Daniel J. Green is ACE’s Senior Project Manager and Editor for Publications and Content Development. In addition to his work with organizations including the International Association of Fire Fighters and Agriculture Future of America, Daniel writes an ongoing blog series covering lifestyle change for NBCbetter.com. He has also written feature articles for local publications in Western North Carolina (WNC), including WNC Parent and WNC Magazine.
What Happens When Weight Loss Doesn’t Magically Change a Client’s Life (Like They Expected It To)
When someone pursues a weight-loss goal—particularly if they want to lose a substantial amount of weight—they often carry with them some lofty expectations of how their life will change once they’ve hit that goal. These expectations could be related to how they expect to feel once they’ve lost the weight, with less joint pain, better mobility, improved mood and more restorative sleep. Others might expect to see their blood pressure and triglyceride levels go down and, with them, their risk of heart disease and diabetes. All these expectations are in line with what the evidence tells us might occur when a person loses weight.
But imagine a client whose goal is to lose 100 pounds in the next 18 months or 300 pounds in the next three years. They are likely dreaming of life-altering success and have a very clear vision of what that looks like. And, they may think that hitting that goal is a panacea, a cure-all that will repair things in their life that may or may not be directly linked to their weight.
For example, consider the client who hopes that their spouse might start treating them better or showing them more affection once they hit their goal weight. Or the person who believes they’ll finally fulfill their dream of a better career once people at the office start taking them more seriously. Others may believe that they’ll begin enjoying activities they’ve always dreaded or that they’ll have fun shopping with their friends once they can fit into a smaller dress or pant size.
And some may dream of simply being happier, whatever that means to them.
But what if some of those things don’t happen? What if they lose the weight and their spouse still pays them no attention? Or if they still don’t like the way they look in clothes and continue to avoid shopping and socializing with friends? Or if they still lack the confidence to try new types of physical activity out of a fear of embarrassing themselves in front of a group of strangers?
What can you, as a health coach or exercise professional, do to prevent this scenario from happening, and, if it does occur, how can you navigate this difficult moment in your relationship with the client and in the client’s wellness journey?
It all begins with managing expectations.
Lee Jordan, MS, NBC-HWC, ACE Master Coach and presenter, often works with clients who have class III obesity (i.e., a body mass index of 40 kg/m2 or higher) and multiple comorbidities. Their goal is often to lose 200 pounds or more. As he explains, by the time his clients hit a weight-loss goal, they’ve gone through the ups and downs and the stops and starts of long-term behavior change.
Conversations about expectations needs to happen in the very early sessions with a new client, or better yet, says Jordan, before you even agree to take them on as a client. A potential client might say, “I want to lose X number of pounds and get my life back.” A highly trained professional should not respond, “Great, let’s sign you up and get started.” Your role is to dig much deeper than that initial simplistic statement.
Jordan suggests asking an open-ended question such as, “Wow, what does that look like?” You’ll find that people often connect being a certain size or weight to things changing elsewhere in their lives, as described above. Your role is to help them manage their expectations through an understanding that weight loss won’t necessarily impact every aspect of their lives, especially those elements that require changes in others and, as such, are out of their control. A client losing weight won’t typically make their spouse, boss or coworker any kinder.
When you ask the right questions of a client early on, says Jordan, “you’ll find that they’re not seeking a number on the scale or on the tag of their pants or dress, but rather the experience that comes along with that.” Take the time to talk through with your client what that experience might be like in realistic terms.
Importantly, Jordan highlights the fact that a client’s expectations should be discussed and managed throughout the weight-loss process, not only in those initial sessions. As a health and exercise professional, you should never be blindsided by something a client says deep into their weight-loss or behavior-change journey, as your coaching and motivational interviewing skills should be uncovering those things along the way.
Chris Gagliardi, MS, Scientific Education Content Manager at ACE and an ACE Certified Personal Trainer, Health Coach, Group Fitness Instructor and Medical Exercise Specialist, agrees that you should be using your coaching skills every step of the way, and that setting realistic expectations is absolutely vital to a client’s long-term success. He suggests having clients do a thought exercise where they imagine what their future would look like after they hit their weight-loss goal. Ask, “What is your life like now? What are you doing?”
