A Review of Exercise Prescription Recommendations for the Treatment of Obesity

1
A Review of Exercise Prescription Recommendations
for the Treatment of Obesity

• Jeff Bauer, Ph.D.
• SUNY Cortland

2
Obesity Trends Among U.S. AdultsBRFSS, 1991-2002
(BMI 30, or 30 lbs overweight for 5 4 woman)
2002
No Data lt10 1014
1519 2024 25
3
Obesity Trends Among U.S. AdultsBRFSS, 2002
(BMI 30, or 30 lbs overweight for 5 4 woman)
(BMI ?30, or 30 lbs overweight for 54 person)
No Data lt10 1014
1519 2024 25
Source Behavioral Risk Factor Surveillance
System, CDC
4
Obesity defined

• BMI 30kg/m2
• Functional obesity is a point at which the
  percent body fat of an individual begins
  contributing to an increased risk of disease.

5
Public ReactionBanned Soda in Schools
Advocates say Connecticut's ban would be the
strongest because it is so broad, applying to all
grades and all school sites where food is sold.
"Connecticut would be the first state to apply
those standards to high schools," said Margo
Wootan, director of nutritional policy for the
Center for Science in the Public Interest. "Most
of the recently passed policies are limited in
that they only apply to elementary and middle
schools." Lawmakers in the House voted 88-55
after an eight-hour debate to pass a law banning
soda and junk food in cafeterias, vending
machines and school stores. It also requires 20
minutes of physical activity outside of gym for
children in kindergarten through fifth grade.
6
The easy answer
7
Why is obesity a problem?

• Multi-factorial problem
• Nutritional changes
• More dining out fast food fat food
• Activity changes
• Less physical activity youth sports
• Societal changes
• Work Family Passive entertainment
• Co-morbidity and reduced life expectancy

8
Key Assessment Parameters

• BMI ? 25-29.9 overweight, 30 obese
• Waist circumference ? BMI of 25-35 and 40 for
  men or 35 for women indicates increase
  co-morbidity risk
• Patient health history

9
Is the obesity epidemic real?

• Daily reports of obesity in every facet of our
  lives from children, to elite athletes
• U.S. Surgeon General Richard Carmona, MD, has
  called obesity the greatest health threat to
  public health today.
• The statistics say we are in the midst of an
  epidemic.
• But just how real is the problem?

10
The World is Flat, Right?
Five hundred years ago, everyone knew the
earth was flat.
Then someone checked
Today everyone knows the world is round
(overweight or obese).
At least thats what were told
11
The Numbers

• CDC gt60 of US adults overweight and gt30 obese
• Data comes from National Health and Nutrition
  Evaluation Survey - NHANES(III) and Behavioral
  Risk Factors Surveillance System BRFSS

12
BRFSS and NHANES

• Centers for Disease Control and Prevention BRFSS
  method cold call individuals and surveys them
  related to health concerns, with 264,684 records
  for 2003. (0.09)
• U.S. Public Health Service NHANES(III) Full
  medical evaluation of participants which provides
  a broad sample of health data on 40,000
  individuals. (0.01)

13
Death by Obesity?

• First the CDC published data indicating that
  400,000 Americans died of obesity related
  causes.
• An updated study by researchers at the Centers
  for Disease Control and Prevention (CDC) and the
  National Institutes of Health (NIH) published in
  JAMA concludes that obesity kills 112,000
  Americans each year .
• In a JAMA article from early 2005 that number of
  obesity caused deaths has been reduced again to
  about 25,000.
• Yesterday in USAToday an article entitled CDC
  retreats from recent obesity study again has the
  CDC being forced to try to clarify its position.
  It is not OK to be overweight. People need to be
  fit

14
No Worries?

• Regardless of the exact figures, obesity is a
  health risk to many.
• Obesity is a problem that affects people in a
  variety of different ways.
• Physically
• Emotionally
• Financially

15
ACSM Recommendations

• Fight obesity through exercise and nutritional
  modifications.
• Interview the individual to determine their
  history of activity and eating experiences,
  potential scheduling difficulties, and the
  locations where the exercise might be performed.
• The mental health of the individual must be
  considered as a third key aspect of a holistic
  approach to fighting obesity.

