Any time we raise the topics of eating and weight with clients, we can be pretty sure that questions about nutrition and fitness will follow. How can we talk about eating without discussing which foods pack the most nutritional punch and which will speed us down the road to serious illness? How can we speak of weight without talking exercise, heart health, disease prevention, and longevity? We cannot avoid these areas, but that does not mean we need to know everything about them. Instead, we can get discussion rolling, then involve other professionals in supporting clients in reaching nutritional and fitness goals.
Although clients might pressure us, or we might feel pressured, to address nutrition hand in hand with eating problems, it is often beneficial to postpone discussion until we thoroughly understand what is going wrong with a client’s eating. Are we dealing with a pregnant woman who has always had a comfortable relationship with food who is now so overly focused on eating “right” for the fetus that she no longer enjoys it? Are we working with an elderly widower whose wife used to cook lavish meals for him who now feels condemned to eating frozen dinners for the rest of his life? If so, discussion about nutrition might be useful but, obviously, that is not all that is needed. We must determine whether the pregnant client is trying to be a perfect mother-to-be in order to produce a perfect child, and whether the widower is depressed and in need of companionship and social connections as well as tasty dinners.
The rule of thumb for working with clients with major eating issues is to help them become “normal” eaters before focusing on nutrition. This may take months or, occasionally, years. Of course, this does not mean avoiding mention of healthy versus unhealthy foods or refusing to discuss the kinds and amounts of food clients eat. Do they eat only junk food or health food? Do they generally overeat or undereat? Or, do they alternate between eating only organic and macrobiotic foods and foods that are unhealthy? It does mean waiting until clients are eating “normally” fairly consistently for many months before changing the focus of discussion to consuming healthier foods.
Here’s why. When disordered eaters focus on eating “right” or healthily, they often (unconsciously or consciously) restrict their choices, believing they should be eating by the book, and end up reacting as if they are on a diet. Restriction for any reason causes them to feel deprived, which often leads to rebelling by eating “unhealthy” foods. Rather than direct clients to eat salads, vegetables, and whole grains, it is better to support them in intuitive eating: helping them identify their hunger level and what they are in the mood for; encouraging them to stay aware while eating and stop eating when full; and teaching them how to deal with emotions without abusing food.
A word here about intuitive or normal eating. For our purposes, the terms are interchangeable and promote an approach to eating that is body-centered. Eating is intuitive, or instinctive, because it is based primarily on innate body signals about hunger, cravings, and satiation. It is considered normal because this is how the standard-issue human body is programmed to keep the species alive—to eat when hungry, make satisfying food choices, eat with awareness and enjoyment, and stop when full or satisfied. However, because eating is intuitive does not mean that it precludes using our brains to abet our instincts. Nor does normal mean that every bite must be for the betterment of self or humankind. Normal eaters eat a wide range of foods.
We must have a thorough understanding of the difference between normal and healthy eating in order to help clients. That means recognizing that intuitive or normal eaters are not necessarily nutritious eaters and that nutritious eaters may eat neither normally nor from instinct. Ideally, of course, each of us (clinician and client alike) would eat intuitively and healthily most of the time, but pressures to be thin and to follow strict nutrition guidelines coupled with an abundance of accessible, delicious foods makes that a (pardon the pun) pie-in-the-sky goal. Food, eating, and weight have taken on such a life of their own in present culture that sometimes the best any of us can be is a work in progress.
Clients with eating problems will have a range of information about and interest in nutrition and exercise. A few might be relatively close to “normal” eaters, but remain relatively ignorant about what foods have health value and what foods do not. A handful of couch potatoes might find that, in spite of eating “normally” and fairly nutritiously, with advancing years they need to engage in some or more exercise. Others might know a good deal about nutrition and exercise faithfully, but be chronic over- or undereaters. Some will be as expert about healthy eating as a dietician or spend hours exercising, but still alternate dieting by the book with binge eating. By far the largest group will be those who have difficulty maintaining an ongoing exercise program and who do not, on the whole, follow nutrition guidelines.
