Obesity Presented by Kristen Billings - PowerPoint Presentation

Slide1

Obesity

Presented by Kristen Billings

Slide2

What is Obesity?

Surplus of adipose tissue-containing fat stored in triglyceride form

Characterized by excess body weight

Overweight is defined as deviation in body weight from some standard or “ideal” weight related to height

.

Body weight is a function of energy balance over an extended period of time

Overweight does not always reflect obesity

The

point at which excessive fat constitutes obesity is arbitrary

Slide3

Epidemiology

Accessible, abundant, and inexpensive energy-dense foods among industrialized countries

S

ubstantial reduction in average daily energy expenditure required for survival.

Evolutionary adaptation theory

More than two decades of steadily increasing rates of obesity

Since the end of 2006 the rates have appeared to stabilize

Slide4

Epidemiology

66% are overweight, 5% extremely obese 18% of children are overweight

In

2006- 33.3% of adult men and 35.3% women in U.S were categorized as obese (BMI > 30)

Notably higher raters of obesity were seen in Hispanic and non-Hispanic black women.

Slide5

Slide6

Cost

Obesity related conditions account for 7% of total healthcare costs in the U.S.

Direct and indirect costs of obesity are in excess of $117 billion annually

Slide7

Symptoms

BMI (weight in kg/height squared in meters): Class I 30.0-34.9

Class II 35.0-39.9

Class III >40.0

Excessive accumulation of body

fat

Women >35%

Men >25%

Slide8

Diagnosis

Body Mass IndexWaist CircumferenceBody Fat Percentages

Waist to hip ratio

Slide9

Complications

Associated with numerous comorbidities, many of which are life threateningIncreases the overall risk and severity of numerous

diseases

Altered physiological responses

: increased fasting insulin, increased insulin response to glucose, decreased insulin sensitivity, decreased growth hormone, decreased growth hormone response to insulin stimulation, increased adrenocortical hormones, increased cholesterol synthesis and excretion, decreased hormone-sensitive lipase

Slide10

Complications

Distribution of fat is of more importance for risk of disease than total fat alone

Upper

body fat distribution (android obesity):

strongly correlated with increased risk of

coronary

artery disease, hypertension, hyperlipidemia, diabetes, hormone and menstrual dysfunction

Slide11

Complications

Chronic DiseasesDiabetes

Hypertension

Hypercholesterolemia

Hyperinsulinemia

Hypertriglyceridemia

Increased risk of cardiovascular disease

Slide12

Treatment

Primary objective of obesity management is to reduce fat weight while preserving lean body weightBehavioral change focused on dietary and activity habits toward weight reduction

FDA

approved drugs

FDA approved invasive procedures

Slide13

Slide14

Treatment- Behavioral Change

Patients are less motivated by health and more by personal appearance

Success

in weight loss is more commonly seen when:

Person is slightly or moderately obese

Has upper body fat distribution

Doesn’t have a history of weight cycling

Sincere desire to lose weight

Became overweight as an

adult

Slide15

Slide16

Treatment- Drugs

Drug

Mechanism of action

Exercise-related precautions

Adipex

-P

Appetite suppressant

Increase in blood pressure

Meridia

Appetite suppressant

Increase in blood pressure

Dexedrine

CNS

stimulant

Possible cardiovascular

risks

Alli

&

Xenical

Reduction in fat absorption via inhibition of pancreatic

lipase activity in intestine

none

Slide17

Treatment- Invasive Procedures

Based on reducing the size of stomach and lowering the absorption of nutrients in the intestineMust have BMI of >40 or >35 with comorbidities such as diabetes and hypertension to be eligible

Surgical treatment of obesity has been shown to reduce excess body weight by an average of 50-60%

Slide18

Treatment- Invasive Procedures

Laparoscopic gastric bandingMinimally invasive surgery

Adjustable silicone band is placed around top portion of stomach

Small gastric pouch is created which reduces capacity of stomach and produces a feeling of fullness shortly after eating

Benefits: minimal surgical trauma and pain, fast recovery rate, rare operative mortality.

Slide19

Surgery Videos

http://www.youtube.com/watch?v=n-

ucSHx9nHM

http://www.youtube.com/watch?v=

P83Vs9GQ0WI

Slide20

Treatment- Invasive Procedures

Roux-en-Y gastric bypassInvasive surgical procedure that reduces capacity of the stomach

A small pouch is created at the top of the stomach that is then connected directly to middle portion of the small intestine

The rest of the stomach and the upper portion of the small intestine are bypassed.

