Obesity in AdultsAlexandra Abraham

Some definitions…• Obesity - The condition of being grossly fat or overweight.

• Body Mass Index – measurement of body composition

• Obesity = BMI of > 30

Some Simple Statistics…• More than 1 in 3 adults are considered to be

obese. (35.7%)

• More than 1 in 6 children and adolescents ages 6 to 19 are considered obese. (36%)

• At least 2.8 million die each year as a result of being overweight or obese. (worldwide)

Estimated Percentage by Sex

Male Female

Estimated Percentage by Race

Extreme ObeseObeseOverweight

Changes from 1962 to 2010

Top: Extreme ObesityMiddle: ObesityBottom: Overweight

Why Obesity is a Problem…• Obese individuals have a higher risk for…1. Type II Diabetes2. Hypertension (High Blood Pressure)3. Heart Disease4. Stroke5. Cancer6. Erectile Dysfunction7. Sleep Disorders (Sleep Apnea)

Why Obesity is a Problem…Other weight related issues…1. Depression

2. Social Isolation

3. Lower work achievement

4. Disability

5. Bone and joint disease (osteoarthritis)

Main Causes of Obesity1. Genetics2. Activity level3. Food consumption

Why a Fitness Program?

Risk Factors for Developing Obesity• Genetics• Family Lifestyle• Sedentary Lifestyle• Unhealthy Diet• Social & Economic Issues• Age

Obesity can cause...• Heart Disease• Stroke• Type 2 Diabetes• Cancers• High Blood Pressure• Decreased Lung Function• Depression• Poor QOL

Benefits from Exercise●Burning off calories and losing weight●Increasing your metabolic rate ●Improving circulation●Improving heart and lung function●Enhances breathing●Increasing your sense of self-control●Reduce stress●Increasing your ability to concentrate●Improved appearance●Reduced depression

●Appetite suppression●Improved sleep●Preventing diabetes●Prevent high blood pressure●Prevent high cholesterol●Decreasing your risk of some cancers, such as breast, ovary, and colon cancer●Decrease risk for CVD●Decrease risk of stroke●Decrease risk of developing cancer

Exercise vs Diet vs Diet+Exercise Study

● Study took place over a years time● 103 randomly selected participants

age >65 ● 4 groups: Control, Exercise Only,

Diet Only, Exercise+Diet

Diet plan● Diet plans for the diet only group

and exercise+diet group were to stay around 500-750 kcal deficit every day

● Met with dietitians weekly and kept a food journal that was reviewed

● Changes were made based on the food logs

● Diet for exercise was to maintain current weight, but followed same food log rules

Exercise Plan● Both the exercise only and

exercise+diet participated in same plan

● Includes both Aerobic and Anaerobic exercises

● Each exercise session was about 90 minutes in duration

● These were group exercise programs that were 3 times per week

Aerobic Work● Exercises included treadmill,

stationary bicycle, stairclimbers● Started at 65% heart rate max,

increased to 70-85%

Resistance training● Progressive program that was a

combination of 9 lower and upper body movements

● Started at 1-2 sets at 65% 1RM for 8-12 reps

● Progressed to 3 sets at 80% 1RM for 6-8 reps

Results● No changes in body weight for the

exercise only group● 10% body weight loss in diet only

group with a decrease in lean body mass by 5%

● 9% body weight loss in exercise+diet group with a decrease in lean body mass by 3%

Results● Bone density loss in diet only group

was 2.6% compared to the diet and exercise group with only a 1.1% loss

● Bone density loss is extremely bad in older adults because your body becomes less efficient at storing calcium and other key minerals

Scientific StudyLong-term weight loss after diet and exercise

Main objective: To assess the effectiveness of dietary interventions and exercise in long term in obese adults.

Scientific studySubjects: Overweight and Obese Adults 18 years and older with a body Mass Index greater than 25.

Comparison: Randomized clinical trials comparing diet and exercise interventions vs diet alone. All trials included a 1 year follow up.

Scientific study details● 40-127 individuals participated

● No goal weight

● Exercise type wasn’t specified, as long as the individuals were getting at least the recommended minimum exercise per week.

The numbers● Baseline weight average ranged

from 83.5 to 106 kg.o Dropout rate was less than 20%o Individuals in the diet and exercise

group had a mean weight loss 20% greater than diet alone after intervention.

Scientific Study after 1 year follow-up

Both groups showed weight regain of about 50%

Both group showed that the initial weight loss was difficult to sustain.

Study suggests that individuals changed their lifestyle for only a short period and then went back to their old ways.

Conclusion of Scientific Study-Including both diet and exercise result in greater weight loss than diet alone after 1 year.-Including diet and exercise also delivers the most benefits after 1 year-Neither group was able to lose or maintain their weight after the 1 year follow-up

Client Assessment● Endurance: Standard submax exercise

testing usedo Eg: 1 mile walk test

● Flexibility: Limited by excess fat tissue● Strength/Power: Avoid tests involving

jumping, lifting body weight, complex movements, rapid change in direction.○ Seated leg press is good to

assess leg strength○ Wall push up for upper body

Exercise Prescription● 5-10 minute warm up: walking,

marching, arm circles ● Focus on aerobic exercises: 5-7

days, 40-60% V02max, 30-60 minutes, accumulating 150-300 minutes/week

● Cardio exercises: Walking, incline treadmill, arm ergometer, any low-impact activities

Exercise Prescription● Resistance Training: 2-3 times/week, 8-10

exercises, 8-12 reps, intensity that fatigues muscle in given # of reps, one set/exercise

● Stability ball exercises:o Core: Seated pelvic tilt and trunk twistso Upper Body: Seated row with tubing,

front/lateral raised and bicep curls with dumbbell/tubing

o leg extensions with ankle weights

Exercise Prescription● Flexibility: Static stretches are

recommendedo Hold about 20-30 seconds, o Hip flexor stretch, chest doorway

stretch, seated leg stretch-hamstrings and gastrocnemius

● Cool Down:○ Similar to warm-up, but lower intensity

● Engaging Clients● Main goal for this population: lose weight● Educate on Physiological and Psychological

benefitso Increase self-efficacyo Increase physiological functioningo Look better and feel better

Motivation: Weight Loss

● Setting weight loss goals will help motivate clients

● 1-2lbs per week (3500-7000 caloric deficit/week)

● Slow continuous training to encourage fat losso Focus on duration

● Sometimes weight loss may not occur right away○ Remind clients of other benefits○ Be patient-benefits will outweigh costs

Engage Clients by Setting Goals

● Mix up exercises● Make workouts fun and enjoyable● Do not force them to do an exercise they

are not comfortable with● Find what they like

Engaging Clients: Provide Variety

● Tell clients to:o Stay hydratedo Avoid hot environments

● Make them aware of:○ Other benefits of exercise besides weight

loss:■ More joint mobility, reduce cholesterol

and BP, improve heart/lung functioning, less fatigue, reduces risk for type 2 diabetes

■ Improved mood, decreases anxiety

Education Components

ReferencesVillareal DT, Chode S, Parimi N, et al. Weight Loss, Exercise, or Both and Physical Function in Obese Older Adults. The New England journal of medicine. 2011;364(13):1218-1229. doi:10.1056/NEJMoa1008234.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114602/

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