PT Tip of the Month

Obesity

Obesity is a worldwide epidemic that is described as increased adipose tissue that can lead to a number of other health concerns. Health risks associated with obesity include stroke, high blood pressure and cardiovascular disease, type 2 diabetes, cancer (breast, prostate, and colon), osteoarthritis, sleep apnea, and even depression. Obesity has been increasing substantially since 1980, with 70% of Americans being classified as overweight or obese. The yearly average cost in health care is normally $3,000 per person. An obese individual can cost employers an additional $460 to $2,500 in medical costs and sick days alone. Making steps towards a healthy diet and increased fitness and activity can dramatically improve your weight, health, and life expectancy.

How do I know if I am Overweight?

Waist measurementThe most commonly used tool to determine weight is based on body mass index (BMI). Adult individuals with a BMI of 25 to 30 are considered to be overweight, while those with a BMI greater than 30 are classified as obese, regardless of gender. BMI is calculated through measurements of height compared to weight (Formula: weight (kg) / [height (m)]2 ). This formula is often used as it is a quick, easy, and inexpensive way to index weight status. It is important to keep in mind that BMI does have some limitations as it does not differentiate between weight from fat and weight from muscle. Therefore, individuals who are very muscular can be classified as overweight, and inversely elderly adults can appear to have a health BMI when they in fact have reduced muscle mass and excess fat. Waist circumference is another easy alternative to determine weight status. The World Health Organization has established a waist circumference greater than 31.5 inches (80 cm) in women and 35.4 inches (90 cm) in men to represent an increased health risk due to obesity, while a waistline greater than 35 inches (88 cm) in women and 40 inches (102 cm) in men is associated with a substantially high risk. These classifications have been determined as abdominal fat is strongly associated with comorbidities compared to fat stored in other areas of the body.

What Are Causes Associated With Obesity?

ScaleWeight gain has been linked through research to a number of factors including genetic, environmental, social, cultural, and behavioral influences. While it has been determined that genetics plays an important role in regulation of body weight, the World Health Organization has also determined that behavioral and environmental factors are the primary causes for the drastic increase in obesity since 1980. Behavioral and environmental factors include sedentary lifestyles and the increase in sedentary jobs, reliance on cars, escalators, elevators, and energy saving technology. In short, weight gain is linked to the imbalance of calorie (energy) intake versus calorie expenditure. When we consume more calories than those that we expend, they are stored within adipose tissue as a reserve when energy requirements exceed intake. It has been reported that an imbalance of this scale resulting in 10 additional calories per day (compared to calories used) can lead to one pound of weight gain per year. Therefore, even the smallest amount of additional calories per day can lead to excessive weight gains in a lifetime.

What Changes Can I Make to Combat Weight Gain?

FoodChanges in diet are strongly linked to changes in weight. While you may be eating a variety of foods, your body may not be getting the appropriate nutrients required to maintain a healthy weight. Consuming foods high in vitamins, minerals, fiber, and other nutrients that are lower in calories are essential. Emphasize eating fruits, vegetables, whole grains, low fat dairy, and lean meats (fish, poultry), while limiting high fat (saturated and trans fats), high sodium diets, alcohol, and sugary foods. The right number of calories you need each day is based on your age, activity level, and health. It is important to consult your doctor or a nutritionist before making substantial changes in your diet, especially if you have other health concerns such as diabetes.

Regular physical activity is another important method to weight management. The American Heart Association (AHA) recommends at least 30 minutes of moderate intensity aerobic activity at least 5 days per week or at least 25 minutes of vigorous aerobic exercise at least 3 days per week. Those with high blood pressure or high cholesterol are recommended to perform 40 minutes of moderate to vigorous exercise 3 or 4 times per week. Common forms of aerobic exercises include brisk walking, running, swimming, biking, or the use of cardio equipment such as the elliptical. Additionally, strength training (moderate to high intensity) at least 2 days per week is associated with additional health benefits. Success of weight management is frequently considered by health care professionals as a 5% to 10% loss of initial body weight with long term success being dependent on maintenance of a 10% loss for at least a year. Sadly, research has determined that only about 21% of adults with excessive weight are successful at one year, with lower long term success on average.

