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Nutrition Help for a Client, Please

I’m a nutritionist and trainer having a difficult time with a returning client. Female 5’2” 42yo. November-May 2020 lost 11 pounds to 122 consuming an average of 1300 calories. After going on her own, she put on 6 pounds and asked for help September, 2021. I started her off at 1540 calories and have adjusted her down slowly to 1170 and she’s only been gaining; currently weighing 131.
I’m asking for suggestions of what I may be missing here. She’s a puzzle I cannot solve.
Any help would be appreciated. Thank you

Are you sure they are following the diet plan…?

@supercardrives, she’s THE MOST accurate-anal-perfectionist ever. She’s been a stickler for detail in both nutrition and training.

How does she look…could it be building muscle or is she gaining fat

Also, what about holding water

Last possibility is PMS or maybe she is going thru menopause

At 42, have medications changed? Like even BP meds?

Imo there are three possible outcomes:

  1. She’s lying to you about her nutritional intake, her daily activity or both. It is not an uncommon thing to happen when your client lacks discipline. This can be the case if she cannot adhere to the diet but also does not want any conflict with you or disappoint you. Lying would be a defense mechanism here.

  2. She’s not lying to you but makes mistakes in logging her food intake and/or has subconsciously decreased her daily activity (especially NEAT). This happens often, especially with inexperienced people. Always copy the nutritional details right from the products you’re buying and weigh your foods dry (off course you as a coach know this but perhaps she does not). My fitness pal is full of mistakes. However, this will probably be the least applicable outcome if she’s a perfectionist and started coaching with you.

  3. She’s been in a caloric deficit for a very long time (before she even turned to you for coaching). The bigger the caloric deficit, the faster the metabolic adaptations (reduced T4 to T3 conversion) occur. The longer the caloric deficit remains, the less T4 to T3 conversion action happens overtime and the more likely a subconscious reduction in NEAT will occur. Clients being stuck in their weight loss journey due to being in a caloric deficit for prolonged periods is often the main reason that makes them reach out for personal coaching. Did you check this with your client? Has she been through a maintenance phase or at the very least stopped being in a caloric deficit for a while?

How does she look? Does she hold a lot of water in her abdominal region? Does she look more muscular or more puffy? Has she been succesful in maintaining her muscle mass (even though at 1170 calories weighing 131 pounds I don’t think that’s likely to be the case)? How good is her sleep/energy? How does she feel on a daily basis? Does she have increased stress levels or is she relatively relaxed? Does she have concentration issues or not? Are deviations from tracking her nutrition and training plan causing her a lot of anxiety? Do you happen to know her neurotype (it is not that important overall but it can give you an edge)?

This sentence alone leads me to believe that outcome 3 is most likely the one that’s going on. Off course menopause and metabolic disorders (is she has one of those) can play a role as well but it almost always comes down to hormonal changes due to decreased recovery, increased cortisol and adrenaline levels which overtime can cause imbalances in neurotransmitters. Neurotransmitter imbalances greatly influence hormones and weight loss progression.

Now, on to the good stuff: the practical solutions for all of these outcomes:

  1. If you suspect that she’s lying or keeping things from you, try to hold her more accountable for her actions. Off course you won’t ask your client if she’s lying to you (except when you’ve tried everything). What you can do though is use tools that hold her more accountable:
  • Have here take photos of every meal/snack and send them to you.
  • Let her take pictures of the products she consumes on a daily basis along with printscreens from her fitness pall loggings to check if she’s tracking correctly.
  • Let her send you data about her daily activity.
  • Use a score card: This card contains all the goals that you want her to achieve on a daily basis. It’s a great motivating tool for her to visualize all the goals she achieved and at the same time it’s another tool for you to analyze what she does right and where she might need more help. Also, as a perfectionist, her drive to tick off all the goal boxes will be increased.
  • Keep track of her weekly progressions in average scale weight. This is actually one of the best tools to track her progress without requiring a lot of effort on your side.
  1. If her weight loss stalls due to inaccurate food tracking or subconscious decreased activity levels (although I doubt it), you can use the same tools mentioned in option 1 or:
  • You can actually use yourself as an example to teach her how to track nutrition and daily activity properly. For example you could make short videos in which you show her how you log your meals and how you track your physical activity (the most easy option being the use of a step counter).
  • Give her a daily step count to shoot for and progress the number of steps overtime when weight loss drops. This is a very effective method to make sure her NEAT does not go down overtime.
  1. This is most likely the case. It’s also one of the biggest challenges for a coach to correct because you will need to put your client on a maintenance phase ASAP to get her back to healthy T4 to T3 levels. This requires a lot of trust from your client, especially with women. If she is structure/detail oriented and has perfectionist behaviour by nature, you will have to be very plan specific and analytical when you explain to her why you’re going to bump up her caloric intake to get her to lose more fat and become healthier overtime.

