As a personal trainer and business owner, I am always looking for new ways to build my business and capitalize on my knowledge, experience and passion for health and fitness. I have discovered a specialized niche population that is both growing in numbers and shrinking in size. Let me introduce you to the bariatric client.

Two years ago, a particular client was referred to me for personal training. She was two weeks post-op from gastric bypass surgery. My background includes 17 years in the medical profession as a licensed practical nurse. We were a perfect fit.

It took everything she had to walk into the gym. She was scared and intimidated, but she knew that if her surgery was to be successful, she would need to change her lifestyle. Along with cardio, strength training and stretching, we focused on her getting to know her body, how it feels and what it can do. We discussed nutrition, meal planning and recipes weekly. She expressed emotional and psychosocial experiences that were new to her due to the surgery. As her physical strength increased, she gained mental clarity and emotional stability. Today, she has a sound sense of self, is living a clean and healthy lifestyle and knows she will maintain her 165-pound weight loss for life.

Let�s throw some statistics out there. Morbid obesity is defined as being 100 pounds overweight or having a BMI of 40 or greater. About 15 million people in the United States are morbidly obese, according to the American Society for Bariatric Surgery. In 2006, an estimated 177,600 people underwent bariatric surgery. That number is increasing every year.

Having bariatric surgery is only one piece of the puzzle. It is a tool to help jump-start weight loss by restricting food intake and caloric absorption. Once the initial weight has come off (usually within six to 12 months), patients must do what we all must do to maintain a healthy weight: They must change their lifestyle by incorporating proper nutrition and meal planning, exercise and stress management. They have not managed this successfully in the past. Without professional help, they risk the ability to maintain their weight loss.

Bariatric clients are a specialized and niche market waiting for us to offer our services. There is a tremendous opportunity for fitness professionals to branch out and customize their business to include both pre- and post-bariatric clients.

 

Understanding this Specialized Niche

Before you can properly and successfully work with a bariatric client, you must first be aware of and understand their specific physical and psychosocial needs. You need to be a lifestyle coach for them, providing a tremendous amount of emotional support and nutrition guidance as well as fitness training.

Most bariatric programs are comprised of a team of professionals that may include � but are not limited to � the surgeon, anesthesiologist, psychologist and nutritionist. These professionals prepare the patient for surgery and their immediate post-operative needs, including pain management, nutrition, activity and returning to work.

Trouble comes when the patient is six months, one year or several years out from surgery, and their team of professionals is no longer available in the same capacity. Patients are left to deal with their new lifestyle and the many challenges that come with it and seek help on their own. They view you as a positive, healthy and fit role model and will seek support, motivation and information.

 

Physical Changes

There are three types of procedures for weight loss, and you will need to know which type your client has had. Restrictive procedures limit the amount of food you can eat. Malabsorptive procedures alter the normal digestive process, causing food to be poorly digested and only partially absorbed. Thirdly, a combination of restrictive and malabsorptive procedures are also performed.

Our focus in this article will be Roux-en-Y gastric bypass, which is both restrictive and malabsorptive. Of all weight loss surgeries currently performed in the United States, approximately 80% are Roux-en-Y. In this procedure, the surgeon forms a small pouch from the stomach and reattaches it to a lower (distal) portion of the small intestine. The new pouch holds one ounce of food or less. Food enters the small intestine farther down, resulting in less time for bile and enzymes to assist in digestion and calorie absorption. This procedure results in greater weight loss but increases the risk of nutritional deficiencies.

 

Nutritional Concerns

As you can see, nutrition is of utmost importance to the bariatric client. It is not acceptable to eat smaller portions of the same foods they ate prior to surgery. They should have received very specific guidelines from their nutritionist, but they will look to you to help them incorporate those guidelines into their new lifestyle. When a bariatric client has a specific nutritional issue or a question you are not qualified to answer, you must suggest that they call their physician or nutritionist.

