L16- overweight and obese clients

obesity - multifactorial

• Socioeconomic
  • Psychological
  • Physiological
  • Biological

obesity as chronic disease

• Impairment of normal function
• Symptoms
• Harm or morbidity of the individual

obesity - genetic factors

Primer
• DNA phenotype
• DNA methylation
• Reversible?

From the mother
• If overweight, passes on the phenotype

current trends for obesity

60% of Canadians are overweight or obese
• 30% of youth are overweight or obese

Childhood physical activity
• At 3 yrs: 53% will remain overweight/obese into their teen
• Adolescents: 70% - 80% will remain overweight/obese at 30 yrs
• Overweight/obese children and adolescence 5x more likely to be
overweight/obese into adulthood

obesity interventions - medication

Typically for BMI ≥ 30

Orlistat (Xenical)
• Reduces fat absorption
• Inhibits lipase activity in the intestines

Liraglutide (Saxenda) & Ozempic
• Glucagon-Like Peptide-1 (hormone)
• Glucose-dependent stimulatory effect on inulin production
• Lowers blood sugar
• Reduces cravings

intervention: diet

canada food guide
- this is what we can suggest
- broad statements can be made
- DO NOT prescribe diets

Registered dietitians
- have training in diet and psychology
- government regulated

tracking intake: recall bias

people can underestimate intake by 10-20%

tracking intake

requires strict adherence (what gets measured gets managed)

reinforce need to track to clients
- they don't need to show you their intake
- if they show you, recommendations must be generalized

nutrition suggestions

- can "sneak" in other stratagies

e.g.
- larger salads will take up space on the plate
- vegetavles are nutrient dense, low cal, and client still gets full
- bake or air fry instead of frying
- low cal alternatives (sauces, dressings, etc.)

caloric deficits: set point theory

- with a deficit, PA declines (not consciously)
- weight loss plateau body adapts to lower kcal requirment
- takes weeks/months to plateau

yo-yo dieting and severe restrictions

- set point extreamely low
- regular BMR is now a surplus
- low muscle mass = lower BMR

intervention: behaviour change

improve diet (easier to achieve)
- slight to high caloric deficit
- 500 - 1000 kcal per day

more PA time (harder to acheive)
- small improvements over time
- goal: 60min moderate intensity walking per day

caloric deficit without PA can lead to muscle degradation

your role

priority: promote behaviour change

what should client success look like?

increase cardiorespiratory fitness, glucose control, endothelial function, lipoprotein profile, life longevity, body composition

ask: discussing weight

clients may be hesitant to discuss weight
- tread lightly
- need consent to discuss weight

but, clients know they are overweight
- will openly discuss their weight
- will be hesitant to discuss underlying factors

stratagy: follow thier lead

assess: pre participation health screening

need to prob questions as clients may not divulge all information

medications
- emphasize they fill our Par-Q+ throughly
- can go over responses with client

other probing questions

• Has your health care provide recommended any restrictions or modifications to PA?
• Are there any types of PA that you would prefer to avoid or cannot perform?
• Do you have pain in the lower back, hips, knees, etc?

when should you refer out your client?

when client has factors outside of scope of practice

- comorbidities
- potential adverse effects to exercise
- movement restrictions
- pain/injuries

motivational interviewing

try puting yourself in their shoes as you may not have the same lived experiences as them

SMART weight loss goals

emphasize realistic
- 1/2 to 1kg per week
- deficite of 3500 - 7000 kcal per week.

translate from numbers to actions
- walk x min per day at brisk risk
- avoid Y in your diet

exercise prescription

follow FITT-VP

also include general nutrition suggestions

FITT-VP: lifestyle

frequency: 3x per week
intensity: moderate
time: 60min per day
type: low impact (e.g. walk)
volume: 150 min per week
progression: more per week

FITT-VP: aerobic exercise

frequency: multiple short sessions
intensity: 40-60% HRR ~ RPE 12-3
time: 30-60 min
type: aerobic: low impact (client preference)
volume: 150 min per week
progression: add vig activity progressively

FITT-VP: resistance training

see beginner recs for strength

arrange

- you need contingencies
- old habits are hard to break
-- defaults are comfortable
-- stress leads to poor decision making
- also need to include "breaks"
-- people need "cheat" days
-- cant alway be on go

T or F: you should train change body position every exercise for resistance training

T
- increases HR

overcoming plateaus: diet

"cheat" days
- 1-2x per month for minor deficits

recommendations
- maintain caloric intake
- avoid fats
- maintain protein intake
- remaining kcal from simple carbs

psychology of cheat days
- remotivation
- teaches moderation
- provides a goal (e.g. if seeing results, they can eat as much junk as they want)
- sense of accomplishment with a reward

overcoming plateaus: physcial activity

back-off for 1-2 weeks
- lower stress levels
- re-sensitizes body to PA

change resistance training
- new focus
- progress from straight sets to giant sets