Obesity and Weight
Management
by Lesley Smyth
Risks
Effects on
Society
Programme
Design
Obesity
Costs to
the
Economy
Behaviour
Change
Causes
What is obesity?
 Obesity is defined as a ‘medical condition in which excess
body fat has accumulated to the extent that it may have an
adverse effect on health’ (NHS, 2012)
 A complex multifactorial chronic disease that develops from an
interaction of genotype and the environment
 Preventing and managing obesity is a complex problem with
no easy straightforward answer
What are the risks?
 Obesity has a severe impact on the health of individuals both
physiologically and psychologically, with the risk of
complications from secondary conditions a major concern
 Linked to Metabolic Syndrome (also known as syndrome X)
Metabolic syndrome
 The medical term for a clustering of symptoms/medical
disorders that, when presented together increase the risk of
developing diabetes type 2 or cardiovascular disease
 The 2006 International Diabetes federation (IDF) consensus
worldwide definition is central obesity defined by waist
circumference AND any two of the following…
Metabolic syndrome
 Raised triglycerides
 Reduced HDL cholesterol
 Raised blood pressure (BP)
 Raised fasting plasma glucose (FPG)
Classifications of obesity
Classification
BMI (KG/M2)
Risk of co-morbidities
Underweight
<18.5
Low (other health risks may be
associated with low BMI
Healthy weight
18.5-24.9
Average
Overweight (or pre-obese)
25-29.9
Increased
Obesity, class I
30-34.9
Moderate
Obesity, class II
35-39.9
Severe
Obesity, class III
>40
Very severe
Combined BMI and waist circumference
 Both NICE and ACSM use combined BMI and waist
circumference figures in relation to disease risk
 Assessment of the health risks associated with overweight and
obesity in adults should be based on BMI and waist
circumference as follows…
Classification of disease risk for type 2 diabetes, hypertension and
cardiovascular disease based on BMI and waist circumference
Weight
classification
BMI (Kg/M2)
Men > 102cm (40”)
Women > 88cm (35”)
Underweight
<18.5
-
Normal
18.5-24.9
-
Overweight
25.0-29.9
High
Obesity class
I
30.0-34.9
Very high
II
35.0-39.9
Very high
III
>40
Extremely high
Disease risk* relative to normal weight and waist circumference
*Increased waist circumference also can be a marker for increased
risk, even for individuals of normal weight.
Metabolic risks - Diabetes
 Defined as a group of metabolic diseases in which a person has high
blood sugar, either because the pancreas does not produce enough
insulin or the cells do not respond to the insulin produced
 Obesity is the greatest risk factor for type 2 diabetes and is
commonly referred to as di-obesity
 It accounts for 80-85% of the overall risk of developing type 2
diabetes and underlies the current global spread of the condition
(Diabetes UK, 2012)
Diabetes Mellitus Type 1
 Type 1 diabetes is an auto-immune condition in which the cells
that produce insulin are destroyed
 Lifelong treatment with insulin is required to prevent death
 About 10% of people with diagnosed diabetes have type 1
(PHE, 2014)
Diabetes Mellitus type 2
 Type 2 diabetes accounts for at least 90% of all cases of diabetes
 It occurs when the body either stops producing enough insulin for its
needs or it becomes resistant to the effect of insulin produced
 The condition is progressive requiring lifestyle management (diet and
exercise) at all stages
 Over time most people with type 2 diabetes will require oral drugs or
insulin
 There is a seven times risk of obesity in obese people with a
threefold risk for overweight people (PHE, 2014)
Gestational Diabetes
 A type of diabetes that arises during pregnancy (usually through the
second or third trimester)
 In some women it occurs because the body cannot produce enough
insulin to meet the extra demands of the pregnancy
 In other women it may be found during the first trimester, although
the condition most likely existed before the pregnancy
 Affects up to 5% of all pregnancies
 The lifetime risk of developing Type 2 diabetes after gestational
diabetes is 30% (Diabetes UK, 2010)
Further metabolic risks
 Hypertension - 5 fold risk in obesity (Foresight Report, 2007)
 Coronary Heart Disease
 Stroke - up to 6x more likely in an obese person (Lancet, 2009)
 Certain cancers - up to 6x more likely in an obese person (Lancet, 2009)
 Non-alcoholic fatty liver
 Polycystic ovaries
 Skin complications
 Dementia
Weight related risks
Respiratory disease
 Respiratory problems associated with obesity occur when
added weight of the chest wall squeezes the lungs and causes
restricted breathing
 Neck circumference of >43cm in men and >40.5cm in women
is associated with obstructive sleep apnoea, daytime
somnolence and development of pulmonary hypertension.
