Obesity

Obesity

An abnormal or excessive fat accumulation that presents a risk to health

Pathophysiology

Primary causes :

  1. Energy imbalance

    1. Consumption of excess total calories

  2. sedentary lifestyle

A complex behavioral & neuroendocrine disorder

Appetite Suppressants

  1. Leptin

    1. Released by white fat cells

  2. Serotonin

    1. Mood hormone ( suppressing hunger)

Appetite Stimulants

  1. Ghrelin ( gremlin) only in stomach

    1. Triggers neuropeptide Y ( NPY), GH & NE

    2. Predominantly Stimulates carbohydrate intake

Altered Physiologic Responses

What are the primary characteristics behind obesity etiology?

  • Increase Fasting Glucose

  • Increase insulin response to glucose

  • Decrease insulin sensitivity

What are the assessments of Obesity?

  1. BMI

    1. Significantly correlates with total body fat

  2. Phenotype

    1. Type I: excess body mass % fat

    2. Type II: excess android fat (apple)

    3. Type III: excess abdominal visceral fat

    4. Type IV: excess gynoid fat ( pear)

  3. Cell morphology

    1. Hyperplastic obesity

    2. Hypertrophic obesity

Health Consequences

Increased risk

  1. PCOS

  2. Impaired fertility

  3. Lower back pain

  4. Complication during anesthesia

  5. Cancer

  6. Fetal defects

Moderately increased risk

  1. CVD especially CHF

  2. Hyperuricemia ( gout)

  3. Pregnancy complications

  4. Osteoarthritis

Greatly Increased risk

  1. Type 2 Diabetes Mellitus

  2. Hypertension

  3. Dyslipidemia ( increased LDL & TG & decreased HDL )

  4. Sleep Apnea

  5. Gallbladder disease

  6. Breathlessness

Prevalence

African americans & hispanics of lower income have high rates of obesity

0ne in two adults will have obesity byt 2030

Childhood Obesity

14-21% of children are obese & most carry into adulthood

What are some factors that determine if children will carry obesity into adulthood ?

  • Obesity severity

  • Age of onset

CVD risk doubles in childhood

Exercise Response

Low functional status :

-Decrease Vo2 peak

-Dyspnea on exertion

What are some comorbidities to consider with an individual who has obesity ?

  1. CVD

  2. Diabetes

  3. Hypertension

  4. Dyskinesis

  5. Gait

  6. economy/ efficiency

Added stress to joints

Osteroarthritis

Joint deterioration & pain

Increased foot pressure ( neuropathy)

Impaired musculoskeletal health

  • Decreased muscle strength & endurance

Exercise training

  • An increase in Vo2 peak by 25% have reduction in long-term mortality & morbidity along with long-term weight loss maintenance

What is the regular exercise expending kcal needed to maintain weight loss?

-2,00o kcals a week is a strong predictor of weight loss

-Walking is effective for a 2-year weight loss maintenance in women

What are some benefits associated with exercise training on fitness components?

  • Cardiorespiratory endurance

    • Increased Vo2 peak ( avg 15-30%) ( HIIT)

-Skeletal Muscle Endurance

- Normal increase in endurance ( assuming there is muscle)

Exercise Testing:

Cardiorespiratory

Generally not needed if beginning a low-to-moderate-intensity program

What is the primary purpose of testing ?

  • Assessing for presence of CVD

  • If BMI > 40 kg/m^2 : seated devices are recommended

    • Upper body ergometers & stationary cycles

Muscular testing & endurance

  • Machines ( 10RM)

Flexibility

  • Sit-reach test/goniometers

  • Testing regularly as losing weight will impact ROM

Medications

RECOMMENDED for those with BMI> 30 & 27 with suppressants

Appetite Surpressants ( Increase BP)

Most common & least expensive

Can result in up to 14% weight loss

  1. Intestinal Lipase Inhibitors

Cause 30% malabsorption of dietary fat

  1. Satiety enhancers

Promote 4% weight loss

  1. CNS Stimulants

Possible cardiovascular risks

Interventions

Diet

  1. Negative energy balance

  2. Hypocaloric diet

    1. 3500 kcal deficit is needed to lose 1 lb

Behavior

  1. Individual & group Therapy

  2. Goal setting & record keeping

Bariatric surgery

  • Average weight loss after 10 yrs 15-24%

Complications

  • 1% mortality rate

  • 15% morbidity rate

Who qualifies for this particular surgery?

  • BMI > 40

  • BMI > 35 with obesity-related comorbidities

Laparoscopic Gastric Banding ( Lap Band )

Placement of an adjustable band at the top portion of the stomach

Roux-en-Y Gastric Bypass ( RYGBP)

Gold standard

Only for those with BMI > 50

Special Considerations

“ Have you been trying to lose weight “

  1. Pre-contemplative

    1. No-intention

  2. Contemplative

    1. intend to in the next 6 months

  3. Preparation

    1. intend to in the next 6 months

  4. Action

    1. 1 day- 6 months

  5. Maintenance

    1. 6 months

What are the 5 hormones :

  1. Insulin

  2. Hormone- Sensitive Lipase

  3. Testosterone

  4. Estrogen

  5. Cortisol ( stress hormone)