Since her caloric intake is so low for her weight, I’m almost sure this will solve her issue after 3-6 weeks, depending on how big/long the caloric deficit was and how severe her stress levels are. It can take longer. Again the most important succes factor here is not the increased caloric intake but making sure she understands why she needs to eat more calories for a while to become a fatburning machine again:

  • Start slowly at first: increase daily calories by 150-250 for 2-3 weeks and keep daily activity the same. She will gain a bit of weight at first but you know this is perfectly normal and you will need to explain this to her.
  • If she starts to feel better after 2-3 weeks (look for cues like less stress, more energy, less water retention etc.) and her average weight has not gone up yet besides the initial increase due to increased glycogen reserves and water retention, you can increase her caloric intake by another 150-250 calories. Keep increasing her caloric intake until her average scale weight starts stabilizing or going up slightly. Then you gradually increase her physical activity but make sure the intensity is low: steady state either via walking, cycling, swimming, gardening etc. No interval or extra resistance training sessions. Maybe an additional metcon session once a week is ok but focus mainly on longer duration energy systems work. If she already does a ton of cardio, do NOT increase it even further but slowly decrease calories again.
  • Keep track of her weekly average scale weight differences and adjust only if there has been a two week stall in progress. If you client is up for it, always adjust by increasing activity first, food intake after. Keeping food intake higher imo creates better long term results because your client will feel better, which will make him/her look better, perform better and be more consistent with the nutrition and training plan. Off course if you can’t increase activity any further or if your client prefers to move less, you can decrease calories again but make sure that you only decrease the necessary amount of calories based on the difference in average weekly scale weight to get back into the right weight loss range.
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Lou, I just wanted to say that the effort you put into your replies shows. Absolute legend.

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I appreciate you noticing the effort. It is hard work (and sometimes draining, I’m not gonna lie) but then again the simple acts of gratitude you get from helping other people makes it all worthwhile.

As a coach but also as a human being there’s nothing more rewarding to me than witnessing the excitement/pleasure/relieve people experience when you help them solve something they were struggling with. That in itself gives me great pleasure.

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Thank you, so much, @lou_smeets for your detailed and thorough response. You are greatly appreciated! This client is one that both @believer423 and I work with and I wanted to take the opportunity to reply to some of your questions and offer a bit more information.

As @believer423 mentioned, this client is very thorough with her tracking. Before coming to us, I do believe she was consistently eating in a deficit. Before setting any goals for her to meet nutritionally, our clients track for 5 days so we have a snapshot of how they have been eating intuitively. She is a mother of two, youngest is around age 8, and she lost 70 pounds after the 2nd child; stuck since. The first 6 months with us, we cycled her a few times from deficit to maintenance, back in a deficit and then to maintenance. We were in communication during her off time and she stuck to her goals, consistently, all during that time.

Yes, she is “puffy.” For the past two months, she finally caved, stepped away from just her Peleton workouts and has me providing her with programming. I have been able to increase her strength training since she purchased a barbell and plates, and she has really done well. I will not have updated photos from her until next week since she is on vacation. When I asked her about her stress, she said it was the same as usual (career mom of two, job: IT for Amazon). Does not claim to have issues with concentration and does not report anxiety with changes in her plan. Neurotype is unknown.She reports her food intake daily with detailed screen shots from MFP. She surpasses 10k steps daily, has 3 strength training days weekly, 2 days of no more than 30 minutes of cardio (because she loves her Peleton) and takes the weekends off. When she returned, she was on maintenance calories for 3 weeks, even bumped them up in there above calculated maintenance. We tried a weekday deficit and weekend controlled refeed schedule for a month, and there was no scale movement. Three weeks later, we gave her a significant carb increase for a week, going with a 60/40 C/F split instead of the 70/30 F/C split usually used. She had a deload week in her workouts week before last and is taking a vacation this week, where they will walk but no workouts. This last cut made was a 200 calorie cut, which was after her deload week, so her training resumed with her strength training being higher rep for the week, and she ended up a pound and 1/4 lost in the waist.

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Well, if she didn’t do any form of strength training before she started coaching with you and she only did peleton workouts alongside a big caloric deficit, chances are high she has lost some muscle tissue along the way.

