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For the trainer or dietitian: Helping a Client Past A Plateau

This is from an article I wrote that was published in the magazine IDEA Fitness Journal.

I am Registered Dietitian and a personal trainer who specializes in weight loss management incorporating lifestyle changes and behavior modification, nutrition and fitness. I’ll share with you the process I go through when a client’s weight loss stalls.

When a client has stopped losing weight on his or her program, rather than simply concluding that the fix lies within their workout or nutrition regimen, experience tells me there’s more than meets the eye; and this is where many trainers miss the mark and often fail to take the necessary next steps to delve deeper into the root of the problem.

Perhaps the client is not following their program as diligently as they did in the beginning.  Maybe they are having challenges with following the program and need fresh ideas and suggestions. They may say they want to do it, but despite their best efforts can’t seem to because they have conflicting feelings about change. Maybe they simply aren’t ready to make any changes at this time; or perhaps there is a medical reason weight loss has stalled.

If a client has stopped losing weight, I assess their adherence to the nuts and bolts of the program.  Are they are still following their program as attentively as they did in the beginning?  Sometimes I find that after some initial weight has come off, clients are not as diligent as they were at the beginning of their program.  A typical pattern I see is that cardio isn’t performed as often or as long; portions start to slowly creep up in size; treats make their way back into their diets; their meals aren’t being logged anymore and/or meals aren’t planned as attentively.

To assess if a client is following their program I ask a few key questions:

  • Are you following the meal plan that I have created for you? (Remember I am a dietitian and can create specific meal plans)
  • Are you planning out your meals in advance?
  • Are you measuring your food and logging your food and beverage intake?
  • Are you reviewing your journal to see if you have met your nutrient targets that I (as a dietitian) have set? (Calories, carbs, protein, total fat, saturated fat, fluid, sugar and fiber).
  • Are you taking your multivitamins and any other supplements that I have recommended? (Remember I am a dietitian and can make these recommendations)
  • How many minutes of cardio have you done this week? What type and what was your heart rate range)?
  • Did you get two weight training workouts in this week?
  • Did you get at least 7 hours of restful sleep?
  • Are you experiencing chronic stress?

Aside from the stress question, if the answer to any of these questions is “no”, then we then (together) come up with some actions that might help them get back on track to reinstate their positive practices into their daily regimen.

As we speak to our clients, it is important to remember that making changes is difficult, and falling back into patterns or unproductive ruts is far too easy. Listen carefully for indications that the client is facing challenges incorporating the new changes.  Perhaps work stress is setting in; the new baby is keeping them up at night; maybe they’re worried about money. You get the point.  The list can be a mile long, and we all know that it doesn’t take much to derail someone from a once-effective program.

Most often, he or she just needs a few suggestions on how to incorporate new behaviors into a daily routine. Ask what challenges they are having and together, come up with some ideas to overcome them.

You may however, face a situation where your suggestions just aren’t met with much of a positive response or action.  Have you ever heard a client saying things like, “I know I need to exercise but I hate to do it,” or “I know I need to stay away from treats but it’s just so hard”. I call that the “yes, well, but” syndrome. These statements signal ambivalence and conflicting beliefs, desires and behaviors. The client “knows” they “should” make some changes but can’t seem to. If a client is ambivalent, they are not going to be moved to make changes if your response is to give them more suggestions.

This client may not be ready to make any big changes. Take a step back at this point and assess their readiness to change.

I have found two counseling techniques which are helpful in increasing intrinsic motivation:  Readiness to Change and Motivational Interviewing.

-Readiness to change provides a framework for understanding the behavior change stages that people go through.

-Motivational interviewing is a counseling method that helps facilitate motivation within the client.

Utilizing these methods, especially motivational interviewing, takes education and years of practice to be effective. It is invaluable for every person working with others to make lifestyle changes to become more competent in this area.

If you don’t feel skilled and think this person may benefit from some help exploring their ambivalence, I’d recommend asking them if they feel that talking to a psychologist might be helpful in helping them explore and resolve ambivalence.

Of course, it is certainly possible that a medical issue exists which lends to the reason for not losing weight. Such issues may include hormonal changes, Cushing’s syndrome, hypothyroidism, PCOS, or insulin resistance, and a visit to the doctor may be justified.

 

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Thyroid Medications Levothyroxine and Food and Vitamin Interactions

Take levothyroxine once a day in the morning on an empty stomach, at least one-half hour to one hour before eating any food.

People who take thyroid medication should be advised that calcium supplements and certain foods such as soybean flour, soy, grapefruit juice, espresso, coffee, millet, cottonseed meal, walnuts, and a sudden change to a high-fiber diet may interfere with absorption of levothyroxine from the gastrointestinal tract.

You should separate the administration of levothyroxine and multivitamin with minerals by at least 4 hours.

 

and dietary fibe

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Maria’s Greek Chicken Breasts with Feta and Caper Sauce

This easy entrée has a rich sauce with a hint of lemon. Serve with Caesar salad with tomatoes and whole wheat orzo (rice-shaped pasta) tossed with olive oil and oregano.
8 (4-ounce) skinned, boned chicken breast halves
6 tablespoons all-purpose flour
2 teaspoons dried oregano or 2 Tablespoon finely minced fresh oregano
2 tablespoon olive oil
2 cup chopped onion
6 garlic cloves, minced or pressed through a garlic press
2 cups fat-free, less-sodium chicken broth
2/3 cup golden raisins
¼ cup tablespoons lemon juice
¼ cup capers
1/2 cup (2 ounce) crumbled, reduced fat feta cheese
4 thin lemon slices to use as garnish
Prep Time: 10 minutes   Cooking Time: 25 minutes
Prep all the vegetables and lemon.
Combine the flour and oregano in a pie pan or other shallow bowl.
Place each chicken breast half in a large Ziploc bag; flatten to 1/4-inch thickness using a rolling pin. Dredge chicken in flour mixture.
Heat oil in 2 large nonstick skillets over medium heat. Add chicken; cook about 5 minutes on each side. While chicken is cooking turn the oven on to 150 degrees.
Remove chicken from pan to an ovenproof dish. Keep warm in oven.
Add onion and garlic to one of the pans and sauté 1 to 2 minutes.
Stir in broth, raisins, and lemon juice; cook 3 minutes, scraping pan to loosen browned bits.
Return the chicken to pan. Cover, reduce heat to low-medium, and simmer 10 minutes or until chicken is done.
If you’d like to serve this over orzo, start the water boiling now and then cook orzo, drain it, season with some olive oil, oregano and salt and pepper.
Remove chicken from pans to the ovenproof dish and keep warm.
Add capers and cheese to pan, stirring with a whisk until cheese is melted.
To serve, either spoon orzo onto a large serving plate and place all 4 chicken breasts on a serving platter, pour sauce over the top and garnish with lemon slices or place one piece of chicken on a plate and top each chicken breast with 1/4-cup sauce and 1 lemon slice and some orzo.
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