Obesity

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Obesity
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What do you think of these people?
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Pathophysiology

• Excess body fat frequently resulting in
  significant impairment of health
• Overweight vs. Obese

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Prevalence

• 30 U.S. adults 20 yrs. are obese (CDC 2002
  using BMI and circumference)
• 38 black women, 27 Hispanic women, 21 white
  women are obese (CDC 2003)
• Students 14 male, 7 female are overweight (CDC
  2002)
• 66 U.S. adults are overweight or obese (NHANES
  2003-2004)
• Males 67.3 overweight, 27.5 obese Females
  61.9 overweight, 33.4 obese (JAMA 2001 using
  BMI)

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Obesity and Children

• 17.1 age 2-19 are overweight (CDC 2003-2004)
• Higher rates in Hispanic and black girls
• Girls 1999-13.8 overweight, 2004- 16 no
  significant change in prevalence in women
• 1 in 4 overweight children is already showing
  early signs of Type 2 diabetes, 61 have 1
  additional CAD risk factor
• Overweight children are more likely to be
  overweight as adults

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Causes

• High fat and high calorie diet and physical
  inactivity are most important factors
• Contributing factors include hypothalamic,
  endocrine, genetic disorders

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Causes, contd
Altered Physiological instability of caloric
balance includes

• Decreased insulin sensitivity
• Increased fasting insulin
• Increased insulin response to glucose
• Decreased growth hormone
• Increased Cholesterol synthesis and excretion
• Decreased hormone-sensitive lipase
• altered insulin function may be primary
  mechanism in the etiology and maintenance of
  obesity

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Classification Systems

• Height Weight Tables
• Obese if one weighs 20 more than desired weight
  defined by table
• BMI- 27.3 men, 27.8 women at increased risk
• Acceptable range 20-25
• Mildly overweight 25.1-27
• Moderately overweight/obese 27.1-30
• Markedly obese 30.1-40
• Morbidly obese 40

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Classification Systems, contd

• Body Fat Percentage
• Minimal- 5 males, 8 females
• Below avg.-5-15 males, 14-23 females
• Above avg.-16-25 males, 24-32 females
• At risk- 25 male, 32 females
• Phenotype
• Type 1 excess body mass or body fat
• Type 2 android pattern
• Type 3 excess abdominal visceral fat
• Type 4 gynoid pattern

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Classification Systems, contd

• Cell Morphology
• Hypertrophic vs. hyperplastic
• Circumference
• Waist 102 cm males, 88 cm females
• Waist/hip .913 males, .861 females

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Medicine and Management

• Exercise and physical activity- most important
  management tactic
• Increase daily activity
• Physical conditioning
• Diet- reduce fat intake and total caloric intake
• Medical techniques- starvation diets,
  gastroplasties, jejunoileal bypass, jaw wiring,
  intragastric balloons, fat excision, anti-obesity
  medications
• Appetite suppressants (stimulation of sympathetic
  nervous system)- amphetamines, synthetic amines,
  isoindoles, caffeine. Seratonin uptake
  inhibitors have been marketed for this purpose
  but is not approved by the FDA

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Effects on Exercise Response

• Low physical work capacity because of excess
  weight
• Obesity often occurs with other diseases and
  confounding influences of those diseases may be
  involved in exercise testing
• Special attention to exercise blood pressure
  responses and glucose intolerance

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Effects of Exercise Training on Disease

• Effective in reducing body weight in moderate
  obesity but may not be as effective in morbidly
  obese
• Physical activity promotes regional fat loss in
  abdominal sites exercise is more efficient in
  those with android patterning (decreasing
  abdominal fat decreases the risk for disease)

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Effects of Exercise Training on Disease, contd

• Physical activity is the most important factor in
  maintenance of weight loss
• Exercise training effects on glucose
• Decrease fasting glucose
• Decrease fasting insulin
• Increase glucose tolerance
• Decrease insulin resistance

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2005 Prevalence of Recommended Physical Activity
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Recommendations for Exercise Prescription

• Exercise Testing
• Additional helpful info weight history
  (cycling), medical history, motivation and
  readiness (HRA), nutrition/eating habits, body
  composition
• primary objective of testing is exercise
  prescription, determine physical work capacity
  for intensity selection

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Exercise Programming

• Prescription must optimize energy expenditure and
  minimize potential for injury
• Activity must be enjoyable and fit into lifestyle
• Goal of treatment with exercise is to expend more
  calories, but the approach is debatable
• Total energy expended for an activity includes
  expenditure during activity, recovery period
  (EPOC)

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Exercise Programming, contd

• 2 shorter sessions vs. 1 longer session
• (higher intensity will have a longer
  recovery?expend more calories longer session
  will effect substrate utilization)

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Exercise Programming, contd

• Mode non-weight bearing if HX of injury,
  walking, increase ADL, resistance training
• Frequency daily or minimally 5 days a week
• Duration 40-60 minutes accumulated per day
• Intensity 50-70 VO2max

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Exercise Programming, contd

• Special Considerations
• Motivation for change (goals and decision/balance
  sheets)
• Injury prevention (overuse prevention, injury
  history, warm-up, cool-down, gradual progression,
  low impact/non-weight bearing, thermoregulation,
  temperature and humidity, hydration,
  clothing/footwear