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Monday, November 19, 2007

Should All Personal Trainers be Allowed to Treat Obesity?

In today's edition of CMAJ there is a statement worth noting regarding the qualifications that exercise professionals should have before being allowed to work with obese individuals.

The basic point of this statement (co-signed by a number of prominent Canadian Kinesiologists and Exercise Physiologists) is that because many overweight and obese individuals are at an increased risk of various co-morbidities, including cardiovascular disease, it is imperative that exercise professionals involved in treating such individuals have a clear knowledge of the absolute and relative contraindications to exercise for patients with obesity.

The authors strongly believe that such knowledge can only be developed through formal and rigorous post-secondary academic training within a faculty of exercise science, which is in clear contrast to some personal training designations provided by "for-profit" organizations that do not require advanced college or university education in health or exercise science. In their statement, the authors go on to describe what they feel is an acceptable standard of qualification and certification that will best ensure patient safety.

The points are certainly well taken and I fully agree that dealing with obese patients in particular requires sound medical knowledge and expertise in exercise physiology.

Not only are obese patients at increased cardiovascular risk, but they are also at extreme risk for mechanical injury due to lack of flexibility, balance and coordination, particularly during weight-bearing exercises. Existing back, hip and knee problems can easily be exacerbated by a misguided "boot-camp-drill-sergeant" approach to "let's-burn-off-those-calories".

Immobility resulting from musculoskeletal injury caused by improper and overzealous exercise routines can only exacerbate obesity and cardiovascular risk factors and will certainly pose a direct threat to effective weight management.

The much bigger question here is not just about personal trainers or self-appointed exercise gurus but rather about the entire for-profit "weight-loss industry".

While there is certainly an important and often invaluable role for lay-persons in peer-support groups, buddy systems and walking clubs, the fact that patients often have no way of recognizing qualified from unqualified health professionals can indeed pose a health hazard, particularly for obese individuals who will clutch at any straw for help.

The key question indeed is that if obesity is really a disease, should someone who is not a certified and regulated health professional be allowed to offer treatment? Can we forbid self-appointed "health advocates" to offer their services? Probably not. Would we recommend that our patients seek help or advise from individuals with "iffy" qualifications? Not likely.

An important function of WW will be to help patients find community services that help them improve their health (with or without weight loss!) without putting themselves at risk.

Clearly, the bigger the patient, the greater the risk - self-imposed limitations and/or legal restrictions on working with clients above a certain size may well be in the interest of anyone working in this industry who does not have the training and credentials to work with obese clients.


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