The Global Wellness Institute, a nonprofit based business in Miami, FL, conducts industry wide research and calculates that the “wellness economy” was worth $4.2 trillion in 2017. Healthy eating, nutrition and weight loss accounted for $702 billion, and fitness/mind-body’s worth was at $595 billion. Opinions to what works, even by medical experts, dieticians and physicians are as varied as hair and eye color. Clearly, there is not one “thing” that works for all, or we would not have the varied market we do.
A look at the history of diet and exercise recommendations, and even as they have changed over the years, shows just how confused we are as to what works. Government recommendations for food intake have morphed over time, and shifted from rectangles to circles to pyramids, and most recently the “plate” analogy. The recommendations have incorporated different ratios and recommended ranges anywhere from 4-7 food groups (see the interesting history of USDA recommendations here).
With exercise, recommendations for individuals to exercise were not on the radar until after the 1950’s. Even in the 1960s and 1970s, the medical community was conflicted on the safety of the various types of exercise and what to recommend. According to health.gov, it was not until 1990 that a more general inclusive approach to exercise recommendations was provided. So, as one can see, opinions have distinctively differed by decade.
Thankfully, there is one thing that everyone seems to agree on. Exercise has numerous benefits for us. Improved mood and overall health are non-disputable. However, exercise as an aid in weight loss is surprisingly quite controversial, and as varied as the books you read or the website you click on. Consider this: if it were so simple, wouldn’t there be one food and exercise reference for us all to take from as opposed to the multibillion-dollar diet and exercise industry that exists? Why is it clearly working for some select few, but not all? Maybe this is why a recent article published by the Mayo Clinic May 2019 says exercise can assist with prevention of weight gain or weight maintenance but does not mention exercise as a key contributor or even factor in weight loss.
This creates a special challenge for us a fitness professionals, specifically personal trainers and health coaches considering the number one most common goal of so many of our clients is “weight loss.” What’s a trainer to do? What kind of recommendations should we give? What is even within our scope of practice as a trainer? Although we are not specific to give nutrition advice per se’, to ignore nutrition completely would also undermine a person’s goals since science is in relative agreeance that nutrition is the strongest factor of weight loss (we just can’t agree on the specific of what that nutrition should look like). Therefore, encouraging our clients to seek information regarding nutrition that works for them is of paramount importance to a weight loss goal, and helping them problem solve what may not be working is an important consideration. Let’s look at a unique perspective on weight loss and exercise.
Gary Taubes of Calories In/Calories Out says, “It would be nice if science and scientists did not make errors, but they happen all the time. It’s human nature. The methods of science are supposed to guard against the adoption of false convictions, but these methods aren’t always followed, and even when they are, inferring the truth about nature and the universe is a difficult business.” Put simply, nothing is fact until countless studies have been completed and it has stood the test of time, and even then, it’s not always guaranteed.
One of the current “truths” is that the relationship between weight and exercise is more “complex” than previously imagined. It would be nice to say the facts were a simple calorie in and calorie out measure. However, we are now finding studies telling us that hormone regulation is a much more individualized matter. Adipose (fat) tissue composition plays a role in weight loss more than previously thought. This means the adipose, or fat tissue of a lean person may be completely different from the adipose tissue of a large person. Believers in these theories (because again, it’s science and nothing is guaranteed) believe that the body of a person with this predisposition of fat tissue will actually strive to keep and maintain their heavier weights despite any other factors. This theory also proposes that weight cannot be fully controlled any more than your height or other parts of you that are regulated by thermodynamics, hormones and other intrinsic bodily functions. Being lean versus being heavy is as simple as a genetic predisposition, with some variance on the scale allowed based on your lifestyle. This would attempt to explain the individual who swears they are following program to no avail.
This is thought provoking and often ignored when many clients are given nutrition counseling by nutrition experts. We cannot control how tall we are, where hair is on our bodies, and where fat tends to lurk on our bodies. For instance, we do not accumulate fat on the backs of our hands, and depending on the person, it may lurk more on our thighs, our stomach, or on our buttocks. Yet, current pop culture tends to lean more towards obesity as a psychosocial disorder than a biological one. Some researchers go against the grain, not believing that obesity is merely a result of our eating and exercise choices. In today’s behavioral psychology movement, we put a lot of blame on how we eat and how little we move (a thought process that did not exist before World War II). However, obesity does have a history that pre-dated the supermarket movement and the internet boom (it was believed to be a disease of the fat tissue prior to WWII). Sure, food as is today and sedentary living may have exacerbated this problem of obesity. There is no denying that. However, certain researchers believe there is more to the puzzle than simply putting the blame on the individual for poor choices. Proponents of this theory believe supermarkets and sedentary living just provide these genotypes easier ways to achieve their body’s “happy place” of fat accumulation.
This theory is saying, it’s not necessarily that larger person’s fault based on a series of poor choices. Rather, the person made poor choices because their body strives to accumulate more fat. Their body’s homeostasis, or state of comfort, is with more fat tissue and different composites of fat tissue, as opposed to a lean person. Furthermore, these studies believe that marathon runners who are super lean have a predisposition for being lean and increased energy expenditure for their body types. This translates as they are internally (not externally) driven to burn more calories. Think about it: A greyhound will always be leaner and have more energy than a basset hound, and different human beings may manifest with this type of diversity also. No one must encourage the greyhound to run. It is driven to do so. Just this past week, a new half marathon record was set by Geoffrey Kamworor. His record was a 4:25 pace for 13.1 miles. What a wonderful feat with no doubt hard work and dedicated training. Yet, the question also becomes, could anyone do that? Or is it a genotype that allows Geoffrey to be that skilled of a runner, with a predisposition for it?
