Please Help: Can't get client to drop LBs

[gischer]

edit: I will most deffinetly rep any, and all well-thought out responses.

First a little about myself...

I have been training clients now since late january 2008, so I am still very fresh to the scene. I am ISSA, and NESTA certified, and while I did learn a decent ammount from each of these organization, i recieved very little formal on-the-job training, and consider myself far from an expert. I work for a coorporate gym btw...

Anyways, I have been relatively succsessful with my clients, getting a high percentage of resigns, and have had some decent results so far (have several clients losing 11+ lbs over 2 months or so). As far as I know I am doing fine (and my gym manager does a good job checking up with my clients' satisfaction, and I have yet to have a complaint). Regardless, I will be the first to admit that there is still plenty for me to learn.

I have one client who has yet to lose a single pound after about 2 months of training... For confidentiality reasons I will refer to her as "J."

J is in her mid 60's and weighs approximatly 170lbs at about 5'2, she is probably in the mid-high 30's in BF % but it is hard to tell as I cannot get an accurate calliper reading as she has a good deal of visceral fat. J has a ruptured disc (I believe it was L-3), and some knee problems.

Because of these health issues, she is limited to cardio workouts on a recumbant bicycle, which she does typically 3x a week for a minimum of 30 minutes. During these workouts she builds up a good sweat. At least two of these workouts are performed as a moderate HIIT workout. She is also fairly active in her personal life, walking around consistently, and playing with her grandchildren a lot.

Basically, she is far from sedentary. For about a month I had her on a Bodybugg, which should be 92% accurate in measuring caloric output. It put her consistently at 2000-2600 kcall burn per 24hrs.

I have had her consistently log her food intake divided into typically 3 meals with 1-2 light snacks such as an orange. In a given day she will consume 900-1300 calories (usually closer to 900 though). She eats a relatively clean diet, and gets almost no calories from flavored beverages. I do have her taking a basic protein powder post/wo with some fruit. For what it's worth, she is taking a Pyruvate fat burner...

I have her drinking 4 bottles of H20 a day as well. Which at first was quite a task...

We train 3x a week (Monday, Wednesday, Friday). While I would love to push her hard, the workouts are always at a very slow pace, as she experiences frequent back pain. Though the workouts don't burn a ton of calories, she has noticed a significant improvement in regards to back pain and overall body function. (YAY!).

Nevertheless she has not dropped a pound. I believe her food logs are quite accurate, as I train her daughter as well, and her daughter backs everything her mother says, and occasionally adds in small details such as "bread crumbs" with the salmon and such.

Myself, and a few of the more experienced trainers are dumbfounded. She is post-menopause, and even if the bodybugg is way off in measuring caloric output, It can't be 1000+ Kcal off can it?

Any sugestions would be appreciated... I can give more insight to the resistance regimin I have her on if it helps... but I don't thinks that's the problem...

edit: though I have been unable to track BF %, I have record of her measurements, which are nearly identical to the begining.

[mrgeecue]

whats her calorie deficit at? initially if shes perfect with her diet she should be able to see results.

[gischer]

well according to the bodybugg, and the normal formulas for measuring caloric burn she is burning a mean of 2,300 calories a day, and consuming roughly 1,100. 2,300-1,100= 1,200

She admits she drinks an occasional glass of wine, but she adds that in when we go over her daily caloric intake. She si very accurate when describind her food. She eats a lot of salads. She hates drinking much other than sugar free iced tea, and occasionally fat-free coffee, with no realy sugar. So I'm finding it tough to see where she could be hiding calories.

Her daughter helps me keep tabs, and the daughter says J has been good with her eating...

[gischer]

can menopause+some innacuracies in the calory burning calculations, and some potentially MINOR innacuracies in food intake really account for a 1200 calorie defecit?