How Do I Know I am Doing Enough Exercise?

To determine if you are performing at an appropriate exercise intensity level, your target heart rate can be calculated and monitored. Your heart rate is the number of times your heart beats in one minute. Heart rate can be calculated at rest (resting heart rate) or during activity. The average resting heart rate is typically between 60 to 80 beats per minute. It is usually lower in individuals with strong cardiovascular fitness. Your maximum heart rate is around 220 minus your age. For moderate to vigorous exercise, you want to maintain a heart rate of 50% to 85% of your maximum heart rate. To determine target heart rate, first find your maximum heart rate (220-age: someone who is 40 years old would have a max rate of about 180 beats per minute.) From here calculate the percentages (50 to 85%) of your max heart rate to determine your target heart rate range (for a 40 year old person, the target zone would be 90-153 beats per minute.) Your resting heart rate or heart rate during activity can be calculated by taking your pulse with light pressure on the thumb side of your wrist and counting the number of beats in 60 seconds (or the number of beats in 30 seconds and multiplying this by two.) It is important to keep in mind that those with heart conditions should consult with their doctor to determine if there should be variations to your typical target heart rate. Additionally, some high blood pressure medications can lower the max heart rate, and therefore the target zone.

What Techniques Can I Use to Maintain an Exercise and Weight Loss Program?

Behavior modification is one of the biggest components to beginning and maintaining a healthy life style. Identifying unhealthy behaviors such as excessive food portions, sedentary lifestyles, using elevators instead of stairs, eating in front of the TV, or frequent dining out is the first step to making the needed changes. From here, you can set goals for diet and activity. Modifications to nutrition can be made to regulate calorie intake to about 2,000 calories per day. This target intake can be adjusted with the assistance of a medical provider. Calorie monitoring can be performed with portion control and logging in a notebook or with health related technology, such as cellphone apps. The goal is not to eat more calories than you know you can use up every day. Increasing the amount and intensity of physical activity to the recommended criteria or the number of calories you take in can also be monitored by logging. You can hold yourself accountable by teaming up with friends or family to exercise with, setting a goal to reach 10,000 steps each day (counted with pedometers or apps), or scheduling time into your day for exercises. Keep in mind, that if you do not enjoying your workout, try something different. Check health clubs or local groups for classes or other physical activities for variety. You are more likely to stick with a program you enjoy. Everyone must start somewhere. If you have been generally sedentary for many years you can work towards your overall goal by gradually increasing activity. Don't consider exercise to be all or nothing. Start with 15 minutes a day instead of 30 minutes. You can begin as early as today.

If you feel that you have signs or symptoms of orthopedic injuries due to weight gain, and you would like to schedule an evaluation, call 617-232-PAIN for our Brookline office, and 617-325-PAIN for our West Roxbury office.

References:

  1. Racette SB, Deusinger SS, Deusinger RH. Obesity: overview of prevalence, etiology, and treatment. Phys Ther. 2003;83(3):276-88.
  2. Richmond SA, Fukuchi RK, Ezzat A, Schneider K, Schneider G, Emery CA. Are joint injury, sport activity, physical activity, obesity, or occupational activities predictors for osteoarthritis? A systematic review. J Orthop Sports Phys Ther. 2013;43(8):515-B19.
  3. Teyhen DS, Aldag M, Centola D, et al. Key enablers to facilitate healthy behavior change: workshop summary. J Orthop Sports Phys Ther. 2014;44(5):378-87.
  4. Waist circumference and waist-hip ratio: report of a WHO expert consultation, Geneva, 8-11December 2008.
  5. American Heart Association. www.heart.org/HEARTORG/GettingHealthy/GettingHealthy_UCM_001078_SubHomePage.jsp.  Accessed October 10, 2014. 

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