Very overweight client!

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Anonymous
Unregistered

Hi, I work as a clinical pilates instructor at a physiotherapy practice. About 7 weeks ago, I was reffered a client (female) who is very overweight - around 140kg, her height is around 1.45m. She also has very weak joints that cause her pain and a bad knee. She cannot kneel at all, or lie down on the floor (we use the cadillac bed for some of her exercises as it is easier for her to get on and off). Due to her weight and bad condition of her body, we cannot do most of the basic mat sequence and i have had to adapt and really think out of the box! I was wondering if anyone knew of any websites or resources that i could look up that would help me to help her more effectively. She only comes to me once a week but the good news is that she has reported that her mobility has improved and it has become easier for her move (get out of bed and the bath for instance). I would really appreciate any assistance that you could give. Thank you!

Posted 1 year ago #
Anonymous
Unregistered

Hi Kerry Ann,

I understand. I had a person in my class last night who was also very overweight, and young too. As a fitness instructor as well as a Pilates instructor, I am a firm believer in encouraging the weight loss first if it's possible. It's my belief that any weight training, calesthetics, dance, tone, Pilates, yoga etc will make a client happier once they rid their frames of lots of extra weight. I am not talking about a few extra pounds, I mean really overweight. I was teaching a class and had several people to contend with and this young lady looked really uncomfortable on her back and scooping the abdominals in and up just wasn't going to happen. She couldn't roll up, go on her knees, nothing. Thinking outside the box is right in this situation.

Have you considered some exercises from the maternity repertoire? Check out the Pulse from Pilates-pro.com and look for Debbie Goodman. There're also some videos out on the market that show maternal fitbess exercises like standing Pilates. Stott put out a chair Pilates video as well. I teach Silver Sneakers for seniors and we have a MSROM class that's done with the option of staying in a chair and marching in place. I don't want to denegrate Pilates because I really do believe in it, but there are so many other forms of exercise out there that I would wonder why this client, or any seriously overweight client would be refered to a Pilates program. This is someone with clearly limited mobilty. She just needs to take 3 months and begin to move her body, even a 15 minute daily walking regimin. Pilates is not the starting place in my opinion, but if you must then look into maternal fitness.

Posted 1 year ago #
Anonymous
Unregistered

Hi Kerry Ann,

Peak Pilates has some information on this topic.

When you're done visiting Pilates Digest, hop on over to http://www.peakpilates.com/community/podcasts/. Master Trainer Zoey Trap offers great advice on "Working with Obese Clients" that you can listen to or download for free.

There is also an interesting discussion regarding obesity taking place in the Peak Pilates Graduate/Instructor Support Forum. Zoey offers some additional insight on the subject. Visit http://www.peakpilates.com/community/fourms/ and click on the "Obesity" link.

Posted 1 year ago #
Anonymous
Unregistered

Hi Kerryann--I listened to the podcast from Zoey Trap of Peak Pilates and there are some great suggestions on working with obese clients. She offers some exercise modifications as well as advice on working with obese clients such as not assuming that weight loss is their goal. It may be the client wants help in feeling better, relieving back pain or becoming more mobile. Desire for weight loss may follow but we can't assume it's what they want. The fact that your client feels better and is more functional in her daily life is a testament that you are on the right track. Modifications with the arc barrel and with stability balls can be very helpful as well as using flex bands. Additionally, the standing pilates repertoire can provide some exercises that your client may be able to practice on her own since she sees you only once per week. Keep up the good work and keep us posted on your client's progress as well as the modifications that you find helpful.

Posted 1 year ago #
Anonymous
Unregistered

Thanks everyone for your most helpful suggestions and information. I will certainly go and have a look at the resources you have recommended. livvyjk - I hear what you are saying about losing the weight first. This lady is close to 60 and already had a gastric bypass. I do have her use our stationary bicycle (she can only manage 5min though) as a warm up and to help strenghten the knees. But I dont think its her priority to lose the weight. Thanks again everyone!

Posted 1 year ago #
Anonymous
Unregistered

Ok, but you weren't describing someone who could shed some pounds to look and feel a little better, you were describing someone who wants to increase their mobility and not looking at EXTREME weight retention, like 100 lbs or more, as a hinderance in movement is not acknowledging an obvious problem. I want to be clear: I wasn't offering cosmetic advise. The young lady I was referencing in my mat class couldn't touch her toes because she had too much bulk on her body surrounding her joints. Your client had gastric bypass? She's very interested in reducing her body weight. Undeniably so. Nobody's saying she needs a beach -body. My mother is 60 and very heavy, maybe 250 plus on a 5' 3" frame. I have seen her reduce her weight by 60lbs and she's much happier. It's much harder when someone comes to a mat class than one on one with a client. It's a very sensitive issue, I do understand that. I was merely thinking of gently refering the client to a Curves or something and to return for Pilates training later. Sounds as if other people on this forum have sound advise too. I am someone who does enjoying spending time in the gym as well as the studio so I am influenced by both worlds. It's overall health that matters. Good luck with your client. It seems as if she has a caring trainer on her side.

