 Our first caller is Anna from Maryland. Hey, Anna, how can we help you? Hi, guys. Well, first off, I just wanted to say, as everyone says, you guys do great work. Thank you for putting this podcast out. So yeah, I just want to start with that. I have a question about one of my clients. So I am a trainer. Actually, this month marks my one year. So I'm a newer trainer. And I have a client that I've been working with since the end of May that is a bariatric patient. So about a little over a year ago, she got the surgery. I had put her on a strength-focused, pretty linear progression, anabolic-esque type workout program. And she was doing really well. Her strength is doing well as she's going up in weight and getting stronger every session. But we did her body fat about the beginning of August. And she actually had went up body fat. So my question is, how do you increase a bariatric patient's metabolism? I think I also put in my question, would things like aminos and other supplements, in her case, be more important? So if you could just speak on that. Yeah, a really, really good question. So first thing I want to ask you, though, is how did you do the body fat test? Because you said she got stronger, but her body fat percentage went up. And I know body fat percentage tests are notoriously challenging to do when people have a lot of body fat. The larger they are and the leaner they are, so when you get in the extreme ends, the more inaccurate they are and the harder they are to try. Yeah, but don't you think that's almost obvious that's going to happen if she had the surgery in the last year or even two years? She's losing weight like crazy because her calorie intakes, she's losing just total weight too fast. Well, I want to, maybe, but she got stronger. That's why I want to ask, how did you do the body fat test the first time and then each subsequent time? Yeah, so I do work at a studio. I moved from a big box gym that did in bodies with bioelectrical impedance to somewhere that does skin calipers. So I was curious about getting her on an in-body machine, but we did calipers. And you did calipers the whole time? Yes. And how much did her body fat percentage go up? All by, like, 4%. OK, so that's within the realm of error, but, again, what Adam's saying could be true. I mean, losing that much weight. The only thing is that her strength went up, and honestly, when you're dealing with that much weight loss, that's really the main thing that I'm looking at is, are you getting stronger? As far as the supplements are concerned, of course, you want to work with her doctor because they do have pretty specific nutritional requirements. She's probably already on multivitamins and other supplements. But can amino acids and protein powders help this person? In my experience, yes, very much so. Easily digestible protein that's easy to consume and convenient can help when somebody's stomach is so small or they can't consume as much at one sitting. Digestive enzymes can help, so can amino acids, but I would work with the doctor to make sure that this is all OK. How many calories is she currently on right now and how long ago was the surgery? So I have her tracking, but she's not very good at keeping it. She seems to be around 1,200 sometimes, can get to like 1,250, so pretty low. And how long, how long? How long she been from the surgery? Away from the surgery, removed from it? Yeah, how long ago was the surgery? A little over a year. OK, well, there you go. I mean, that's, Sal, if someone goes down, if someone was eating 3,000 plus calories a day, they do the surgery, they're eating 1,200, you can get stronger, especially since you've been training with them. It's very normal for her to get stronger, but she's losing weight at such a rapid rate that the ratio of muscle to fat is higher. So that's what makes the body fat percentage go up, which is extremely common with this situation. So that's not, I wouldn't be too worried about that. That's how I'd explain that to her, is that, listen, we have dramatically cut your calories. And even though we are building some muscle and we are heading in the right direction, you're losing so fast that it's very normal for you to also lose muscle because we're no longer feeding it enough calories to sustain it on your body. So that's all normal. Yeah, I would be entirely focused on performance. I've worked with a few bariatric patients. And I mean, essentially, that surgery forces you to lose weight. And when it comes to supplements, I always would work with the doctor because you're not dealing with a normal digestive system anymore, so there are special requirements. But I would focus entirely on performance, make the whole thing about performance. I wouldn't look at the scale. I wouldn't, first off, she's gonna look at the scale anyway. She's probably already getting tracked by the doctor. She's very aware of how much weight she's losing or not losing because that's why she did the procedure. I would focus entirely on performance, stamina, strength, mobility and endurance, and move in that direction because in my experience, it's already so body focused that if I keep placing focus on body, it can oftentimes make it a very stressful situation. And when you're dealing with somebody who medicated themselves with food for so long, what you don't wanna do is make an experience something that may not be as enjoyable. And I found that just focusing entirely on performance tends to do a better job with this particular population of people. I mean, I would