertension, hyperlipidemia, and type 2 Diabetes with an added risk of either an earlier mortality and/or shorter life expectancy in relation to obesity (Armstrong, et al. 2006). The fitness professional would need to conduct some basic risk stratification with the suggestion of using the ASCM/AHA pre-participation screening tools. Some of the screening methods would include the partnership of the client's primary care provider, which would include the basic labs of a lipid profile and fasting glucose. The other forms of screening the fitness professional should conduct would include those of a health risk appraisal, fitness assessment, circumference measurements, and more user friendly forms of body composition analysis like that of the bioelectronic impedance or the air displacement BodPod depending on the comfort and girth of the client. Another tool for screening would be the use of journaling for physical activity habits and the food intake in association with amount, time, feelings, and places of consumption. (Reimers, et al. 2000) A final part of the screening process is involved with the strategies of goals evaluation and setting in making sure that they are specific, measurable, attainable, realistic, and timely (or SMART) goals.

Treatment or Lifestyle Modifcation

Treatment or lifestyle modifications are indicated for these members to change and lose weight. Some of the more current treatment options include but are not limited to: dietary manipulation, physical activity intervention, behavior modification, cognitive restructuring, pharmacological intervention, surgical intervention, and medically supervised modified fasts (Reimers, et al. 2000). The areas of application for the fitness professional will be in relation to physical activity, behavior modification, and possibly cognitive restructuring. The basic guidelines for physical activity are: low impact cardiovascular modes of training, 60-80% of maximum heart rate or the talk test, exercise session duration of 40-60 minutes per day (which can be split into two 20-30 minutes sessions per day), use of static stretches for flexibility training, 1-3 circuits of 10-15 repetitions with the special considerations of the client's comfort, and performing most exercise in either seated or standing positions (Clark, et al. 2008). Both the behavior and cognitive modifications can be completed via the continued use and reflection of the journaling that was indicated as a screening tool.

References:

1. Armstrong, Lawrence E., et al. ACSM's Guidelines For Exercise Testing and Prescription. 7th ed. Baltimore: Lippincott Williams and Wilkins, 2006.
2. Clark, Micheal A., Scott C. Lucett and Rodney J. Corn. NASM Essentials of Personal Fitness Training. Baltimore: Lippincott Williams and Wilkins, 2008.
3. Durstine, J. Larry, and Geoffrey E. Moore. ACSM's Exercise Management for Persons with Chronic Disease and Disabilities. 2nd ed. Champaign: Human Kinetics, 2003.
4. Reimers, Kristin, Thomas R, Baechle, and Roger W. Earle. Essentials of Strength Training and Conditioning. 2nd ed. Champaign: Human Kinetics, 2000.