16
Obesity and Mental Health

• Obese people in their 40s are 74 more likely to
  develop dementia (NIH).
• Professor Clive Ballard, of the Alzheimer's
  Society, said "The findings are consistent with
  previous studies showing that risk factors for
  heart disease, such as high blood pressure and
  high cholesterol, are also risk factors for
  dementia.
• Children are also at risk as indicated in
  Childhood Obesity and Self Esteem by Richard S.
  Strauss M.D. in Pediatrics 105(1), 2000. Using
  self perception tests examined 9-10 year olds, a
  follow-up at ages 13-14 showed marked decreases
  in self-esteem for obese versus non-obese.

17
Increasing Burden of Overweight Children

• Late 1990s
• 13 of children and adolescents are overweight or
  obese
• Current prognosis
• 1 in 4 children will be obese already 2 out of 3
  adults are considered overweight
• U.S. spending is at greater than 117 billion
  spent to combat this risk factor

18
What this problem leads to

• 70 of adolescents who are obese will be obese as
  adults

19
Modes of Exercise

• Indoors
• Water based
• Treadmill
• Cycle ergometer
• Elliptical trainers
• Household activities
• Sports

• Outdoors
• Water based
• Walking
• Cycling
• Household activities
• Sports
• Recreational games

20
Maintaining Weight
Calorie intake equals calorie expenditure.
21
Weight Gain
Calorie intake exceeds calorie expenditure.
22
Weight Loss
Calorie intake less than calorie expenditure.
23
What to do?

• See a physician before starting any significant
  exercise program.
• Initial exercise prescription should be based on
  low intensity and progressively longer durations
  of activity.
• Based on individual response, work toward
  increasing the intensity to bring the person into
  a target heart rate range suitable for
  cardiorespiratory conditioning.

24
What does the person want?

• Maybe the person doesnt want more than reducing
  their risk of illness and is not concerned about
  being overweight.
• Because of the slow course of successful weight
  management treatment plans must have the
  enthusiastic support of the individual.

25
Weight control Options

• The magic pill
• Surgery
• Fad diets
• Lifestyle changes
• Lifestyle changes, Nutrition, Exercise
• Most effective
• Most difficult
• Slowest

26
The Pyramids and Obesity

• Nutrition, Exercise, Mental Health
• Food Pyramids

Nutrition
Exercise
Mental Health
27
Todays Pyramids
28
Today and Yesterday
29
Stay with guidelines for weight loss

• Dont do an Oprah
• Max. 1kg per week
• Decrease of calories by 7700 per week

30
It takes time
31
Exercise

• The goals of an exercise program for the obese
  are adherence, consistency, and fun.
• Do NOT focus on mode of exercise or intensity.
• Losing weight is not the problem for most, it is
  maintaining weight loss.
• Any activity is good!
• Particularly important for children is the fun
  factor.

32
Success

• 500-1000 kcal/day through eating changes and
• of 300-500kcal/day from exercise.
• Initial goal is 5-10 weight loss over 6 months
• Calorie reduction by itself is best method of
  reducing weight.
• Continued physical activity is the best predictor
  of long-term weight loss and maintenance.

33
Summary

• Obesity effects all persons and all ages.
• Obesity is a multi-factorial problem that
  requires efforts in the area of exercise,
  nutrition, and mental health.
• The plethora of illnesses are linked to obesity
  and must be screened for before a treatment plan
  is put into action.
• Pharmaceutical and surgical methods may be
  employed to combat obesity but only in extreme
  cases.

34
Summary

• Lifestyle changes that encourage a planned
  long-term approach to weight management are most
  successful.
• Childhood obesity must be addressed aggressively
  and programs developed based on substantiated
  population obesity data.

35
Special Thanks

• Dr. Phil Buckenmeyer, Director of the Center for
  Obesity Research and Education at SUNY Cortland
  for his contributions to my education on the
  topic of obesity.

36
Thank You!