Physical Activity And…Obesity

Scope of the Problem:

Obesity is a condition characterized by excessive body fat that can be stored around the waist. The BMI of 30 Kg/m2 in adults is classified as obese. However, BMI is not a suitable measure for children or athletes. It is usually an imbalance between exercise and food intake that usually results in obesity.

Scotland has one of the highest levels of obesity in; only the USA and Mexico having higher levels. In 2015, 28% of adults (16+) in Scotland were obese and 65.1% were overweight; 15.1% and 31.7% children.

Gender: Men are more likely to be more obese.

Age: Obesity peaks between the ages of;

  • Men: 55 and 64 years old
  • Women: 65 to 74 years old

Location: Lanarkshire, Scotland

  • More prevalent in deprived areas. (16.2% in Lanarkshire).
  • 65% of adults in Lanarkshire are overweight or obese.
  • 75 year old life expectancy for males and 79 year old life expectancy for females.

Psychosocial

  • More common in smokers and people with drinking problems.

Increased risk of developing:

  • Diabetes
  • Hypertension
  • Heart disease
  • Some cancers
  • Cardiovascular disease
  • Hyperlipidemia

Future Challenge

  • Predicted that by 2030 adult obesity in Scotland could reach over 40%.
  • Total cost including both direct and indirect costs, up to 3 billion pounds.

Physiological Benefits of Exercise on Obesity:

  • Exercise triggers the release of IL-6:
    • Lipolysis
    • Decreases hypoxia with adipose tissue
    • Anti-inflammatory (adipose tissue, vascular epithelial cells and blood mononuclear cells)
    • May decrease insulin resistance

  • Aerobic exercise increases blood flow
  • Exercise increases mitochondria production which increases energy ATP production

 

  • Lipoprotein lipase (LPL) – released when smooth muscle contracts
  • Frees fatty acids from storage
  • Hydrolyzes the triglycerides that are in circulation for tissue uptake

 

  • Some studies show that moderate exercise does not have an effect on body composition but did promote beneficial effect on low grade inflammatory state
  • Balance of diet and exercise is crucial to improve the low grade inflammatory state and cardiovascular system

Evidence for the benefits of exercise for obesity

A systematic review from Miller et al (2013) showed that exercise training in addition to calorific restriction promoted increases in cardiovascular fitness (relative and absolute), muscular strength and had a positive impact on body composition in obese middle aged and older individuals. in addition, it was seen that the application of exercise training elicited greater fat mass loss and preserved lean mass more so than just calorific restriction weight loss programmes alone. Furthermore, it was found that energy restriction alone, had an undesirable effect on cardiorespiratory fitness, muscular strength and loss of lean muscle tissue.

A randomised controlled trial by Slentz et al (2004), studied the “Effects of the amount of exercise on body weight, body composition and measures of central obesity”. An eight-month exercise program was implemented with three groups participating in varying amounts of physical activity (high amount/vigorous, low amount/vigorous and low amount/moderate) and a control group. It was found that the non-dieting control group gained weight, meanwhile a dose response relationship was found with the exercise groups. From this it may be suggested that independent of diet modification a modest amount of exercise can lead to a reduction in body weight and a high amount of exercise will promote further benefits in initially obese individuals.

In a study done by Jakicic and colleagues comparing the effects of exercise duration and intensity over a 12-month period in sedentary, overweight women showed that duration of exercise had a greater impact on weight loss. Those in both the moderate and high intensity/high duration had a greater percentage weight loss than those in both the moderate and high intensity/low duration groups.

A study conducted by Barbara J Nicklas  (2009) and colleagues discussed the impact of diet and exercise on fat loss and cardiovascular health in postmenopausal obese women. The trial had three groups carrying out a 20-week intervention: one with calorie restrictions, one with calorie restrictions and moderate exercise and the last group having calorie restrictions and vigorous exercise. The results showed that diet restrictions were not enough to reduce fat and improve cardiovascular health, but there was no difference in the impact of intensity of exercise on the participants.

A meta-analysis by Wu et al. (2009) has shown that of the two most common therapies for obesity (diet and exercise) the combination of exercise and diet produced longer lasting benefits than diet alone. This is supported by Ozcelik et al. (2015) that found in women with obesity those that were treated with diet, drugs and exercise lost more weight and had better body composition with lower obesity-related CV risk factors than the group that were only treated with drugs and diet alone.

Policy

Australia Policy

– Display nutritional information on foods in vending machines and on outside of vending machine

– Main focus is on young children

– Implementation of APPs ; Traffic Light App –> The app gives a traffic light rating based on the amount of total fat, saturated fat, sugars and sodium per 100g – green for low, amber for medium and red for high.

– Effects of the environment: Access to fresh healthy foods, Density and placement of fast food outlets,

http://www.opc.org.au/downloads/positionpapers/policy-brief-planning-laws.pdf

UK NICE guidelines

– Listed through prevention, identification and management

– Including guidelines for Adults, Young Adults and Children

– PREVENTION: Vending machines, Nutritional information at the point of choosing food and drink options, Prominent placement of healthy options, Maintaining details of local lifestyle weight management programmes, Publishing performance data on local lifestyle weight management programmes, Raising awareness of lifestyle weight management programmes, Referral to a lifestyle weight management programme for people with comorbidities, Preventing weigth regain, Reducing sedentary behaviour

– IDENTIFICATION : BMI – sometimes waist circumference

– Lowered BMI threshold for Black African + African Carribeans + Asia

– MANAGEMENT: Advice assessing lifestyle, willingness to change, referrals, drug treatment, surgery