also, I wouldn't, I would personally, whether that's you, you don't need to probably involve her as much, I guess, but I would definitely make an effort to keep her protein intake perfect because she's gonna be so low calorie that making sure she's on a higher protein diet will be muscle sparing for her. Even though to Sal's point, that shouldn't be the focus. We don't need to worry too much about that. It's inevitable that if you reduce your calories at that rate from the size that she probably was at before, we're gonna lose muscle too. But to minimize how much muscle we lose, I would, I'd be focused for you as a coach at keeping her protein intake, you know. But you could tie that to performance, right? So rather than saying eat more protein so you don't lose muscle or so you get leaner. So be stronger. Exactly. We wanna look at strength. We wanna see how strong you can get. I wanna see your performance. And I think we need to increase your protein intake in order to do that. And then shakes can be very valuable for people in this particular situation because of the procedure that they had, it's harder to digest food. They don't have as much capability to have as much food at one time. And liquid shakes can oftentimes be something that helps quite a bit. And here's what's happening is we're so low calorie that fat and muscle is just coming off the body at such a fast rate. At what point that will start to, especially if you're strength training, if you're strength training, we're getting adequate protein. At one point, probably the fat loss will continue and then she'll start to kind of hold her muscle mass. And really that's kind of your indicator of like you guys are really on the right path is that she started to level off on the body fat percentage. But I would- She has. Oh, she has. Well, and that's to update since I wrote in the question for a little under a month now, she's been at the same weight. Like she comes in, she's like- That's great. It has not budged. This is so funny. So I'm hopeful that like the next time we do the body fat percentage, there might be a change in that composition, but I don't know. And again, it's a different client I've ever worked with. I told her to try to up her cow. See, I wasn't sure about upping it with protein or carbs because I know protein is very satiating. And for her, it's really hard. She's already had, I think it's called dumping syndrome which a bariatric patients can get. And it's just, they get really full and they feel sick kind of thing. So I actually told her about like 200 calorie surplus with carbs, you're saying protein instead, most likely. Yeah, proteins, fats. I mean, you want to get that. But I mean, if she feels better with some carbs, that's fine. Small meals throughout the day, this is where the benefit of that is. You know, someone like this would be doing like seven or eight snacks throughout the day because eating too much at once can cause problems like you said with dumping syndrome. I do want to go back to the body fat test though because when you're testing, especially skim fold, when I'm doing someone who's super obese, boy, the error that I can measure with that is tremendous. Like how much did she weigh the first time you tested her versus the second time you tested her? Like what is her weight at now and where was she when you first did her body fat test? Do you know? Yeah, so she came in, she was 186, 186 and now she is budget 162. Okay. Well, that's not too, that's not too heavy but you- No, so it's not as hard but it's still interesting. Yeah, but again, I mean, I never tested body fat with bariatric patients. I didn't even- I was gonna say that. We didn't even talk about that. No, that wasn't part of the conversation. I think the focus with that, they've obviously taken extreme measures to lose the weight. At this point now as a trainer to be able to establish building muscle as the main goal and objective and getting active recovery with that and being able to implement these better habits is the utmost priority. So to focus on the strength part of it and really just keep reiterating it's gonna take a while. Like this extreme shift, now we have to really kind of take all these steps which is gonna take a lot of time to establish a built, repaired metabolism to be able to kind of go forward from here. And increasing the calories through carbs and fat I think is fine so long as she's getting at least the bare minimum protein. So I would, that's the one thing. Otherwise we're gonna lose, continue to lose muscle. She's eating 20 grams of protein every day. And the rest is most carbs and fat to get to her 1200 or so calories. Then you can do all the strength training in the world in a caloric deficit and grossly under consuming protein, we're gonna lose muscle. Minimum we wanna hit like 70 grams. Yeah, so that's how I would decide what those calories come from is, if she's hitting a good amount at 60 to 80 grams of protein at least, okay, well we could eat whatever feels the best for you whether that be carbs, fat or protein. But if she's grossly under eating protein, 20 to 30, say even 40 grams of protein every day then I'd be encouraging those extra calories to come from protein. Consider this Anna, you're working with the hardest, one of the hardest segments of the population in terms of getting someone to achieve permanent success with fitness and nutrition. It's one of the most challenging segments of the population. So think that way the entire time. What you don't wanna do is think of goals