1. Obesity in Adults Alexandra Abraham

2. Some definitions… Obesity - The condition of being grossly fat or overweight. Body Mass Index – measurement of body composition Obesity = BMI of > 30

3. 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)

4. Estimated Percentage by Sex MaleFemale

5. Estimated Percentage by Race Extreme Obese Obese Overweight

6. Changes from 1962 to 2010 Top: Extreme Obesity Middle: Obesity Bottom: Overweight

7. Why Obesity is a Problem… Obese individuals have a higher risk for… 1.Type II Diabetes 2.Hypertension (High Blood Pressure) 3.Heart Disease 4.Stroke 5.Cancer 6.Erectile Dysfunction 7.Sleep Disorders (Sleep Apnea)

8. 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)

9. Main Causes of Obesity 1.Genetics 2.Activity level 3.Food consumption Why a Fitness Program?

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

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

12. 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

13. 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

14. 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

15. 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

16. Aerobic Work ● Exercises included treadmill, stationary bicycle, stairclimbers ● Started at 65% heart rate max, increased to 70-85%

17. 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

18. 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%

19. 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

20. Scientific Study Long-term weight loss after diet and exercise Main objective: To assess the effectiveness of dietary interventions and exercise in long term in obese adults.

21. Scientific study Subjects: 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.

22. 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.

23. 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.

24. 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.

25. 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

26. Client Assessment ● Endurance: Standard submax exercise testing used o 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

27. 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

28. 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 twists o Upper Body: Seated row with tubing, front/lateral raised and bicep curls with dumbbell/tubing o leg extensions with ankle weights

29. Exercise Prescription ● Flexibility: Static stretches are recommended o 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

30. ● Engaging Clients ● Main goal for this population: lose weight ● Educate on Physiological and Psychological benefits o Increase self-efficacy o Increase physiological functioning o Look better and feel better Motivation: Weight Loss

31. ● Setting weight loss goals will help motivate clients ● 1-2lbs per week (3500-7000 caloric deficit/week) ● Slow continuous training to encourage fat loss o 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

32. ● 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

33. ● Tell clients to: o Stay hydrated o 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

34. References Villareal 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/ "The Health Effects of Overweight and Obesity." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 06 Dec. 2013. Web. 29 Apr. 2015. "Obesity." Complications. N.p., n.d. Web. 29 Apr. 2015. "Obesity." Effects of. N.p., n.d. Web. 29 Apr. 2015. "Overweight and Obesity Statistics." Overweight and Obesity Statistics. N.p., n.d. Web. 29 Apr. 2015. "Causes and Consequences." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 27 Apr. 2012. Web. 25 Apr. 2015. "Health Risks." Obesity Prevention Source. N.p., 20 Oct. 2012. Web. 25 Apr. 2015. "Obesity." Risk Factors. Mayo Clinic, n.d. Web. 25 Apr. 2015. "Long-term Weight Loss after Diet and Exercise: A Systematic Review." Ebsco. Nature Publishing Group. Web. 26 Apr. 2015.