People often mention things like a better job or improved relationships. In such cases, an appropriate follow-up question might be, “So, all of that is contingent upon the weight loss?”
Here is another line of questioning Gagliardi likes to use at this point: “What if all of that doesn’t happen? Is it still worth it to pursue this goal? What are some other benefits that you know about that are more directly related to weight loss or that you have more control over?”
This conversation can help tie the weight loss back to attainable and measurable health benefits. Before moving any further into setting goals or developing a program, it’s essential that you and your client are on the same page when it comes to their expectations. Have a conversation about how the two of you cannot control the tone of their marriage through weight loss, for example, but that there are evidence-based and measurable outcomes that you can track over time.
A reminder: Never lose sight of the fact that the client is sharing their hopes and dreams, and that this includes what they believe is a better version of themself. So don’t downplay or dismiss any element of that future vision. Instead, encourage them to think more deeply about it. Ask what other steps they can take in parallel to their weight-loss efforts that will help them achieve those other objectives. If their vision includes a better job, for example, help them explore education opportunities that might support their efforts to get a desired promotion.
Jordan usually proposes to clients that they complete reflection exercises, often in the form of journaling. “If you begin using reflection tools, like journaling and that kind of thing, early on in the relationship and in the process,” he says, “that’s setting them up for a level of self-awareness and growth.” This strategy will help clients manage their own unrealistic expectations.
Jordan also brings up the OARS skills, which stands for open-ended questions, affirming, reflective listening and summarizing, and lies at the core of motivational interviewing and health coaching. Coaches and trainers should get in the habit of affirming what a client says to recognize and acknowledge the positive aspects of what is being said and done. Affirming is not the same as praise and should center on you-based affirmations.
Avoid offering affirmations like, “I knew you had it in you! I’m so proud of you.” This is positive praise but places the emphasis on you rather than your client and positions you on a pedestal above them. This type of statement tells the client that you are judging and declaring their performance as being worthy. You’ve given them praise and can just as easily take it away.
Instead, say something like, “You really showed up for yourself this week in an amazing way.” This tells the client that they have done something that doesn’t have anything to do with their coach or trainer. “People who achieve sustainable behavior change have two characteristics consistently: autonomy and self-efficacy,” explains Jordan. You-based affirmations support the development of both essential characteristics.
Another element of managing expectations is discussing with clients the value they place on receiving praise from others. Everyone loves hearing praise and congratulations as they pursue and achieve their goals, but this can get very complicated for individuals who lose substantial amounts of weight. For example, if someone goes from weighing 500 pounds to 425 pounds, many people’s perception of them will remain unchanged. This can be deflating and demotivating: “I’ve worked so hard to lose 75 pounds and no one even notices.”
On the other hand, receiving praise for losing a lot of weight can sometimes feel dehumanizing. The same holds true when people start treating someone differently once a large amount of weight is lost. Imagine a client who loses 200 pounds and starts getting invited to happy hour events after work or notices something as simple as people holding doors open for them around the office. These changes beg the question: “What did they think of me before? Was I not worthy of friendship or even common courtesy before I lost the weight?” People sometimes don’t realize how poorly they were being treated until they see how the world interacts with them once they have a smaller body.
As Gagliardi points out, this highlights the mental and emotional aspect of the work you do with your clients as a health and exercise professional, and demonstrates why it’s so important to have a full understanding of each client’s expectations before beginning your work together.
“My life didn’t change as much as I thought it would.”
So, you’ve set expectations, used your motivational interviewing and coaching skills, encouraged your client to use of vision boards and journaling, and helped them develop autonomy and self-efficacy. And yet, even after they hit their weight-loss goal, they say, “My life didn’t change as much as I thought it would.”
How do you handle that moment? This is a crossroads, not only in your relationship with the client, but also in their behavior-change journey.
“It’s really important to shine a spotlight on the things that did change,” Gagliardi says. Discuss measurable markers of health such as blood pressure and blood glucose levels, but also changes they can perceive in their quality of life. Talk about their self-efficacy and self-confidence, as well as their energy levels and overall well-being. Encourage them to be excited about how far they’ve come.