For clients who are more or less “normal” eaters, but lack information about nutrition, the wisest thing to do is to refer them to a registered dietician or certified nutritionist (make certain the professional is licensed and experienced) while you continue to talk about their food concerns. Maybe they have recently received a promotion and are now constantly traveling for work and eating out a lot. While you discuss the stress (or distress) this change in eating has generated—the clients might be anxious about succeeding in their new position and may be fixating on eating rather than experiencing their angst—a dietician can help them choose satisfying foods and master a knack for eating well down the road.
A pregnant teenager who is eager to have a healthy baby and afraid of gaining too much weight might have no clue how to read labels, and a nutritionist may help her understand what all that tiny print on food packaging actually means. A client who never had weight problems might need guidance about what to eat after colon cancer surgery or being diagnosed with Crohn’s disease or celiac disease, food allergies, or irritable bowel syndrome. Elderly clients who have been losing weight steadily and have little interest in food might benefit from learning what they must eat to stay healthy and finding out about nutritional supplements.
On the exercise front, it is crucial to make sure that clients who intend to begin any kind of program are in good enough health; some may even need to get medical clearance before beginning an exercise regime. Although most healthy clients can get away with not visiting a doctor, anyone with serious medical problems or who is postsurgery, elderly, or pregnant should, especially if they have any history of cardiovascular disease. While we all have our share of clients who need to be prodded to buy a gym membership or take a walk, there are also clients who suddenly become gung ho for exercise and may endanger themselves if they are not careful.
There are many avenues that could lead to discussion about exercise. A divorced or widowed client who is thinking about dating and getting into shape might be guided toward joining a health club—not only to become fit but to make friends and social contacts. A middle-aged man recovering from a heart attack who has never run for a bus or lifted a barbell would benefit tremendously by getting advice from a trainer, privately or at a gym. A couple trying to spend more time with each other might achieve their intimacy goals—and stay fit—by taking time out to learn a sport together (bicycling, skiing, tennis, bowling), by joining a dance class, or by doing yard work or household chores together.
Along with advising clients to see a licensed professional for nutritional counseling, it is equally important to steer clients toward reputable health and fitness facilities and athletic trainers and fitness coaches who have the skill level, experience, and training to know what they are doing. The last thing we want is to have a client injured while she is trying to get into shape! It is excellent assertiveness training for clients who are joining a gym to ask about the expertise and availability of staff and to inquire about credentials, experience, and references when hiring a trainer or coach.
Although we should not expect to be experts in nutritional counseling or exercise physiology (it is hard enough to stay current on psychological issues!), it helps to have a basic grounding in these two areas. This is all clients generally need from us as they explore their eating and weight concerns. We can always read books and go online, if necessary, to expand our knowledge about healthy eating and fitness. Again, with so much conflicting information on the Internet, we must separate out reputable Web sites from those that are trying to sell products.
There are hundreds of books on nutrition, but not all are based on good science. Some are the experiences of one person, include only anecdotal or unproven evidence, or are based on pseudoscience. The same is true of Web sites on which a person gives her opinion of what is healthy and unhealthy to eat, and on which companies push products (such as food, supplements, medications, and diet plans). Our best bet is to refer to books by well regarded, credentialed dieticians, medical doctors, and scientists; the most up-to-date information may be found on the Web sites and in the newsletters of nutrition schools (for example, Tufts University, Johns Hopkins, the University of California at Berkeley, as well as most government Web sites, especially the U.S. Department of Public Health).
There are also fitness Web sites that are trying to sell products, usually aerobics videos or exercise machines, which may not give the whole story on exercise and may even make false claims. Again, we should seek out Web sites and books whose legitimacy comes from science and licensed professionals, especially those who have good standing in their fields and a sound track record. Remember, giving clients the wrong information can often be worse than giving them no information at all.