She has an IT job so she spends a good amount of the day sitting so her TDEE is probably on the lower side. Did she do any other form of activity except peleton (for example walking, playing with the kids etc.) to increase her caloric expenditure any further during the day? How often did she do those peleton workouts (daily, every other day, 2-3 times/week)? These workouts burn a lot of calories (provided that you put big enough of an effort into it). If she has been doing this quite often to bump up her caloric expenditure and she has been doing this for a long time (months on end) with a low caloric intake, the deficit might have been to big for too long. This causes metabolic adaptations and (in some cases drastic) decreases in caloric expenditure overtime. The end result is often a puffier look because of the lost muscle tissue and increased water retention from inflammation and chronically elevated cortisol levels (being in a deficit and doing a lot of energy systems work increases cortisol output. Cortisol increases the action of vasopressin and aldosterone, two hormones that increase water retention and make you look fat even if you have lost fat tissue).

How big was the deficit you put her on and how fast did you switch between deficit and maintenance calories from 6 months up until 2 months ago? If the deficit was really small besides giving her weekly refeeds and you switched back to maintenance after a month or 2 and on top of that if the refeeds were done with an increase in carbs, there is a very good chance her average weight might have stayed the same or even gone up a bit. She might have lost some fat tissue, but the increase in water retention can be very misleading and make it look like she didn’t lose fat at all. I’m not saying this was the case because I don’t know the numbers. It is just an hypothesis.

This is definitely a good change of direction. Gen pop often have a hard time understanding that being a caloric deficit alone via food restriction and energy systems work is not sufficient to effectively lose fat (at least not long term). Don’t misunderstand me though, being in a caloric deficit consistently is the most important factor to lose weight (notice I’m using weight here and not fat) and doing energy systems work (mostly steady state form) will cause weight loss and will enable you to lose some fat (women often have a preference for this approach because they generally have more slow twitch muscle fibers than men), but doing only aerobic energy systems work, especially when it is performed for long bouts, will drastically increase the upregulation of AMPK via an increase in cortisol and adrenaline. And although you need cortisol/adrenaline to mobilize and utilize fat, too much of it for too long causes hormonal and metabolic changes. For example cortisol increases AMPK output, which shuts off mTOR, the enzyme responsible for muscle protein synthesis. Cortisol also upregulates the myokine myostatin, another enzyme that inhibits muscle protein synthesis and promotes muscle protein breakdown. Keep in mind that cortisol is not evil, you need it to be able to perform in the weight room and outside of that in daily life. Too much of it or chronically elevated levels is bad and will cause unwanted adaptations.

I want to make a point that cardio does improve fat oxidation and again, I do believe energy systems work is very important for maximizing fatloss IF it is performed in combination with resistance training 2-4 times per week alongside a moderate caloric deficit. Cardio can be a very effective tool to enhance fatloss, but you need to be careful and strategic in how you apply and periodize in into you training periodization.

Performing resistance training on a fatloss program provides a great stimulus for the body to maintain (or even slightly increase ) muscle mass via the upregulation of mTOR. This is the ONLY reason why should be lifting weights on a fatloss program, to get the right hormonal responses that help maintain or increase muscle mass.

So by incorporating both resistance training and energy systems work in your training plan alongside a moderate caloric deficit, you maximize fat oxidation and reduce muscle protein breakdown due to a better balance between mTOR and AMPK regulation.

I get what you’re doing but do not make the mistake of switching too fast between diet strategies or caloric intake. It’s cool to introduce all this variation to keep things interesting for your client and as a means to keep moving forward. Just make sure that it does not get too complicated.

I would suggest the following approach after she comes back from vacation:

  1. Let her perform resistance training 2-4 times/week depending on how she feels and give her a cardio progression for 12-16 weeks starting with a fixed amount of cardio per week and only increase the time or the amount of cardio sessions if weight loss stalls.

  2. Go for the marathon fatloss approach (0.5%-1% weightloss per week) and pick either ONE diet approach for the whole macrocycle or switch diet approaches from phase to phase. I would choose the higher carb approach because carbs do have a positive impact on T4 to T3 conversion due to their cortisol decreasing effect.

  3. When you start the new fatloss periodization, use the correlation method to recalculate her maintenance calories. The correlation method is best described as follows:

  • Calculate her maintenance calories based on her activity level and how often she does resistance training.
  • Let her eat the estimated maintenance calories for 2 weeks, writing down the total amount of calories she ate each day. After two weeks you calculate the average caloric intake from those two weeks.
  • Let her weigh herself every morning in the same outfit after she got up and went to the toilet for two weeks. Let her write down her daily weight and calculate the average body weight at the end of the week. You let her do this for week 1 and 2.
  • When the two weeks are over, check the difference in average body weight between week 1 and week 2. Convert this body weight difference to calories and add or subtract these calories to her average caloric intake.