During the first two to three months, your client will be following a fairly rigid nutrition plan provided by their surgeon or nutritionist. Afterward, they will need to start settling into a healthy eating routine. The biggest concern will be malnutrition due to decreased absorption in the small intestine; therefore, they are advised to eat protein first at every meal to maintain and build muscle and prevent skin from sagging. Vitamin and mineral supplements will need to be taken for life as well. They should sit down to three meals per day to avoid �grazing� all day. Food needs to be chewed thoroughly so it can pass freely through the new pouch and stoma. Fluids are consumed between meals, stopping 30 to 45 minutes before a meal and resuming 60 to 90 minutes afterward, as the new pouch is too small to consume liquid and solid together. Sugar, carbonated beverages and alcohol should be avoided. Clients may find they can no longer tolerate foods they enjoyed prior to having surgery. The bottom line is, since absorption is compromised, the bariatric client must make every bite count. There is no room for empty calories.

 

Psychosocial

Understanding the psychosocial affects of bariatric surgery is key. Some of the positive outcomes are increased activity, improved health resulting in less medications taken and relief from chronic pain. Other outcomes, while still positive, can create stress or tension.

Old habits of using food for comfort or obesity to avoid social situations no longer apply, so learning to put their nutrition and fitness needs first may seem near impossible. Friends may not react positively to the weight loss due to jealousy or their own insecurity. It is a psychological challenge for a person with a huge weight loss to adapt to a smaller self-image � helping them maintain a positive attitude is crucial to their success.

 

Fitness Training

When working with a bariatric client, follow similar guidelines as you would when working with the morbidly obese. Ensure their safety by maintaining them in a supported position during all exercises. Alternate short periods of cardio with light resistance training, monitoring their pulse before, during and after exercise. Be cautious of weak joints due to years of supporting large amounts of weight.

A program progression might look something like this:

 

�         Interval training: five minutes on a stationary bike, alternating with two sets of 12-15 reps of a single joint exercise, such as leg extension, seated leg curl, cable pushdown, dumbbell bicep curl, etc., followed by gentle stretching.

�         Incorporate basic core strengthening and hip-opening exercises.

�         Progress by introducing elliptical or treadmill intervals and multi-joint strength moves.

�         As client becomes more comfortable, increase to three sets of 12-15 reps, and add longer cardio sessions.

�         Add balance challenges, such as performing bicep curls on one leg or using a balance disc.

 

As your clients fitness level and self image improve, continue to challenge them as you would any other client.

 

Where Do You Find Clients?

             Attracting this type of client involves a persistent proactive approach, as the bariatric client is less likely to respond to traditional advertising and more likely to respond to a personal connection with you.

 

�         Educate yourself � There are two places you can start. First, take a trip to your local book store. There are many books available that guide you through the process, procedure and life after bariatric surgery. Read and read. Then read some more. Second, start talking to people. Maybe you already know someone who has had surgery, or someone you know knows someone who had surgery. Ask questions. They will be a wealth of knowledge and most likely happy to share their story. In return, express your interest in them and the importance of exercise as part of their new lifestyle. Suggest a consultation, and come up with a winning and realistic exercise plan for them which details what they can expect from a personal training program. All it takes is one happy client who belongs to a bariatric support group.

�         Support groups � The best way to approach a support group is through your established client. You will find that most belong to either a hospital-based or private group. Ask if you can be their guest and sit in on a meeting � the education you will get from listening is invaluable. You will also have the opportunity to introduce yourself and let them know that you would like to come back to a future meeting as a guest speaker. This creates a comfort level for members of the group and will make you the topic of discussion at their next meeting. Your satisfied client will have ample opportunity to spread the word. When you do return as a guest speaker, you will be a trusting, familiar face. Bring plenty of business cards, brochures and even a healthy recipe to share with them.

�         Physician referral � Once you have spoken at several support groups and retained happy bariatric clients, you have something to bring to the table when approaching a physician. You may have a client who can introduce you to their surgeon or team. Take advantage of every opportunity presented to you. I have met physicians by going to post-op visits with a client, accepting an invitation to a clients �graduation� from their program and attending a clients bariatric group holiday party. You may try to cold call several physicians to set up an appointment as well. Have professional brochures and business cards, and be prepared to express what experience you have with bariatric clients and how your knowledge and expertise will benefit his or her patients.  

 

As you can see, there is great need for knowledgeable, professional fitness trainers in this growing, specialized niche market. If you are willing to put forth the effort, it can be both financially lucrative and personally satisfying, as bariatric patients stand to see the most dramatic improvements and represent a growing number of Americans.

Melissa Shanes is a licensed practical nurse and a certified personal trainer, and she is the owner of Physique � Fitness Health and Wellness. You can contact her at MelissaShanes@gmail.com.

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