Reflections for Therapist
1. How close is the client to being a “normal,” intuitive eater?
2. How motivated is the client to exercise, eat “normally,” or eat nutritiously? What might increase her motivation?
3. Would physical therapy or a nutritional or exercise consult help motivate her?
4. What issues need to be addressed and resolved before the client is ready for a consultation?
To assess client motivation and goals
in the areas of motivation and fitness, ask:
1. What are your eating goals? weight goals? nutritional goals? fitness goals?
2. What is a reasonable amount of time for you to reach each of these goals?
3. How would you assess your motivation in each area (high-medium-low)?
4. What obstacles do you identify in reaching each of these goals?
5. How could we work together to remove these obstacles and improve your incentives?
Nutrition
Food
Whether or not we follow nutritional eating guidelines ourselves, most of us know the basics by now: eat more fruits, vegetables, and whole grains, avoid transfats and foods high in bad cholesterol, and keep sweets and treats to a minimum. This advice has stood the dual tests of science and time and sounds suspiciously like what our grandparents might have practiced and told us regarding eating simply and in moderation.
In our work with clients, it helps to have a more comprehensive body of knowledge to draw from, especially as this information is more or less at our fingertips thanks to the World Wide Web. However, sometimes it seems as if the recommendations we find for foods, supplements, vitamins, and minerals change more rapidly than we can follow. We go along for decades believing that potatoes are wholesome and good for us, then discover they are right up there on the glycemic index and that we should eat them sparingly. Same goes for eggs, which many of us were taught contained good-quality protein—until we learned that eggs were high in bad cholesterol and then, in a turnabout, that they are not so harmful after all. The biggest debates have been between diets that promote consumption of red meat and fat and others that consider them the primary cause of heart disease and premature death. Then there are the questions about the benefits of eating organic or raw foods only, the hazards of products that are genetically modified, and whether to pursue a vegetarian or vegan lifestyle.
An excellent, commonsense, well-received book about food is What to Eat by Marion Nestle, professor of nutrition at New York University (Nestle, 2006). She does as good a job as anyone explaining the nuts and bolts of healthy eating and musts and myths of nutrition, although she is right up front in saying that most adult Americans do not follow dietary guidelines. Another excellent resource is MyPyramid.gov, the Web site of the U.S. Department of Agriculture (USDA), which presents and explains the food guide Pyramid released in 2005. Based on a 2,000-calorie diet, it recommends that adults consume daily:
• at least 6 ounces of whole grains in the form of rice, crackers, cereal, bread, or pasta, half of which are whole grain and half of which are refined;
• 2–3 cups of vegetables divided into categories of dark green, starchy, orange, other, and dry beans and peas;
• 2 cups of fruit, but go easy on fruit juices;
• 3 cups of milk or milk products, including cheese and yogurt; and
• 5.5 ounces of lean meat, chicken, fish, and beans.
The site describes the differences in types of oils and goes into detail about varieties of fruits and vegetables. It also talks about “discretionary” calories, or those that we should keep to a minimum, that is, foods that are high-calorie and/or high-fat, and the need to limit salt. Although the site is a bit difficult to navigate, it does move away from the one-size-fits-all nutritional plan of yesteryear and offers a more individualized approach based on gender, age, weight, height, and physical-activity level. It also provides information for a number of ethnic/cultural groups, including Latin American, Native American, Asian, and Mediterranean.
The explanation of a serving size is a bit confusing and may range from a half cup to a cup, a slice, a piece, 2 tablespoons, or 2–8 ounces, depending on the food. The site does give a great many examples and most folks should be able to get the hang of what a serving is with practice—or they can always refer back to the Web pages. This is only one site among many with a wealth of solid information on nutrition and to which we can refer clients who want to learn more about healthy eating.
