FINAL/CH8- Obesity Flashcards
overweight + obesity definition by WHO
excessive fat accumulation that is a risk to health
how is obesity commonly rated
using BMI
BMI
weight (kg) / height^2 (m^2)
what else can be useful to determine risk
body composition + waist circumference
risk waist circumference for men
40+ inches
risk waist circumference for women
35+ inches
android/gynoid figure is associated with comorbidities like diabetes, high cholesterol, cancer, etc.
android
when does obesity commonly occur
can begin in childhood but 70% of occurrences begin in adulthood
multifactoral influences on obesity
-decreased physical activity
-increased food intake
-societal influences
-individual psychology
-biology
result of obesity pathophysiology
longstanding eneryg imbalance (positive energy balance)
obesity increases risk of…
-diabetes
-hypertension
-dyslipidemia
-breathlessness
-anesthesia complications
-osteoarthritis
-depression
-gallbladder disease
-eating disorders
-coronary heart disease/heart failure
-fetal defects
-sleep apnea
-hyperuricemia + gout
-cancer
-polycystic ovary syndrome
-LBP + other joint pain
-complications during pregnancy
obesity is a ____ issue
SYSTEMIC
-affects various parts of body
signs/symptoms of obesity
-fatigue
-dyspnea
-difficulty with physical activity
history + physical examination
review risks with pt
-assess physical factors at each visit
-assess exercise history
-also want to gauge the likelihood that the pt will change their behavior to combat this issue
how do you determine pt’s readiness to lose weight
ask “have you been trying to lose weight?”
-no, and I do not intend to in the next 6 mo. (precontemplation)
-no, but I intend to in the next 6 mo. (contemplation)
-no, but I intend to in the next 30 d. (preparation)
-yes, but for less than 6 mo. (action)
-yes, for more than 6 mo. (maintenance)
obesity treatment
-diet therapy
-behavioral therapy
-exercise therapy
-pharmacotherapy
-surgical therapy (typically reserved for severely obses)
treatment goals
-BMI 25 kg/m^2 or LESS is considered normal weight
-need to determine goals with respect to pt expectations + timeline (pts commonly want to lose 35% current weight)
diet therapy
-calorie reduction (should be based on RMR + physical activity)
-micro + macronutrients
-types of diets
____ kcal deficit for 1 lb weight loss
3500
hypocaloric diet
restrict to 500-750 kcal/day
2 types of meal replacement diets
-partial
-complete (very low calorie diet, aka VLCD)
partial meal replacement
just having a shake/bar for breakfast
complete meal replacement
3 shakes per day, each only 300 calories
-effective for someone MORBIDLY obese
behavioral therapy
use of behavior change to promote adherence
-stages of change (transtheoretical model)
-cognitive restructuring (used to avoid all-or-nothing mindset)
-individual or group therapy (accountability, motivation, skill-building)
-lapse/relapse planning (problem-solving)
-address emotional, societal, familial, environmental issues
stages of change (transtheoretical model)
-precontemplation
-comtemplation
-preparation
-action
-maintenance
exercise therapy
-accelerated rate of weight loss when combined with diet + behavior change
-maintenance of weight loss
-National Weight Control Registry suggests 2500-2800 kcal/wk expenditure for best results
-this may require 60-90 min/day of exercise
-not needed to lose weight because you can lose weight through diet alone but exercsie ACCELERATES rate of weight loss
pharmacotherapy
-weight loss drugs are recommended for BMI of 30
approved drugs for treatment
-phentermine (adipex)
-orlistat (zenical, alli)
-additional medications are pending FDA approval
phentermine (adipex)
appetite suppressant
-capsule taken as short-term adjunct to weight loss
orlistat (zenical, alli)
intestinal lipase inhibitor
undesired side effects of pharmacotherapy
-loose/oily stool
-abdominal pain
-flatulence
lipase
enzyme that catalyzes fat metabolism
-inhibiting lipase will allow fat to pass through digestive tract without being digested
flatulence
accumulation of gas
surgical therapy
-fastest-growing area of obesity treatment
-possible loss of >50% excess weight
-10 yr loss ranges from 15-25%
-not without risk of death/infection (1% death risk, 15% morbidity risk)
which 2 effects are most common in surgical therapy
-restrictive effect
-malasorptive effect
Roux-en-Y gastric bypass
-stomach stapled to size of an egg (reduced amount of food you can eat)
-reduced portion stapled directly to jejenum (bypassing duodenum, reduces food absorption)
adjustable gastric banding (lap band)
silicone band placed around stomach to reduce amount of food you can eat
metabolic syndrome definition
collection of interrelated cardiometabolic risk factors that are present in a given individual more frequently than may be expected with a chance combination
-uually presence of overweight/obesity
-greater risk for developing atherosclerotic CV disease
prevalene of metabolic syndrome
nearly 35% of adults 20+ y/o
etiology of metabolic syndrome
widely debated
-likely a combination of obesity/abdominal adiposity, insulin resistance, + mitochondrial dysfunction
HDL
good cholesterol
5 risk factors for metabolic syndrmoe
-abdominal obesity
-high fasting blood sugar
-low HDL cholesterol
-high BP
-high triglycerides
**presence of 3+ of the following abnormal findings reflects presence of metabolic syndrome
-elevated waist circumference
-elevated triglycerides (or on drug for elevated triglycerides)
-reduced HDLc (or on drug for reduced HDLc)
-high BP (or on drug for hypertension)
-elevated fasting glucose (or on drug for elevated glucose)
metabolic syndrome treatment
similar to obesity treatment
-promote weight loss + physical activity
-diet quality
-pharmacological agents
-surgical procedures, when necessary
exercise testing for both obesity + metabolic syndrome
-routine testing is not necessary but it is helpful
-one of the reasons you may not have to do it is- testing may be a barrier to exercise participation, particularly if announced just before a class occurs
-alternative modes should be available for those with difficulty walking
-IF testing occurs, it should follow standardized treadmill protocols/procedures
ExRx for both obesity + metabolic syndrome
-aim for at least 2000+ kcal expended per week
-combination of aerobic + resistance training necessary to preserve lean mass during weight loss
**remember net deficit of 3500 kcal to lose 1 lb
ExRx for ROM + balance
-little is known about structural effects/plasticity on CT + muscle in those with extreme weight loss or metabolic syndrome
-greater ROM shown in hip, knee, + ankle with weight loss
-may need to focus on balance in cases of extreme weight loss (shift in center of gravity)
conclusion
-exercise + behavioral modification are vitally important for successful weight management in obese individuals as well as those with metabolic syndrome
-clinical exercise physiologists play a vital role in prevention and treatment of overweight + obesity
-development as a competent clinical exercise physiologist should include knowledge + understanding of behavior theory used to develop programming + educate patients
