When it comes to general health, diet and exercise go hand in hand. You can't have one without the other.

When it comes to health clubs, helping people get healthy and generating revenue must go hand in hand. Again, it's hard to do one without the other.

But what happens when, caught up in the pursuit of giving your members and your club the best results possible, you or your staff overstep the bounds, crossing and perhaps blurring the line between exercise professional and nutritionist? Unless you're certified or licensed as both, you could be in a whole lot of trouble.

While most people in the industry are aware of the highly covered negligence lawsuit Capati v. Crunch Fitness (a wrongful death case where a 37-year-old woman died of a brain hemorrhage after working out and taking dietary supplements — allegedly recommended by her personal trainer — that negatively interacted with the prescribed medication she was taking for hypertension), many clubs still unknowingly push the legal limits of what fitness professionals can and can't do when it comes to nutrition. Although no recent cases have gone to trial in this area (most lawsuits are settled out of court and are never published), the potential for lawsuits is there, especially as more clubs sell supplements.

It's no wonder fitness facilities want a piece of the supplement pie. Supplements make up $21 billion of the $75 billion nutrition industry. An estimated 38.2 million adults in the United States used herbs and supplements in 2002, and more than half of those consider herbs and natural products as important to their health and well being. When it comes to weight loss, a survey by the University of Connecticut's Center for Survey Research and Analysis found that of the more than 1,400 people surveyed, 65 percent of them mistakenly said that weight loss supplements were tested and proven safe, and more than half incorrectly stated that weight loss supplements are approved by the U.S. Food and Drug Administration.

“I've had several personal trainers who say the same thing consumers say, ‘It wouldn't be on the market if it wasn't safe,'” says Cynthia Sass, RD, spokesperson for the American Dietetic Association.

Not to mention that supplements are everywhere, especially in health clubs, says Barry DeVilbiss, vice president of retail products and services for 24 Hour Fitness, San Ramon, CA.

“That's both good and bad,” he says. “It's great that there are more options for people to consider, but the challenge is when you don't have [supplements] that have been reviewed, tested and integrated into everything else you're doing.”

The other challenge is making sure your fitness staff stays within its expertise.

“Owners and managers need to understand the distinction of individual versus general nutrition information,” says JoAnn Eickhoff-Shemek, professor and coordinator of exercise science at the University of South Florida. “Our role is to provide education and information and tell clients where to go to get good, reliable information on supplements, then let them know that if they take something, it's their decision.”

Walk the Line

It's easy to see how the line between fitness and nutrition can become blurred. Answering a client's simple question such as, “Should I take a multivitamin?” or “What do you think of the [insert latest diet fad]?” can quickly put a fitness professional into litigious territory.

Eickhoff-Shemek hears about benign situations like these all the time from her undergraduate and graduate students. Giving individualized advice about nutrition and diets or recommending a supplement to lose weight is outside of the scope of practice for personal trainers and other fitness staff unless they are licensed, registered or have a statutory certification in nutrition or dietetics (for more about regulations, read Laws that Regulate Dietitians/Nutritionists at www.fitnessbusinesspro.com/legislation/law-dietitians).

“It's a pretty concerning issue facing health and fitness facilities,” Eickhoff-Shemek says. “This is definitely a liability exposure that managers and owners should be aware of to help minimize.”

By overstepping into the nutrition realm, fitness professionals can potentially face criminal charges or civil claims/lawsuits. In the Capati v. Crunch Fitness case, the decedent's family sought $320 million in compensatory and punitive damages for the personal trainer's alleged negligence. Note that in that case, both the club and personal trainer (based on the legal principle of respondeat superior) were defendants in the case, meaning both were liable for $1.75 million of what ended up as a $4 million settlement (the supplement companies were liable for the remainder of the amount).

“Facilities and trainers who don't have the proper training shouldn't be involved with supplements,” says David Herbert of Herbert & Benson in Canton, OH, who followed and wrote about the five-year Capati v. Crunch Fitness case extensively. “Those substances known to have adverse side effects with or without medication shouldn't be recommended.”

In Bounds

One way for clubs to get expertise about supplements and nutrition is through a registered dietitian (RD). RDs are trained about errors and malpractice, and they ask questions that a typical personal trainer wouldn't know to ask.

“Dietitians ask about more medical and health conditions,” says Eickhoff-Shemek. “If a client has certain conditions, recommending supplements can be very harmful. The diet issue is so critical.”

Town & Country Sports & Health Club in Wilder, KY, first hired an independently contracted RD in 2005 to add a nutrition component to its Lifestyle Change program.

“We want to give our members the best advice we can give them,” says Matt Quinn, general manager at the club. “We hire trainers with credentials, and we wanted someone with credentials to give nutrition advice.”

Although Town & Country Sports & Health Club doesn't sell or recommend supplements, it does consider its nutrition programs to be a profit center. About 150 people either enroll in the Lifestyle Change program or meet with the club's RD in a single consultation or a package annually. A single nutrition counseling session costs $50 an hour for an individual or $60 an hour for a family. Although these services are available to members and nonmembers alike, most clients are members, and the prices listed reflect a 20 percent member discount.