Jordan once again emphasizes the need for ongoing coaching and the use of motivational interviewing. He recommends actively listening for words, emotions and expressions, as well as for the things the client doesn’t say. Identify a value they’ve mentioned that you can elevate with a you-based affirmation. “When you listen this way with somebody,” he says, “you’re essentially sending a message that says, ‘I have time for you and I want to work together with you to address your problems.’ But more important than that, you’re telling them, ‘I have time with you.’” This demonstrates a very high level of empathy, which is much needed at a moment like this.
The next piece of advice from Jordan also stems from the use of OARS skills. He recommends asking an open-ended question and then jumping to the reflection element by reflecting back whatever they’re saying. The goal here is to spark a deeper understanding and transformative change. Open-ended questioning sets the stage for active listening through a lens of unconditional positive regard. Reflecting back to the client what you think you heard them say or taking a guess at the meaning behind what they said not only shows that you are listening, but also gives the client a chance to correct any misunderstanding and to agree or disagree with your reflection. This lets the client know that you heard the words they are saying and that you care enough to make sure you understood the words and the meaning behind what was said.
Ultimately, your goal in this moment should be to let the client know that you hear and understand their concerns and that you’re ready to collaborate with them on the next phase of their journey, wherever it may take them.
If a client expresses dissatisfaction in aspects of their life not directly related to weight loss, this may be an opportunity to make referrals. It’s essential that you respect your scope of practice and avoid venturing into any type of marriage counseling or mental health care, for example. Adopting a team-based approach with a client can sometimes help them achieve goals that extend beyond your relationship with them.
Finally, Gagliardi recommends introducing the idea of discussing the client’s new baseline after a long-term goal has been reached. For example, you might say: “Thinking about where you are today, what are your hopes and dreams for the future? The old version of you couldn’t walk for three minutes without stopping and knew very little about healthy eating. Now, you’re doing healthy meal prep each week and you’re walking for 60 minutes at a time and even doing some hiking on the weekends. This new version of you is wanting more. Where do you want to go from here?”
ACE Mover Method™
Over the course of a year, you worked with a client who was focused on changing their behavior to lose weight. In that time, the client successfully lost 75 pounds by changing their eating patterns and becoming more physically active. They were very happy with these results. Several months later, the client reaches out to schedule a follow-up session, during which they reveal that they are maintaining their weight but are feeling defeated because their life did not change in all the ways they hoped after achieving such dramatic weight loss.
The following is an example of how the ACE Mover Method and the ACE ABC Approach™ can be used to explore the discrepancy between what a client hoped to achieve and the reality of what was achieved, to focus on the positive, and to empower the client to keep moving forward with actionable steps toward accomplishing new goals.
Ask: Asking powerful open-ended questions during this exploratory conversation is essential to learning more about the discrepancy between the client’s hopes and dreams and the reality of how their life changed after losing weight.
Health and Exercise Professional: You achieved your weight-loss goals and thought things would be different once that occurred. What were you hoping for?
Client: Well, my main goal of course was to lose weight and I still can’t believe what I achieved. For a while, my life seemed to have changed just as dramatically as my weight, but as time went by, I started feeling like things hadn’t really changed as much as I thought they might. I though all aspects of my life would be different.
Health and Exercise Professional: Different how?
Client: To be honest, I thought all physical activity and exercise would be easier for me and that I would really start to enjoy being active. I also thought that I’d finally get the promotion I’ve been hoping for and that my career would be in a better place. The only thing that changed is the number on the scale and that I am just the same old person, but in a smaller pair of jeans.
Health and Exercise Professional: You thought changing your weight would change your entire life.
Health and Exercise Professional: Thinking back to where you were 18 months ago and where you are now, in what ways have you changed?
Client: The biggest change has been the 75-pound weight loss, but there have been other changes, too. I am wearing smaller clothing and becoming more comfortable with the person I see when I look in the mirror. I can now meet the physical activity guidelines on a regular basis and have improved my food knowledge and feel like I have better control of what food and drink goes into my body. I have less physical pain and activities of daily living have become easier to perform. And, I can’t forget about the decrease in all the medications I was taking. I went from taking five prescription medications to only one.
Health and Exercise Professional: You have worked hard to change your lifestyle and achieved so much, from weight loss to taking fewer medications, but that is not the end of your story. What else would you like to focus on? And tell me more about your job situation.
