Obesity

Obesity is a chronic disease characterized by abnormal (excessive) deposition of adipose tissue. In the long term, obesity can lead to serious complications, which is why it is important to recognize the problem in time and start solving. Below we will review the risk factors leading to obesity, analyze its physiology and discuss rehabilitation approaches to the treatment of obesity.

Risk factors

Body mass index or BMI is used to diagnose obesity. Body mass index is defined as a person’s weight in kilograms divided by the square of his height in meters (kg/m2). For this index, a value greater than or equal to 25 is considered as overweight, and a value greater than 30 is considered as a sign of obesity.

It is a mistake to assume that the only factor in the development of obesity is malnutrition. In fact, this disease is multifactorial and has many prerequisites.

In general, the development of obesity is associated with an imbalance between energy intake from food and energy expenditure. When one of the two links is significantly different from the other, obesity develops.

The development of obesity, as a result of the increased energy intake from food, is a well-known factor associated with malnutrition. Excess calories that enter the body and are not used up are converted into fat which accumulates in the body.

A common cause of excess calorie intake is psychogenic overeating. Having this disorder, patients “seize” negative emotions, such as anxiety, longing, resentment, or helplessness. At the same time, they do not experience either a feeling of hunger or a feeling of fullness, however, such attacks lead over time to gaining excess weight. Psychogenic overeating refers to eating disorders and is treated with psychotherapy methods.

The link associated with energy expenditures can suffer for a variety of reasons. The main one is a sedentary lifestyle, which leads to fact that energy received from food is not consumed. Other factors include:

• Genetic disorders that cause an increase in activity of lipogenesis enzymes and a decrease in activity of enzymes which break down fats. With such disorders, excessive fat deposition occurs in a patient’s body, which is not related to malnutrition.

• Endocrine diseases such as hypothyroidism, Cushing’s disease, etc. can cause disturbances in fat metabolism in the body, which leads to weight gain.

• Some physiological conditions: pregnancy, lactation, menopause.

• Stress.

• Administration of some drug substances (hormonal and psychotropic drugs).

Physiology of obesity. Complications

types of obesity depending on the localization of body fat

Obesity is characterized by excessive accumulation of fat in the body. Depending on the localization of body fat, there are three types of obesity:

Abdominal type

A figure resembles an apple. Excessive deposits in the upper body and abdomen. This type of obesity is characterized by complications such as cardiovascular diseases, diabetes, stroke.

Hip-buttock type

A figure resembles a pear. Excessive deposits in the lower part of the body, in the thighs and buttocks. This type of obesity is characterized by such complications as spine and joint diseases, vascular diseases.

Intermediate type

It is characterized by an even distribution of fat deposits in the body.

types of obesity according to the mechanism of development

According to the mechanism of development, obesity is primary, secondary and endocrine.

Primary or alimentary

Primary or alimentary type of obesity develops due to the increased energy value of the diet at low energy expenditures. Food rich in carbohydrates and animal fats, irregular meals leads to the accumulation of excess weight. Energy expenditures for this type of obesity are not comparable with energy consumption – patients lead a sedentary lifestyle. Hypodynamia itself leads to a decrease in the body’s ability to break down fats, and therefore they accumulate in fat depots: subcutaneously, in the internal organs, and the abdominal wall.

Secondary type

Secondary type is caused by genetic diseases (Laurence-Myna- Biedl-Bardet- syndrome, Babinsky-Froelich disease), craniocerebral injuries, diseases of the central nervous system. It is related to dysregulation of fat metabolism.

Endocrine type

Endocrine type of obesity is a consequence of endocrine gland diseases (thyroid gland, adrenal glands, pancreas), which are normally involved in the regulation of fat metabolism.

The main symptom of obesity is overweight. Deposits appear on the hips, buttocks, abdomen, back, shoulders, neck. The second chin, typical pseudogynecomastia occur – fat deposits in breast area. The second and third types of obesity are characterized by disease-related symptoms that caused fat accumulation: menstrual dysfunction, skin symptoms (stretch marks), excessive hair growth on the face and body, dry skin.

Complications

An elevated BMI is a major risk factor for the development of complications such as:

• cardiovascular diseases (ischemic heart disease, arterial hypertension, angina pectoris, stroke, heart failure), including the increased probability of a sudden coronary death.