short term but rather how can I get this person to develop a relationship with exercise and nutrition to where they'll be able to maintain it forever? Okay, always and forever. They've already, I mean, we can guess that they probably had a bad relationship to food to begin with and exercise is very closely connected to that. So measurements, body fat tests, weigh yourself, macros, counting calories, like that can all be a stress and make it feel negative and all that stuff. So I like to really focus on performance. Like imagine if this client really started to just love, they stopped thinking about their weight and really just love getting faster, getting stronger, being able to do new exercises and move in different ways and enjoy that. The often side effect of that is they eat better. They start to eat to fuel their body. They start to develop this relationship with exercise where they, I just love doing it. I just love going to the gym because I feel good and I love moving and I love doing these new exercises I couldn't do before. So that's really the direction that I would say to focus on because don't think of yourself so much as I'm a trainer and you produce results for this person. Think of yourself as more of a guide and I need to lead them to a situation where this person now has achieved permanent success. I don't know if you're familiar with the long-term fail rate even with bariatric patients, it's not very good. So that's where I would place my entire focus, at least that's what I did and I still didn't have the greatest success rate but it was better than when you looked at the averages. Gotcha. Yeah, no, she's starting to get there and I mean, I started working with her when she'd already dropped a lot of weight. You know what I mean? After those initial months, you start losing really quickly. So she was already down pretty much and the other day tried to pick up the 45 pound barbell and like curl it for like 12. So she's getting into the strength part of it and I think the strength is actually what's exciting her. Excellent, perfect. All right, well, perfect. Well, thank you for calling in. And actually, I wonder if this person would benefit from our intuitive nutrition guide. Do you have that? No, I do not, no. Let me send that over to you. You could read through it and pull from it and it might help you communicate with this particular client in a healthy way with nutrition. There's some good stuff in there. Awesome, sounds good. Thank you very much. Thank you, Adam. I appreciate it guys. Do you guys remember, so I know you guys have worked with clients who've been trained quite a few. Yeah, and I know that the 24-hour Santa Teresa, there was a clinic there. I worked, and I remember my first time working with this population and it's very, very challenging. I remember the first client I had, I got them, they lost lots of weight, got them in shape, we did the whole meal plan, the whole deal, didn't see them for years, ran into them later and I could not believe how much of the weight they had gained back. I thought it was impossible to gain the weight back, but I guess through just sheer will and just not having a great relationship with nutrition and food, they were able to do it. And I remember thinking to myself like, I need a completely different approach. Same thing happened, it's like not addressing the root of it all and it was so frustrating to see that. But again, it's so addictive once you start losing weight. Like that's like one of those things, like to slow them down and to be able to kind of really address it through behavior and to change those behaviors later on in my career. Like I figured how to do that and how to communicate that a lot better. But I mean, you're their cheerleader in a sense too. Like you want them to lose the weight because you think the weight is really the biggest issue that's keeping them unhealthy. And then you further on realize, oh, well, this root of this behavior hasn't been addressed yet. And so therefore, this is gonna keep coming back and something that you gotta keep continually dealing with. Well, and for all the trainers that are listening to this and that have clients like this, it's very normal to see the body fat percentage go up like that. So that's why I was trying to stress that like it really doesn't matter what they're using. And did you even test body fat for clients like this? I know. And that's part of the reason why you don't worry about that because it's not good news you get back. They're training with you three days a week. They're doing what they're supposed to. Strength training, they've got a good balance in their macros. You would like to show them, oh look, you lost 30 pounds the last two weeks but we got more muscle. The reality is their calories are so low. And they can't absorb very much. Yeah, never really gonna lose muscle with it. That's right, they're gonna plummet. And really the strength training aspect of it is just to slow down the atrophy of muscle during that process. That's the sad truth, isn't it? Yeah, because it's inevitable because of how low a calorie they are. And then again, back to my point about the protein, that would be my biggest concern as far as helping slowing that process down because if she is eating only 1,200 calories and only eating 20 to 40 grams of protein, that's gonna continue for a while. I mean, she's gonna continue for quite some time before her body probably levels out or else she's gonna continue so your body fat go up even with the scale going down.