Editor's note: This is the first of a series that will illustrate the necessities of working with certain populations of society. Look for the continuation of the series on training seniors in the next issue!

You've undoubtedly heard the phrase, "Do what you love, and the money will follow."I did it by serving a large segment of the population. Large both in number - and in pounds. I'm speaking of the obese special population, hereafter referred to as the obese population or "OP."

As you probably know, two thirds of Americans are overweight or obese, and one of three Americans is not just overweight, but obese. By obese, I mean having a Body Mass Index of 30 or greater, per World Health Organization. That is a huge percentage of the population, which can create a hugely successful niche market for you.

But how do you go about getting obese clients? And once you get them as clients, how can you help them? Interestingly, the first is more difficult than the second, as long as you take advantage of all the tools available to you.

As many obese Americans as there are out there, and as many as you see tour your gym or facility, the obese market will most likely come to you. However, it is your job to convince your OP that you are the trainer who can get them the best results.

Knowledge Is Key
To serve this population well, you must have specific knowledge of their special needs and the tools to meet those needs. Specific knowledge can come from a variety of sources, but make sure those sources are credible. There is so much ridiculous information out there that you need to be educated by authoritative sources.

Attending a weekend continuing education seminar is a great first step. As important, though, is the continuing education that you provide yourself through the wealth of information available in peer-reviewed scientific and medical journals.

Being a credible and believable source of information on the current science of weight loss and weight maintenance will give your client the correct impression that you have the knowledge to guide them to success.

Tools to Determine the Proper Plan
Now that you've got the knowledge, there are some applicable tools necessary for training this special population. Helping your obese clientele determine their resting metabolic rate (RMR), their non-exercise activities thermogenesis (NEAT), the thermic effect of food (TEF), their exercise caloric burn or their daily caloric need gives you the power to identify to the calorie a necessary level of exercise output and a necessary level of food intake to achieve a sustainable weight loss.

Using indirect calorimetry, a method of estimating energy expenditure by measuring respiratory gases, you can measure RMR and exercise calorie burn. With accelerometry, the quantitative determination of acceleration and deceleration in the entire human body, you are able to estimate how much energy your clients burn when not engaged in exercise (known as NEAT). By utilizing these tools, you can advise your client to the calorie what her reduction of food, her increase in exercise burn, or both, must be to achieve a weight loss.

If you're depending on your clients to provide an accurate account of their meals, you may be misled. It isn't uncommon for those with food issues to underreport their food intake. Add to your tool chest software technology, workable in even handheld computers (PDAs), so that your clients can track their intake of calories, macronutrients and even some micronutrients.

Weigh your client every week. Track using a software spreadsheet so your client can see the date, the week, the goal weight, the actual weight, the week's gain or loss, the cumulative gain or loss, the average weekly loss, the net exercise calories per day (for the week), the net exercise calories per day (from inception), the daily intake (for the week) and the daily intake per day (from inception). For extra impact, graph this data as well.
Journals: Obesity Reviews, Obesity (formerly Obesity Research), International Journal of Obesity, Appetite, Behavior Modification, Journal of the American Dietetic Association,Eating Behaviors, Journal of the American College of Nutrition, Journal of Nutrition, Nutrition, Nutrition Research, Physiology & Behavior, Preventive Medicine, Preventing Chronic Diseases.
Books: The Way To Eat by David L. Katz; Mindless Eating by Brian Wansink; Volumetrics series by Barbara Rolls; The Spectrum by Dean Ornish; The Fattening of America by Eric A. Finkelstein and Laurie Zuckerman; Start Strong, Finish Strong by Kenneth H. Cooper and Tyler C. Cooper; The Duke Diet by Howard J. Eisenson and Martin Binks; What to Eat by Marion Nestle; You: on a Diet by Mehmet C. Oz and Michael F. Roizen.

Training Considerations
Before you begin training an obese clientele, you must first screen all your clients for health risks. With OP, you need to be especially tuned into coronary artery disease risk factors and signs and symptoms suggestive of cardiopulmonary and/or metabolic diseases.

You also need to be mindful of the likelihood that your OP will have orthopedic issues, or you must be mindful that orthopedic issues can occur from weight-bearing exercises. If used at all, weight-bearing exercises should be of shorter duration and less intensity.

While sufficient protein intake is essential for your muscle-building clients, it is likewise very important to your OP, but for different reasons. First, adequate protein intake by your OP greatly reduces the loss of lean mass, which naturally occurs with weight loss (It's called adaptive thermogenesis). Second, quality protein - skim dairy, lean meats, salmon, albacore tuna, protein rich vegetables, some grains - enhances a sense of fullness, therefore causing the obese client to eat less.

Be especially sensitive to your OP's self-image and sense of reality. Often, obese clients limit themselves due to their past "failures." They often believe their "condition" is not their fault. And there will be a big disparity between their goals (set low) and your goals for them (set high with a plan to get there). Obese clients are generally down on themselves, have had a number of failures (not limited only to weight loss efforts),  are insecure and/or lacking in confidence, are in denial and (probably a result of the past failures) set very low weight loss and fitness goals. Be sensitive, patient and encouraging but, as the need arises, tough.

As a competent, educated trainer, you will design an effective workout program for your obese clientele. In the process, realize that your OP will be especially prone to chronic lower back pain - due in part to the load on the lumbar spine and low levels of movement. As such, you need to be especially careful in selecting exercises focusing on the core, including these muscle groups: erector spinae, rectus abdominus, quadratus lumborum, adductors, abductors and abdominus obliques. Those muscles, while probably severely atrophied in an OP, would, if strengthened, lessen or eliminate the OP's propensity not to utilize their muscles in the rest of their bodies. As we learned in our early exercise physiology coursework, every significant muscle action originates in, is transferred through or is stabilized by the core.

You'll want your OP to exercise the core while putting as little load on the spine as possible. "Pulling" the upper half of the body toward the lower half (visualize a sit-up) generally puts the same muscles to work as pulling the lower half of the body toward the upper half (visualize "reverse curl" or "knees up") but pulls less on the spine.

Aerobic exercise can't be overstressed for an obese clientele. It is here, not necessarily in strength training, that you'll get the most bang for the buck. I'm not talking marathoning. A 77-year-old obese client of mine finally has her treadmill speed up to 1.3 miles per hour. As a result of aerobic fitness, your clients will reduce "all cause" mortality risks, see immediate benefits in loss of subcutaneous abdominal adiposity and visceral abdominal adiposity and, almost as important, weight loss.

Warren E. Jones, JD, NSCA-CSCS, ACSM H/FI, ACSM-CEQ is a contributing author to NSCA's Performance Training Journal and Personal Fitness Professional. He is an Honorably Discharged US Marine Corps Sergeant whose clients range from the "8th Grade to the 8th Decade" and from the morbidly obese to competitive triathletes and runners. He can be reached at wej@cox.net.

Editor's note: This is the first of a series that will illustrate the necessities of working with certain populations of society. Look for the continuation of the series on training seniors in the next issue!

You've undoubtedly heard the phrase, "Do what you love, and the money will follow.


How much of your time would you estimate you spend growing your business?