Basic of Geriatrics and Internal Medicine for Physiotherapist by Rasheedy D - HTML preview

Obesity

A person with a body mass index (BMI) > 30 kg/m2 or (preferentially) a waist circumference > 94 cm for males and > 80 cm for females is considered obese.

Types: central and peripheral obesity

Etiology:

Complications:

Assessment:

Anthropometric measurement:

1. Measure body mass index weight (Kg)/Height (m2): Interpretation of BMI

2. Skin fold thickness e.g. over triceps (N : 20 mm in ♂, 30 mm in ♀).

3. ( Waist / hip ratio ):

• Central (Visceral) obesity (WHR>1 in♂, 0.9 in♀) more fat in the upper body (Apple shaped), associated with more morbidity.
• Peripheral obesity: more fat in lower body (pear shaped), associated with less morbidity (WHR<0.85 in♂,< 0.75 in♀).

4. Measure fat content using CT, MRI,DXA, BIA usually research methods rather than diagnostic tools.

Assess for other components of metabolic syndrome:

It is a group of risk factors that raises the risk for heart disease and other atherosclerotic conditions such as Peripheral arterial disease and stroke.

It has 5 components:

1. Visceral obesity.
2. Insulin resistance, impaired glucose tolerance
3. Low HDL<50 mg/dl in ♂,< 40in♀).
4. Increased triglyceride>150 mg/dl
5. Hypertension

Assessment for possible causes for obesity: according to history and examination e.g. TSH, cortisol level.

Assessment for complications: ECG, Echocardiography, polysomnography, abdominal ultrasonography, Liver function tests.

Treatment:-

1. Diet:

An energy deficit (calories burned minus calories eaten) of 500 to 1000 kcal/day will result in 1 kg loss/week (rapid weight loss increases the risk of gallstones and secondary amenorrhea). Low carbohydrate low fat diet is recommended.

2. Exercise: this not enough to lose body weight without dietary restriction

3. Medications Only in patients with BMl > 30 Kg/m2

• Anorexiant sympathomimetics :Mazindol, Diethyl propion, phenylpropanolamine
• Orlistat (Xenical(acts as an intestinal lumen lipase inhibitor, decreasing the absorption of ingested fats.

4. Surgical: when BMl> 40 or BMl > 35 with family history of heart attack or diabetes.

• Jejuno-ileal bypass, Gastric placation, Gastric balloon: By endoscopy.
• Liposuction for regional obesity.

Physiotherapy in obesity

Exercise Training Recommendations in Patients with Obesity

• ≥5 days per week of aerobic exercises to maximize caloric expenditure.
• Sedentary individuals should build up to their physical activity targets over several weeks, starting with 10 to 20 mins of physical activity every other day during the first week or two, to minimize potential muscle soreness and fatigue.
• Start with moderate-intensity activity, individuals choosing to incorporate vigorous intensity activity into their program should do this gradually and after an initial 4–12 week period of moderate-intensity activity.
• Patients who are overweight or obese should be prescribed a volume of 45 to 60 mins of moderate-intensity activity a day (corresponding to approximately 225 to 300 mins/week of moderate-intensity physical activity or lesser amounts of vigorous physical activity).
• People who have been obese and have lost weight should be advised they may need to do 60 to 90 mins of activity a day to avoid re gaining of weight.
• Walking is an excellent form of physical activity for overweight and obese people (for obese, sedentary individuals, brisk walking often constitutes moderate-intensity physical activity).
• Weight-bearing physical activity may be difficult for some individuals with BMI over approximately 35 kg/m2, particularly for those with joint problems. For these individuals, gradually increasing non-weight-bearing moderate-intensity physical activities (e.g. cycling, swimming, water aerobics, etc.) should be encouraged. Cycling exercises should thus only be used as a warming-up mode, and for a limited duration (up to 5–10 min), except for patients experiencing joint pain or knee-hip arthrosis: such exercise types may be ideal to start-up an exercise program.
• A minimal exercise program duration of 6 months is recommended to achieve a significant and clinically relevant adipose tissue mass loss and it is advised to permanently increase daily physical activity next to supervised exercise training to minimize body weight regain.

Precautions

1. Pre-exercise cardiopulmonary testing due to Increased cardiovascular risk in obese patients
2. Obese individuals are prone to the development of (degenerative and inflammatory) overuse symptoms due to elevated mechanical loads and altered biomechanics. Therefore, the musculoskeletal system should be evaluated thoroughly and exercise training modalities should be adapted accordingly.
3. These symptoms can be reduced or even prevented by progressive exercise training adaptations, altering the type of aerobic exercise training and by incorporating low-weight bearing exercise training sessions (e.g. aquatic exercise, cycling, rowing, etc.).

Cholesterol and triglycerides (TGs) are the major circulating lipids. Cholesterol is used by all cells for the synthesis and repair of membranes and intracellular organelles and by the adrenal glands and gonads as a substrate to synthesize adrenal and gonadal steroid hormones. TGs are an energy source and can be stored as fat in adipose tissue or used as fuel by muscle and other tissues.

Cholesterol and TGs are not water soluble and, thus, cannot be transported through the circulation as individual molecules. Lipoproteins are large, spherical particles that package these lipids into a core surrounded by a shell of water-soluble proteins and phospholipids. Lipoproteins serve as vehicles that transport cholesterol and TGs from one part of the body to another.

Types and functions of different lipoproteins

Types of dyslipidemia:

1. Primary
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