How should I train my 60+ year old obese mother?

[Renard]

Hey Barbell Medicine crew. The title implies a bit more ignorance than I actually have on the matter. Thanks to the excellent video by Alan, Training Older People with ZERO Experience, I feel comfortable with the general concept of how to train an older individual. More specifically, I’m looking for more information and details on how to run the Beginner Prescription for her.

Context for my mother: My mother is in her sixties, extremely sedentary, BMI of around 39, pre-diabetic, needs both knees replaced (one of which is scheduled for later this year), and is incredibly resistant to dietary or lifestyle changes. My father and I are trying to motivate and help her to drop weight and improve quality of life, as it is significantly impaired. In addition, if she wants this knee replacement to last, we know that she needs to make changes.

Context for myself:
I’ve been following fitness for over ten years, but my practical hands-on experience is minimal. One of those “armchair experts”, if you will. I’m a partially-educated nutrition and food science major who focused on dietetics and I’ve trained off and on following a variety of styles of training and sports throughout those ten years, but I only have about eight months of barbell training under my belt, all performed with Barbell Medicine templates.

With the knowledge Alan has passed on, I have a general idea of how to coach the movements for her and how to load them appropriately, but should I just run her through the first month repeatedly as she progressively improves her performance? At what point should I try to push her to further levels or continue in the program? Is there a superior program for her out there? Unfortunately there isn’t a suitably qualified coach in the area to help her and she seems unenthused about the prospect of online coaching. Truthfully she is unenthused about training at all, but with a program we can physically put in her hands it seems more likely to succeed.

My intention for GPP is to get her started with walking in the pool for 20-30 minutes 1-3x per week if possible and focus on that as the priority to manage her investment and stress to keep her engaged. So pairing that with the strength training, I’d like to see her in the gym more frequently for shorter sessions to build the habit.

As one last aside, I wasn’t sure whether to make a separate post in the nutrition forum or not, especially since this is verging on a consultation I fear, but are there any recommendations for internet accessible programs for nutrition? I can tell her exactly what to eat and do all the number crunching for her and she still doesn’t want to listen because she’d rather listen to someone on her Ipad tell her how to do things with flashy infographics. Apart from Layne Norton’s Carbon Diet Coach app, I can’t think of any apps or programs that are from sources that aren’t just a gimmick or fad diet. Are there any reliable evidence-based sources that I can just put in my mother’s hands via electronic device?

[Jordan_Feigenbaum]

Thanks for the post and good on ya for getting your mom involved. A few thoughts in response to your questions:

should I just run her through the first month repeatedly as she progressively improves her performance?

We would have her repeat the last week in perpetuity as long as she was increasing her performance week-to-week.

At what point should I try to push her to further levels or continue in the program?

She should probably be able to demonstrate a strength improvement week-to-week on the main exercises, I.e. the ones done first on each of the training day.

This is described in the Beginner Prescription article as follows:

The fourth and final week of this phase is designed to be run repeatedly as long as the trainee is demonstrating a continued trend of improvement.

The expectation is that, on average, an individual should be getting demonstrably stronger week-to-week when following appropriate programming. With that said, there isn’t a one-size-fits-all answer regarding how much weight to add per week, as individuals vary greatly in their response to a given training program. In general, we recommend adding approximately 1-5% per week without overshooting the recommended RPE targets.

There are more in-depth discussions of what to do and how-to do it in the Beginner Template, which may be useful to you and your mom.

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Is there a superior program for her out there?

I think there are many viable exercise programs for individuals to meet or exceed the current physical activity recommendations. I think there should be a high amount of user-directed exercise selection, autoregulation, variety, etc. and so there are certainly other programs that fulfill these criteria. Are they better? I’m not sure there is a best program for this application.

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Are there any reliable evidence-based sources that I can just put in my mother’s hands via electronic device?

Are you sure that’s what she needs to change her dietary pattern? In other words, does she need to interact with an app to change her eating habits, eating environment, etc.? I am thinking this is likely not the case and I’d be curious to know where she’s currently at with respect to behavioral change.

[Renard]

Thank you for the response, Jordan. Compliance and adherence are her two biggest problems without question. It’s so hard to facilitate behavioral change with her. If it weren’t for my father pressing me to help I think I would have given up months ago. As the old saying goes, you can lead a horse to water, but you can’t make it drink.

We would have her repeat the last week in perpetuity as long as she was increasing her performance week-to-week.

So just run her through the program the same way I went through it, repeating the last week of each training block as long as progress is being made? Makes sense. I just wasn’t sure if any changes needed to be made because of her specific situation. I actually started with the Beginner Template as well, so I’m very familiar with it and, risking arrogance, its nuances. I suppose since she’ll be starting with some of the deloaded variations shown in Alan’s video she’ll have quite a bit of room to progress, even repeating the final week of the first month.

I think there are many viable exercise programs for individuals to meet or exceed the current physical activity recommendations. I think there should be a high amount of user-directed exercise selection, autoregulation, variety, etc. and so there are certainly other programs that fulfill these criteria. Are they better? I’m not sure there is a best program for this application.

If you believe the Beginner Template is appropriate even in this situation then that’s certainly what I’d prefer to implement. I have more faith in the Barbell Medicine crew than anyone else in the industry, so anytime I can use your programs to help others that’s my preference.

Are you sure that’s what she needs to change her dietary pattern? In other words, does she need to interact with an app to change her eating habits, eating environment, etc.? I am thinking this is likely not the case and I’d be curious to know where she’s currently at with respect to behavioral change.

It feels like we’ve tried most of the other options so far. \She’s incredibly resistant to change and is firm in her belief that dieting means starving yourself. She consistently goes through the cycle of starving herself throughout the day before binging on highly-processed ultra-palatable foods at night. I’ve tried cooking healthier alternatives of foods she likes using lower calorie ingredients, prioritizing protein and foods with low caloric density like fruit and vegetables, but she balks at anything that isn’t her preferred food, even if it’s nearly as good. Sometimes she even goes so far as to compliment my cooking at the dinner table before picking at the meal. Then she leaves the leftovers to rot because she didn’t actually enjoy them, she simply lied to my face so as not to insult me.

I consider it a miraculous success that we’ve managed to convince her to start having a bowl of 0% fat greek yogurt with berries and a non-nutritive sweetener as a snack at night.

When my father or I try to convince her that eating cake every day is bad for her, or that she doesn’t need to starve herself but rather eat healthy portions and better foods, she acts like we’re insulting and deriding her. I’ve tried both aggressive speech (usually when I’ve lost my temper) and pandering kindness, and she responds similarly to both. She is always the victim who is being harassed.

A big reason why an external source of information and dietary programming might be the solution is that she sees me as a rude child who is treating her with disrespect, while she sees my father as a rude husband who is just being mean. Meanwhile she’s glued to her Ipad, lapping up whatever nonsense is spouted by influencers on the internet. Not that she implements anything they’re saying either, but at least she’s receptive to them. Her doctors don’t seem to care either, as none of them have addressed her weight as being a concern. Even the doctor involved with her knee replacement hasn’t brought it up. But of course, changing doctors isn’t an option because she likes them. If my father were to try and find a different doctor for her, then that would be his controlling an

She had a rough childhood and that has led to this self-defensive “everyone is against me” mentality, but even if its understandable, it doesn’t make her easier to work with.

I don’t even know if we’ll ever be able to get her to agree to anything, fitness or food, but having the right plan could make a difference. She does recognize she needs to make changes, even if its only a verbal agreement to make my father and I shut up. She just doesn’t act on it. She says she needs to lose weight for all the reasons we’ve told her, but then halfway through the day says “I want cake”. Then she gets cake. But if I try to make a lower calorie cake to meet her halfway? Disgusting. Wretched. She won’t touch it.

[Jordan_Feigenbaum]

Yes, I think she - and everyone else- who is running the Beginner Prescription should run the final week as long as it’s working, is enjoyable, etc.

As far as being resistant to change, I can understand that. There are a number of different ways to come at this, though I suspect a professional might be the best if she’s open to seeing someone. I would prefer this over an app.

A few things that may be helpful, if she’s open to talking about this:

1. Ask her more about her current beliefs and knowledge of nutrition, e.g. “what is your understanding of diet and its influence on your health?” - and just let her talk. It probably will help reveal some additional nuance.

2. Ask her if she would be willing to make any changes to her diet and, if so, what would she be willing to do? She may ask or need suggestions, which is where a professional or you can come in if you feel comfortable. You may use phrases like, "on a scale from 1 to 10, with 10 being extremely ready to ___ and 1 being not ready to ___, where are you at with respect to ___. " Identify some things she IS willing to do and go from there.

3. Ask her what foods she likes and see how you can work those into the family’s eating plan.

4. See if it’s possible to change the food environment. For example, why are there foods like cake and ultra processed energy dense foods in the house? Are there foods that could be part of a health promoting diet that she’s willing to eat that could make up the majority of the food environment?

5. See if making it a social thing helps, e.g. having her change her eating habits with a friend or the rest of the family is something that could be leveraged.

In any case, this might be a time where Luke (from the bible) got it right when he wrote, “Truly I tell you,” he continued, “no prophet is accepted in his hometown.”

It sounds like you’re willing to help, but you might not be the right person with the right authority for this particular audience. If she has access to a number of different doctors, I’d bet it would be possible to get a referral to a dietician and/or a behavioral specialist to leverage their skills.

It definitely seems like a tough situation and its admirable that you want to help, but there are no easy solutions here, unfortunately.

-Jordan

[Renard]

Thank you so much, Jordan. I really appreciate your time and advice.