Obese Client Help

[Quest4Perfection]

I have a client who I train in her home for the last year. She weighed 406lbs when we started and she is now down to 308lbs. However in the last few months she has been fluctuating and basically just maintaining her weight. She travels alot and so she will be home for 2 weeks and then away for 2 weeks. Whens shes away she goes into holiday mode and when she gets home she is generally up in weight. By the time we get back down again she is off again! I have tried to make her keep a food diary via email while shes away but she never does. Basically its a motivation problem and denial. She will insist that she has stuck to her program all week and yet she will not be down in weight or she will be up. Then after probing for an hour she will admit to having 6 glasses of wine on friday night and cant remember if she ate crap or not! Her usual diet consists of
9am oats x 50g + 2 scoops of protein
12pm protein shake x 2 scoops + 50g nuts
3pm brown rice x 100g + chicken/tuna
6pm protein shake x 2 scoops + fish oil
9pm chicken and green veg
5litres of water, multivit, glucosamine and fish oil
Training - 5 days of cardio on empty stomach x 45mins - 60mins at 65-75% mhr. Compound weights x 2 per week full body and body balance
I dont train her in her gym, I train her outside, we do cardio and talk about her week - nutrition wise etc. So basically for an hour she gets a cardio session, nutritional advice and a motivation lecture.
I have her once a week and keep in contact throughout the week to make sure she stays on track.
I have thought about telling her that I cant keep her on as a client unless she starts putting more effort in but I dont think thats the best approach for her. Also after all the hard work ive put in I dont want someone else taking over and getting her to her target. But I really dont believe anyone could do anything different that would work. I have a waiting list of clients and I really could do without her but ........
Does anyone have any advice for me on how she can progress. She is doing my head in as its the same thing every week

 

[The Shadow]

how many cals total?

 

[Quest4Perfection]

About 2000 as I thought 10 x bodyweight would be way too highand she reckons thats as much as she can get in as she has stomach problems. Do you think this is too low?

 

[T-Cake]

I have seen this time and time again, women who waiver on that line after having great success with weight loss (I myself being one of them).

I bet you she's burnt out on what she's been eating. I know for me -- I dropped a LOT of weight but when I get burnt out on my what I'm eating, I'm worthless.

Take a look at my log and see my rules of how I eat, when I eat, etc. And does your client get a cheat day at present? This may be the reason she is more likely to falter on the road.

Maybe she'd do better with fitday.com and a percentage a day to fall in to instead of the "Here is what you should eat and how much" approach. This way, she can eat whatever she wants, as long as she maintains the 40/30/30 macro ratio (protein/carbs/fat) and it'd be another way for you to watch her (you can log in to her fitday).

I eat out at restaurants daily... I cook for myself and I've dropped a great deal of weight and gained tons of muscle eating what I want, but I use the internet to find nutrition and log it all. For some folks, that's just easier and it gives them their freedom back to cook, go out to eat, have a glass of wine now and then, etc.

As for the cals, if she is 300, I would at least put her on 2500 a day, especially if she is active daily. Maybe 3000 cals is too much for her (and most women cannot burn through 3,000 cals a day unless they have muscle previously to burn it), but I think 2000 may not be enough.

Keep posting to bump this thread; you'll get lots of ideas, but I'm begging you -- on behalf of someone formerly in her position -- please don't let her go just yet. Give her a new routine, something new to try, and a timeframe (e.g. 8 weeks). This may remotivate her because she's burned out... if in 8 weeks she is not keeping up with her side of the bargain, then reassess the situation, but I think she deserves a little more time.

Good help like you is really hard to come by. Had I not found mine (Ulter), I would still be 185# and stuck going to WeightWatcher meetings and eating too much refined food. All it took was a new approach and I was hooked and successful again (and now down to 158#).

Hope that helps.

 

[Quest4Perfection]

Thanks for the help. It would be easy working with someone like you! I use fitday alot and have other clients using it aswell. She is so loazy though that she really would not bother using it and would see it as an escape route if u know what I mean. I can hardly get her to write her food down every week or get up to train at 8am, she reckons its too early. She said she cant imagine getting down to 266 and thats why shes waivering. We have worked on imagery etc but no go. I am not dissin ur idea I just know she would never do it. Also re the cheat meal, we tried a cheat meal which turned into a cheat weekend, which turned into 3 weeks of trying to get back on track. Psychologically she seems to get on better without one. If I up her calories to 2500 I cant even be sure that she will get all that in because she doesnt weigh her food properly and eats out alot. I reckon I want it for her more than she does. Any ideas are greatly apreciated!