• type 2 diabetes;

• musculoskeletal disorders (especially osteoarthritis – a degenerative disease of the joints with a high degree of disability);

• gastrointestinal diseases (cholecystitis, cholelithiasis, liver cirrhosis);

• reproductive system disorder (decreased libido, infertility, menstrual dysfunction).

• certain cancer types (including endometrial, breast, ovarian, prostate, liver, gallbladder, kidney, and colon cancers).

The risk of these diseases grows with increasing BMI. Due to the risk of complications, it is necessary to diagnose obesity in time and refer to  a medical specialist. Early treatment of obesity can reduce the body mass index to normal values and reduce health risks.

Obesity treatment and rehabilitation methods

Preventive measures

Overweight and obesity, and related complications are largely preventable. The simplest and most affordable method of preventing the development of obesity is the conscious choice of healthier food and regular physical activity.

On an individual level, people can:

• limit the consumption of fats and carbohydrates;

• increase your intake of fruits and vegetables, as well as legumes, whole grains and nuts;

• regular physical activity (60 minutes a day for children and 150 minutes a week for adults).

Physical activity is of great importance in the treatment of obesity. Obesity leads to a movement limitation affecting physical activity. The exercises prescribed by a physiotherapist or a rehabilitation specialist are designed to gradually restore the patient’s ability to motor activity, while reducing excess body weight at the same time.

A rehabilitation program for an obese patient may include:

• provision of individual recommendations for lifestyle correction, taking into account individual views, beliefs, circumstances, cultural and social preferences and willingness to change.
• prescribing appropriate physical activity to increase muscle strength, flexibility and endurance, as well as maintain energy production and expenditure to increase and maintain weight loss in safe and controlled conditions, with constant monitoring of the dynamics of changes by a physiotherapist.
• treatment of obesity related conditions such as arthritis, osteochondrosis, joint pain and other chronic conditions such as heart disease.
• coordination of comprehensive rehabilitation programs in collaboration with other health professionals..

Physiotherapy for the patients with obesity

In rehabilitation and therapy of patients with obesity, such physiotherapeutic methods are widely used as:

Physical activity and therapeutic exercise

Movement plays an important role in the treatment of obesity, as it directly affects the link associated with energy expenditures. Physical exercises affect the tone of the central nervous system, increase the activity of the endocrine glands. Properly selected physical exercises by a physiotherapist can mainly affect fat, carbohydrate or protein metabolism. For example, long-term “endurance” exercises increase the body’s energy consumption by burning carbohydrates and fats, which is critical in the treatment of obesity.

Particularly effective are special physical exercises in the swimming pool, combined with work on simulators, running or walking, and therapeutic exercises. Swimming in the pool allows you to gain the necessary amount of cardio load without harm to the body, and also relaxes the spine.

The problem is that overweight people often have difficulty exercising due to limited mobility, difficulty breathing even with slight exertion, and sometimes due to orthopedic restrictions (such as knee and back pain) that result from overweight. Therefore, in physiotherapy exercises, the general physical load and physical activity should be individualized in accordance with the functional capabilities of the patient’s body. It is also very important to start increasing the load gradually.

Benefits of physical activity for overweight people

Exercise and physical activity make it less dependent on diet as the main source of weight loss. The more active the person, the more varied and richer the menu will be without necessity to reduce dramatically the (unhealthy) menu.

Regular exercise contributes to fat burning as an important source of energy. The more active a person is, the more his body will use adipose tissue during aerobic exercise.

With age, there is an increase in fat mass and a decrease in muscle mass. Physical exercise as a way of life largely prevents the accumulation of fat and loss of muscle mass, and thus contributes to the increase in basal metabolism.

Decrease of fat mass significantly reduces the tendency to develop diabetes and diseases.

Aerobic activity is the main preference

Recommended physical activity for weight loss, prevention and rehabilitation of cardiovascular diseases.

What is aerobic activity?

Prolonged exercise requiring oxygen. Activities that can last for a long time and activate large muscle groups in the body, such as walking, running, swimming, cycling, etc. If there are orthopedic restrictions, it is recommended to engage in non-body weight activities such as cycling, swimming, etc. Aerobic activity should be started gradually, in terms of frequency (number of times per week), duration of activity, and pace of activity. It is recommended to increase one of these parameters every two weeks. For example: start exercising 3 times a week for 30 minutes. After two weeks, increase the number of workouts to 4 per week, and after two weeks, increase the duration of the workout to 40 minutes.