If this is true, people with the opposite predisposition are not necessarily “lazy” or “gluttons,” Taubes states. Contrary to popular belief, this theory states that these people overeat because they are getting fat, not getting fat because they overeat. That means it’s not just willpower, or lack thereof. It’s not necessarily behavior modification techniques that are going to work for this population because the body will find a way to store fat and their bodies will naturally resist it (which is why we see these diet programs fail as opposed to simply a lack of willpower). Studies have been done on different mammals that have different predispositions for excess fat and have found that their bodies will find a way to conserve energy or eat more to maintain their fat deposits (think tigers versus hippos). Hibernating squirrels will double their body weight in late summer regardless of scientists’ attempts to control their environment (calorie restriction). The body finds a way to do what it wants.
One thing is for sure. Obesity is multifaceted.
In 1998, the National Institutes of Health stated, “obesity is a complex multifaceted chronic disease that develops from an interaction of genotype and environment.” If obesity is complex and multifaceted, how can it possibly be as simple as behavioral modification strategies such as keep cookies out of the house and park at the back of the parking lot to get more steps in? Again, it is not that these strategies don’t have merit. They do. However, here I am talking about those people (and there are many), who cut back on calories and overextend themselves in the gym only to lose minimal or no weight or get discouraged by the slow movement of the scale. These are the clients who we may have to take the theories of fat tissue composition, hormone regulation, and other internal factors evidence into account. Taubes believes for some, exercise can pose a problem, because these individuals will tend to be “hungrier” and eat the calories they burned (and then some more likely).
What should we do as trainers and other fitness professionals? We never want to encourage someone to be sedentary! However, finding a “happy medium” in programming, and keeping this research in our minds can assist in developing a program that works for the individual. Of course, it is important to stay within our scope of practice. However, ignoring that exercise is not the mainstay of weight loss and making empty promises is also violating an ethical code of conduct. Some strategies to think of:
- Realistic expectations: Helping our clients develop realistic expectations is critical. Educating them on the range of healthy within their own body type is a sensitive but critical step to program success.
- Help Them Educate Themselves: Pointing them in the direction of different theories and principles behind weight loss is advantageous. As a trainer, I find that often times our beginning may be as simple as begin a simple exercise program with homework to simply read several different articles, or assigning a couple of books to choose from that pertain particularly to their goals. This is not us making recommendations about what is right. This is encouraging them to make their own decisions, and if need be, reach out to professionals specialized in helping them get to the goal they want.
- Constant Re-evaluation throughout the Program: Constantly, each session, evaluating what is working and what is not by asking a series of open ended questions helps us develop empathy and figure out what the client is thinking about the program, and fine tune what may or may not be working for them.
- Meeting in the Community: If your programming allows it, meeting a client outside of the gym space sometimes can be advantageous to give the program more of a “real life” feel, and help you to take a fresh perspective on what it’s like to be this person. As coaches, developing empathy is key to the foundation of our programming.
One of my graduate degree professors provided a piece of advice in class that I never forgot. She said “you are not going to always have the answers for your clients. However, it is your rightful duty to help point them in the right direction. Sometimes that is in the form of information for them to read so that they can make their own decisions. Sometimes it is in the form of a support group. Whatever it is, your job is to help them find it.”
This topic of weight loss is a particularly sensitive one. Most people are sensitive about other factors regarding their bodies, such as hair type (and where it lands) and how tall they are, the shape of their teeth, etc. We must remember we are talking with our clients about their personal attributes, a topic very touchy for all of us. Let’s remember this fact and discuss it openly, but with sensitivity. The take home: Never assume it is as simple as providing a handful of guidelines telling a person how to eat and exercise, information that can be easily found online. Human to human connection demands more than that. Be more.
This article is not intended as a substitute for medical advice of physicians, or in any way written to deter you outside of your scope of practice as a fitness professional. The information provided here is designed to help your clients and yourself as a fitness professional make informed decisions about health and success in fitness.
Bjorntorp, P. 1997. “Hormonal Control of Regular Fat Distribution.” Human Reproduction. Oct; 12 (Suppl 1): 21-25.
Greenwood, M.R., M. Cleary, L. Steingrimdottir, and J.R. Vaselli. 1981. “Adipose Tissue Metabolism and Genetic Obesity.” In Recent Advances in Obesity Research: III, ed. P. Bjorntorp, M. Cairella, and A.N. Howard, pp. 75-79. London: John Libbey.
Mayo Clinic Staff. 2019. “Exercise: 7 Benefits of Regular Physical Activity.” May 11.
McGroarty, Beth. “Wellness Industry Statistics and Facts.” Global Wellness Institute. https://globalwellnessinstitute.org/press-room/statistics-and-facts/
Taubes, G. 2011. Why We Get Fat And What to Do About It. New York: Random House.