The problem with this information is that it actually can promote or reinforce disordered eating by asking that clients measure and weigh food and think about the number of calories they contain. To the ears of disordered eaters, the food pyramid sounds suspiciously like a diet. The trick is to help clients see it as a basis for making choices and not as a way to obsess about food and deny themselves pleasure. The food pyramid and accessing nutritional information is most helpful to clients who truly have no idea about the number of calories or amount of fat and salt they consume in a day. Some are positively shocked to hear how many grams of fat there are in a Big Mac or a Whopper or how calorie-laden a Frapuccino is.
The best approach for clients is not to count calories or fat grams but to focus on eating to feed their cells effectively. Better that they consider whether a food will nourish their body than how fat or thin it will make them. This change of viewpoint is crucial if clients are to create a positive relationship with food and maintain a comfortable weight for life. The truth is, much of this change can be generated by how we as clinicians approach the subject, that is, whether we focus on fatness and thinness or health and fitness.
Dietary Supplements
Also known as micronutrients, vitamins and minerals are “substances [the] body needs in small but steady amounts for normal growth, function and health” (“Dietary Supplements: Using Vitamin and Mineral Supplements Wisely,” Mayo Clinic Web site). Because the body cannot make most micronutrients, we must get them from food or dietary supplements. There is nothing wrong with taking supplements, and in some cases, they are essential to health and well-being, but the general consensus is that it is better to get nutrients from food. Some folks believe that if they take vitamins and minerals, they can afford to fudge a healthy diet. They live on junk food and pretend that they are not compromising their health because they swallow handfuls of supplements daily. They are better off supplementing their poor diets in this way, but are still endangering themselves by making ongoing unhealthy food choices.
Vitamins are needed for growth, digestion, and nerve function. They are involved in many biological processes, including enabling the body to use carbohydrates, fats, and protein for energy and to repair cell damage. Most vitamins have multiple functions, but do not themselves contain calories. Vitamins can be either water-soluble or fat-soluble.
Water-soluble vitamins are easily absorbed by the body and are not stored in large amounts by the body. They include vitamin B1/thiamine, B2/riboflavin, B3/niacin, B5/pantothenic acid, B6/pyrionxine, B12/cyanocobalamin, C/ascorbic acid, H/biotin, and Folic Acid (folate).
Fat soluble vitamins are stored in body fat and are pulled out of storage, so to speak, when they are needed. They include vitamin A/retinoids, D/calciferol, E/tocopherol, and K/naphthoquinone.
Minerals are the primary components of bones and teeth as well as the building blocks of cells and enzymes. They help regulate fluid balance and the movement of nerve impulses, and they deliver oxygen to cells and carry carbon dioxide away from them. The most important minerals include Calcium, Iodine, Iron, Magnesium, Phosphorous, and Zinc.
Because the requisite amount of vitamins and minerals varies in many cases according to gender, age, and other conditions (such as pregnancy and menopause), it is impossible to provide general information about an individual client’s actual needs. This information is readily available through books and on the Internet. Clients should be encouraged to acquire this information on their own, when possible, and bring it into therapy for discussion. It is important, especially for clients who tend to be disorganized or overwhelmed, or who frequently “forget” or lapse for long periods of time in their self-care duties, to explore how they feel about taking supplements and come up with a plan to help them stay motivated and committed.
During a crisis or in times of stress—when a client’s body is most in need of nutrients—may be exactly when she becomes overwhelmed, depressed, and anxious, eats poorly, and gives up taking supplements. This is a sign of stress itself, leading to poor self-care, and she may need help recommitting to getting her daily doses and may respond well to periodic check-ins about them. Clients who have an all-or-nothing perspective tend to take supplements for a while, when they are on the upswing, and stop taking them (along with ceasing other beneficial activities such as exercising and sleeping and eating well) as they start to backslide or become more depressed.
To help the client assess knowledge
about and motivation to take vitamins, ask:
1. Do you regularly take vitamins? If so, how long have you been doing so? If not, why not?
2. What motivates you to take them?
3. What makes you stop taking them?
4. How do you think not taking them affects your health?
5. How can we work together to keep you on track?
6. Do you need a consult with a dietician or nutritionist who can help you figure out what vitamins and minerals to take?
