Obesity management


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Obesity management

  2. 2. • 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 mass.
  3. 3. CAUSES OF OBESITY Energy Expenditure Energy Intake nutritional, activity levels, endocrine, genetic, drugs
  4. 4. CALORIC BALANCE Intake ???? Resting Met Rate Thermic Effect of Food Spontaneous Activity Exercise + _
  5. 5. Energy Imbalance 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 the body. • Weight gain usually involves the combination of consuming too many calories and not expending enough through physical activity. CDC
  6. 6. 2009 Energy Imbalance Effects in the Body • Excess energy is stored in fat cells, which enlarge or multiply. • Enlargement of fat cells is known as hypertrophy, whereas multiplication of fat cells is known as hyperplasia. • With time, excesses in energy storage lead to obesity. Fat cells J La State Med Soc .2005; 156 (1): S42-49.
  7. 7. Fat Cell Enlargement Hypertrophy • Enlarged fat cells produce the clinical problems associated with obesity, due to the following: – The weight or mass of the extra fat – The increased secretion of free fatty acids and peptides from enlarged fat cells.
  8. 8. Factors Contributing to Obesity Lifestyle • Poor diet • Skipping meals • Sugary soft drinks • Poor sleep • Snacking • Alcohol • Sedentariness • Etc. Psychosocial • Depression • Anxiety • Binge eating • Boredom • Social events • Low income • Stress • Etc. Biomedical • Genetics • Metabolism • Intrauterine growth • Medications • Injury • Mobility issues • Etc.
  9. 9. Theories of obesity • Genetic • High calories and high fat diet. • Insufficient energy expenditure • Environment and life style • Lipoprotein lipase • Leptin gene • Drugs and disease.
  10. 10. Health risks • Psychological burden • Osteoarthritis • High blood pressure • Increased level of cholesterol • Diabetes • Increased heart disease • Cancers • Stroke, dvt • Renal disease • Sleep apneas • Menstrual irregularities • Gallbladder diseases
  11. 11. Criteria for excessive body fat • Percentage of body mass composed of fat • Regional fat distribution • Adiocytes size and number.
  12. 12. Indications for Obesity Treatment Symptoms/ Condition Caused by obesity? Aggravated by obesity? Unrelated to obesity? Indication for obesity treatment Primary Secondary Tertiary Sharma 2006
  13. 13. DIETING • Set point theory • Early weight loss is largely water
  14. 14. SETPOINT THEORY • 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
  15. 15. SETPOINT THEORY • 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”
  16. 16. Exercise prescription FIIT principle. • 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
  17. 17. Before Beginning an Exercise Program • 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 disease • 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 surgery • Smoke • Are overweight or obese • Tale medication to manage a chronic condition • Have an untreated joint or muscle injury, or persistent symptoms after a joint or muscle injury • Unsure of your health status • Are pregnant • . You should check with your doctor before beginning an exercise program if you:
  18. 18. EFFECT OF EXERCISE ON FAT METABOLISM • 2 main source of energy- fats and carbohydrates. • At rest body metabolizes only about 30% of FFA. • 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 from FFA.
  19. 19. EFFECT OF EXERCISE • A large percentage of the FFA is used a source of energy. • Lactic acid threshold will be higher. • Resting metabolic rate increases. • Increased level of epinephrine and non epinephrine.
  20. 20. Specific exercise consideration • Non weight bearing activities. • Recreational activities. • Planned vs incidental • Supervised vs nonsupervised
  21. 21. Health Benefits of Exercise Training with or Without Substantial Weight Loss • 1. Maintenance of reduced body weight and body fat content • 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
  22. 22. • 8.Increased blood glucose control, reduction in oral hypoglycemic medications, reduction in insulin dosage, increased insulin sensitivity • 9. Decreased cancer risk: colon, breast, prostrate, lung • 10. Decreased bone and joint problems • 11. Increased aerobic capacity • 12. Increased functional capacity • 13. Increased muscular function • 14. Increased psychological profile: decreased stress, decreased depression, increased self-esteem, decreased body image disparagement, decreased eating pathology • 15. Decreased mortality risk
  23. 23. • 16. Increased immunity • 17. Increased pulmonary function • 18. Increased or maintenance of bone mineral density • 19. Decreased risk of stroke • 20. Maintenance or increase in lean body mass • 21. Augmentation in RMR and/or 24-hr energy expenditure (dependent upon changes in body composition, exercise protocol, and accompanying diet)
  24. 24. 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 FFM. • 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 sessions.
  25. 25. Preventing Weight Regain After Weight Loss • Extended Treatment/Professional Contact. • Skills Training • Food Provision/Monetary Incentives • Peer Support • Exercise/Physical Activity
  26. 26. Behavioral Modification • Self-monitoring • Stimulus control • Body image and self-esteem counseling • Stress management • Social support