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The War on Obesity: The Way to Weight Management

The second edition in our 12-part "War on Obesity" series, this article offers tips on how to develop exercise and nutritioin programs for the overweight.

The American public may be packing on pounds at an alarming rate, but there is one place where we are losing weight: in our wallets. Each year, as our waistlines expand, we empty $33 billion from our pockets. That's the amount we spend annually on weight-loss products and services, according to the national Centers for Disease Control and Prevention (CDC).

To get consumers to spend more of that $33 billion in our industry, clubs need to provide weight-loss programs that work. And, according to experts, the best weight-loss programs are the ones that don't emphasize weight loss. Instead, the programs concentrate on changing behaviors and providing encouragement.

Arguably, all club members could use a little encouragement, but there's a big difference between a 25-year-old looking to lose 5 lbs. and an obese 55-year-old who has never exercised before. A little pep talk may be all the 25-year-old needs, but the 55-year-old will need a great deal of structure and direction.

Structure and direction are not synonymous with education overload, however. Richard J. Wolff - owner and president of Wolff Health & Fitness, a health club in Elgin, Ill. - believes that many health professionals spend too much time teaching concepts. People who want to lose weight don't need to understand the structure of fatty acids or what happens when glucose enters the cell; they need guidance. "Temper the idea of educating them with coaching and support and behavioral emphasis," Wolff stresses.

Wolff's Health Management Resources (HMR) Program for Weight Management shows people how to develop skills and build tolerance. Participants build tolerance by sticking with behaviors that emphasize activity and proper nutrition.

While the staff members who lead the program offer encouragement, they carry the title of coaches, not cheerleaders. They don't behave like drill sergeants, but they do make participants understand that success demands dedication. The best encouragement comes from results, and results come to those who work for them. That's why the HMR coaches follow this motto: "You have to want it more than I do."

This may not sound very motivating, but what makes you think an obese person needs more motivation than anybody else does? Say an overweight woman walks into your club. Would you conclude that her weight indicates a lack of discipline and motivation? If you did, you'd probably be wrong. "You have to assume she is motivated," points out Dr. Fred Hatfield, president of the International Sports Sciences Associa-tion (ISSA), a certification organization based in Santa Barbara, Calif. "Other-wise, she wouldn't come into the gym in the first place."

The goal, then, isn't to build motivation because the motivation most likely exists already; the goal is to show people how to direct their motivation toward diet and exercise practices. However, don't shoehorn people into a program that emphasizes harsh diets and exercises that they dislike. Help clients find something they actually enjoy doing, Hatfield suggests, even if it means leaving the confines of the gym. If the client likes swimming in the pond up in the woods, encourage him to do that. Remember: The predominant goal isn't weight loss, it's helping the people change behaviors - to introduce activities and sensible eating habits into their lives.

Cardio vs. Strength Hatfield's weight-loss program of choice emphasizes weight training. The diet that goes along with this program promotes fat loss and muscle gain, he says. For this to work, you need to determine the person's approximate calorie balance. First, discover his lean body mass (not just his total body weight) in kilograms. Multiply this number by 24 to determine how many calories he would burn in a day if he were just resting. Now, since overweight people are normally sedentary, they burn approximately 30 percent more calories just by moving around. So after you multiply the person's lean body mass by 24, times that figure by 1.3. The result is the person's calorie balance, Hatfield reveals.

While this is a rough way to determine calorie balance (actual balance differs by sex), it should get you into the ballpark, according to Hatfield. On days when the person is resting, subtract 300 to 500 calories from the calorie balance to help lose weight. On days when the person is lifting, add 300 to 500 calories to build muscle. As muscles get larger, they will aid fat loss, in Hatfield's opinion.

"Bigger muscles burn more calories than smaller muscles do," he says.