 Asthma and COPD are more common in obese people
Weight related risks
Osteoarthritis
 14x more likely in obese individuals (Grotle et al. 2008)
 The link between obesity and osteoarthritis is strongest in the
knee joint
 The risk increases by 35% for every 5kg of weight (March, 2004)
 Biomechanical factors associated with gait increase the risk
 Obesity contributes to the progression of knee arthritis as well as
the disability associated with it
Further weight related risks
 Lower back pain
 Sleep apnoea
 Stress incontinence
 Varicose veins
 Hernia
 Oedema
 Depression
Effects on society
 Obesity is the fifth leading risk for global deaths
 2.8 million adults die each year from this condition and its
associated co-morbidities
 44% of diabetes type 2, 23% of coronary heart disease and
41% of cancers can be attributed to obesity (WHO, 2013)
 More than half of the adult UK population are overweight and
one-third of people between 55 and 74 years old are classed
as obese (NHS, 2012)
Effects on society
 In 2012, an estimated 62% of adults (aged 16 years and over) were
overweight or obese in England (BMI>25), 24.7% were obese
(BMI>30) and 24% were severely obese (BMI>40). (PHE, 2014)
 Adult obesity increased from 13% of men in 1993 to 24% in 2012
and from 16% of women in 1993 to 25% in 2012. (PHE, 2014).
 According to a four year study concluded in 2013 from the Health &
Social Care Information Centre (HSCIC) nearly 1 in 4 adults are
obese
 The 2009 Health Survey for England (HSE) found that 1 in 6 children
aged 2-10, are obese
Effects on society
 The 2007 Foresight report, Tackling Obesities: Future Choices
predicted that if no action was taken 60% of men, 50% of
women and 25% of children will be obese by 2050
 Obesity has a severe impact on the health of individuals both
physiologically and psychologically, with the risk of
complications from secondary conditions a major concern
Costs to the economy
 Direct costs caused by obesity were estimated to be £15.8
billion in 2007 with a cost of £4.2 billion to the NHS.
Predictions suggest this figure could rise to £27 billion in 2015
and forecast to more than double to £50 billion by 2050 if we
carry on as we are (Foresight Report, 2007)
 Heart and circulatory disease costs the economy £18.9 billion
every year
(BHF, 2013)
Causes in the rise of obesity
 Genetics/biology
 Medical disorders
 Early years
 Modern lifestyle
 The impact of the media
 Food advertising and marketing
 Different types of food
 Hunger hormones
 Stress
Causes in the rise of obesity
Genetics
 There have been numerous studies on hereditary links to weight
gain and obesity, and it is generally accepted that genes, alongside
environment factors play an important role
 The analogy used by George Bray when he said ‘the genetic
background loads the gun, but the environment pulls the trigger’ is
a much used expression when discussing the role genetics plays in
the rising epidemic
Biology - Abdominal Adiposity
 Individuals diagnosed with obesity have increased fat stores,
particularly in the abdominal region
 Fat around the middle is the most dangerous place to store fat
rather than on the thighs and bottom as it is more indicative of
coronary heart disease, type 2 diabetes or insulin sensitivity
 The main cause of stubborn fat storage around the abdominal
area is hormones
Can overweight and obesity be reduced?
 Overweight and obesity as well as their non-communicable
diseases, are largely preventable
 Supportive environment and communities are fundamental in
shaping people’s choices
 Making the healthier choice of foods and regular activity
accessible, available and affordable
At the individual level
 Eat a healthy, balanced diet which includes the right number of
calories to maintain a healthy weight
 Engage in regular physical activity - 60 minutes a day for and
150 minutes a week for adults (WHO)
At the societal level
 Support individuals to follow the previous recommendations,
through sustained political commitment and the collaboration
of many public and private stakeholders
 Make regular physical activity and healthier dietary choices
available, affordable and easily accessible to all - especially
the poorest individuals (WHO)
The role of the food industry
 Reducing fat, sugar and salt content of processed foods
 Ensuring that and healthy nutritious choices are available and
affordable to all consumers
 Practising responsible marketing, especially those aimed at
children and teenager
 Ensuring the availability of healthy food choices and
supporting regular physical activity practice in the workplace
(WHO)
Nutrition
 Individuals are advised to make small, sustainable changes to
their diet, following general healthy eating principles such as
The Healthy eating Pyramid or Healthy Eating Plate for
reference
 Portion control is essential
 People should expect to lose no more than 0.5-1kg (1-2lbs) a
week
Nutrition
CYQ (2014) Level 4 Certificate in Weight Management for Individuals with Obesity, Diabetes Mellitus
and/or Metabolic Syndrome, version 1.0. London: Central YMCA Qualifications
Nutrition
CYQ (2014) Level 4 Certificate in Weight Management for Individuals with Obesity, Diabetes Mellitus
and/or Metabolic Syndrome, version 1.0. London: Central YMCA Qualifications
Encouraging long-term behaviour change
 Long-term behaviour change is essential for developing client
health, wellbeing, fitness and for the prevention and
management of additional medical conditions like diabetes and
osteoarthritis
Models and theories of behaviour change
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Health Belief Model
Theory of Planned Behaviour and Reasoned Action (TRA)
Relapse Prevention Theory
Self Efficacy Theory
Social Cognitive Theory
Transtheoretical Model of Change
Methods and strategies
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Understanding and applying behaviour change models
Adhering to a healthy eating programme
Identifying and overcoming barriers
Setting SMART goals
Planning progressive physical activity programmes
Developing a support network of friends, family, instructors
and other health care specialists
Designing weight management programmes
A physical activity component as part of a weight management
programme must be:
 Safe and effective
 Appropriate to the client’s needs, abilities, fitness/skill levels
and goals
 Agreed by health care professionals, if required
Information gathering
A range of information is needed to plan an effective weight
management programme such as:
 Medical conditions and referrals (includes pre-activity
screening)
 Physical profile
 Nutrition
 Physical activity (past and present)
 Motivation
Methods of collecting information
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PARQ (health questionnaire)
One-to-one interview
Five-day food diary
Health/fitness tests
Lifestyle/motivation questionnaire (including likes, dislikes,
goals, barriers etc.)
