Obesity Flashcards
Define obesity
Term obesity describes an individual who is very over weight with a lot of body fat
How is obesity measured
Body Mass Index (BMI) is a way of measuring whether an individual is of a healthy weight for their height
BMI is calculated by Weight (Kg) ÷ Height (m2)
Once someone has a BMI at an obese level they are then classified into three groups I, II, III.
Waist circumference is a better measure of excess fat and it is used as an additional measure in people who have already been identified as having a high BMI. It is used on people with a BMI of 25-29.9 (overweight) or 30-34.9 (moderately obese). In men, they should have a waist circumference of less than 94 cm (37”) and women should have a waist circumference of less than 80cm (31.5”).
What are the health risk categories
There are five categories when looking at BMI and waist circumference; they are underweight, normal, overweight, obese and extremely obese.
Causes of obesity
Generally by eating too much and not moving enough
The causes of obesity are poor diet, high calorific intake, decreased activity, medical reasons and very rare genetic conditions.
Theory of the energy balance equation
The theory is that a healthy weight is maintained by a balance between energy intake and energy output. We need to take in kcals through carbohydrates, fats and proteins that equal to how much is used through TEF (Thermal Effect of Food), physical activity and resting metabolic rate.
Total Energy Expenditure (TEE):
~ 8% Thermic effect of food (TEF) & thermoregulations
~ 20-40% physical activity & recovery from it (EPOC)
~ 55% basal energy expenditure
What is the obesity trend
Obesity trend - Obesity reflects a continued +ve energy balance, which is accompanied by unhealthy weight gain, and is linked to physical inactivity (Ross & Janssen 2007)
US Phenomenon - Average American = 80Kg, world average 62Kg
USA = 6% worlds pop’ but store ~33% world fat
Worlds excess fat could power nuclear station for 20yr
Europe - 1 in 3 of all 11 year olds are overweight or obese in Europe
Over 50% of people are overweight or obese
Over 20% of people are obese
6/10 men are overweight or obese
5/10 women are overweight or obese
Health implications of obesity
- Pulmonary disease – abnormal function, obstructive sleep apnoea, hypoventilation syndrome
- Nonalcoholic fatty liver disease - Steatosis, steatohepatitis, cirrhosis
- Gallbladder disease
- Gynaecologic abnormalities – Abnormal menses, Infertility, polycystic ovarian syndrome
- Osteoarthritis
- Skin
- Gout
- Idiopathic intracranial hypertension
- CVA
- Cataracts
- CHD
- Type 2 Diabetes, dyslipidemia , hypertension
- Severe pancreatitis
- Cancer – breast, uterus, cervix,colon, oesophagus, pancreas, kidney, prostate
- Phlebitis – venous stasis
Prevalence of obesity
Number of people with diabetes up 60% in last decade - relating to obesity
NHS Quality and Outcomes Framework 2014 - 3,333,069 diagnosed with diabetes i.e. 1.2m more adults than in 2004 (Note: ~590,000 adults undiagnosed)
NICE - Recommend healthcare checks: BP, blood glucose, kidney function or = kidney disease, stroke, amputation
Diabetes costs NHS £10b per year, 80% spent on managing avoidable complications… so better care but mostly prevention required
Implication for physiotherapy
- Increased numbers of patients with obesity related health complications (CVA, heart disease, orthopaedic etc.)
- Staffing levels - understaffed as a group of professionals
- Manual handling and staffing levels - heavier patients require more staff
- Bariatric equipment - cost increase
- Reaction to treatment may be different
Role of physiotherapists with obese patients
- Very varied depending on reason for referral
- Post bariatric surgery care
- Safe physical activity
- Lifestyle advice & education
- Emerging roles - (Bariatric Physios) more awareness of physios value in obese patients recovery
