Obesity Flashcards
What is the definition of obesity?
Obesity is defined as abnormal or excessive fat accumulation that may impair health.
What is BMI?
Body mass index BMI) is a simple index of weight-for-height commonly used to classify overweight and obesity. It is divided by the square of height in meters (kg/m squared)
What are the outcome measurements that would be selected for an intervention in an adult obese population?
The outcome methods of measurements include laboratory testing (hydrostatic weighing, air displacement plethsmography and dual X-ray absorptiometry and field based methods (BMI, weight circumference, anthropometry or skinfold)
Obesity measurements?
- BMI: (desirable 19 – 25 kg/m2; ≥ 25 kg/m2 indicates need for intervention; ≥ 30 kg/m2 classified obese).
- WHR: Men > 0.95, Women > 0.86 at increased risk
- Fat distributed in abdomen associated with greater morbidity & mortality.
- Waist circumference: men > 102 cm; women > 88 cm.
- Body Fat: men > 25%; women > 32% = ‘at risk’ classification.
What is adipose tissue?
Adipose tissue is a collection of adipocytes cells and acts as a storage for excess calories consumed when energy needs of the body are less than the calorie intake. Gender influences deposition i.e. men tend to collect fat in the upper body & abdomen (apple-shaped) whilst women tend to collect fat peripherally in the thighs, arms & buttocks (pear-shaped).
What are the combined classification system of overweight/obesity?
Men: BMI (kg m2)/ waist (cm)= 25-30/>94= Overweight
Women: BMI (kg m2)/ waist (cm)= 25-30/>80= Overweight
Men:BMI (kg m2)/ waist (cm)= 30-35/>102= Overweight
Women: BMI (kg m2)/ waist (cm)= 30-35/>88= Overweight
What are the health risks of Obesity?
The health risks include:
- Circulatory disease
- Type 2 diabetes
- Some cancers
- Hypertension
- Gall bladder disease
- Osteoarthritis
- Sleep apnoea
- Breathing problems
- Lower back pain
- Liver disease
- Complications in pregnancy
- Increased risk of surgery
- Psychosocial problems (self-esteem, depression)
What is the definition of metabolic syndrome?
Metabolic syndrome is defined as the cluster of medical characterised by insulin resistance in the presence of obesity, high levels of abdominal fat, high blood pressure, high triglycerides and Low HDL- cholesterol.
What are the various caused of Obesity?
The causes of Obesity can be grouped into 3 different groups; Behavioural (Nutrition, Dieting/Attitude to food, smoking, activity level and socio-economic status such as education and income), Metabolic (Metabolic and Endocrine factors and Genetic factors) and Biological (Race, Gender, Age and Pregnancy).
What are the benefits of exercise for an obese population?
- Exercise expends energy as the use of calories that can assist with diet to create negative caloric balance.
- May Suppress appetite, which means exercise should be scheduled at times when overeating is common
- Counteracts the ill effects of obesity- exercise reduces morbidity and mortality via positive effects on BP, serum cholesterol (elevates HDL), body composition, improves glucose tolerance and cardiorespiratory function.
- Improves psychological functioning- changes in anxiety, depression, general mood and self concept and improves self esteem.
- Minimises loss of lean body mass- up to 25% weight lost through dieting is LBM
- Counteracts metabolic decline produced by dieting- which prevents suppressed Resting metabolic rate
What screening and testing would be done in commencement to exercise for the obesity population?
You would test for heart rate, blood pressure, blood tests (Lipid levels, blood cholesterol) and psychological tests, medical screening for glucose intolerance, hypertension and dyslipidaemia which indicates the increased risk CVD.
What exercise testing would be done in commencement to exercise for obesity?
- Aerobic- Cycle (25-50W@ 3 mins. stages)/ Treadmill (1-2 METs @3 mins.stages) which include measures such as 12 lead ECG, BP, RPE and Mets. Endpoints- detection of serious dysrhythmias, 2mm ST segment depression/elevation, T wave inversion wuth sig.ST change and increase in BP i.e. SBP> 250mmHg or DBP > 115mmHg. Reasons is clients have a higher chance of CAD/HTN, Orthopaedic injury and heat tolerance.