Posted 1 year ago #
Anonymous
Unregistered

Thanks Livvyjk :-)
I have suggested to her to try some other form of exercise to lose some of the weight but she was not interested so I did not want to push the issue. Hopefully in time she may change her mind for the sake of her health and wellbeing. Either way, I will try to do the best with what i have :-)

Posted 1 year ago #
Anonymous
Unregistered

WOW I am stunned by the response that encourages turning away overweight clients rather than encouraging them to participate in pilates, what a horrible bias by instructors and other clients. Over weight people can do pilates, they may need modifications just like a pregnant or injured client but the can surprise you with strong cores. I am stunned to see the bias against over weight clients - I promise if you tell someone they are too fat to do pilates you will never see them again.

Posted 1 year ago #
Anonymous
Unregistered

I wanted to post my experience as a counter to livvyjk's suggestion to send a client elsewhere to lose weight first before doing Pilates. I'm morbidly obese. My highest was 300 lbs. I'm now 278 lbs. I'm 49 years old, and yes, the obesity has affected mobility and my joints. Due to multiple health issues since infancy, my health was never ideal or very good. But I spent several years nearly bedbound, and the weight piled on. Taking it off sans surgery has been unsuccessful. This does not mean that I have not spent a great deal of money on dietitians (4 total) over the years, as well as other plans such as Weight Watchers. As even the latest reports from researchers show, dieting fails far more often than it succeeds, although exercise and attention to calories remains necessary. There wouldn't be a global obesity epidemic were losing weight as simple as wishing.

Now, that said: I wanted to improve my health. I have been sedentary for years (part of those due to health issues including severe asthma since infancy). I decided my joints would take less of a beating with Pilates and it would help me gain strength, flexibility, and attain more muscle tissue. I called a local Pilates studio and bluntly asked if anyone there was a certified Pilates teacher able to work with a morbidly obese client. I was told yes. I began within a week. I've now been exercising 3x a week in private 1 hour sessions with a certified Stott Pilates trainer. She's patient, encouraging, creative, and makes me feel like I CAN DO THIS. She doesn't look down on me for my girth. She doesn't poo-poo my efforts (which at first were those of, probably, an invalid level). I've gained strength without harming my bum joints. She's cautious and she finds ways to work around my enormous belly and the impediment posed by excess fat on thighs and upper arms and such. She uses the tools she needs to get my body into proper position. I imprint well and scoop as much as I can. I and my husband notice the difference in my ability to do daily living activities such as walking, errands, carrying heavy groceries, etc. I can reach farther down (yes, I can now not only touch my toes but flatten my hand to the floor during roll downs and roll ups). While my apple-shape makes anything that crunches the middle much harder, instead of sending me off, my trainer found a way to get me to work at my capacity. I'm sore after every workout--as she continually challenges and pushes me to do more. I've seen measured increases as I was later able to do exercises I could not at first. More reps. More tension on the springs. She started me on the Cadillac and Reformer, as getting up and down from mats is difficult (even still) because of my knee issues. I've used the pedal chair (like the Wunda), the side barrel for side bends and stretches, the ball for balance work and roll backs, the barre for stretching and lower body work, the springboard, the mat, and just about every piece of equipment at the studio. It's very difficult. For me, much more difficult than just thephysical: I have to wear formfitting clothing and be subject to stares. I ahve to workout as the ONLY fat woman I've seen at the studio. A studio frequented by models (this is Miami, after all). So, I'm proof that the quality of life can be very much improved for those still struggling to lose weight (even if unsuccessfully), who nevertheless need the rehabilitative and life-improving, health-increasing benefits of Pilates. I've never exercised this consistently and frequently in my life. Imagine if someone had said, "Go to Curves." I've been to Curves. It didn't make me want to go. I miss Pilates if I have to take a day off cause I'm ill (as I was recently with a bad stretch of asthma that left me hardly able to breathe for a three weeks.) But my trainer said we'd get me back to speed, and in less than a month, I am. I'm back to the strength level before my illness.

I thank God for a trainer who isn't fatphobic and cares about the needs of the obese. She's a gem. And I hope other fat ladies like me consider Pilates, because I do believe it has done me good. Do I still want to add aerobics and more calorie control. Yes. But it's better to get some good, regular Pilates than none, especially for those like me who are terrified of gyms and who can't do much walking and can't do running due to joint issues. If you're a trainer in Pilates, please try to get informed about the modifications that can be done to work around the issues of the obese. If you had an invalid with a bad back, you'd work around it. Think of us as those who need to work around our issues, the obstacle to mobility that is fat. It's not insurmountable, but it is a challenge.

Hope this helps.
Mirtika

Posted 1 year ago #
Anonymous
Unregistered

Mirtika, thank you so much for sharing your experience. It is important for instructors to have another perspective, particularly from a client who sees such positive results from their Pilates program. Your instructor IS a gem; a very compassionate and caring person. We would love to hear from her--perhaps she can shed some insight into the modifications she has used. Our readers would find that very helpful. Thanks again!

Posted 1 year ago #