Rhonda Gates makes her living developing weight management programs for hospitals, corporations and health clubs. Her work places her on the cutting edge of emerging trends in weight management and fitness.

Some of what she sees, such as McDonald's discontinuing its super-sized meals, heartens her. But other things, such as the way many health clubs treat overweight and obese clients, dismays her. Gates says many club owners and trainers want overweight people to buy memberships but don't necessarily want them using the club.

“At the clubs what I got was, ‘Oh yeah, we really want that population,’” says Gates, president of Lifestyles by Rhonda Gates. “But underneath, what they wanted was to increase membership and saw this as a market they could capture. There is a definite prejudice against people who are heavy, especially in the fitness industry.”

It's an astounding claim, particularly considering that, theoretically at least, health clubs exist to help overweight people get into shape. But it's a claim that has some resonance inside the industry. Even those who disagree with Gates admit that many club owners and trainers aren't equipped to work with overweight and obese clients.

“I wouldn't say there is a bias, but just that some club owners, trainers and instructors are lacking in education for this special population,” says Len Kravitz, senior exercise physiologist for IDEA Health and Fitness Association. “Not all trainers and instructors know how to design programs for people with arthritis, another special population. So what can be done lies in more education for any special population.”

The overweight and obese population is increasing rapidly and, no pun intended, represents the fitness industry's biggest market. Almost two-thirds of American adults are overweight, according to a study by the United States Department of Health and Human Services (HHS). Almost another one-third are clinically obese. Both categories have been climbing steadily during the past 40 years. Between 1960 and 2000 the number of overweight people rose from 31.5 percent to 33.6 percent. But the increase in the number of obese people during that same period has been much more dramatic, rising from 13.3 percent in 1960, to almost 31 percent in 2000.

In the same study, HHS reports that between 1988 and 2000, the number of people with extreme obesity increased from 2.9 percent to 4.7 percent. If those numbers aren't startling enough, in 1991 only four states had obesity rates of 15 percent or higher. By 2000, 22 states had obesity rates topping 20 percent and only one, Colorado, had an obesity rate below 15 percent.

“I don't feel the industry is prepared for that market,” says Dino Nowak, a fitness consultant and author of The Final Makeover: Your 40 Day Guide to Personal Fitness. “This is a key time in the industry because people recognize that diets don't work and people are coming over to fitness. We can't lose them here. This is a potential for great growth for the industry.”

Realizing that potential and helping overweight and obese people become fit and healthy will require education and some attitude adjustment. Some trainers know how to exercise overweight and obese clients, but Gates knows from experience that many don't. When she asks professionals at her training seminars how they teach flexibility to an obese person, most say they put them on the floor and have them reach. The problem, Gates says, is that most people with a 50-inch waist can't get down on the floor or reach over their girth.

In body image classes, Gates asks trainers what the best way is to get people into the gym the day after Thanksgiving. The overwhelming answer, she says, is to tell them to come in and work off the extra pounds. A better answer, she says, is to tell them to come in because it is part of a healthy lifestyle.

“Trainers need body image and sensitivity training,” she says. “A lot of trainers feel these people don't want to take care of themselves. They think they are slovenly or lazy. They have a prejudice or preconception. You need to be more compassionate.”

The fact is, many trainers never consider the psychological and emotional baggage that overweight and obese people carry. It takes an immense amount of courage for a heavy person to step foot inside a club filled with fit or mostly fit people. Keeping them coming back requires trainers to be aware of those emotions. It also requires patience and an understanding that they will have to motivate their clients to persevere and strive for consistency because they are people who have given up, Nowak says.

Some clubs are striving to be more welcoming.

Not hanging a lot of mirrors in the exercise rooms is a simple but helpful change, Kravitz says, because mirrors can be a real deterrent to anyone who is overweight and obese. He also suggests that the instructors who work with these clients be healthy and fit but not extremely muscled because that physique may seem unattainable to them, which will be discouraging rather than motivating.

Minnesota's Life Time Fitness is one club that welcomes overweight and obese clients with open arms, says Chris Freytag, an American Council on Exercise-certified trainer for Life Time Fitness. She is also author of Move to Lose and host of a cable fitness show and ShopNBC.

“We are very focused on helping people and not just pigeon-holing them,” Freytag says. “The staff at Life Time get a lot of education and are equipped to assess people when they come in. Sixty percent of our new clients are overweight and are people who really want to make a life change. If you are discriminating toward obese people, you are going to go out of business.”

But everyone agrees that nothing will do more to attract and retain obese clients than trainers who not only know how to work with this clientele but who also want to work with them. It frustrates Nowak to watch a trainer making heavy clients attempt the same movements designed for fitter clients. Trainers have to spend time evaluating their overweight clients. They must assess their needs, set realistic goals and design a program that meets both. They may also have to deprogram their clients from thinking a magic pill or a diet exists that will help them shed pounds.

“Unlike more fit clients, obese clients are looking at finding small successes and building from there,” Nowak says. “We are taking small steps with small successes.”

Those small steps should start with an assessment.

“Not every obese person is coming in for the same reason,” Freytag says. “And you always have to worry about their health history and joint safety. You have to start out a little slower. You just can't send someone obese to run five miles on a treadmill.”

No special equipment is needed to train overweight and obese people although using some machines and equipment may be uncomfortable. If they are grossly obese, Freytag says, the first goal is to remove the layers of fat and change their calorie equation. Changing the way they eat may also mean suggesting they sit down with a nutritionist or registered dietician. As far as exercise goes, Freytag may start them with light weights and a cardio program.

“My philosophy with a new obese client is not to beat the crap out of them,” she says. “No one likes to hurt, and they may not want to continue [if they hurt].”

Nowak suggests using tubing, bands, ball movements or steps to get them started.

“You are getting them to use their body and move it again,” he says. “That's where it comes back to the training staff. You can't throw these people on the machines and it's business as usual.”

Even Gates can see a glimmer of hope for the future. There was a time when heavy people entered clubs through a side door.

“I'd like to think that it's getting better, but I'm not sure that it is,” she says. “Trainers have to get away from thinking they have the answers and instead pay attention to what their clients need.”