Ex Rx for Weight Loss P 1

overweight defined as

BMI: 25-29.9 kg-m2

obese defined as

BMI: > 30 kg-m2

increased risks of living w obesity (8)

• type 2 diabetes

• CV disease

• hypertension

• mental health

• stroke

• MI

• high cholesterol

• some cancers

when is weight loss recommended (4)

• overweight + 1 indicator of increased CV risk OR

• obese OR

• WC: males > 100cm, females > 90cm

• AND client has this as a goal

clinically sig weight loss occurs with

a 5% reduction in body mass

components of total energy expenditure (3)

• basal energy expenditure (BEE)

• thermic effect of food (TEF)

• activity energy expenditure (AEE)

energy content of 1 lb fat (0.5 kg) is

~3500 kcal

for 1 lb of fat loss to occur

must be a negative energy deficit of 3500 kcal

energy management models (3)

• additive model

• performance model

• compensatory model

additive model

assumes inc PA= inc TEE, W/O change in basal EE

performance model

assumes inc PA= inc TEE WITH an inc in basal EE

compensatory model

assumes inc PA= no sig change in TEE due to a dec in basal EE

what is energy compensation (aka metabolic adaptation)

reflects discrepancy b/w amount of weight loss predicted from energy deficit and actual weight loss

comp responses w PA-induced weight loss include (3)

• inc drive to eat

• reduced basal EE

• changes in behaviours

if quick and sig fat loss is the goal

severe caloric restriction is the fastest result

severe caloric restriction: minnesota starvation experiment

energy intake was 50% of normal and resulted in 24% loss of weight

• + severe weakness, depression, fatigue etc

challenge w weight loss based on PA alone study

• both PA groups compensated w greater energy intake

• those w greater compensation reported inc appetite, esp cravings for sweet foods

if sustainable fat loss and prevention of disease is the goal

combo of severe caloric restriction and inc energy expenditure methods

other advantages of PA in weight loss (4)

• max fat loss esp visceral fat

• minimizes ms loss

• reduces risk of CVD, diabetes, some cancers

• improves psychological function

realistically weight loss usually results in (3)

• an inc in appetite and thus energy intake

• a reduction in basal EE

• change sin behaviour (sleep and sit more etc)

using PA as part of weight loss Rx (4)

• weight loss multifactoral

• equations to predict weight loss are imprecise

• dietary change + PA most effective at reducing weight and weight regain

• while MVPA is imp, it can’t come at expense of inc EE or dec light PA

healthy weight loss

• 1-2 lbs/week

  • achieved by dec EE and inc PA equating to energy deficit of 3500-7000 kcal (~500-1000 kcal/day)

  • must also inc strategies to support weight loss program (i.e barriers to regular PA)

client w a weight loss goal

• weight loss is complex!

• client’s “best” weight may not be their “ideal” weight

• ideal weight is predicted by BMI

• better to approx weight loss goals based on 5% reduction of body mass

CSEP - ASK 1st (4)

• don’t assume client’s have a weight loss goal

• ask permission to address weight

• create a weight-friendly practice

• ensure all other pre-participation health screening procedures followed

CSEP - ASSESS 2nd (3)

• body comp (WC + BMI)

• aerobic fitness (be aware of potential difficulty w thermoreg)

• MSK fitness (use discretion)

CSEP - ADVISE 3rd

see weight loss recommended goals criteria

CSEP - AGREE 4th (4)

• HIIT and MICT virtually identical changes in fat loss and FFM

• results from HIIT are accomplished in less time but much higher exertion

• easier to create an energy deficit from dietary restriction

• exercise helps preserve lean mass and functional performance as well as help prevent weight regain

AGREE cont (FITT)

• weight loss achieved solely through PA is about 0-3 kg for interventions ranging b/w 15 weeks to 1 yr

• F: 3 → 5-7 days / week

• I: light mod → mod vig intensity

• T: 10 → 60+ mins/day

• T: large ms activities that reflect ADLs (mixed modes best)

CSEP - ASSIST & ARRANGE (5)

• need to understand root causes that contribute to fat gain

• behavioural interventions are key

• ensure prescribed program incorporates training principles

• arrange f/u appts

• consider sending report to treating physician if client agrees