- Flexibility- Goniometry and is done to determine the joints that need stretching
- Neuromuscular- Gait analysis, Balance and is done due to uneven weight distribution and altered centre of gravity often obese clients have balance problems.
What are the exercise testing considerations for the Obesity population?
Due to de-conditioning low initial workload (2-3 METS) and small workload increments per test stage (0.5-1.0 METS)
Co-morbidities (HTN) or other concerns may dictate modifications to testing procedures
Use of leg or arm ergometry may enhance testing performance
Medication should be taken at usual time relative to exercise bout
May have difficulty adjusting to exercise equipment, so initial stages may need to be extended, test re-started or test repeated.
Ensure proper cuff size for BP measurement
Exercise programming for obese clients?
Aerobic (Large muscle group: walking, rowing, cycling, water aerobics); Prescription: 40-60%V02 Peak (up to 75% if low), 5 days a week, 30-60 mins/day (or 2x sessions a day of 20-30 mins), Emphasise duration (60-90 mins); Reduce weight, increase functional performance, reduce risk of CAD; Time to goal: 9-12 months, increase duration over intensity
Flexibility: Prescription is daily or >5 x week; Goals: increase ROM
Functional: Goals include ease of ADLs, increase vocational potential; and increase physical self-confidence
What should be the emphasis on exercise for obese patients?
Low-moderate intensity activity.
Completed at any time.
Any place.
Individual or group (beware of increased self-consciousness/low self-esteem).
Low risk of musculo-skeletal injury (low impact due to increased risk of lower limb injury).
High degree of success (to promote increase self-efficacy)
What is the cardiorespiratory response to acute aerobic exercise for obese patients?
- Higher BP, HR, CO, absolute O2 consumption and minute ventilation at any given work rate.
- Obese tend to perform a given work task at a higher percentage of HR max and energy cost.
- Reduced aerobic capacity expressed relative to body weight.
- Other limiting factors: heat intolerance, hypernoea/dyspnoea, movements restriction, orthopaedic pain, local muscular weakness, balance problems, anxiety
What role does resistance exercise play into obese patients?
Resistance training is useful in the preservation of FFM and increases muscular strength and power.
Not a substitute for endurance exercise but useful supplement to endurance exercise in weight loss programmes.
Focus: Improving muscular strength and endurance (low weight/high repetition).
May help overcome orthopaedic difficulties.
What are the exercise considerations of obese population?
- Prevention of overuse injuries
- Adequate warm-up, flexibility and cool-down
- Gradual progression of intensity and duration
- Use low impact or non-weight bearing exercises
- Emphasise good posture and use support for those with poor balance or displaced centre of gravity
- Adapt exercise to accommodate large body mass
- Supine positions should be avoided.
- Use RPE as manual pulse palpation difficult
- Thermoregulation (keep cool) and adequate hydration
- Loose fitting clothing (comfort and facilitate evaporative heat loss).
How would you promote exercise adherence for the obese population?
If exercise is to be beneficial, obese patients must be kept activity for as long as possible through maintaining long term contact and thus promotes long term weight loss outcome and the reason for this is to prevent further weight gain to maintain healthy weight/body composition reduce risk of disease associated with a sedentary lifestyle.
What are the alternatives to exercise for obesity?
Pharmacotherapy- Recommended for use by those with BMI >30kg/m2 or with a BMI >27kg/m2 in presence of co-morbidities , uses orlistat which blocks the action of an enzyme used to digest fat and includes side effects such as fatty or oily stools, frequent toilet trips, abdominal pains and headaches.
Surgery (Bariatric)- Obese patients can be encouraged to put on weight in order to quality for surgery/Cost- expensive and last resort intervention and not without complications.