[mrgeecue]

the whole idea behind the bodybugg is the law of thermodynamics. so if shes really burning more calories than shes taking in, there should be weight loss. i can't think of a good reason of why shes not seeing any results other than the fact then she could be inaccurate with her food log.

even her daughter might be inaccurate. is "j"'s diet really complex? or is it a simple diet with just fruit, salads, chicken breast, etc. if shes eating ethnic foods that are little more difficult to accurately count calories then that maybe problematic.

what are her workouts like? do you focus more on core strength, balance, that kind of stuff? explain her workouts, pls

[gischer]

she prepares most of her foods. I was actually finding it difficult at first to add in a protein shake b/c she said she normally feels too full after. She has pretty small portions typically. Lots of salads/fruits...

She is very limited b/c of a bad back (ruptured disc), so I am forced to focus a lot on core strength in order to hopefully someday get her body strong enough to handle heavier compound movements.

A typical workout will look something like this:

3x12 Deadlifts with a 6lb medecine ball (had her pressing overhead as well, but the standing pressing was causing her to arch her back too much, and her spine become too compressed)

they are pretty ez so there is maybe a 45 second rest period between sets

12x2 LIGHT (5lb) reverse wood shops holding a light 5lb plate. These guys are there in part b/c she wanted to improve her golf game. It will also teach her body to deccelerate while twisting which should hopefully keep her spine safer...

These are supersetted doing right side and then left side. She goes pretty slow on these guys.

10x3 Squats w/ stability ball combined with a DB military press. relatively low rest periods here, as the weight is pretty light. maybe 45 sec

8x3 Split Squats holding some stable object.

25 secondsx4 Planks

15x3 Situps on stability ball

15secondsx3 Static hip thrust (bridge) on a stability ball (these guys have really helped strengthen her lower back)

10x3 DB bench press on stability ball

15x3 Lat Pulldowns (sooo frustrating, she refuses to go heavier on these guys. so sometimes i will have her pull outwards, causing the biceps to shut off, and forcing the lats to work harder)

12x3 cable Pullovers lying on s stability ball 1-2 sets she holds a bridge while performing the set

10x3 Seated overhead tricep extensions
<supersetted>
10x3 DB curls

edit: she is very stubborn, and often ignores my corrections when she performs with bad form. For this reason I avoid some more difficult compound exercises such as a standard lunge.

She often refuses to increase the weight, so typically I end up increasing the number of repetitions hence so many sets of 12. The intesnsity is pretty low. Maybe 50-65% of 1RM

Also, she can't perform anything bent over...

[Lift062406]

I don't see any Cardio after her workout; I would lighten the workout and throw in 1/2 hour bike session after the workout.

I don't think the problem is the workout tho, it has to be the diet.

What is her Prot/Fat/Carb ratio?

She may also be closet cheating on the diet or just too many carbs late in the day or eating carbs too close to bed time.

If I were you I zero in on her diet and cardio.

[toms1967mustang]

2 things:
1 with that much of a calorie deficit is she losing the muscle she is gaining?

2. Has she been checked for Allergies? When I first talked my wife into working out she could not lose weight no matter what she did. We had her tested for allergies and she came back positive to multiple items. When someone is allergic to the food they are eating, the body may surround the item with fat to protect itself. Just a few ideas.

[fruehling]

I had the same problem. As soon as I switched to meals every < 3 hours and 20% fat, 45% protein, 35% carbs, the fat started coming off. Dropped weight fast in first 1-2 weeks, then about 1-2 lbs per week.

One note, is that I had to have that ratio in each meal, not averaged through the day (like it wouldn't work when I would have an all carbs meal, then a all protein meal 3 hours later). Also, on training days I would raise the carbs ratio for the one meal pre and post workout.

Hope this helps.

[EMISGOD]

Has she been checked by a doctor, specifically for hypothyroidism, prior to starting with you?

Is she now or has she been previously complaining of low energy?

What is the macro breakdown of her diet?

In the first scenario, there is not a great deal you can do, but you would need to be aware of it, were that the case. This would also be the case if she is hovering near a Type 2 Diabetic situation.

In the second, very possibly she's in a pretty cranky stall. In that case, she may need to increase calories to an area somewhat closer to her caloric expenditure.

The macro breakdown, as mentioned, might also need some tinkering.

I personally suspect, if none of those earlier things pan out, that either her diet numbers or the BodyBugg is off...

[Ryall]

If her deficit is that low, then she either is miscalculating on her diet, lying, or it has something to do with the timing.

