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Hard Copy sent a camera crew to my home to conduct an interview about the dangers of Phen-Fen only days after someone had died on the operating table from complications incurred during excessive liposuction surgery. The segment topic was "The Dangers of Desperate Weight Loss Solutions." After collecting valid information from a multitude of biochemists and true pharmaceutical experts, I was prepared to explain to the television audience some of the Phen-Fen realities. I had also had a number of Phen-Fen "victims" come to me for help. As the cameras rolled I explained that Phen-Fen, albeit a cute little name, is actually the combination of two drugs, phentermine and fenflouramine. In combination, these drugs alter neurotransmission of the brain chemicals serotonin and dopamine so appetite is virtually switched off. These drugs are also noted to initiate a stimulant effect, however, the ability of the drug combination to alter brain signals often minimized the sense of raciness associated with amphetamines. The Physicians Desk Reference lists one of the potential side effects of the Phen-Fen drugs as "possible short term memory loss." Interestingly enough, cocaine affects the same neurotransmitters as cocaine. When we discuss the potential side effects of cocaine, rarely do we hesitate to use the term "brain damage." When a substance is being promoted to feed the financial health of the pharmaceutical and medical communities, the terminology is somehow altered to "possible short term memory loss." Aside from the possibility of brain damage, I also explained the correlation between Phen-Fen prescriptions and incidence of a disease known as PPH, Primary Pulmonary Hypertension. In most cases, those diagnosed with PPH have two options. Death or a complete heart and lung transplant with death likely in the near future. The effect of the Hard Copy interview shocked me. The day it aired, I received over 200 phone calls from people asking where they can get Phen-Fen! I spoke about life threatening side effects, yet Americans are so desperate for weight loss at any expense . . . . my phones rang for days with callers asking for Phen-Fen sources! After several Phen-Fen related deaths, the FDA began steps to determine whether this truly was a safe weight loss alternative. They soon after determined it wasn't. It was pulled from the market. Luckily Personal Trainers were not allowed to disperse Phen-Fen. It was classified as a drug and could only be obtained with a medical prescription. Is it fair, therefore, to state that Personal Trainers are not allowed to prescribe dangerous drugs? As you read through the rest of this article, you might come back to that question with a new viewpoint. On Monday, June 29, 1999, a $320 million dollar lawsuit was filed against a New York City fitness facility and one of its trainers for "recklessly" prescribing nutritional supplements. Ann Marie Capati, a 37-year old fashion designer, suffered a stroke on October 1, 1998 while working out after ingesting "fat burners" prescribed by her personal trainer. We, as fitness professionals, have selected career paths in a field that is, for the most part, unregulated. While some certification agencies certainly have merit, there isn't a single governing agency that sets standards for Personal Fitness Trainers on a national scale. Many certification programs offer two day conferences that prepare students to pass an exam. Should such a conference open a door for individuals to call themselves "professionals?" Should a two day workshop and satisfactory exam score be enough to qualify any individual to affect the health and well being of others? I'll come back to addressing these questions, but first let's understand a bit about "fat burners" supplements, and drugs. We'll then move on to explore the area of self regulation in an industry where it is desperately called for. About 10 years ago bodybuilders found that the asthma medication, clenbuterol, seems to be a fat-release aid and appeared to act without compromising muscle tissue. It wasn't long before abuse led to federal regulations classifying clenbuterol as a Class III drug (you can be arrested for possession without a prescription). Simultaneously, a study was providing evidence that the combination of two OTC drugs, the stimulant caffeine and the bronchodilator ephedrine, can act as aids in quest of weight reduction. The study was published in the Journal of Obesity and it wasn't long before caffeine:ephedrine combinations were springing up under varied labels throughout the bodybuilding and weight loss communities. It's important to note that while caffeine and ephedrine were both available in most drug stores without prescription (i.e. Vivarin and Primatene tablets), they are drugs and with drugs come the risk of side effects. It was soon noted that aspirin, another OTC drug, may potentiate the "thermogenic" effect of the caffeine:ephedrine mix and the major supplement companies scrambled to release and position their own thermogenic formulas. Marketers of products found that the words, "herbal" and "natural," from a marketing standpoint, are