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Evidence For Downsizing

Interested in helping your members get lasting results from their weight loss efforts? You can do a lot to improve members' outcomes by using the National Institutes of Health (NIH) guidelines on treatment to either choose a weight management program, or modify what you're already doing.

In 1998 the NIH published a comprehensive evidence-based report based on the review of 20 years of research and over 230 randomized controlled clinical trials. Prior to this report, which identified what approaches work, there were no guidelines for physicians on effective treatment of overweight and obese patients.

Are clubs qualified to apply the guidelines? In my opinion fitness professionals are as qualified as any other health professional to work with weight management (in otherwise healthy individuals), providing they follow evidence-based guidelines and some good old common sense.

Most popular diet books and programs focus on diet, and some exercise. However, while diet and exercise are important components of weight loss, they are just two of nine key behaviors/skills that clients need to master (or utilize) to keep weight off that your nutrition — as well as other fitness — staffers can help them achieve.


  • Problem solving — consists of identifying barriers to appropriate eating and daily exercise, and then generating, implementing, and evaluating possible solutions. Problem solving applies to all the other behaviors/skills on the list.

  • Physical Activity (PA) — weight loss/maintenance is associated with 2,000 or more calories of (PA) per week (similar to ACSM's guidelines for optimal health of 2,100 calories week).

  • Stimulus Control — stimulus control strategies include keeping high-calorie trigger foods out of the house, consciously avoiding situations in which overeating occurs, and buying and keeping plenty of healthy foods on hand.

  • Self-Monitoring — tracking what and how much is eaten, as well as tracking weekly physical activity facilitates “problem solving,” which significantly improves outcomes.

  • Diet — weight loss cannot be achieved without a reduction in energy balance. The calorie level chosen should create a 500- to 1000-calorie per day reduction from usual intake, which will lead to a weekly weight loss of one- to two-pounds, which is considered a healthy and safe rate of weight loss.

  • Social Support — Adherence is optimized when family members, friends, or colleagues participate in, or at least support, the healthy behaviors that must be adopted for long-term success. Each client must be encouraged to actively develop a support network.

  • Stress Management — Stress can trigger dysfunctional eating patterns. Coping strategies, meditation, and relaxation techniques can all be used to successfully reduce stress.

  • Cognitive Restructuring — identifying and replacing false/self-defeating beliefs, or unrealistic goals, with accurate information and positive affirmations.

  • Contingency Management — Use of rewards (from a professional/coach, or self-rewards) are effective tools to encourage behavior change. Rewards can be verbal, tangible/monetary, or social in nature.

  • Delivery of weight loss services from an evidence-based foundation, such as described here, will improve client outcomes, regardless of how well your program is already doing, while fattening the facility's bottom line at the same time.

    For more information, or to order a report on the NIH guidelines visit its Web site at:

    Dorene Robinson is the Director of Nutrition & Education Beyond Fitness Division, Peak Performance. She can be reached at

    Bob Esquerre is a program design specialist, a business planner, master trainer and program developer for Reebok University. He is also the owner of the Esquerre Fitness Group International, and a personal trainer.

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