• Overweight refers to increase body weight in
relation to height , when compared to some
standard of acceptable or desired weight.
• Obesity is defined as an excessively high
amount of body fat in relation to lean body
CAUSES OF OBESITY
nutritional, activity levels, endocrine,
Resting Met Rate
Thermic Effect of Food
What is it?
• Energy balance can be compared to a scale.
• An energy imbalance arises when the number of calories
consumed is not equal to the number of calories used by
• Weight gain usually involves the combination of consuming
too many calories and not expending enough through
Effects in the Body
• Excess energy is stored in fat cells, which enlarge or
• Enlargement of fat cells is known as hypertrophy,
whereas multiplication of fat cells is known as
• With time, excesses in energy storage lead to
obesity. Fat cells
J La State Med Soc .2005; 156 (1): S42-49.
Fat Cell Enlargement
• Enlarged fat cells produce the
clinical problems associated with
obesity, due to the following:
– The weight or mass of the extra
– The increased secretion of free
fatty acids and peptides from
enlarged fat cells.
Criteria for excessive body fat
• Percentage of body mass composed of fat
• Regional fat distribution
• Adiocytes size and number.
Indications for Obesity Treatment
• Set point theory
• Early weight loss is largely water
• A weight-regulating mechanism, located in the
hypothalamus of the brain, regulates how much
the body should weigh
• Setpoint sets the amount of body fat it considers
necessary and works tirelessly to maintain it
• Setpoint functions like a thermostat: it detects
fluctuations in weight and makes adjustments in
energy metabolism and appetite
• The setpoint has a profound effect on amount of
food you eat
– As you lose weight, it signals _______
– As you gain weight, it _______ appetite
– As you overeat, triggers body to “waste”
– As you don’t eat enough, triggers body to “conserve”
• Type –aerobic exercise and resistance training
• Duration- 40 min
• Frequency- 4-5 days
• Intensity-EHR=(DI x H.R.R)+R.H.R
• where E.H.R.=exercise heart rate in beats per minute;
D.I. = desired exercise intensity or desired percentage
of VO2max expressed as a decimal (e.g., 40% = 0.40);
H.R.R.=heart rate range or maximal heart rate minus
resting heart rate; and R.H.R. = resting heart rate.
Maximal heart rate for the obese can be estimated by
the formula:200 -(0.5 x age)
• High intensity vs low intensity
Before Beginning an Exercise
• Are a man older than age 40 or
a woman older than age 50
• Have had a heart attack
• Have a family history of heart-
related problems before age 55
• Have heart, lung, liver or kidney
• Feel pain in your chest, joints, or
muscles during physical activity
• Have high blood pressure, high
cholesterol, diabetes, arthritis,
osteoporosis, or asthma
• Have had joint replacement
• Are overweight or obese
• Tale medication to manage a
• Have an untreated joint or
muscle injury, or persistent
symptoms after a joint or
• Unsure of your health status
• Are pregnant
You should check with your doctor before beginning an exercise program if you:
EFFECT OF EXERCISE ON FAT
• 2 main source of energy- fats and
• At rest body metabolizes only about 30% of
• During exercise only 25% of FFA converted
back into fat.
• During light exercises (30-50% of VO2
max)about 50 %to 70% of energy will come
EFFECT OF EXERCISE
• A large percentage of the FFA is used a source
• Lactic acid threshold will be higher.
• Resting metabolic rate increases.
• Increased level of epinephrine and non
Specific exercise consideration
• Non weight bearing activities.
• Recreational activities.
• Planned vs incidental
• Supervised vs nonsupervised
Health Benefits of Exercise Training with
or Without Substantial Weight Loss
• 1. Maintenance of reduced body weight and body fat
• 2. Prevention of weight/fat regain
• 3. Reduced systolic and diastolic blood pressure,
• control of hypertension
• 4. Decreased resting heart rate, increased stroke volume,
• increased cardiac output
• 5. Reduced blood lipids: LDL cholesterol, VLDL cholesterol,
triglycerides, free fatty acids
• 6. Increased blood high-density lipoproteins
• 7. Reduced cardiovascular disease risk
• 16. Increased immunity
• 17. Increased pulmonary function
• 18. Increased or maintenance of bone mineral
• 19. Decreased risk of stroke
• 20. Maintenance or increase in lean body
• 21. Augmentation in RMR and/or 24-hr energy
expenditure (dependent upon changes in
body composition, exercise protocol, and
Facts on exercise in obesity tx.
• Exercise alone only leads to slight weight loss, if any,
but marked reduction in mortality.
• Adding moderate/vigorous aerobic exercise to dieting
slightly increases weight loss.
• Aerobic exercise during weight loss lessens loss of
• Resistance exercise during weight loss preserves FFM
and may help maintain wt loss.
• Any type of exercise helps maintain weight loss, but
duration must be 4-10 hours/week.
• Compliance may be better with multiple short-bout
Preventing Weight Regain After Weight
• Extended Treatment/Professional Contact.
• Skills Training
• Food Provision/Monetary Incentives
• Peer Support
• Exercise/Physical Activity
• Stimulus control
• Body image and self-esteem counseling
• Stress management
• Social support