Fitness
There was a time when exercise was not a multibillion-dollar industry, but was meant to provide enjoyment—think skating, bowling, swimming, sledding, softball, and bike riding—and get our blood moving. Now, although it still brings pleasure to some, it is more often viewed as an activity to check off on a daily or weekly to-do list. Sadly, for many folks, exercise has become yet another self-care chore on a list that seems to grow longer by the year. Exercise, which used to be thought of as a fun way to pass the time, is now considered work because we have attached the goal of fitness to it.
What exactly is fitness? It is generally defined as the attributes that people have or achieve relating to their ability to perform physical activity. Talking about fitness with clients can be dicey and delicate, a subject on which we may need to tread lightly. Along with “healthy eating,” it is another one of those must-do activities that may cause clients to either feel proud when they do it or ashamed when they do not. The subject is complicated by the fact that some clients appear healthy because they throw themselves into getting into shape, when the truth is that they are addicted to exercise to avoid distressing feelings and may be damaging their bodies in the process.
Some clients with food problems will bring up the desire to be fit and to exercise, while others will want to focus only on changing their eating habits and ignore this aspect of physical well-being. Most understand the health benefits of exercise, but many consider it merely a way to lose weight. A large number will have tried exercise programs and dropped out, coming to us with a history of failure they do not completely understand and fear repeating. As always, we need to start where the client is, which may be helping them view exercise as part of a broader goal of being fit and healthy, being honest about how committed they are to these goals, and exploring underlying self-care conflicts that make clients sabotage health gains.
According to most experts, there are five basic components of physical fitness: cardiorespiratory endurance, muscular strength, muscular endurance, flexibility, and body composition. All are equally important to physical health. The U.S. Department of Health and Human services cites the following requirements for fitness (“Components of Phsyical Fitness,” U.S. Department of Health and Human Services Web site).
Cardiorespiratory Endurance: The ability of the body’s circulatory and respiratory systems to supply fuel during sustained physical activity, to deliver oxygen and nutrients to tissues, and to remove wastes. This kind of endurance is increased by keeping the heart rate elevated at a safe level for a sustained period of time. Walking, swimming, skating, skiing, and bicyling are activities that build cardiorespiratory endurance.
Muscular Strength: The ability of muscle to exert force during an activity. In order to strengthen muscles, they must work against resistance. Using weights, elastic bands, medicine balls, and exercise machines such as a stairstepper all build muscular strength.
Muscular Endurance: The ability of the muscle to continue to perform without fatigue. Walking, jogging, bicycling, and dancing are activities that build muscular endurance.
Body Composition: The relative amount of muscle, fat, bone, and other vital parts of the body.
Flexibility: The range of motion around a joint. Good joint flexibility is a must to prevent injury. Exercises that increase flexibility are stretching, swimming, and yoga.
In addition to these five basic components, physical fitness also includes the following (from “Components of Fitness,” Sports Coach Brian Mac’s Web site):
Power: “The ability to exert maximum muscular contraction instantly in an explosive burst of movements. The two facets of power are strength and speed (for example, jumping or starting a sprint).”
Agility: “The ability to perform a series of explosive power movements in rapid succession in opposing directions (for example, zigzag running or cutting movements).”
Balance: “The ability to control the body’s position, either stationary (for example, doing a handstand) or while moving (for example, performing a gymnastics stunt).”
Coordination: “The ability to integrate the above-listed components so that effective movements are achieved.”
There are numerous reasons that clients cite for not exercising or not doing it consistently enough to achieve benefit, including not having the time, lacking money to join a health facility, fear of injury or damaging health (common in people who have had heart problems), doubting that they will stay motivated and continue (often based on previous experience), believing that getting fit is too hard, fear of and shame about wearing workout clothes in public (this reason surfaces most frequently with clients who are overweight, and sometimes with clients who are underweight), feeling overwhelmed by all the effort ahead, and not knowing how to get started.
