As our country continues to struggle with the growing epidemic of obesity, trainers need to be vigilant and open with their clients about topics that can worsen this condition. Without knowing it, many of the medications our clients take for the treatment of a variety of chronic disease states have the potential to cause weight gain as a side effect. After determining this as a roadblock to their successful weight loss, there are appropriate ways to handle the situation and get the client back on track to their health and wellness goals.
According to the CDC, 36.5% of U.S. adults have clinically defined obesity. Overweight individuals are defined as those with a BMI 25 to 30 and obese if the individual has a BMI of greater than 30. Let’s put this into perspective. A sedentary and unhealthy lifestyle leads to obesity, which then lends to many other co-morbid conditions including heart disease, high blood pressure, diabetes, heart attack and stroke. Because of these newly added diseases brought on by being obese, the patient has come full circle and is now on other potential medications that can lead to even more weight gain.
During the first meeting with the client, it is important to learn their overall goals for the sessions as well as to take a thorough health and medication history to tailor their workouts to fit their needs. This can be done in several ways. A standardized form can be utilized with checkmark boxes next to the condition and a space to write corresponding medications used to treat the condition or just a general questionnaire with enough space to write out the condition along with medications they are taking. But be sure to let them know that it is imperative you have this information to make their workouts effective and keep them safe.
There are many medications that the World Health Organization terms “obesogenic,” but for our purposes, we are going to focus on those that treat the four most common conditions: diabetes, high blood pressure, depression and inflammation.
In 2012, the American Diabetes Association estimated that 9.3% of the American population had a diagnosis and were being treated for diabetes. One of the recommendations for diabetic patients is to lose weight and to increase physical activity; chances are, you have clients that fall into this category. Three of the classes of medications commonly used to treat diabetic patients, including insulin, sulfonylureas, and thiazolidinediones, can cause a weight gain of anywhere from 2.2 to 13.2 pounds. That is a lot of weight to add on to someone who already needs to get some weight off.
The most commonly diagnosed chronic disease state in the U.S. is high blood pressure. According to the American Heart Association, 85 million Americans over the age of 20, roughly 33% of adults, have high blood pressure. Though there are several classes of drugs used to treat high blood pressure, there is currently only evidence that one class contributes to overall weight gain. Beta-blockers, used for the treatment of many diseases related to the heart, only lead to a mild amount of weight gain of about 2 to 4 pounds. This minimal weight gain can easily be overcome with your help.
Depression is another commonly diagnosed and treated medical condition, though many clients might not be as forthcoming with this information as they would be with a diagnosis of high blood pressure. Within the antidepressant category, there are four classes of drugs that have a known side effect of weight gain, ranging from mild gain of 1.1 pounds to moderate gain of 11 pounds. The class of medications most commonly prescribed by physicians is the SSRIs. Overall, this class has been shown to cause less weight gain of all the antidepressants, except for paroxetine, which can cause a patient to gain as much as 3.6% of their baseline weight during treatment. That might not sound like a lot of weight to gain, but if the patient starts out obese and adds this medication on top of that, it is a recipe for disaster.
The fourth and final condition we will touch on is inflammation. For the treatment of inflammation, many times patients are prescribed a corticosteroid. Long-term use of steroids can cause us to be hungry as well as to retain water and be bloated, leading to weight gain. This class of medications is known to cause the most weight gain out of all of them, ranging from 6.6 to 24.2 pounds. Some clients will have to be on this drug long-term due to a condition they are treating that causes a lot of inflammation. Such conditions can include autoimmune disorders, asthma, and COPD.
With some of these clients, the underlying disease states can potentially be corrected back to baseline or close to baseline with your assistance and expertise. All said our jobs as coaches is to aid in correcting the problem with lifestyle modifications and increased overall health and wellness, which can lead to less medication for most clients.
There are many ways in which you, as a practitioner, can help clients who struggle with one or multiple chronic disease states, but still have a desire to reach their health and fitness goals. These include teaching therapeutic lifestyle choices, specifically nutrition counseling, workout routine modification, ways to help the client overcome cravings and increase mindset, and even how to talk to the client about a medication that could potentially be hindering their weight loss goals and how they can speak with their doctor or pharmacist about an alternative option.
In addition to prescribed medications, it is also important to take note of the client’s over-the-counter weight loss supplements. According to the Mayo Clinic, many of these products interact with prescription medications and have unwanted side effects like dehydration, increased heart rate and blood pressure, and dizziness. Not only are these side effects dangerous when the client comes to the workout, but they can also worsen the condition we are trying to treat with the prescription medication.
Don’t forget that the client is there because you are the fitness expert -- they trust you. It is your job to keep them safe as well as to help them reach the goals they set at your very first meeting. As a practitioner, it is of the utmost importance that you know as much as possible about the overall health of your client for them to gain the most out of every session. There might be roadblocks along the way but with the right knowledge and some clever modifications, anything can be overcome.