Recommended frequency in the long run: at least 5 times a week. Duration: 30-60 minutes. Those who have difficulty with prolonged activity can do 10-20 minutes 2-3 times a day. It is recommended to take about 10,000 steps per day to maintain normal cardio-pulmonary levels and lead a healthy lifestyle. Research has shown that today the average person takes only 3,000-4,000 steps per day due to a lifestyle change in which they spend most of the day sitting.

Strength exercises and load

After starting an aerobic program, it is recommended to add strength exercises about 2 times a week. Strength exercises are exercises performed with resistance, such as: dumbbell exercises, band exercises, etc. In addition to strengthening muscle mass, this activity helps to speed up the metabolism and thus promotes the process of losing weight.

Daily functional activity

In addition to aerobic activity and strength training, it is highly recommended to increase your level of daily household activity. Many studies have shown that a person who is inactive during the day is at a higher risk of heart disease than a person who is physically active during the day.

Performing daily activities increases energy expenditure and thus contributes to the process of losing weight.

Daily household activities are activities that are not designed for specific physical activity, but are performed for the purpose of performing daily tasks such as climbing stairs, cleaning house, gardening, walking a dog, shopping at a supermarket, etc.

Video: “EXERCISES FOR OVERWEIGHT | OBESE PEOPLE”

EXERCISES FOR OVERWEIGHT | OBESE PEOPLE. SET NO. 1: GENERAL EXERCISES TO STRENGTHEN MUSCLES AND IMPROVE JOINT MOBILITY

For additional information about Rehabilitation of the patients with Obesity you can watch a video demonstrating exercises and rehabilitation recommendations.

Apparatus physiotherapy

Among the methods of apparatus physiotherapy, methods such as electrosleep, transcranial electrical stimulation, decimeter wave therapy are used to stimulate the work of the central nervous system and endocrine glands, for example, the thyroid gland.

Massage and manual therapy

Massage and manual therapy are of great importance in the treatment of obesity. With the help of massage, there is an improvement in blood flow, metabolism in the massaged area, the elasticity of muscle fibers increases, and atrophy of muscle tissue slows down.

All methods of physiotherapy can and should be combined with a diet therapy prescribed by a specialist: reducing the intake of fats and carbohydrates, increasing the content of fiber, nuts, whole grain in food.

We should not forget about the importance of the psychological component in the treatment of obesity. Overeating is often caused by stress or psychological trauma, without the correction of which a complete rehabilitation is not possible. Psychotherapy combined with diet therapy and physiotherapy is an integral part of rehabilitation.

Drug therapy

In some cases, with BMI >30, when the above methods are ineffective for a long time (more than 3 months), drug therapy is indicated. Drugs that directly affect the nervous system, inhibit hunger and accelerate satiety are prescribed. However, these drugs have a large number of adverse effects and are addictive, so drug therapy should be resorted to only in extreme cases. Methods of surgical treatment are used for persistent BMI<40.

CHECK OUT THE DEMO VERSION OF OUR  WORKOUTS FOR REHABILITATION OF PATIENTS with obesity ON YOUTUBE

Our website presents sets of exercises for the rehabilitation of the patients with obesity in the following areas:

1. EXERCISES FOR OVERWEIGHT/OBESE PEOPLE. SET NO. 1: GENERAL EXERCISES TO STRENGTHEN MUSCLES AND IMPROVE JOINT MOBILITY

2. EXERCISES FOR OVERWEIGHT/OBESE PEOPLE. SET NO. 2: POWER EXERCISES WITH A GYMNASTIC ELASTIC BAND/TERABAND

3. EXERCISES FOR OVERWEIGHT/OBESE PEOPLE. SET NO. 3: POWER EXERCISES WITH DUMBBELLS. WEIGHT IS SELECTED INDIVIDUALLY. IT IS RECOMMENDED TO START WITH 1-2 KG

4. EXERCISES FOR OVERWEIGHT/OBESE PEOPLE. HYDROTHERAPY MODULE: SWIMMING AND HYDROTHERAPY, EXERCISES IN THE WATER