Not everyone agrees. Dorene Ro-binson - director of nutrition and health education with Beyond Fitness, a division of Peak Performance - argues that weight training isn't the same thing as weight management. Although she says that leaner people burn more calories during cardio activities than their heavier counterparts, she claims that there is no proof that muscles raise resting metabolism significantly. "Skeletal muscle is hungry when you are using it," she offers.

This doesn't mean that Robinson dismisses weight lifting; in fact, she recommends that overweight people do strength training for 20 to 30 minutes, two or three times per week. However, she points out that the No. 1 goal of weight management is to burn calories, and "the best way to burn calories is cardiovascular activities."

Robinson encourages overweight people to burn 2,000 calories per week. She points out that calorie expenditure is dependent on weight, so the heavier you are, the more calories you use while active. "A 300 lb. person burns 200 calories [walking] a mile," she notes. "To hit 2,000, they only have to walk 10 miles a week." And many will go even further than that - especially if you put together a walking program.

Wolff finds that 70 percent of the people in the HMR program choose walking as their form of activity. He doesn't discourage them from exercising outside of the club - just as long as they remain active.

Ideally, HMR participants should exercise every day, with two days dedicated to strength training. However, that's the preference, not the rule. At the very least, participants must burn 2,000 calories per week. To hit that number, they work with HMR coaches to identify activities they "can tolerate," according to Wolff.

Three Ways to Weight Loss Burning 2,000 calories is part of what Wolff calls the "triple imperative" - that is, the three things that comprise the HMR program. The other two parts are eating five cups of fruits and vegetables a day, and using a snack replacement to help balance out calories (e.g., drinking a shake in the morning instead of eating a croissant). Before participants can balance out calories, however, they first must know how much they should eat. Coaches determine a person's caloric intake by multiplying 12 to 14 calories per pound for men, 10 to 12 for women, then subtracting calories for weight loss.

This isn't to suggest that the coaches give the participants a calorie breakdown, then send them on their way. HMR is a structured, 13-week program that stresses ongoing feedback. Participants come in for an hour-and-half session each week. At the beginning of every session, the coaches check the participants' weight. The coaches also look over the records that participants keep of their eating habits. They discuss what worked and what didn't, evaluating progress and creating new plans. Finally, the coaches give the participants advice on how to stick with their goals. Then, later in the week, the participants call the coaches to report on their exercise activities and diets.

HMR boasts a high retention rate, with only 10 percent of participants dropping out. The program is open to everyone. In fact, 25 percent of the participants don't belong to Wolff's club. However, by the time the program ends, nearly 50 percent of the nonmembers end up joining.

Once the 13 weeks are over, participants can sign up again, although Wolff recommends that they enroll in the long-range maintenance program, which is less expensive than HMR. (The 13-week program costs a service fee of $250, plus $60 to $80 per week for nutrition products such as shakes and bars. The long-range maintenance program costs $220 for three months; there is no obligation to use the nutritional products.)

The long-range maintenance program still follows much of the same structure as HMR, with an emphasis on record-keeping and ongoing dialogue through meetings and phone calls. The goal is to keep people on the path to health and fitness. "If we can help people long term, that's where success lives," Wolff says.

Safety First Long-term programs are laudable - as long as they begin with safety in mind. The severity of the person's weight can indicate certain physical limitations. For example, people who suffer from morbid obesity often have orthopedic problems due to their condition, according to ISSA's Hatfield, so trainers must monitor them for lower-back stress. Also consider what kind of stress an exercise is putting on the knees and hips, areas ripe for injury for those who are severely overweight.

In the HMR program, Wolff takes precautions by giving participants a very simple PAR-Q (Participation Activity Readiness Questionnaire) to discover potential limitations. Still, Wolff and his coaches want people to start exercising on day one, and they haven't had any trouble getting people to burn the prescribed 2,000 calories. As Wolff points out, low-intensity, low-impact workouts are safe for the vast majority of the population, so there's no reason why your weight-management programs shouldn't include some form of exercise at the very beginning. "Everyone needs to move," he says.

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