 Psychological assessment completed by a suitably qualified
professional
 General observation of the client’s behaviour
Guidelines for Overweight and Obesity
(ACSM 2013)
Frequency
> 5 days a week to maximise caloric expenditure
Intensity
Moderate to vigorous intensity aerobic activity.
Initially moderate intensity (i.e., 40-60% of VO2R or HRR ( RPE 11-13 on 6-20 scale)
Eventual progression to more vigorous intensity (>60%VO2R or HRR ) may result in
further health/fitness benefits.
Time
A minimum of 30 minutes as day (i.e., 150 minutes per week), progressing to 60 minutes a
day (300 minutes per week) - accumulation of intermittent exercise of 10 minutes an
effective alternative to continuous.
Type
Primary mode of exercise should be aerobic physical activities that involve large muscle
groups. As part of a balanced programme resistance, flexibility and ADL
activities/exercises should be incorporated.
Exercise and activity considerations
 Functional, everyday activities may be enough
 Use of home, outdoor environment initially could avoid
embarrassment and aid motivation
 Some equipment not built for weight/size
 Gradual progression of intensity and duration
 Adequate hydration (heat tolerance and control)
 Use of low impact or non-weight bearing exercises
Maintaining weight loss
 Maintaining weight loss is a challenge
 People on successful weight loss programmes usually regain
on average 33-50% in one year
 The ACSM recommend at least 250 minutes of moderate to
vigorous activity per week than the usual 150 minutes to
enhance the chances of keeping the weight off
References
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NHS Information Centre (2012) Statistics on obesity, physical activity and diet: England, 2012. Leeds:
Health & Social Care Information Centre
International Diabetes Federation (2013) The IDF consensus worldwide definition of the metabolic
syndrome. Retrieved from http://www.idf.org/webdata/docs/IDF_Meta_def_final.pdf
Diabetes UK (2012) Diabetes in the UK. Key statistics on diabetes. Retrieved from
http://www.diabetes.org.uk/About_us/What-we-say/Statistics/Diabetes-in-the-UK-2012
Public Health England (2014) Adult obesity and type 2 diabetes. Retrieved
from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/338934/Adult_obesity
_and_type_2_diabetes_.pdf
Diabetes UK (2010) Diabetes in the UK 2010: Key statistics on diabetes. Retrieved from
http://www.diabetes.org.uk/Documents/Reports/Diabetes_in_the_UK_2010.pdf
Prospective Studies Collaboration. Body-mass index and cause-specific mortality in 900 000 adults:
collaborative analyses of 57 prospective studies. Lancet, 373: 1083-96, 2009.
Margreth Grotle*, Kare B Hagen1, Bard Natvig13, Fredrik A Dahl4 and Tore K Kvien. Obesity and
osteoarthritis in knee, hip and/or hand: An epidemiological study in the general population with 10 years
follow-up. BMC Musculoskeletal Disorders, 9:132, 2008.
References
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March LM, Bagga H. Epidemiology of osteoarthritis in Australia. Med J Aust. 180(5 suppl):S6-S10, 2004
World Health Organization (2013, March) Obesity and overweight. Retrieved from
http://www.who.int/mediacentre/factsheets/fs311/en
HSCIC. Statistics on obesity, physical activity and diet. London, 2014.
Craig R, Hirani V (eds) Health Survey for England 2009, London: The Information Centre, 2010.
British Heart Foundation National Council. Economic cost of physical inactivity. British Heart Foundation
National Centre (BHFNC) for Physical Activity and Health, Loughborough University, 2013.
CYQ (2014) Level 4 Certificate in Weight Management for Individuals with Obesity, Diabetes Mellitus
and/or Metabolic Syndrome, version 1.0. London: Central YMCA Qualifications
ACSM. (2013) ACSM's guidelines for exercise testing and prescription, 9th edition. Philadelphia, PA:
Lippincott Williams & Wilkins
ymcafit.org.uk/courses/obesity-and-diabetes
Thank you
ymcafit.org.uk/courses/obesity-and-diabetes
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