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Clinical Exercise Prescription > Obesity > Flashcards

Obesity Flashcards

1
Q

% of men and women overweight in the UK

A

44% men

34% women

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2
Q

% of men and women obese in the UK

A

23% men

23% women

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3
Q

what are the components of daily energy expenditure in sendentary person

A

8% thermic effect of feeding
17% energy expenditure of PA
75% resting energy expenditure

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4
Q

what are the components of daily energy expenditure in a PA person

A

8% thermic effect of feeding
32% energy expenditure of PA
60% resting energy

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5
Q

relationship between EE and fat free mass

A

as fat-free mass increases REE increases

e.g obese have greater REE

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6
Q

norml BMI

A

18.5-24.9

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7
Q

overweight BMI

A

25-29.9 kg/m2

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8
Q

obesity BMI

A

obese 1 - 30-34.9
obese 2 - 35-39.9
obese 3 - >40

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9
Q

relationship between BMI and %body fat

A

as BMI increases, body fat increases in general

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10
Q

realtionship between BMI and CV mortality

A

as BMI increases risk increases

3 step increases for each chnage in BMI classification

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11
Q

obesity and diabetes

A

greater prevealance of T2D in obese
excess body fat leads to insulin resistnce
possible genetic predisposition

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12
Q

why does excess body fat lead to insulin restistance

A

Adipose tissue creates demand for insulin – increase fat deposition
Chronic high blood sugar down regulates insulin receptors
Fats block insulin receptors, leading to insulin resistance
Fat tissue, especially visceral fat, has a role in promoting diabetes

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13
Q

obesity and hypertension

A

often associated
for every 10% increase in body weight, systolic BP increases 6.5mmHg
6x more prevelant in obese

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14
Q

obesity and blood cholestrol

A

each kg of fat, approximatley 20mg/dl of cholestrol is synethiesised

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15
Q

obesity and respiratory disease

A

Burden of excess fat on thorax makes breathing more difficult and reduces lung volume
Hypoxia develops initially , hypercapnia can also develop reduced respiratory drive
Sleep apnea and snoring are common

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16
Q

obesity and orthopeadic problems

A

Strong positive correlation between arthritis and obesity
Every 5kg ↑ in weight, increased knee arthritis by 35%
Energy cost of movement is much greater in the overfat
Sedentariness becomes habitual leading to atrophy of muscles

17
Q

fat but fit

A

If you are over fat then being aerobically fit helps reduce risk
Mortality rates are low in obese / overweight if fit
Metabolically healthy but obese (MHO) phenotype
Should not assume just because obese they are unhealthy 15-30% obese are MHO
CVD risk appears to be no higher in MHO compared to normal healthy normal weight adults

18
Q

Causes of obesity

A

Genetic
Metabolic
Over eating
↓ Physical activity

19
Q

Cause of obesity: Genetic

A

Faulty Leptin production or resistance
Leptin a hormone, which ↓ appetite, secreted from body fat in proportion to the number of body fat stores.
An increase in body fat causes an increase in leptin production, which suppresses intake, which should lead to a decrease in fat and therefore leptin production.

20
Q

Cause of obesity: Meatabolic Factors

A

Some obese persons have a lower metabolic rate
Can be caused through defects; hypothyroidism, Cushing’s syndrome (overproduction of cortisol).
Metabolic control of appetite may go wrong
Food intake is controlled by orosensory, gastrointestinal & neuroendocrine factors.
Defects in these pathways may lead to dysregulation of appetit

21
Q

effects of parents on child weight

A

If both parents obese, 70-80% chance of child being obese.
Mother more critical.
If neither parent obese, 14% chance of being obese

22
Q

what is the set point theory

A

Body defends a certain weight like a thermostat regulates temperature
Normally returns back to that weight

23
Q

Passive consumption

A

Individuals allowed to eat ad-lib diets that contain different fat levels will consume more energy on the high fat diet than on high CHO diet

  • People tend to consume the same weight/volume of food at each meal and are unable to sub-consciously adapt to varying energy densities
  • The same volume of a high fat (energy dense) meal will provide many more calories than the same volume of a high CHO meal
24
Q

benefit of a 10% weight reduction

A 
↓ > 20% total mortality (diabetes related and cancer deaths) 
↓ 10 mmHg systolic BP 
↓ 20 mmHg diastolic BP 
↓ fasting blood glucose 
↓ 10% total cholesterol 
↓ 15% LDL cholesterol 
↓30% triglycerides 
↑8% HDL cholesterol
25
Q

Goals of weight management

A

Prevent further weight gain (minimum goal).
Reduce body weight.
Maintain a lower body weight over long term.

26
Q

background info required before starting weight loss

A

Background - occupation, family circumstances
Motivation- why they want to lose weight
Treatment expectations- what do they hope to achieve? Are they realistic?
Confidence- are they confident that they will succeed?
Knowledge- nutritional awareness, benefits of weight loss
Weight- agree goal weight
Previous dieting & weight-loss history
Exercise – likes / dislikes

27
Q

Effect of PA for weigth loss

A

Modestly contributes to weight loss- Strong evidence
Decreases abdominal fat - Good evidence
Increases CV fitness - Strong evidence

28
Q

benefits of regular PA in obese people

A

Decreases loss of fat-free mass associated with weight loss
Improves maintenance of weight loss
Improves cardiovascular and metabolic health, independent of weight loss

29
Q

effect of exercsie alone for weight loss

A

Modest weight loss of 2-3kg

If energy intake is held constant, greater weight loss seen

30
Q

effect of diet only for weight loss

A

Diet alone produces more weight loss than exercise alone treatments
Mean weight loss with diet only 1 -12 kg

31
Q

effect of exercise and diet for weight loss

A

When exercise + diet are combined = greatest reduction in fat mass
Mean weight loss with diet + exercise combined 3 - 15kg

32
Q

exercise considerations

A

Aggravation of pre-existing conditions (Hypertension, angina, arthritis etc.)
Orthopaedic problems
Avoid high-intensity and high-impact exercise energy cost orthopaedic problems
Avoid agility and balance exercises
Inappropriate food choices post exercise - food intake as a reward for exercise
Avoid high ambient temperatures
Be sensitive to body image, physical confidence issue - where and when they exercise

33
Q

aim for overweight and obese people

A

↑ calorie expenditure = ↑ duration x ↑ frequency x ↓ intensity
Expend an accumulated 1000-2000 Kcal.wk-1
Expend 200-500kcal each exercise session

34
Q

frequency of exercise

A

3+ days a week

35
Q

exercise guidelines - time

A

20-60 mins

broken up into 3-10 minute sections

36
Q

exercise guidlines - intensity

A

40-70% VO2 or HRR
55-65% HRmax
RPE 11-14

37
Q

exercise guidlines - type

A

any aerobic
weight bearing and non weight bearing
resistance training - 2d/wk
- 1-2 sets of 8-15 reps

Clinical Exercise Prescription (12 decks)

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