WHEN does she eat? What does her macro breakdown look like?

[CM82682]

I could be wrong but did you say she takes 900-1300 cals a day? If so, you may want to up cals a little bit, her metabolism might have slowed down a lot to where she cant drop fat. Just a thought.

[John Prophet]

IMO..simply not enough calories. Using a typical BMR calculator her maintenance comes to like 2000-2300. I would try increasing her gradually up to like 1800ish calories just to see what happens. Id have her eating 5 "meals" per day with a protein at each meal.

IMO 900-1300cals is basically "starvation" and I would suggest that its just making her metabolism grind to a halt.

I had a female client like that. She weighed like 210 or something while at the time I was weighing like 204. She was eating 1-2x per day and I was eating like 7-9x per day. I tried to at least get her to question how it was that I was eating all the time yet I was lighter and leaner than her. She basically wouldnt listen and she never really lost any weight and she just fell by the wayside.


one of the methods that John Parillo suggested back in the 90s was for people to at first try to GAIN weight even if their goal was to cut. I am pretty sure he just did that in order to first stimulate the metabolism as opposed to just going directly into starvation mode, which would cause the metabolism to become more and more sluggish

this is from the Q+A in his book "Hi performance bodybuilding":

Q: Im ready to start your nutrition program. Id like to lose body fat right away and then put on weight later. Is this the right approach?

A: No! Regardless of how much fat you want to lose, start the diet with the goal of gaining a lb/week per 100lbs of bodyweight. That way you increase your muscle, which in turn boosts your metabolism so you can burn fat much faster. To do that, gradually increase your calories until you gain weight at the suggested rate.

Look at it this way: If you gain a lb a week for 5 weeks and lose a lb a week for 5 weeks, youll gain more mass and be much leaner than if you tried to lose first and gain later. So try to put on weight for several weeks. You will be amazed at how much bigger and leaner you will get.

[EMISGOD]

Using a typical BMR calculator her maintenance comes to like 2000-2300.

Where did you find this, exactly?

http://www.bmi-calculator.net/bmr-calculator/ (first one that came up on Google)

Using this one comes up with a BMR 1375.7, using an age of 66. Assuming no activity, her maintenance would then be 1650.84, calculated.

[EMISGOD]

Has she been checked by a doctor, specifically for hypothyroidism, prior to starting with you?

Is she now or has she been previously complaining of low energy?

What is the macro breakdown of her diet?

In the first scenario, there is not a great deal you can do, but you would need to be aware of it, were that the case. This would also be the case if she is hovering near a Type 2 Diabetic situation.

In the second, very possibly she's in a pretty cranky stall. In that case, she may need to increase calories to an area somewhat closer to her caloric expenditure.

The macro breakdown, as mentioned, might also need some tinkering.

I personally suspect, if none of those earlier things pan out, that either her diet numbers or the BodyBugg is off...

Also, which fat burner is she on, specifically and how long has she been on it?

What is her exact weekly workout schedule, both Lifting and Cardio?

[John Prophet]

http://www.theloseweightdiet.com/lose-weight2.html


from what you describe id say she is "moderately active"

5'2", female, 170lbs, 65 yrs old = 2107

[EMISGOD]

I chose specifically "sedentary" because the moderately, slightly, etc. modifiers are all meaningless. Here is another one, which is probably the most accurate:

http://health.howstuffworks.com/calorie3.htm

This one comes up at 1367 BMR.

From there, here are some additional numbers for maintenance:

http://health.howstuffworks.com/fram...blcalories.htm

The "how stuff works" calorie page, by the way, for anyone who hasn't read it, is a very good explanation of many of the principles at play here.

This is kind of a sidetrack discussion (about the "maintenance issue"), but if her BMR is at least 1300, using 3 different calculators, which has been done here AND her activity level is causing a caloric expenditure of 700 - 1,000 additional calories, barring some of the medical stuff I touched on, 900 - 1200 calories daily is indeed too low. Her body is very likely hoarding calories and going into a metabolic stall whenever her activity level hits a lull enough to permit it and is probably overcompensating for the presence of the fat burner, depending on which it is. The body's first task is to survive and if sent into starvation mode, as she is very possibly doing, it will collect as many "batteries", in the form of stored fat, as possible.

