04 assessment and management in Obesity.pdf

Physical Therapy Assessment and Treatment for Obesity BY Prof. dr/ Mona BDEL-KHALEK Dr. Mina Atef Dr. Ahmed M. Abdel-Halim Obesity  Is a medical condition in which excess body fat has accumulated to the extent that it may have adverse effect on health, leading to reduce life expectancy and/or i...

Physical Therapy Assessment and Treatment for Obesity BY Prof. dr/ Mona BDEL-KHALEK Dr. Mina Atef Dr. Ahmed M. Abdel-Halim Obesity  Is a medical condition in which excess body fat has accumulated to the extent that it may have adverse effect on health, leading to reduce life expectancy and/or increase health problem (Haslam, 2005). Associated Health Risks with Obesity  Diabetes  Cardiovascular disease  Some cancers  Strokes  Gallstones  Sleep apnea  Osteoarthritis Assessing Body Weight and Body Composition  A Healthy Weight Depends On:  Body structure  Height  Weight distribution  Fat to lean tissue ratio  Muscle weights more than fat, so muscular individuals might be overweight based on traditional height/weight charts. Assessing Body Weight and Body Composition  Overweight and Obesity  Overweight—having a body weight more than 10 percent above the healthy recommended levels; in an adult, having a BMI of 25 to 29  Obesity—a body weight more than 20 percent above healthy recommended levels; in an adult, having a BMI of 30 or more  Morbid Obesity—having a body weight 100 percent or more above healthy recommended levels; in an adult, having a BMI of 40 or more Negative Health Effects of Overweight and Obesity Negative Health Effects of Overweight and Obesity Negative Health Effects of Overweight and Obesity Negative Health Effects of Overweight and Obesity Negative Health Effects of Overweight and Obesity Negative Health Effects of Overweight and Obesity Negative Health Effects of Overweight and Obesity Negative Health Effects of Overweight and Obesity Negative Health Effects of Overweight and Obesity Negative Health Effects of Overweight and Obesity Factors Contributing to Overweight and Obesity  Genetic and Physiological Factors  Thermic Effect of Food  Adaptive Thermogenesis  Endocrine Influence: The Hungry Hormones  Environmental Factors  Psychosocial and Economic Factors  Lack of physical activity Factors Contributing to Overweight and Obesity  Genetic and Physiological Factors  Body type and genes  Metabolic rates  Basal metabolic rate (BMR)—the rate of energy expenditure by a body at complete rest in a neutral environment  A BMR for the average healthy adult is usually between 1,200 and 1,800 calories per day.  Resting metabolic rate (RMR) includes the BMR plus any additional energy expended through daily sedentary activities.  Exercise metabolic rate (EMR) is the energy expenditure that occurs during exercise. Factors Contributing to Overweight and Obesity  Thermic Effect of Food  An estimate of how much energy is necessary to burn food calories  Adaptive Thermogenesis  Adaptive thermogenesis refers to a slowing of metabolism that’s greater than expected based on lean body mass. When you lose weight, you also lose muscle. This reduces your energy needs and your metabolism slows slightly.  Yo-Yo Diets  Refer to dieters who resume eating after their weight loss so their BMR is set lower, making it almost certain that they will regain the pounds they just lost Factors Contributing to Overweight and Obesity  Endocrine Influence: The Hungry Hormones  Less than 2 percent of the obese population has a thyroid problem and most experts agree weight problems can be traced to a metabolic or hormone imbalance.  Hunger—an inborn physiological response to nutritional needs  Appetite—a learned response to food that is tied to an emotional or psychological craving.  Satiety—to feel satisfied, or full, when one has satisfied their nutritional needs and the stomach signals “no more” Factors Contributing to Overweight and Obesity  Hormones  Gherlin—“the hunger hormone” During periods of weight loss, such as dieting the body produce high levels of gherlin to slow down fat metabolism , encourage eating and promote fat retention, changes which normally make it difficult to lose weight and keep it off  Obestatin—a hormone opposing to gherlin and producing by specialized epithelial cells of the stomach and small intestine.  Leptin— (satiety hormone) tells your brain when you’re full  GLP-1—slows down the passage of food through the intestines to allow the absorption of nutrients Factors Contributing to Overweight and Obesity  Environmental Factors  Bombarded with advertising  Bottle feeding in infants  Increase in sedentary lifestyle  Misleading food labels  Increased opportunities for eating  Larger portions, junk food  Decline of home cooking  Internet and video games Misleading food labels Factors Contributing to Overweight and Obesity  Psychosocial and Economic Factors  Food as reward  Socioeconomic factors can provide obstacles or aids to weight control.  