It is true that some clients have very little time for formal exercise—they may be raising a family and already have two (or three) jobs. It is also a fact that health clubs are expensive. However, studies have shown that people can gain physical benefits from informal exercise such as walking, raking leaves, cleaning house, taking out the dog, and playing touch football with the kids. Making lifestyle changes such as climbing stairs rather than taking an elevator and walking or bicycling to work rather than driving all help get a body moving and into shape.
Although one of the ways to engage clients in becoming more fit is through their desire to achieve or sustain a particular weight, it may not be the one with the most sticking power. In general, those clients who are serious about exercise—other than those who are compulsive—are doing it as much (or more) for its health benefits as to get or stay trim. These people have a strong, ongoing commitment to care for themselves the best they can. Explaining how exercise can improve the quality of life for clients both physically and mentally can go a long way toward improving clients’ motivation and commitment to exercise.
Health Benefits
WebMD cites the following health benefits for regular exercise (“The Incredible Benefits of Regular Exercise,” WebMD Web site).
• Healthy weight: Regular exercise helps use up oxygen, causes the body to burn stored fat and, therefore, reduce fat stores. It creates muscle, which burns more calories than fat (even when the body is at rest), so that there is a two-for-one positive effect.
• Strong bones: Weight-bearing activities such as walking, running, dancing, handball, and resistance training build bone mass and keep muscles strong.
• Better skin: By improving circulation and the delivery of nutrients to skin, regular exercise helps remove toxins or poisons from the body. Circulating oxygen to the skin also gives it a more “alive” color and increases the production of collagen, the connective tissue that plumps skin and reduces the appearance of wrinkles.
• Reduced stress: Regular exercise reduces the production of stress hormones that can be harmful to the body. Instead, activity causes muscles to relax as the body reduces its heart rate and decreases blood pressure.
• Improved mood: Ongoing exercise can be a real mood booster. It reduces symptoms of moderate depression by releasing endorphins, the brain chemicals that produce happy, positive feelings, and by increasing production of serotonin, a neurotransmitter that is a mood calmer and natural antianxiety chemical.
• Stronger immune system: Regular exercise bolsters the immune system, which may result in reducing viral activity in the body, such as colds and flu.
• Better brain power: Exercise generates blood flow to the brain, helping it receive oxygen and nutrients that are necessary for clear and quick thinking.
• Disease prevention: The best news about regular exercise may be in disease prevention and increased longevity. Staying active helps lessen the chest pain of angina and symptoms of coronary artery disease, decreases heart attack risk, delays the onset of type 2 diabetes and helps in diabetes management, lowers the risk of developing Parkinson’s disease, may help prevent breast, colon, and other types of cancer, and may delay the onset of Alzheimer’s disease.
Clients often wonder about and ask how much exercise they need on a regular basis to maintain a healthy weight and stay fit. Although there has been disagreement among experts in the past, the current rule of thumb is to shoot for mild exercise at moderate intensity for at least 30 minutes a day. The exercise does not need to be done all at one time and can be broken up into 10-minute spurts; in fact, the latest thinking is that sporadic exercise promotes greater physical benefit than doing it all at once. Nor need exercise be “formal,” such as using a weight machine or attending an aerobics class. The best exercise program is one that clients will continue to do that targets endurance, flexibility, strength, and balance.
In the area of exercise—as in nutrition—it works best to do what we know best, which is supporting clients in reaching their goals. That means helping them clarify their fitness objectives, identify the kinds of activities they enjoy and believe they will stay motivated to do, recognize health conditions that would make exercise difficult or prohibitive, and work through unconscious ambivalence they have about exercise (related to money, time, body image, etc.). Sometimes our role is to act as a cheerleader and encourage clients to call friends to form a walking group, head to the park with their dog for a run, or take advantage of a membership special being run at a local gym.