Example: average caloric intake from week 1 and 2 (so the average intake from daily caloric intake from 14 days): 2550 calories. Average bodyweight week 1: 88,5 kg/ average bodyweight week 2: 88,3 kg → this is 0.2 kg weight difference → one kg of fat is approximately 7700 calories → 0.2 kg x 7700 = 1540/7 (7 days in a week) = 220 calories that you need to add to her average caloric intake → 2550 (average caloric intake from week 1 & 2) + 220 calories = 2770 calories → this is her exact maintenance calorie number.

  • The goal is to lose 0.5-1% bodyweight per week so after you’ve found out her exact maintenance calories, you can make the proper adjustments to get her into the right weightloss ballpark. OR if she wants to be in a deficit right from the start, estimate her maintenance calories, put her in the desired caloric deficit to get 0.5%-1% weightloss per week and use the same approach as the correlation method. After 2 weeks you can use the difference between average weight from week 1 and 2 to readjust her caloric intake.

  • When her average weight loss stalls for 2 weeks straight, make adjustments by increasing her caloric expenditure (increasing cardio sessions either by time or total number and NEAT), decreasing her caloric intake (fat first until you reach 20%, don’t go lower than that for women, then reduce carbs) or do a combination of both.

@lou_smeets i greatly appreciate your time and effort to detail. You’re quite an asset. Lots to mull over. Thank you!
Thanks also @TrainForPain, @supercardrives and @fitafter40.

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I would reffer her to someone who doesnt look for advice online from people who most have no education in the field.
I would feel super shitty if i would pay someone and then find out he is getting advice on some forums.

As a combat instructor, if i cant teach a person, i dont go on youtube to watch some MMA highlights to “teach” this person - im honest and i say that i cant train him, and reffer him to other good people i know. If you need help from random people on the internet, the correct way is to be honest to your client, not take their money and look for answers online. What sucks is that most people online cant deal with themselves, not to mention advicing someone who takes money for that.

I honestly can NOT thank you enough! Much of what you have said is in line with some of our assumptions and you have also offered some deeper insight that this client will appreciate as we do. @believer423 and I have been collaborating about this client and have assumptions but your input is so incredibly valued. May you and your family be blessed beyond measure

@hankthetank89 … it appears some the community guidelines for the forums have escaped you.

Be kind to your fellow community members.
Does your reply improve the conversation?
Constructive criticism is welcome, but criticize ideas, not people.

First, this client has already had success with us, as have the thousands of others we have helped. Because of this client’s success the first go around and things not budging, with two minds working with her, both of which are highly educated and trained. There are times, as a professional, where collaborating with other like-minded individuals is more about helping the client than tripping over one’s own pride. She truly has us both stumped and that hasn’t happened. We both wanted input from a fresh set of eyes, to see if there was anything of which we had not thought.

You sure do jump to conclusions, sir, and make some wild accusations of others, without knowing a thing about their background and abilities. Hopefully your clients don’t suffer the same prejudgments as you show in a forum filled with true professionals.

Just because you dont like my opinion, it doesnt mean i am not kind. I didnt call anyone a bad name or imply that someone is bad. I, as a trainer myself, said, that the best thing to do is to refer the client to someone else. I do it, most good trainers do. It is not a moral thing to do, to hold on to a client and google the problem, instead of being honest to him.

He asked what to do, and i answered what would be the moral thing to do in my opinion.

I critisize the exact idea of someone googling answers for which he takes money. I never said the person is a bad trainer. I said that in this case, you refer to someone else. If a doctor cant fix a problem, he should call other doctors, NOT watch youtube on how to perform surgery and do it anyways.

Exactly 0 accusations from me.

A professional who respects his profession knows that looking for answers on online forums might not be a moral thing to do. At least, while he cant offer a clear solution to a problem, he shouldnt charge money.

I understand that we live in a world where anyone who takes some tren and looks a bit leaner than anyone else, can say he is a trainer. BUT… I still believe that if you cant help 1 person, you shouldnt take money and continue to train him, while googling answers and not knowing what to do.

All i said was that if i would to hire a trainer, and i found out he is just discussing me online looking for solutions, i would want my money back.
I never made any accusations, or insults to anyone. I just stated that i believe in morality of a profession and if you ever get a client you cant help, you should just be honest - thats it.
You trying to turn this into a personal thing only says you know the OP or you alse get some money from the same client.
Again - i never turned on a personal note. You tried to do it. And all the accusations came from you about me making accusations :man_shrugging:t3: