Introduction

Welcome to the Board Certified Obesity Management Specialist, COMS Guide. This program is a guide for professionals who are interested in expanding their careers to include clients who are considered overweight (BMI >25), obese (BMI >30), and morbidly obese (BMI >35) as defined by the National Institutes of Health.¹  BMI <35 Handout  BMI >35 Handout

The Board Certified Obesity Management Specialist, COMS program provides a well-rounded approach to weight and health management. The Board Certified Obesity Management Specialist program is a guide to assist you in leading your clients to achieve both short-term weight loss goals, but more importantly, achievement of long-term weight management. This is accomplished through education and training that combines the three areas of weight management: nutrition, physical activity, and behavior management. Each of these components is necessary in any design of a successful weight management program. This three-part education module allows for you to meet the individual needs of your clients. It also assists you in preparing your clients for continued success and improved health.

A study published in the Annals of Internal Medicine reported that dietary counseling for a period of one year resulted in an average weight loss of 6% or 10-15 pounds compared to no weight loss with the control group. Once the intervention ended approximately half of the weight loss was maintained at three years, but almost none of the weight loss was maintained after five years.² It has been known for decades that some form of intervention and accountability is necessary for clients to maintain long-term weight loss. With this program it is important to understand that your goal is to encourage an activity program and nutritional balance that lead to success rather than setting your clients up for failure. Having your clients begin with more than they can achieve will lead to frustration and possible failure. The objective is to encourage increased physical activity in many forms.

The recent increases in mortality due to the presence of obesity have caused great concern within the medical and health communities. Dr. Michael L. Dansinger, MD of Tufts-New England Medical Center stated,

Moderate weight loss, 10 to 20 pounds, has a dramatic effect on most of the medical problems caused by obesity. Diabetes, cholesterol, blood pressure, and stroke risk all appear to be nicely reduced by a moderate amount of weight loss. People don’t have to lose 100 pounds to make a big difference in their health.³

Clients are now afflicted with multiple diseases or comorbidities associated with obesity including cardiovascular disease, diabetes, hypertension, and elevated triglycerides and cholesterol.  The assessment and management of obesity has increased in difficulty; thus the importance in weight loss and/or maintenance has become imperative. The current approaches are not providing lasting effect; a new approach must be made, and education and support must be continuous for weight maintenance.

The treatment of obesity, although multi-faceted, plainly involves disease management, consuming a nutritious, portioned diet, increased daily physical activity, and behavior management. COMS utilizes lifestyle patterns and behaviors to slowly, but progressively promote the necessary changes. For many of your clients achieving and maintaining a healthy weight is a lifelong challenge. Your program should embrace a long-term approach with focus on health and quality of life, independent of weight loss. COMS suggests that your treatment design should be structured around a six-month to one-year intensive program with an unlimited maintenance phase and availability for the client as he or she continues to progress in lifestyle management.

Understanding that some of your clients have the knowledge but lack the motivation will help you properly shift from an educator role to the coaching role. Behavior management and coaching can be the most important elements of understanding and guiding your weight management clients. As one client stated,

The behavior education and guidance were the most effective part of my weight loss program. Most people who need to lose weight know how to read labels and exercise; we just don’t know why we don’t do the obvious steps for our own health.

The traditional approaches of dieting fail because they measure success only by rigid external goals such as weight loss, the achievement of an “ideal” body weight, and strict adherence to a restrictive diet. Despite any initial weight loss successes, it is difficult to follow a traditional program for any length of time. These programs often raise more negative issues for the dieter than they resolve. Your clients may complain of frequent feelings of hunger, feeling of restriction and deprivation due to elimination of many favorite foods, awkwardness at mealtime when eating differently from family and friends, or feelings of guilt with “cheating.”

More than ten years ago the Health and Medicine Division issued a report recommending that treatment shift the emphasis from weight loss to weight management. “Specifically the goal of treatment should be refocused from weight loss alone, which is often aimed at appearance, to weight management; achieving the best weight possible in the context of overall health. This concept includes weight loss but is not limit to it.”^4,5 The report went on to recommend that weight management programs incorporate components that go beyond traditional dietary changes aimed solely at weight loss. Suggested components included:

• Increased physical activity
• Behavior modification to change high-risk eating patterns and sedentary lifestyles
• Cognitive-behavior strategies to reshape attitudes and beliefs about unrealistic dietary expectations and weight loss goals
• Stress management
• Self-empowerment
• Participation in support groups

Even though these recommendations are more than a decade old, most programs continue to use portions of them to this day. Each of these components is contained within this program. The primary goal of the program is to reduce the effects of excess weight and unhealthy lifestyle habits, regardless of whether an “ideal weight” is reached. Successful treatment outcomes are not defined by adherence to a particular diet and achievement of a targeted weight goal, but by improved health and a reduced risk of disease. Read this article on IMPROVING WEIGHT MANAGEMENT OUTCOMES through a multidisciplinary approach.  

Sensitivity to your clients’ behavioral management needs will allow you to have a better relationship promoting trust, understanding, and growth. Many businesses are now offering sensitivity training to employees to assist in this very area. You must be sensitive with your choice of words, mannerisms, and motivational techniques. With improved understanding through this certification program and new direction with your weight management approach, you will help your clients see increased success!

Remember: as a health and wellness professional working with clients who are overweight or obese, you will be considered as providing professional or medical intervention. Your professionalism in your documentation is key to maintaining information on your clients; clear and concise notes are helpful in your clients’ care and follow ups. Your notes can also be helpful information for your clients’ treatment plans with their physicians. Do note they are legal records and can be subpoenaed.

This is a guide that should be utilized in association with your professional training and the additional suggested reading material. Although the supplementary reading material is not necessary, it is provided for you to gain additional education for your benefit and the benefit of your clients.

1. Losing Weight, Body Mass Index. (n.d.). Retrieved January 9, 2019, from https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi_dis.htm
2. Meta-analysis: Effect of Dietary Counseling for Weight Loss. Annals of Internal Medicine July 3, 2007.
3. Dansinger, Michael, et al. Meta-analysis: Effects of Dietary Counseling for Weight Loss. Annals of Internal Medicine. July 3, 2007; 147(1);41-50.
4. Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, Buchner D, Ettinger W, Heath GW, King AC, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995. 273(5):402-7.
5. Yumuk V, Tsigos C, Fried M, Schindler K, Busetto L, Micic D, Toplak H. European guidelines for obesity management in adults. Obesity Facts. 2015. 8:402-424. http://doi.org10.1159/000442721