Our job is to ferret out clients’ unconscious reasons for not exercising. They may be out of touch with their emotions and may not understand that starting and stopping exercise over and over means that they probably have conflicting feelings about getting or staying in shape. Most clients are in touch with manifest beliefs and feelings that they should exercise but are out of touch with latent ones about why they do not want to. Often they are surprised at how these unconscious reasons keep them stuck. A word of caution: We have to be careful not to play out the positive side of their ambivalence and encourage them to “get over” negative feelings. It is their job to sort out their internal conflicts and come to a decision about exercising; they are the ones who must make the choice and live with its consequences.
If a client starts an exercise regime and begins to slack off, it is vital to raise the subject and ask what happened. The client may feel ashamed, but we must teach them that unlocking an underlying conflict is the only way to health. They need to grasp that their intent is not aligned with their behavior, which means that something unconscious is preventing them from staying on track. When they stop exercising, they may try to place us in the role of “monitor” or “parent,” hoping we will be the force to “make” them resume. Our best bet is to process what is going on in the relationship and dig under the exercise issue for other dilemmas about dependence, self-care, and motivation.
To help the client recognize beliefs and
feelings about exercise and fitness, ask:
1. Do you exercise regularly? If so, what do you do, for how long, and how often? If you don’t exercise, why not?
2. What are your honest (perhaps mixed) feelings about exercising?
3. What is your reason for exercising (for example, health, fitness, to lose weight, believing you should)? Is this enough to keep you motivated?
4. If you slack off or stop exercising after a period of time, why do you think this happens? What is the longest you’ve maintained a regular exercise program?
5. What obstacles are in the way of exercising? What would increase your commitment and motivation? What needs to change in your life to keep this commitment?
6. How can we work together to keep you exercising regularly?
7. Would a trainer help you start exercising or keep you motivated?
Weight
Supporting clients in establishing weight goals is not as simple as it may sound. They may have a realistic or unrealistic view of what they desire to weigh and we also may have our own (conscious and unconscious) opinions. This is true whether a client is under-, over-, or of average weight. That is, an underweight client might want to remain considerably below what might be healthy for her, a middle-aged overweight client might want to get down to the unachievable weight he was in high school, and an average-weight client who appears healthy might want to lose weight when she does not need to because she thinks she is fat.
For client and therapist alike, it is nearly impossible to identify an individual’s “correct” weight. Doctors and the media tell us one thing while our bodies may tell us another. The best we can do is explore why clients want to be a particular weight and what is wrong with being higher or lower. Frequently clients want to return to a previous weight. However, if they have been overweight since childhood, they may have absolutely no idea what weight would be comfortable for their particular body (which may very likely be different from what weight charts say). A helpful approach is to suggest that the weight that will work best for them is the one they can easily maintain when they are eating “normally,” have an active lifestyle, and are exercising regularly.
An important digression: We may sometimes have clients who are unable to do traditional exercise due to poor health or physical limitations. In this case, they should consult a doctor, a trainer, or a physical therapist to find out what they can do. Just because they cannot do everything that other people do does not mean that it is healthy for them to do nothing. For example, they can do chair or isometric exercises, use elastic bands, or swim.
As underweight clients put on a few pounds and overweight ones take them off, it will be necessary to help them revise their goals. It is common for clients to over- or underestimate what is possible by picking a number they wish to be and forcing their bodies to get there. Those who are too thin may not realize what a Herculean emotional effort it will take to gain weight and tolerate feeling full and “fat.” Those who are heavy may be misled by rapid initial weight loss, only to find that they slow down fairly soon or reach a plateau. A healthy view is that putting on and taking off weight is going to be far more difficult than expected, both physically and psychologically.
Balancing out talking about nutrition and fitness with discussions on “normal” eating makes for a well-rounded approach to health and well-being. Most clients enjoy being educated—they perceive it as being given to—and psychoeducation is often a welcome break from the grueling work of digging up the past, straightening out the present, and preparing for the future. As always, we must take our lead from the client, neither forcing information on them nor failing to provide it when the time is right.