However, I do not agree that you should insist on running her up to 2,000 - 2,300 calories, since her goal is not to maintain but to actively lose weight. In my own personal experience, most people do not need to have specific caloric thresholds, meaning that as long as you are within a few hundred calories, they will start to see progress.

Once you isolate that it is not some of the other items I mentioned in previous posts and it is that she is in a metabolic stall due to her diet, since I like to do things in increments of hundreds, were it me, I would deduct 500 from the 2,000 figure and put her at 1,500 calories and then modify accordingly from there.

[fruehling]

IMO..simply not enough calories. Using a typical BMR calculator her maintenance comes to like 2000-2300. I would try increasing her gradually up to like 1800ish calories just to see what happens. Id have her eating 5 "meals" per day with a protein at each meal.

IMO 900-1300cals is basically "starvation" and I would suggest that its just making her metabolism grind to a halt.

I'd second this. I even read that your body can begin to drop it's metabolism at 2-3 hours of awake time between feedings. That seems to have been the key for me.

[EMISGOD]

I'd second this. I even read that your body can begin to drop it's metabolism at 2-3 hours of awake time between feedings. That seems to have been the key for me.

It seems very possible, but there is so much going on (advanced age, medical complications, fat burner usage, low dietary numbers) that I think a lot of variables needed to be eliminated before making that specific conclusion. Senior citizens typically need more care accorded them than younger clients...

[mrgeecue]

let me get this straight. so whats recommended is that she up her calorie intake just a tad to get her metabolism going? since it is thought that she is at a stall because of her low calorie intake?

[John Prophet]

let me get this straight. so whats recommended is that she up her calorie intake just a tad to get her metabolism going? since it is thought that she is at a stall because of her low calorie intake?

Here is my thinking. People come to PTs with all kinds of wacked up issues due to the weird eating habits they've had for years. Like I have had a couple clients who simply wouldnt eat ALL DAY and then theyd have 1 meal at night. or theyd have a snack from a machine at work and that would be that until dinner.

To me, thats not normal at all. If I tried that id seriously be lying in the floor somewhere seeing spots or hallucinating

When I see someone who is fat yet doesnt seem to eat much there is a light going off in my mind going "does not compute". So I think in those cases it could be helpful to establish some sort of rational baseline and semi "normal" habits to start from....and that includes calories. Thats why I think it could be beneficial to take some of these fat/starvation types and have them actually eat more for a while even if they increase a lb or 3 in the short term.

in any case, some of these people need to get into the habit of eating meals at regular intervals as opposed to eating according to life's little interruptions. Most of the fat people ive worked with tended to say stuff like "I dont have time to eat breakfast" and "I dont have time to eat at work". Funny how the lean people make time to eat at regular intervals

IMO there needs to be some rational baseline developed and then u start working from there. There needs to be some reference point or else you are just shooting in the dark. Perhaps it has to do with a metabolism "set point". The body is only going to go SO far in "one direction" before it begins to really resist.

If a person was somewhat starving themselves already, (or skipping meals) then I dont see what good cutting more calories would do at that point since the body is already fighting it. Id rather take a chance on gaining a couple pounds at first but then at least having a responsive body to work with.

[John Prophet]

I had a male client who was sort of skinny fat. not much muscle tone yet weighed 205ish.

dude usually ate 1 meal per day...dinner. I tried hard to get him to eat more meals. IMO he never really did worry too much about doign what I asked him to do. He seemed to work up to eating 2x per day and on occasion actually 3 times. he lost like 22lbs. of course he was doing 3 workouts/cardio per week also but I dont think we would have been succesful if he kept eating only 1x per day

[mrgeecue]

If a person was somewhat starving themselves already, (or skipping meals) then I dont see what good cutting more calories would do at that point since the body is already fighting it. Id rather take a chance on gaining a couple pounds at first but then at least having a responsive body to work with.

That is a very good point. I understand what your saying, although I've encountered many stubborn women clients who would refuse the idea of gaining more weight.

