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Doctors who think they're fitness experts. 
Hey Christina!
Long time. You mentioned that the client had an underactive thyroid and the doctor wanted to make sure it was within normal limits. Is the client's thyroid actually within normal limits? Signs of hypothyroidism (underactive thyroid) are usually:
Weight gain Puffy face
Loss or thinning of eyebrows
Cold intolerance
Low sex drive
Depression
Abdominal bloating
Cold hands or feet
Dry or thinning hair
Joint or muscle pain
Thickening of the skin
Thin, brittle fingernails
That being said, skeletal muscles are responsible for more than 25% of our calorie use so an increase in muscle tissues causes a corresponding increase in metabolic rate. I went back through Randy F's notes from UCLA and also found that 1 extra pound of muscle mass leads to an increase of 50 calories in metabolic rate per day while an increase of 1 fat pound causes a mere 2 calories of increase in metabolic rate per day.
Couple of more factors to consider here. Have you done a recent body mass comp on the client either with skin calipers or the BIA method to determine if the client is indeed lowering her fat mass from your original measurements? Remember, muscle weighs more than fat so she could be increasing her muscle mass while total weight is remaining about the same.
Have you done a total calorie count on her to see what amount of calories she needs per day to maintain her current body weight? I like to use the Katch-McArdle Formula as it accounts for basal metabolic rate. Link below:
http://c.1asphost.com/health/
I personally would go with an exercise presciption that emphasizes aerobic activity with this client if there are no muscular-skeletal disorders as ACSM recommends aerobic activity as the primary method for weight loss. All of this again assumes that the client's thyroid is working properly. Can't emphasize that enough.
Once I got the calorie numbers on the client that would be needed to maintain her current weight, I would then use the ACSM walking or running formulas to check her calorie burn for each aerobic exercise session remembering that a 500 calories deficit or burn per day below the level needed to maintain current body weight will lose 1 pound of fat per week.
This method should work to make sure that the client loses 1-2 pounds per week which is within the ACSM guidelines.
Finally, the doctor's claim that, "The reason you're not losing weight is because your trainer is adding too much muscle," is nonsense. The main issue here is not increased muscle mass but rather how much calorie burn those muscles are generating per exercise session. Again, I would emphasize an aerobic regimen for weight loss and add resistance training on the off days for cardio workouts. If there are muscular-skeletal issues for the cient, I would have her do swimming or low impact activities.
What do you think?
Curt
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