Studies show that the more educated you are, the lower your BMI is in the United States.  In poor countries where malnutrition is prevalent, those with higher education tend to have a higher BMI. Factors Contributing to Overweight and Obesity  Lack of physical activity  Any form of activity that burns additional calories helps maintain weight Assessing Body Weight and Body Composition  Body fat is composed of:  Essential fat—amount necessary for maintenance of life and reproductive functions, including:  Insulation, cushion, nerve conduction, vitamin absorption, energy, and body temperature regulation  Dropping body fat too low can compromise performance and normal bodily function, including amenorrhea for females  3–5% of total BW in males  8–12% of total BW in females Storage fat—the nonessential fat that stored in adipose tissue.  12% of total BW in males  15% of total BW in females  Assessing Body Weight and Body Composition  Body Mass Index (BMI)  Index of the relationship between height and weight  BMI = weight (kg)/height squared (m2)  BMI of 18.5 to 25 kg/m2 indicates healthy weight Body Mass Index (BMI) is the global method of determining overweight/obesity Assessing Body Weight and Body Composition  waist circumference: is one way to determine an increased amount of fat around the abdomen.  A high waist circumference is associated with an increased risk for health conditions like hypertension, elevated blood lipids, type 2 diabetes, and cardiovascular disease.  Even if the BMI has indicates a healthy weight, it’s possible to have too large of a waist circumference. Assessing Body Weight and Body Composition  Waist circumference How to measure the waist circumference?  - detect the lower border of the least palpable rib and the top of the iliac crest in mid axillary line.  -the measuring tape is parallel to the floor  - Exhale normally while measuring and relax the abdomen sucking in is not allowed.  -Place the tape measure midway between the two points and round the tape measure around the bare stomach.  Normally for women less than 35 inches or 88 cm (80-88 cm)  Normally for men less than 40 inches or 102 cm ( 94 -102 cm) Assessing Body Weight and Body Composition  Waist-to-hip ratio: detect the widest part of the buttocks ,Then place the tape measure at this location and measure around the circumference of the hips and buttocks.  Using the waist circumference measurement, calculate the waist-to-hip ratio by dividing the waist circumference by the hip measurement. Assessing Body Weight and Body Composition  Waist-to-hip ratio  Abdominal obesity is defined as a waist–hip ratio above 0.90 for males and above 0.85 for females, Assessing Body Weight and Body Composition  Measures of Body Fat  1: Skin Fold Caliper  2: Bioelectric Impedance Analysis Assessing Body Weight and Body Composition  Skin Fold Caliper: measuring the thickness with a body fat caliper. The reading is given in millimeters, then compare to a chart with age and gender Assessing Body Weight and Body Composition  Bioelectric Impedance Analysis: Muscle has high water content, and is highly conductive, while fat has lower water content and is not highly conductive. Physical therapy Management for Obesity 15 minutes break Weight Loss The key to any successful weight loss is making changes in your eating and physical activity habits that you can keep for the rest of your life. How Much Physical Activity a Day? To reduce the risk of chronic diseases in adulthood: Engage in at least 30 minutes of moderate-intensity physical activity, above usual activity, at work or home on most days of the week. To help manage weight and prevent gradual, unhealthy weight gain in adulthood: Engage in approximately 60 minutes of moderate- to vigorous-intensity activity on most days of the week while not exceeding caloric intake requirements. To sustain weight loss in adulthood: Participate in at least 60 to 90 minutes of daily moderate- to vigorous-intensity physical activity while not exceeding caloric intake requirements. (Some may need to contact their healthcare provider before participating in this level of activity.) Calories Burned by Different Activities The Concept of Energy Balance Treating obesity demands a multi-faceted approach with chronic monitoring 1. Decreased caloric intake 2. 3. 4. 