I can imagine "I eat only twice a day and I'm fat. Now your telling me you want me to eat more?? I'll just get more fat!"

oh if i had a nickel everytime I've heard that, I'd be making more than my regular wage as a trainer. lol

[Sikk]

That is a very good point. I understand what your saying, although I've encountered many stubborn women clients who would refuse the idea of gaining more weight.

I can imagine "I eat only twice a day and I'm fat. Now your telling me you want me to eat more?? I'll just get more fat!"

oh if i had a nickel everytime I've heard that, I'd be making more than my regular wage as a trainer. lol

yea ive dealt with that a ton, use this to clarify it for them:

Explain that when you go for a long period of time and only eat once or twice a day, the body knows that its not going to see food again for a long time, so it stocks up on EVERYTHING after that one meal. By eating more frequently, the body will begin to anticipate another meal coming and instead of holding onto the entire meal in your fat tissue, it will start discarding it.

[Environ]

In a given day she will consume 900-1300 calories (usually closer to 900 though). .

This is a huge problem right here. 900 calories a day? That is well below her BMR. Either you are starving her or she is starving herself. The result is that her metabolism is slowing down rapidly (the body adapts by resetting the body to burn the minimum number of calories during periods of starvation) and she may also be simultaneously losing muscle and adding fat. Take her off that fat burner. It's not helping.

You said you're ISSA certified. Therefore, you know how to determine her caloric requirements. If not, then I suggest you get on their forum and ask Pat Gamboa for advice on how to calculate caloric requirements.

In addition to the above, have you been able to use progressive overload in anything realted to her training? Even if she is only capable of using a stationary bike, she should still be able to increase the level of intensity, either the speed or the time of the workout during successive workouts. Have you been able to do any resistance training with her? If she has back pain, she should be in the care of an Osteopath, Physical Therapist or Chiropractor to help with this issue. Furthermore, if the pain is in her lower back, she should still be able to do resistance training exercises that do not require flexion of the spine.

With regard to her diet, what are her food choices? If she has a lot of visceral fat, then she may be insulin sensitive - that means you have to work hard to control her blood sugar levels and prevent insulin spikes. Insulin promotes fat storage. Does she eat starches? She may be gluten intolerant or Coeliac. Coeliacs suffer from inflammation of the gut when they eat gluten-containing foods. Take a look at her food diary and check for foods containing either wheat or gluten.

Bear in mind that she might also not be completely honest with her food diary. Challenge her on this (in a nice way of course; don't jump down her throat and accuse her of being a liar. Rather, ask her if she is really writing down everything she is eating.

Finally, you said that she is relatively active during the day. I wouldn't really factor that in at all. While it does burn calories, her body is so adapted to her daily activities that they won't affect her performance/weight loss significantly.

[John Prophet]

I can imagine "I eat only twice a day and I'm fat. Now your telling me you want me to eat more?? I'll just get more fat!"

I usually try to show them the flip side to that..like "uhmm, whats your next move...eating ONCE per day?". Then..."whats after that? eating once evry other day?"


or the classic "uhmm, hows that working out for you?"

or depending on my mood right then it could be "uhmm, what u r doing isnt working"

[Sikk]

do you really say "uhmm" before sentences?

[Takuan]

I have had her consistently log her food intake divided into typically 3 meals with 1-2 light snacks such as an orange. In a given day she will consume 900-1300 calories (usually closer to 900 though). She eats a relatively clean diet, and gets almost no calories from flavored beverages. I do have her taking a basic protein powder post/wo with some fruit. For what it's worth, she is taking a Pyruvate fat burner...

How long has she been training? And how high is her heart rate getting during cardio?

Sometimes for 4-6 weeks they'll gain some weight due to cardio: more red blood cells, minor gains in muscle, etc.

[homerun16]

Am not a PT yet getting ready to take my issa course. First make her see her family Doctor get some blood work done to rule out any medical problem. I also read that she eats salads is she loading her salad down with fat dressing. There is a ton of fat in salad dressing even the fat free. Just an idea you cant push an old person but so hard. Good luck with her

[John Prophet]

do you really say "uhmm" before sentences?

if i feel like it..ill say or do anything to achieve a desired result