It's about exercise training

1. OBESITY

5. Types
There are 2 types of regional fat distribution
1. Fat deposition in the abdominal area – central or
android or apple –type obesity
2. Fat in the gluteal and femoral region –peripheral
or gynoid or pear type of obesity

7. android or apple –type obesity

8.  Storage of fat in upper part of waist.
 Obese individuals with an android distribution of body fat in the
abdominal area giving an apple shape and Waist : Hip ratio is more than
1.
 Seen mainly in male population.

9. Gynoid or pear –type obesity

10. Evaluation of Obesity
1- Measurements based on anthropometry
A) Skin fold thickness:
Used by clinicians that depends on calipers to measure the fatty layer directly under the skin.
For greatest precision, the mean of the skin fold at four sites should be calculated. The following are
example of caliper locations at different sites:
1) In the upper limb:
* Subscapular:
An oblique fold measured just below the interior angle of the scapula.
* Triceps:
A fold at the mid line half way between the olecranon and acromion with the arm hanging freely at the side.
* Over the biceps:
Above the cubital fossa, at the same level as the triceps.

11. 2) In the lower limb:
* Thigh:
A fold in the anterior midline of the thigh, taken midway between the
patel1a and the hip.
* Calf
A fold measured in the leg at the level of the greatest calf girth.

12. 3) In the trunk:
* Chest:
A fold located one half of the distance between the anterior axillary line and nipple, for
men, and one third of the distance, for women.
• Abdomen:
A vertical fold measured 2 cm to the right of the umbilicus.
• Suprailiac:
Suprailiac, on the mid-axillary line immediately superior to iliac crest.

13. The approximate desirable ranges of mean skin fold thickness are 3-1.0 mm in
men and 1.0-2.2 mm in women.
(B) Waist to hip ratio:
-Measuring the circumference of the waist at its smallest point at level /or above of
umbilicus and the circumference of the hip at its widest point, and then calculating a
ratio of the two can easily determine the site of fat in the body.
-A waist to hip ratio is recommended to be below 0.85 and 0.95 for women and
men respectively.

16.  It is closely related to a greater risk for diabetes and heart disease than
were those with a gynoid distribution, because of the visceral fat deposit
in close proximity with the portal circulation.

17. (C) Body Mass Index (BMI):
BMI = Weight (kg)/Height (m)2
Normal (average): BMI equal 20 -25Kg/m2
Over weight: BMI 25-30 Kg/m2
Obese: BMI > 30 Kg/m2

18. D) Waist Circumference:
The waist circumference is a simple measure around a person's natural waist
(just above the navel). A high-risk waist circumference is defined as 35
inches (88 cm) or more for women and 40 inches (103 cm) or more for men.
 Waist circumference - girth measurement
More than 103 cm in men
More than 88 cm in women

20. Management
(1) Diet
• Restriction of energy intake to low calorie (800 to 1200 KCal./day) or
very low calorie (less than 800 KCal./day) Balanced diet is a common
treatment for obesity .

21. (2) Physical activity (exercise)
Exercise or increase physical activity should be used as a treatment modality
for obesity as long as there is no contraindication to its use.
Vigorous exercise should be avoided due to general lack of conditioning for
most obese individuals. Regular aerobic activity promotes a basic good
health and sense of well being.