Other clubs also have found value in hiring RDs. Ocean City Health & Racquet Club (OC Health & Racquet Club) in Ocean City, MD, hired Amy Gehrig, RD, three years ago as an independent contractor. Unlike, the RD at Town & Country who, similar to most personal trainers, gets paid by the session, Gehrig rents space in the club, and all the money she earns from sessions goes directly to her. She pairs with the club's fitness employees for her most profitable program, The Weight is Over, an eight-week lifestyle program that includes 16 personal training sessions, fitness evaluations, and two educational lectures on nutrition, a supermarket tour and a nutritional evaluation all given by Gehrig. OC Health & Racquet Club charges $399 for nonmembers and $359 for members. Nonmembers have full access to the facility for the duration of the program. This winter, almost a dozen people signed up for the program.

“We try to market that you can't just do the exercise component alone or just the nutrition component,” says Gehrig. “It's a dynamic duo to have exercise and nutrition together.”

As part of that dynamic duo, the club ensures that members know what their trainer can advise them about and what Gehrig can help them with. The OC Health & Racquet Club sells supplements, but Gehrig doesn't push them on members, she says. The club's personal trainers also stay within their professional boundaries.

“The trainers know where to draw the line,” she says. “I feel confident they're giving good, basic information, and if it's beyond their scope of practice, they'll refer the client to me.”

Even smaller facilities can work with a RD. Personal training studio AYC Health and Fitness in Prairie Village, KS, refers clients to a RD when general nutrition information just isn't enough.

“I'm an exercise physiologist, not a dietitian,” says Greg Justice, owner of AYC. “I've never stepped outside of my realm of professionalism.”

Final Score

Larger club companies also are watching the boundaries related to offering supplement and nutrition advice. In 2000, Life Time Fitness opened its first clubs with a full-time RD. Now, almost every Life Time facility has a RD as part of its personal training department to help with Team Weight Loss, a program that offers nutritional advice along with exercise. A RD works with program participants through meal planning, individual meetings and classes.

“On the RD side, it helps to complete that triangle of exercise, nutrition and education,” says Lee Syndergaard, associated marketing manager-nutritionals for Life Time Fitness. “With a RD, we can say, ‘Here's why we go through this and why it's recommended.' It makes us more accountable.”

To control the quality of the supplements it sells, Life Time Fitness developed its own supplement line.

“We saw what was out there and found out it didn't meet our standards,” says Kent Wipf, spokesperson for the company. “We listened to what our members wanted and developed our own brand.”

24 Hour Fitness took a similar approach for its supplements. The chain developed its own branded line of supplements that have been internally tested for efficacy and composition. For the last seven years, supplements have been in all of 24 Hour's locations.

Instead of hiring RDs though, the company developed a computer-based program, Solutions, to provide individualized fitness and nutritional plans for its members. The program, which was designed through a team of RDs and other professionals, is constantly updated and reviewed to ensure its recommendations are accurate and up-to-date regarding dietary research and trends. All 24 Hour Fitness' 4,500 personal trainers are trained on the system.

“Based on what a client inputs with their trainer, Solutions will provide that person with a game plan,” says DeVilbiss. “Our protocol is that when advising, our trainers use the computer software to provide recommendations.”

Some manufacturers offer similar nutritional software, says Herbert. Even if the electronic program isn't developed in-house, this software approach to nutrition minimizes risk and can be much cheaper than hiring a RD.

Either through computers, increased education about scope of practice, or hiring a RD, club owners that ensure only qualified staff are recommending supplements or nutrition is a smart move legally and financially. Clubs that fail to pay attention could hurt members and face lawsuits that could cripple business.

Weight Loss Supplements Settle

WASHINGTON, DC — In early January, the Federal Trade Commission (FTC) filed complaints in four separate cases alleging that weight-loss and weight-control claims were not supported by competent and reliable scientific evidence. Marketers of the four products — Xenadrine EFX, CortiSlim, TrimSpa and One-A-Day WeightSmart — settled with the FTC, surrendered cash and other assets worth at least $25 million, and agreed to limit their future advertising claims.

Two marketers of Xenadrine EFX will pay at least $8 million and as much as $12.8 million to settle FTC allegations that Xenadrine EFX's weight-loss claims were false and unsubstantiated. The seven marketers of CortiSlim and CortiStress will surrender, in total, assets worth at least $12 million. The marketers of TrimSpa will pay $1.5 million to settle FTC allegations that their weight-loss claims were unsubstantiated. The Bayer Corporation will pay a $3.2 million civil penalty to settle FTC allegations that advertisements for One-A-Day WeightSmart multivitamins violated an earlier Commission order requiring all health claims for One-A-Day brand vitamins to be supported by competent and reliable scientific evidence.

To read more about these cases go to www.fitnessbusinesspro.com/news/ftc-case-weight-loss. Copies of the documents for these cases are available on the FTC's Web site at www.ftc.gov.

What Can You Do?

  • Regardless of whether or not your club sells or recommends supplements, have a written policy on the subject.

  • Train your staff on their scope of practice and include situational role playing.

  • Hire a registered dietitian on a full-time, part-time or independent contractor basis. At the very least, have a licensed/certified nutritionist you can refer questions to.

  • Pay attention to supplement-related news to ensure you're not selling a banned product.

  • Attend seminars on scope of practice and issues related to it.

Additional Resources

American Botanical Council:
www.herbalgram.org

American Dietetic Association:
www.eatright.org

American Herbal Products Association:
www.ahpa.org

Council for Responsible Nutrition:
www.crnusa.org

The Food and Drug Administration:
www.fda.gov

Natural Medicines Comprehensive Database: www.naturaldatabase.com

National Institutes of Health Office of Dietary Supplements:
dietary-supplements.info.nih.gov