 

[macrophage69alpha]

she needs to do cardio every day, even if its just walking. those 2 days off are not helping.

have you considered a diet that is more strict for 2 weeks, followed by her current diet (it will also then seem to be almost a luxury). calorie cycling can be quite effective.

also 5 liters of water is actually low end for that bodyweight and protien intake, increasing it will also help with dietary control.

 

[Quest4Perfection]

Yeh might try cycling her calories a bit and il push with the extra cardio. I know she struggles with the water and even though every single week i ask her to log exactly how much shes drinking, the answer is always 'oh loads', which I reckon probably isnt even the 5.

 

[treilin]

Do you do the cardio with her? Or do you just stand there while she walks or does her cardio time? Do you have another client that would be willing to work-out with her and you can train both at once? Or does she have a friend? How about offerring incentives. Like if you lose another 25 pounds we can *insert reward*
I know sometimes it's like why should I pay for a reward for her when I'm rewarding her with health. Maybe she doesn't get the feeling that you are sensitive to her. She keeps you as a crutch just to say to everyone,"Hey I have a trainer and I still can't lose any more weight." Like your an scapegoat.
Have you cooked with her? Showed her how to make blah food fun? Maybe buy her a cookbook, or make copies out of a cookbook for her to try. Or if you happen to make food for yourself tell her you'll set a portion aside so she can try something new every week. It seems like she has lost interest and you have to find out where her interest resides. Maybe it's the work-outs are to monotonous. Try different weight methods, get music she likes to listen to. COMPLIMENT her. Have a calendar to hang on the wall with goals of the week, or month, with nice little motivational quotes. Work on her verbal communication about herself. Emphasize she speak only positive things about her, and the energy and vitality she gets from working out. The more you speak up the positives and don't let her say the negatives the less likely she will be to complain.
Try crystal light in the water...
O.k... maybe that's more ideas that could help..

 

[nefertiti]

I don't know much about training, but boy do I understand food issues (though perhaps from the other end of things).

1) That diet is bland and unmotivating. Healthy, for sure, but there have to be better ways to keep her diet clean and nutritious while still having some variety and flavor. This will help satisfy her more and prevent cheating. Agreed that upping it to 2500 is a good idea.

2) Re: motivational issues. I don't know her so I can't assume anything, but don't be too quick to label her lazy. It might seem that way but often laziness is a cover up for depression/anxiety/etc. I have a good friend who is very overweight, works with a trainer and does - most of the time - "try" to keep her diet healthy. But nonetheless, her progress stalled at about 230 lbs. Recently we had a heart to heart in which she admitted that she compromises herself because she's terrified of losing the weight. She admitted to hiding behind her fat, and if people don't like her she has that to blame it on. But if she's not fat and people still don't like her, then what? Being fat gives her a scapegoat for anything that goes wrong in her life and also provides a, pardon the pun, layer of protection between her deep rooted self esteem issues and depression and the rest of the world and without that, er, layer, she would be vulnerable and exposed.

Now, I'm not saying this is the case with your client, but it's something to consider.

 

[Quest4Perfection]

Thanks for your ideas. I do the cardio with her yes and she refuses to do it in any other area other than the beach. I have tried doing intervals with her and she complains about it being boring, ive tried cycling with her but she doesnt like it, i have gone swimming with her and she wasnt self conscious but I couldnt get her heart rate up high enough, and i have done circuits with her but she hates it. I will try again to introduce more walking routes and change it about a bit.
In terms of the diet that was just an example of a day. She eats all fish, brown pasta, brown pita breads, cottage cheese etc... all basically clean sources of food. We have tried the crystal light (or an alternative as its unavailable here) and still the same response regarding the water. She lives at home and so her mother cooks for her. So no I havnt cooked with her but have given her recipies i have done out like protein pancakes and other ideas from sites like this.
I realise she is unmotivated and I know Im coming accross like im 'slaggin' her off but Im not, im just frustrated. When I said shes lazy its because she, like I said, will not get up earlier than 8am, she wont do cardio when she gets in from work, she wont walk without company, she wont push herself beyond her comfort zone, she will only do enough to get by. I have been overweight myself so i can empathise with her but when I lost the weight I pushed myself to do things I didnt want to do in order to achieve my goal. She is way more confident than I was when I was overweight, and thats not just a facade. I have known her for 3 years and I really go out of my way for her, 10 times more than any other client, but because I get no apreciation for it or even effort on her part it just pisses me off. I dont even want thanks just input and for her to be honest about what shes actually doing. Like she'll say 'i ran the whole length of the beach the yesterday' and she knows that I know she physically cant run for 30 seconds!
I am going to talk to her about it and see what we can come up with together between carb cycling, varying her workouts and using new motivational tactics, and hopfully somthing will work. Thanks again and I hope you dont think im not taking in what your saying coz I am, I am just being realistic about what she will actually do and wont do.