Our GPs are putting more and more effort into treating obesity and its medical complications. The unofficially named M&M&M syndrome, where people have the metabolic syndrome plus mechanical complications resulting in poor motivation, often lead to a deteriorating level of health and well being.
So what part does exercise play in improving and perhaps reversing these trends and what help is available in our community to support GPs in managing these problems? This article will point out some exercise strategies that may help and we will discuss in more detail adolescent obesity.
Not putting on weight in the first place
Early intervention in encouraging people not to put on weight in the first place should always be on GPs’ agenda in their advice to patients. Always remember it is much harder to lose weight than not to put it on initially.
How much physical activity do we need to do to prevent primary weight gain? This obviously depends on caloric intake of food and drink as well as how much incidental activity we get in our occupation and leisure pursuits. The National Physical Activity Guidelines will tell us we need at least 30 minutes of planned activity a day, plus as much incidental activity as possible and more strenuous aerobic activity sometimes if we can. The minimal recommended level of physical activity to promote improvements in health and prevent weight gain is at least 150 minutes a week. More research is currently being done on this and advice may change in the more active direction over time.
Losing weight
Being overweight or obese is a result of an imbalance between energy intake and energy expenditure. To lose weight we can either eat less or increase activity levels. But how much exercise do we need to do to lose weight?
Over six months of intervention many studies have shown that diet plus exercise interventions show the greatest weight loss. Diet alone comes second and exercise alone is by far the least successful with only marginal losses in weight recorded. Typical results are shown in a recent study that showed over 12 weeks of intervention in a group of men 11.4% weight loss for diet plus exercise, 8.4% with diet alone and only 0.3% for exercise alone.
However, exercise alone that increases expenditure by 700 kcal/day can be as successful as reducing the diet energy intake by 700Kcal/day. Over three months one study showed that there were comparable weight losses of 7.6kgm between energy restriction and energy expenditure groups respectively. The big catch is that a 90.7kgm individual would need to do brisk walking or equivalent exercise for 1 hour 57 mins per day to expend the extra 700 kcal/day.
A more manageable clinical approach may be to increase exercise expenditure by 350 kcal/day and reduce energy intake by 350 kcal/day, which theoretically should lead to the same result. Some people fail to lose much weight with exercise because of excessive energy intake - it doesn’t take much energy dense food to undo all the good of exercise as many will have discovered.
Weight loss without regain
To look at the longer term success in weight control the National Weight Control Registry (NWCR) was established in 1994 by Dr James Hill from the University of Colorado Health Services Centre, Denver, Colorado. The NWCR is the largest ongoing study of individual weight loss maintainers. Research has shown that about 20% of overweight individuals are successful at long term weight loss when defined as losing at least 10% of initial body weight and maintaining the loss for at least one year. The NWCR members have now lost an average of 33kg and maintained the loss for more than five years.
The key to their success has been reported as due to engaging in high levels of physical activity of one hour or more a day, eating a low calorie, low fat diet, eating breakfast, self monitoring weight and maintaining a consistent eating pattern across weekdays and weekends. Continued adherence to diet and exercise strategies, low levels of depression and disinhibition, and medical triggers for weight loss are also associated with long term success. It was also found that weight loss maintenance may get easier over time and the chance of long-term success improves after 2-5 years.
Improving insulin sensitivity
Insulin resistance is an important feature in the development of glucose intolerance and type 2 diabetes. Exercise increases post-exercise insulin sensitivity for 48-72 hours. Even in the absence of weight loss insulin sensitivity can be improved, which is helpful for managing type 2 diabetics who may find it hard to lose weight, particularly if they are on insulin, sulphonylureas or troglitazones.
Improving cardio-respiratory fitness
There is growing evidence that physical activity results in improvements in cardiovascular fitness and health outcomes independent of weight loss. Many physicians have reported that cardio-respiratory fitness was a significant predictor of CVD and all cause mortality across categories of normal weight, overweight and obese men. Similar findings have been found with women with low levels of cardiorespiratory fitness being a stronger predictor than BMI of all cause mortality. Reducing sedentary lifestyles is a major preventative health strategy for GPs to promote in their practices.
Other health benefits of exercise
There is an increasing body of evidence to support some benefits from exercising and weight loss in helping with pain reduction and physical function in arthritis sufferers. Also there are studies showing improved mental state and feelings of well-being in those with mild to moderate depression and anxiety.
2. Adolescent Obesity
Obesity is twice as common in adolescents as it was 30 years ago. Although most of the complications of obesity occur in adulthood Obesity and the Metabolic Syndrome Obesity, obese adolescents are more likely than other adolescents to have high blood pressure and type 2 diabetes. Although fewer than one third of obese adults were obese as adolescents, most obese adolescents remain obese in adulthood.
The factors that influence obesity among adolescents are the same as those among adults. Parents often are concerned that obesity is the result of some type of endocrine disease, such as hypothyroidism, but such disorders are rarely the cause. Adolescents with weight gain caused by endocrine disorders are usually of small stature and have other signs of the underlying condition. Most obese adolescents simply eat too much and exercise too little. Because of society's stigma against obesity, many obese adolescents have a poor self-image and become increasingly sedentary and socially isolated.
Intervention for obese adolescents should be focused on developing healthy eating and exercise habits rather than on losing a specific amount of weight. Caloric intake is reduced by establishing a well-balanced diet of ordinary foods, making permanent changes in eating habits, and increasing physical activity. Summer camps for obese adolescents usually help them lose a significant amount of weight, but without continuing effort, the weight is usually regained. Counseling to help adolescents cope with their problems, including poor self-esteem, have proven to be helpful.
Drugs that help reduce weight are generally not used during adolescence because of concerns about safety and possible abuse. One exception is for obese adolescents with a strong family history of type 2 diabetes; they are at high risk for developing diabetes. The drug “Metformin” also known as GLUCOPHAGE, which is used to treat diabetes, may help them lose weight and also lower their risk of becoming diabetic.
In 99.9% of all cases yes.