more appealing to the general public than words we usually associate with drugs. "Herbal" seemed to be associated by the average consumer with "healthful" or "safe." Herbs are often the predecessors of drugs with opium being an elegant example. We can extract the drug caffeine from several herbs including Guarana, Kola Nut, and Green Tea. We can extract ephedrine from the herbs Ephedra or Ma Huang. Aspirin (salicylic acid) is a derivative of White Willow Bark. Herbal formulations emerged in every health food store and gym containing this "thermogenic" blend. Here's the hole in the legality of "drug prescriptions." Since these drugs were over the counter, and since the herb combinations can legally be sold in any health food store, no law appeared to prevent Personal Trainers from "prescribing" these drugs to their clients. As I mentioned, drugs do come with side effects. The side effects of ephedrine range from headaches and tremors to stroke and death. Combine ephedrine with caffeine and you create an addictive combination with heightened risk. Don't get me wrong. These formulas may very well have their place. Whether or not that place is on the shelves of health food stores, a bit of education is in order before anyone is allowed to prescribe any drug to anyone else. As the medical community struggles to offer sound weight loss advice, the general public is with greater frequency seeking out alternatives to conventional medicine. In seeking out a Personal Fitness Trainer, the public is lead to believe "certification" is the equivalent of "qualified." Is it? No law says otherwise, still, I'll offer my opinion and publicly state that "credible certification" is only a small piece of "qualifying" to direct others in quest of health and fitness. Despite my opinion, well intentioned trainers nationwide hand hundreds of thousands of bottles of "formulas" across the counters of countless stores and health clubs with very little regulation. One of the clear-cut contraindications for ephedrine is hypertension. Did the trainer know his client had hypertension? If so, is he more liable for the fatality? Should he be held for a higher level of negligence if he neglected to establish whether there were pre-existing medical conditions? The real question here is one of competence. Is a trainer competent to suggest or prescribe OTC products? Dr. Anthony Abbott, President of Fitness Institute International in Lighthouse Point, Florida, shared his much revered opinions with me on the topic of credentials and certification. Fitness Institute provides vocational schooling for individuals who want to become certified by the most credible organizations; and as testimony to his expertise, Dr. Abbott has been retained as an expert witness in several lawsuits involving Personal Training related deaths. "There are many certifications that involve nothing more than a weekend workshop; and it's quite dangerous to lead people to believe that they can become competent trainers in two days as well as be equipped to handle special needs and emergency situations." While Dr. Abbott agrees many of the certification programs do have value in the area of continuing education, he believes firmly that there are only two professional associations which can legitimately certify fitness trainers, those being the American College of Sports Medicine and The National Strength and Conditioning Association. Dr. Abbott provided some questions that can serve as a foundation for evaluating a fitness certification. 1. Does the evaluative process include a comprehensive written exam as well as practical testing? 2. Does the evaluative process require examination development by academically qualified and experienced personnel who are under the supervision of a professional examination development service (i.e. psychometricians). 3. Does the exam thoroughly test the candidate on his knowledge of screening procedures? 4. Does the exam determine whether successful candidates truly understand and are capable of doing CV testing and other important tests to develop a fitness profile? 5. Does the exam evaluate a candidate's ability to prescribe exercise and to safely supervise the exercise program? The two certification agencies that Dr. Abbott feels lead the field are both non-profit professional associations which are governed by a board of directors and officers elected by the membership. Their memberships are composed of primarily of Masters, PhDs, and MDs, and they have established high standards for their certifications. There are some words that, due to limited control of their use, can be used to create false credential in our industry. One such word is "accredited." While many for-profit certification programs set up their own accrediting agency so they can use the word in their marketing, at this point in time the NSCA has the only nationally accredited certification in the country. There is a federally recognized accrediting agency in Washington DC, the National Organization of Competency Assurance. Their certifying arm is the National Commission for Certifying Agencies. They have very strict standards that must be met for an organization to become accredited