T Nation

Helping A Severely Obese Friend


#1

One of my oldest friends who has always been fairly overweight but in recent years has crossed over to morbidly obese has finally decided to lose weight. First of all, I would like to congratulate him for finally committing to this. Better late than never, as far as I'm concerned.

He would never officially state his weight in the past, but I estimate it to be around 450. Through an improved diet and the occasional mile walk, he has dropped to around 380. What has me more excited is that he has dropped his initial refusal to perform resistance training and has asked me to write a program for him.

What I'm looking for in this thread are suggestions from anyone who has trained a severely overweight person. At this stage, bodyweight exercises are pretty much out of the question. He intends to join a gym, so I assume he'll have access to most kinds of strength equipment, so I figure I'll have some freedom there. Right now, I figure the primary goal is to increase my friend's work capacity, get him moving more, maybe even clean up his diet even more, if he lets me. He's really not in as bad a shape as I thought someone his size would be, but obviously there's enormous room for improvement.

If anyone has a good break-in routine or some helpful ideas, I'd love to hear them. I just want to do everything I can to keep my friend on the right track.


#2

Go as easy as possible on him. He's likely to feel self conscious and embarassed so putting him in any position where there's potential for failure may result in his never coming back.

There's a very high drop out rate for this type of client. I'd do lots of easy cardio and a very easy, simple and short weight program. Squats and deadlifts will probably be out due to the high levels of fatigue involved, anything 'hard' will probably just discourage.

Keep it easy, keep the encouragement up and keep him feeling in control.

And if I were you, put him onto a personal trainer. Don't take responsibility for his results. Emphasise that for him, 80% of the equation is diet, which is only under his control.


#3

I have trained one of my frat brothers in the past who would probably qualify as "obese". He didn't stick with it. Mind you, he had the support of several of us who would go train with him, tell him what to eat (as a few of us played football and I was a personal trainer), and motivate him. He kept up the routine for about 4 weeks before he started spending more time in the pool than on the weights. Then, he just quit coming. Before you even spend the energy, you shouldn't be his motivation. He has to find that for himself. Otherwise, all it will do is tire you out and leave him sitting on his fat ass in a few months. Nothing replaces individual drive and dertemination. You can't give that to someone else.


#4

True Prof X... this would apply in other areas of life as well.
I've tried over the years to motivate employees for example. A lot of time can be wasted, however well intended,
on people who will not understand our
motivation to help them.


#5

I absolutely understand what you guys are saying about my friend being the only one responsible for his own motivation. However, the fact that he has asked me to write a routine for him is by itself an enormous step forward.

Ever since he decided to lose weight, he's refused my help, thinking I train in some crazy, medieval manner and would make him do the same. I didn't push the issue, just told him I would always be there if he changed his mind. I never claimed to have all the answers, but he was a witness to my own transformation and saw me learn from my early mistakes.

I guess the one good thing about someone as obese as my friend beginning to train for the first time is that his gains should come rapidly at first, both in body composition and strength. Hopefully, that will convince him of the benefits of strength training.

As for the training itself, it is true that squats and deadlifts, even lunges, are out of the question. This might be one instance where leg extensions and leg curls are superior to the former. I also thought very light, partial-range good mornings might work. As for upper body work, there's nothing really stopping him from performing most of the classic exercises.

Thanks for the comments.


#6

Leon,
One option if you already haven't done it would be just to introduce him to this site. There are alot of effective programs and nutrition approaches on here. Obviously, you're friend has made some great progress in dropping from 450 to around 380.

I purchased Precision Nutrition recently, and that might not be a bad thing for your friend to purchase. For about $100, you get alot of info. There's also an online calorie calculator you get access to upon purchasing it, so you can adjust to your current goals while you make progress. He'll probably get the most bang for his buck by doing Total Body 3 times a week initially, but get him on here and see what catches his attention.

I wish your friend the best of luck, you're a good friend to be watching out for him.
-Greg


#7

Just some thoughts:

Read the new Dave Tate article, it will provide motivation

HIIT and fasted cardio will be good after walking is easy and he wants something more

Leg press - better than ham curl/quad ext.

Cable pull-throughs (hits the hams well)

Good mornings (excellent choice, and he can work on his range of motion in the exercise as an indicator of improvement in ROM/flexibility as well)

Bodyweight lunges if possible, "static" then dynamic then walking eventually.

I don't even think I'd mess with bench press yet honestly, just overhead press for a while, and standing at that. I'm thinking of COMPOUND exercises, and bench almost seems too isolated for this guy at this point, standing OHP will hit the core and probably burn more calories.

Bent-over rows and weight-assisted pull-ups/dips are perfect.