Client: Reflecting on all that has changed in my life over the past 18 months is helpful. I guess I have transformed in many ways. The challenge is that where I am now is my new baseline and perhaps I am feeling ready to do more or to move on to even bigger and better things. For example, while I know that exercise is important for my health, I’m still not really having much fun while I do it. It’s still a bit of a chore. I’d like to find more activities I enjoy.
About work, I’ve always felt that I missed out on opportunities because of my size, that people just didn’t take me seriously or respect my opinion as much as they should have. I thought that would change with the weight loss.
Health and Exercise Professional: So, it is not so much that what you hoped for was not attained, but more that you want to find fun activities so you can continue your journey. How will having more fun during exercise prepare you for the next steps you would like to take? Also, I remember talking about your career goals when we first met and that you took some classes at the local community college to enhance your skill set. How was that received at the office?
Client: Even though I know my fitness has improved, I don’t always feel strong enough to do certain activities or like I have the muscular endurance to do outdoor activities or play sports, which are things I think I would enjoy. I feel like I am still the same out-of-shape person as I was before, just living in a smaller body. Being stronger or getting my muscles in better shape is not about looking a certain way to me but about having the strength I need to confidently say yes to doing all kinds of activities.
About work, I did complete those courses and share that news with my boss, but they still have not given me the raise or promotion I’d hoped for. I think a good next step might be to talk to them about what skills or knowledge they think I’m lacking and then pursuing more education in those areas. I have to say, it feels good to know I have the confidence to approach my boss like that. In the past, I simply sat back and hoped for things to change.
At this point, the professional has uncovered more about the discrepancy between the client’s hopes and dreams and the reality of what was achieved. Open-ended questioning was used to learn more about what the client is hoping for, what they have already achieved, and what they would like to focus on next. Notice the shift from understanding what the current problem is, to shining a spotlight on the positive, and then moving on to breaking down barriers and collaborating on next steps.
Break down barriers: Ask more open-ended questions to find out what obstacles might get in the way of the client exploring more kinds of physical activity.
Health and Exercise Professional: Feeling more fit and having the confidence to say yes and to try new things is important to you. What is stopping you from doing that?
Client: Actually, now that I am talking this through with you. I am not sure that anything is really stopping me. I guess I just assumed that I still wasn’t in good enough shape to go on long hikes or play soccer with friends on the weekends. I have the time to exercise, and exercising is a habit for me now, but I think a lack of confidence about keeping up with others is something that is still holding me back.
Health and Exercise Professional: You are motivated to be more active and have the time to exercise already built into your schedule. You just need to identify things you enjoy and find groups of people to do those activities with. Who do you know who is already doing activities you think you’d enjoy?
Client: If you would have asked me that question a year ago, I would not have had much to say. It simply wasn’t a topic I’d talk to friends or coworkers about. Now, I know that a group of coworkers are in a recreation league where they meet up to play different games or sports each week, like soccer, pickleball, even kickball. It sounds like fun, but I’ve always been too intimidated to join. But I’ll talk to my friends about what level of fitness is needed to participate and about joining.
Collaborate: Now we have learned more about the clients’ current thoughts and feelings, their perceived barriers, and in what direction they want to head. Now is the time to work together with the client to decide on next steps for having more fun while exercising.
Health and Exercise Professional: You have learned a lot since you and I have been working together and have a progressive training plan that you’re still maintaining. The next step for you is to add some fun into the equation.
Health and Exercise Professional: What is a specific next step you can take to learn more about finding more types of movement that you enjoy?
Client: I will talk to my friend at work about joining that recreation group and ask my sister if she’d like to go hiking with me on Saturday mornings, which would replace one of my cardio sessions at the gym. Oh, and I will request that meeting with my boss to discuss what I need to do to take the next step in my career.
Would it be O.K. if we connected again next week so I can share with you what I found?
Health and Exercise Professional: Absolutely. Let me make sure we are both on the same page. Between now and next week, you plan to talk to you sister and friend about finding fun activities to do and will schedule that meeting with your boss. Is that correct?
In this example, the exercise professional and client worked together to explore the discrepancy between what the client was hoping they would feel like after losing weight and how they are feeling, all the changes that took place, and how the client would like to move forward from a new and healthier starting point. The health and exercise professional followed the tenets of the ACE Mover Method and used the ACE ABC Approach to guide the conversation and to keep it client centered.
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