by the NCCA. Because the NSCA has had to meet so many obstacles to meet NCCA standards, they can truly say that their process measures what it promises to measure. In fact, psychometrics is the study of statistics, and the NCCA uses psychometric criteria to measure whether an exam actually measures what it claims. If we are looking for a standard of certification for fitness trainers, the NSCA is the only certifying agency that has met that accreditation standard. The ACSM certification commission is working to also become accredited. Geogia H Goslee, Attorney at Law, is a graduate of Fitness Institute International and certified by the American College of Sports Medicine and the National Strength and Conditioning Association. She maintains a concern that most trainers have credentials that will not survive judicial scrutiny should they ever be challenged in a court of law. "As a lawyer, personal trainer, and fitness consultant, I have first hand knowledge from both a legal and training perspective that the public is not aware of the knowledge base of personal trainers, nor do they have any understanding of what certification really means. The legal profession as well as the judiciary share some of the public's naivete. Often times lawyers, while familiar with negligence, simply do not understand that there is a "standard of care" promulgated by leading fitness organizations who remain on the cutting edge of research and enhanced knowledge." Goslee goes on to explain that personal trainers are expected to develop exercise prescriptions for clients after careful and deliberate screening and testing. "They are not prepared, qualified, or draped with sufficient legal authority to prescribe drugs in any fashion. Personal trainers should know that they are legally required to operate within their area of expertise and not to practice medicine without a license." She suggests that every personal trainer pose the following question, "Is my fitness certification legally defensible?" This article is not intended to pass judgement, but rather to bring to the forefront some questions that beg to be answered. The article is further intended to encourage you to strengthen your position as a professional by examining some of the legal loopholes that have come to light and recognizing your own exposure. Is a trainer at fault if he or she, with good intentions, recommends something that can be of risk to the client? Can a trainer possibly expect to keep abreast of all new developments and be able to distinguish safe products from those with higher than acceptable risk? Is a doctor who prescribes weight loss drugs resulting in fatality any more or less negligent than a trainer who steps beyond the bounds of measured expertise? These are questions I don't pretend to have the answers to. I simply put them out there for thought and for discussion. We are, in fact, taking on a great responsibility when we commit to help any individual improve his or her body and health. I believe it's time some guidelines are set to truly distinguish the Professional from the rest of the field. Consideration of these questions and actions to bring about a national standard can only be beneficial to the credibility of our chosen profession. Until such guidelines are set, I suggest protecting yourself by always seeking continuing education. While there are many certification programs that can educate you, I encourage you to sit for the NSCA and/or ACSM exams. I'd also suggest that you practice three very powerful words. "I don't know." If a client or potential client asks you whether a drug, product, or untested formula is safe and effective, it's OK to remain a specialist in the area in which you were trained. Ann Marie Capati might be alive today had she received a bit of education on the dangers of the supplements prescribed or had her trainer stayed within the boundaries of exercise prescription. Certification is certainly a step, and one that
should not be neglected, but it simply proves that you acquired
enough knowledge to pass a test.
There's no need to "know it all."
In fact, the most prestigious experts I've met in this field
are committed to lifetime learning, validating the fact that there
is always more to learn. Let's
keep our standards high, protect the credibility of our field, and
establish the professional careers we deserve with a healthy dose of
caution, common sense, and a willingness to accept and improve on
our own limitations. With
that commitment and a promise of making your clients feel as if they
are the most important people in the world, your personal potential
in an industry still finding its footing is without limit! *
END * Following are references quoted or mentioned within
the article: Dr. Anthony Abbott, Ph.D. NSCA ACSM
Georgia Gosley, Attorney at Law Phil
Kaplan's New Book, Personal
Training Profits and A Secure Fitness Future has been added to
his line of products and programs geared toward increasing the
success of Personal Fitness Professionals Worldwide.
His
PEAK Training
Seminar Programs share his success methodologies in a workshop
format for elite trainers. |
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