I'm thinking...

First few months:
-Daily walking
-Some light cardio (cycling, swimming)
-2-3 full body workouts

Next few months:
-3 sessions fasted cardio per week (still walking for the most part)
-3 full body workouts per week
-1 session HIIT (probably on a stationary bike)
-Walking as preferred

With progress:
-Fasted cardio when possible if it has proven successful and he likes it*
-3-4 full body workouts (clearly he isn't going to be doing any failure work!)
-3 sessions HIIT, adjust with fasted cardio, do at least 5 combined...2 sessions fasted cardio, 3 HIIT, 4 HIIT 1 fasted cardio, and so on
-Walking as preferred, it's still convenient and enjoyable even if there are more effective methods

Here's a little program that shouldn't be too hard:

Full body 1
Cable pull-throughs 4x12
Stiff-legged deadlifts (start light and teach the movement, shouldn't be overly challenging) 4x10
Overhead press 4x8
Assisted pull-ups or machine/cable pull-downs 4x8

Full body 2
Good mornings 4
BW lunges 3x15 or work up if 15 aren't possible, when 15 static lunges are possible go up to 15 dynamic, 15 dynamic to 15 walking, then add weight
Assisted dips or if these aren't possible, light bench press DB or BB 4x8-10
Light-weight bent-over rows - if they're uncomfortable, machine rows or horizontal cable rows 4x12

Hope you find some of this useful.


#8

I'm all about compound movements, but honestly with someone in this situation, I'd start him off with dumbbells and maybe some machines/cables. Don't be suprised if just the bar is too heavy right now. In my opinion, the absolute most important thing is to start giving him the expectation of success and progress. In addition, with someone this out of shape, it will be very difficult for him to generate enough intensity to necessitate his staying out of the gym for long, right now the more light productive workouts a week the better, get him in the habit of going to the gym regularly. Maybe something like this:

Monday
Dummbbell Shoulder Press
Lat Pulldowns
Dumbbell Hammer Curls

Tuesday
Walk on treadmill

Wednesday
Seated Chest Press Machine
Seated Cable Rows
Tricep Pushdowns

Thursday
Slow pedal recumbent Bike

Friday
Leg Press
Leg Curls
Seated Calf Machine

Saturday & Sunday Off

Start everything at the lowest weight, the slowest setting, etc. and tell him you're going to be moving up a notch every time we do this until you get strong enough to use some more advanced exercises. Deliberately let him know you're setting up his program specifically so that he'll make steady gains. Have him keep a log so he can see his progress each week.

A month or two in, and he should be alot stronger. At that point it will be time to slowly start introducing barbell exercises.


#9

I disagree with HIIT.

Everything will be intense for him. So don't even try interval or high intensity.

I also disagree on the lunges. A stable lunge is very hard for overweight people. And with the extra weight they can seriously damage their knees.


#10

At this point, getting his diet in order and performing any amount of physical activity will probably result in some pretty dramatic weight loss. Definitely don't jump in with both feet, start slow and let him enjoy his initial success. This isn't like training a 'newbie' - more like a 'pre-pre-newbie.' I agree that it'll be awhile before compound movements are even an option. Even walking for more than few minutes is probably quite a challenge for him at this point.

Good for your friend, I sincerely hope he sticks with it. Is he working out in a gym? If he's not comfortable with that, I'm sure you could use some bands and dumbells and design a simple program for him to do at home.


#11

How motivated is he?

How many days is he willing to work out?

I would be more inclined to say start him slowly: 3 days per week, total body each time, 30 minute weights, 30 minute cardio.

You must balance motivational drive with getting results. Obviously, if he is more active (more days per weeks exercising), his progress will be faster. However, he may lose motivation if he does too much too soon.

You also may want to change his diet gradually. Many people perceive diet and exercise as 'suffering', so once again, you may want to proceed cautiously without making the task of weightloss too overwhelming.

beef


#12

An example workout may be:

Day1
Squats 3x8
Bench press 3x8
Cable rows 3x8
Abs 3x8
10 minute walk

Day2
Deadlifts 3x8
Military press 3x8
Lat pulls 3x8
Abs 3x8
10 minute walk

Day3
Squats 3x8
Incline dumbell press 3x8
Barbell row 3x8
Abs
15 minute walk

Keep the workouts simple. Eventually increase his walking to 30 minutes. The goal should be to get him in decent condition to jog. When he gets into 'reasonable' cardiovascular shape, perhaps HIIT would be more appropriate.

If he likes working out, you can increase the number of workouts per week, and add more sets.

Keep the workouts simple.

beef


#13

THANK YOU. HIIT for a 380lb person, what are you smoking?