Procedure has a higher mortality and complication risk than the lap-band

Slide21

Effects of Exercise

Biomechanical EffectsExcess joint stress

Affected movement and gait

Increased foot pressure

Decreased strength

Increased risk of osteoarthritis

Slide22

http://www.youtube.com/watch?v=

cNATWsVVwgo

Slide23

Effects of Exercise

Comorbidities of obesity (diabetes, hypertension, CAD, sleep apnea, increased overall risk of exercise) may affect the exercise response.

Past experiences/current fears of exercise

Exercise training in combination with caloric restriction reduces body weight and favorably alters body composition.

Ineffective in morbidly obese individuals

Slide24

Benefits of Exercise

Preservation of lean body mass despite caloric restrictionImproved insulin sensitivity

Favorable changes in metabolic rate and lipid profiles

Reduced blood pressure

Improved mood

Possible effects on satiety

Overall reduction in comorbidity risk

Slide25

Benefits of Exercise

Loss of regional fat More effective in reducing abdominal fat cell size than diet alone

Energy expenditure following exercise remains elevated above pre-exercise levels

Glucose metabolism

Decreased fasting glucose and insulin

Increased glucose tolerance

Decreased insulin resistance

Slide26

Slide27

Exercise Testing

Primary goal: develop a safe and effective exercise programLow-level protocols are recommended because of the low function capacity of most obese individuals

Testing protocol must take into consideration any comorbidities, orthopedic limitations and current medications.

Arm or leg

ergometry

may be more appropriate depending on orthopedic limitations and weight limits of treadmills.

Slide28

Exercise Testing

Initial exercise intensity is most likely far below the point at which cardiac risk is of concernExercise testing is used to determine physical work capacity

Slide29

Special Considerations

Increased risk of orthopedic injuryPhysical injury may be primary reason for discontinuation of exercise

Increased risk of cardiovascular disease

Increased risk of heat intolerance

Weight regain averages 33-50% of initial weight loss within 1 year of terminating treatment

Slide30

Exercise Prescription

Exercise prescription should optimize energy expenditure while maintaining minimal potential for injuryTotal energy expenditure should include that of the actual exercise as well as the recovery period

Two or more short sessions/day may be more tolerable and result in same or higher total energy expenditure

Slide31

Exercise Prescription

ACSM recommends accumulating 200-300 min/week (>2000 kcal/week) of physical activity for weight loss and weight maintenance.

Initial intensity and duration should be low and progression should be gradual:

Mode- non-weight-bearing exercise such as: walking, swimming, biking increase in activities of daily living and resistance training

Frequency-daily or at least 5/week

Duration- 200-300 min/

wk

(30-60 min/day)

Intensity- 40-60% of peak oxygen consumption

Slide32

Exercise Goals

Significant health benefits can be achieved by losing only 10-20% of body weight even if the ideal body weight is not reached

Loss of 1lb/week, -3500 calories/week, -500 calories/day

L

oss of 10lbs maintained for 6 months before further weight loss

Slide33

Summary and Conclusion

Overuse injury prevention

Adequate flexibility, warm-up, cool-down

Gradual progression of intensity and duration

Use of low-impact or non-weight-bearing exercises

Thermoregulation

Neutral temperature and humidity

Cool times of day

Adequate hydration

Loose fitting clothing

Slide34

References

1.American

College of Sports Medicine. 2010. ACSM’s guidelines for exercise testing

and prescription

, 8th ed. Baltimore: Lippincott Williams &

Wilkens

, chapter 10

.

2

.ACSM

. 1999. Roundtable Supplement. Physical activity in the prevention and treatment

of obesity

and its

comorbitities

. Med. Sci. Sport

Exer

. 31(11) : S497-S667

.

3. American

Obesity Association. 2000.

http://www.obesity.org

/

4

.ACSM

. 2009. Position Stand. Appropriate physical activity intervention strategies for

weight loss

and prevention of weight gain for adults. Med. Sci. Sport

Exer

. 41 :459-467

.

5

.Rampersaud

, E., et al. 2008. Physical activity and the association of the common FTO

gene variants

with body mass index and obesity. Arch Intern Med. 168(160): 1791-1797

.

6. Patricia Curtis. 2007. Fighting Fat New Frontiers. Readers Digest. 85-91