5. Increased exercise Behavioral modification +/- Pharmacotherapy +/- Surgery A Healthy Diet  Emphasizes fruits, vegetables, whole grains, fat-free or low-fat milk, & milk products;  Includes lean meats, poultry, fish, beans, eggs, and nuts  Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars. Calorie Deficit Needed For Weight Loss A caloric deficit of 500 can be done by:  Eating 250 kcal less per day:  burning 250 calories through  Leave out mayonnaise in a exercise:  Walk for 30 minutes  Swimming 25 yards  Bicycling for 30 minutes sandwich  Leave out dessert  Switch from soft drinks to water  Reduce portion sizes 2009 Exercise Prescription for Obese Patients  1-Cardiovascular Exercise( aerobic)  2-Resistance Exercise  3-Range of Motion Exercise 1-Cardiovascular Exercise( aerobic)  Mode of Aerobic exercise: weight bearing 2. non-weight bearing 1. 1-Cardiovascular Exercise( aerobic)  weight bearing aerobic exercises: -Walking is the best form of exercise for several reason -Advantage of walking exercises: 1. Walking is an excellent, low-intensity activity with little risk of injury. 2. It is available to most patients Neighborhoods, parks, walking trails, shopping malls, fitness centers, and so on offer walking opportunities. 3. A minimum amount of attention is necessary, so socializing is easy and convenient 1-Cardiovascular Exercise( aerobic)  Walk on a treadmill, care should be taken to assess the weight limits of the treadmill.  Treadmills especially designed for obese individuals up to 227 kg are available.  Jogging should usually be avoided, especially in patients with no previous jogging history or people who have a preexisting musculoskeletal pain 1-Cardiovascular Exercise( aerobic)  Non-weight-bearing exercise options include: • stationary cycling, • recumbent cycling, • seated stepping, • upper body ergometry, • seated aerobics, • water activities. 1-Cardiovascular Exercise( aerobic)  Non-weight-bearing exercise :These activities are useful at any time but are particularly useful for those with joint injury or pain.  Water activity  Advantage of walking exercises: 1. The buoyancy of water takes much of the body weight off the joints. 2. Patients who experience heat intolerance with other activities are often more comfortable performing waterbased exercise 1-Cardiovascular Exercise( aerobic)  Non-weight-bearing exercise : People who are obese often have difficulty getting on or off these types of equipment so providing larger seats and stable equipment are recommended. 1-Cardiovascular Exercise( aerobic)  Frequency: • Daily exercise and physical activity at the recommended levels of duration and intensity are required to achieve and sustain long-term, significant weight loss. • Key factors are to minimize the duration and intensity initially to avoid excessive fatigue or muscle soreness that may sabotage the patient’s willingness to exercise the next day 1-Cardiovascular Exercise( aerobic)  Intensity: • Initially 50-60% of heart rate reserve is typically low enough for sustained exercise • Progression, 60% to 80% of heart rate reserve 1-Cardiovascular Exercise( aerobic)  Duration: • beginning with 20 to 30 min each day is appropriate, breaking this exercise time into two or three sessions per day of shorter duration (5 to 15 min) may be required for highly deconditioned people. • Progression of approximately 5 min every 1 to 2 week, until the person can perform at least 60 min of exercise. 2-Resistance Exercise  Resistance intensity in the range of 60% to 80% of an individual’s one-repetition maximum (1RM,) performed for 8 to 15 repetitions for two sets each, with 2 to 3 min of rest after each bout.  Resistance exercises can be performed maximally on 2 or 3 d/wk.  These exercises should focus on the major muscle groups of the chest, shoulders, upper and lower back, abdomen, hips, and legs Fat-free mass  Fat-free mass can refer to any body tissue that does not contain fat as Skeletal muscle, bone and water What type of exercise is best for weight loss maintenance?  A combination of aerobic AND resistance training Does aerobic exercise vs. diet alone alter the composition of weight loss?  YES  Diet alone leads to marked reduction in fat free mass (FFM) as well as fat mass  7 of 10 studies: aerobic exercise preserves (FFM) What is the effect of resistance training on body composition? Definitely preserves, and may even increase, fat free mass FFM Aerobic physical activity amount and expected weight loss. Adapted from the American College of Sports Medicine position stands, “Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults ” Aerobic physical activity amount Weight loss amount <150 min per week No weight loss or minimal weight loss 150-225 min per week Weight loss of 2 to 3 kg 225-420 min per week Weight loss of 5 to 7.5 kg 200-300 min per week Weight maintenance after weight loss References  Clinical Exercise Physiology-3rd Edition  ACSM | The American College of Sports Medicine