National Institute for Health and Clinical Excellence (Great Britain), 2007. Obesity: Guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. National Institute for Health and Clinical Excellence. Vancouver

UK GUIDELINES

Sets out plans for involving the whole of society in reducing obesity states that obesity is everybody’s business and that it is the responsibility of individuals to change their behaviour to lose weight says that a range of partners, including government and business, have a responsibility to help people lose weight

Barriers

A common barrier to exercise for the obese is the feeling that they are already too fat to participate in physical activity (Ball et al., 2000). This is particularly pronounced in the female population where an emphasis on body image is traditionally observed (Ball et al., 2000). Obesity has also been proven to be associated with fatigue, especially during the day. This has implications for exercise as it further reduces the desire of the obese patient to participate (Vgontzas et al., 2006). Furthermore, daytime sleepiness and fatigue may also be associated with insulin resistance, which may be a sign of other underlying conditions (Vgontzas et al., 2006.)

Comorbidities associated with obesity could also a barrier to these individuals:

  • Diabetes – barriers discussed yesterday
    • Lack of energy
    • Pain in knees and feet
    • Fear of hypoglycemia
  • Cardiovascular Disease
    • Increased risk of having cardiac complications
  • Mainly just a perceived limitation to exercise but actually exercise is very safe and good for them
  • Musculoskeletal conditions
  • Increased risk of having disabling musculoskeletal conditions, like osteoarthritis, low back pain, gait disturbance, soft tissue complaints.

References

GONDIM, O.S., DE CAMARGO, V.T.N., GUTIERREZ, F.A., DE OLIVEIRA MARTINS, P.F., PASSOS, M.E.P., MOMESSO, C.M., SANTOS, V.C., GORJÃO, R., PITHON-CURI, T.C. AND CURY-BOAVENTURA, M.F., 2015. Benefits of Regular Exercise on Inflammatory and Cardiovascular Risk Markers in Normal Weight, Overweight and Obese Adults. PloS one, 10(10), p.e0140596.

 

GRANT, I., FISCHBACHER, C. AND WHYTE, B. (2007). Obesity in Scotland An Epidemiology Briefing. Edinburgh: NHS National Services Scotland.

JAKICIC JM, MARCUS, GALLAGHER KL, NAPOLITANO M, LANG, W. (2003) Effect of Exercise Duration and Intensity on Weight Loss in Overweigh, Sedentary Women: A Randomized Trial. JAMA 290(10): 1323-1330 doi:10.1001/jama.290.10.1323

 

MILLER CT, FRASER SF, LEVINGER I, STRAZNICKY NE, DIXON JB, et al. (2013) The Effects of Exercise Training in Addition to Energy Restriction on Functional Capacities and Body Composition in Obese Adults during Weight Loss: A Systematic Review. PLoS ONE 8(11): e81692. doi: 10.1371/journal.pone.0081692.

 

NICKLAS BJ, WANG X, YOU T, LYLES MF, et al. (2009) Effect of exercise intensity on abdominal fat loss during calorie restriction in overweight and obese postmenopausal women: a randomized, controlled trial. Am J Clin Nutr 89: 1043-52

 

OZCELIK, O. OZKAN, Y. ALGUL, S. COLAK, R. (2015) Beneficial effects of training at the anaerobic threshold in addition to pharmacotherapy on weight loss, body composition, and exercise performance in women with obesity. Patient Preference and Adherence 9: 999-1004

 

PETERSON, A., & PEDERSEN, B., (2005) The anti-inflammatory effect of exercise. Journal of Applied Physiology. 98 (4), pp.1154-1162. Available from http://jap.physiology.org/content/98/4/1154?rss=1&ampssource=mfr

 

SEIP, R.L. AND SEMENKOVICH, C.F., 1997. Skeletal muscle lipoprotein lipase: molecular regulation and physiological effects in relation to exercise. Exercise and sport sciences reviews, 26, pp.191-218

 

SLENTZ CA, DUSCHA BD, JOHNSON JL, et al. Effects of the Amount of Exercise on Body Weight, Body Composition, and Measures of Central Obesity: STRRIDE—A Randomized Controlled Study. Arch Intern Med. 2004;164(1):31-39. doi:10.1001/archinte.164.1.31.

 

The Scottish Government, (2010). Preventing Overweight and Obesity. Edinburgh: Scottish Government.

T, GAO. X, CHEN, M. AND VAN DAM, R.M. (2009) Long-term effectiveness of diet-plus-exercise interventions vs. diet-only interventions for weight loss: a meta-analysis. Obesity Reviews 10: 313-323

 

YOU, T., ARSENIS, N.C., DISANZO, B.L. AND LAMONTE, M.J., 2013. Effects of exercise training on chronic inflammation in obesity. Sports Medicine, 43(4), pp.243-256.

 

Statistics from: https://scotpho.nhsnss.scot.nhs.uk/scotpho/profileSelectAction.do

 

Contributors: Mohamed Yusuf Admani, Stacey Ann Beierling, Elizabeth Ann Britton, Alastair Colin Callander, King Hong Chan, Jamie Lee Baker Conrick, Marissa Leanne Durnan, Ross Farro, Lynda Margaret Flaws, Paul Michael Fortin, Jayson Thomas Gallahue, Erik Peres Gouveia, Allison Claire Graham, Jenna Rae Holdham, Ning Lei, Lindsay Jane MacDonald, Ranvita Mahto, Kristina Mckeown, Mary Annette Naughton, Kulwinder Saggi, Jessica Ashley Swallow, Jonathan Wilson

Class Tutor: Kathryn Savage

 

 

 

 

 

 

 

Leave a Reply

Your email address will not be published. Required fields are marked *