Reino Muller

According to the World Health Organisation (WHO) obesity is classified as a chronic disease (Van Der Merwe & Pepper, 2006). Obesity or being obese is an excessive accumulation of body fat mass and visceral adipose tissue. (Van Der Merwe & Pepper, 2006; Durstine et al., 2009; Banicek & Butcher, 2010; Ahima, 2011; Podebradska et al., 2011)

Obesity is a morbidity related to a number of adverse health effects (co-morbidities) and is a component of the metabolic syndrome, these adverse health effects include; Depression (Marijinissen et al., 2011), Cardiovascular disease CVD (left ventricular hypertrophy) (Athyros et al., 2011), type 2 diabetes mellitus which could lead to arteriosclerosis, insulin resistance, non-alcoholic fatty liver disease, hypertension, dyslipidemia, osteoarthritis, asthma (affecting ventilatory control and mechanical efficiency of breathing), reproductive abnormalities, sleep apnea as well as certain cancers and indefinite mortality if not controlled (Van Der Merwe & Pepper, 2006; Mollentze, 2006; May & Buckman, 2007; Davenport et al., 2009; Guverich-Panigrahi et al., 2009; Sasai et al., 2009; Clark et al., 2010; Kotchen, 2010; Hatch, E.E. 2010; Garaulet, M. 2010; Burke, L.E. 2011; Robinson, K.T. 2011; Robinson, K.T. 2011; Eimarieskandari et al., 2012; Tan et al., 2012; Sakurai et al., 2012; Garaulet et al., 2010; Burke & Wang, 2011; Robinson & Butler, 2011)

According to Paans et al., (2013), it is estimated that approximately two thirds of the world population is either overweight or obese. Obesity is a major contributor to the prevalence of preventable death which accumulates to approximately 400 000 deaths per annum. Morbid obesity is responsible for approximately two and half million deaths per year. A 25-year-old male who is morbidly obese can lose up to 12 years of his life due to the condition (Hatch et al., 2010).

According to Ahima, (2011), in 2008 the World Health Organisation (WHO) estimated that over 1 and a half billion adults ≥20 years of age were overweight and approximately 10% of adults worldwide were obese. 65% of the world’s population live in countries where mortality rates as a result of obesity is higher than that of under nutrition. A study performed in 2010 indicated that approximately 43 million children under the age of five were classified as overweight of which 35 million are living in developing countries particularly low-middle income countries thus obesity is dubbed the “double burden” of diseases for individuals living in these environments as a result of the already ongoing battle against infectious diseases and under nutrition (Rossouw et al., 2012).

Obesity can be quantified using Body Mass Index (BMI) which relates a person’s weight to their height in other words weight divided by height squared (kg/m2) (Banicek & Butcher, 2010; Mknonto et al., 2012). A BMI of greater than or equal to 25 kg/m2 classifies an individual as overweight and a BMI of 30-35 kg/m2 and greater indicates obesity, however, a BMI of 40 kg/m2 and greater indicates morbid obesity (Mollentze, 2006; Guverich-Panigrahi et al., 2009; Ahima, 2011).

Another measure of obesity is using measurements of waist circumference (WC) measured at the level below the last rib and above the umbilicus as well as hip circumference (HC) measured at the level of the greater trochanter in order to obtain an individual’s waist to hip ratio (WHR), which is calculated as WC divided by HC (Marijinissen et al., 2011; Mknonto et al., 2012).

Males with a WC greater than or equal to 102cm and Females with a waist circumference greater than or equal to 88cm are also classified as obese (May & Buckman, 2007)

Overeating is perceived as the primary cause of obesity; however, research suggests that obesity is related in part to the over indulgence in food that is high in fat and refined sugars such as, soft drinks, fried chips and fast-foods etc. The consumption of these foods can result in an energy imbalance as a result of the excess intake of total calories combined with a sedentary lifestyle (Mollentze, 2006; Durstine et al., 2009; Guverich-Panigrahi, T. 2009; Rossouw et al., 2012; Guverich-Panigrahi et al., 2009). These two reasons are the primary causes of obesity both in South Africa and around the world. The rate at which obesity is increasing is attributed to foods high in energy becoming more readily available and accessible which is relatively inexpensive coupled with reduced amounts of average daily energy expenditure that is required for survival (Mollentze, 2006; Pescatello et al., 2013).

According to the evolutionary adaption theory, we have inherited the genetic make-up from our ancestors or hunter gatherer forefathers who during periods where food were scarce, crops failing to grow and hunger, expended large amounts of energy for survival, and as a result prevented them from becoming obese or overweight (Durstine et al., 2009). This theory infers that even though our bodies have evolved over millenniums we still have that innate capacity for energy expenditure or have the need to expend more energy than what we consume, however, as previously mentioned the lifestyles chosen by many prevent this desire for energy expenditure to surface.

Chronic or prolonged periods of energy imbalances make it difficult for the human body to adapt, as a result of the altered physiological responses linked to obesity such as:

• Decreased Insulin sensitivity
• Decreased Growth Hormone (GH) response when stimulated by insulin
• Decreases in Growth Hormone (GH)
• Decreases in Hormone-sensitive Lipase
• Increases in fasting Insulin
• Increases in Insulin response to Glucose
• Increases in Adrenocorticol Hormones
• Increases in Cholesterol synthesis and excretion (Durstine et al., 2009).

The use of body fat % to determine obesity should not be seen in isolation because other factors such as the location of fat deposits and their implications to health should also be noted. A disadvantage of BMI is that it does not quantify body composition (Guverich-Panigrahi et al., 2009). An advantage, however, is a mutual relationship exists between BMI and subcutaneous body fat and is easily obtainable e.g. (Anthropometrical measures such as the sum of 4 or 7 skinfolds) (Durstine et al., 2009).

EFFECTS OF EXERCISE TRAINING ON OBESITY

Exercise training as a treatment as well as regular physical activity has multiple benefits for the obese population which includes:

1. Preserved lean body mass despite a restriction in caloric intake
2. Favourable changes in metabolism and lipid profiles such as intramuscular triglyceride storage and utilisation as an energy source (Podebradska et al., 2011; Sakurai et al., 2012)
3. Improvements in insulin sensitivity
4. Reduced Blood Pressure
5. Improvements in mood and effects of satiety
6. Reduction in co-morbidity risk
7. Reduction in abdominal fat deposits thus exercise is the most efficient way of getting rid of excess abdominal fat (Durstine et al., 2009; Guverich-Panigrahi et al., 2009; Doyle-Baker et al., 2011).

The American College of Sports Medicine (ACSM) recommends 200-300 min/week or >2000 kcal/week of moderate-vigorous physical activity for weight maintenance and weight loss. (Lee et al., 2012; Doyle-Baker et al., 2011; Pescatello et al., 2013).

ROLE OF THE BIOKINETICIST

It is important that the Biokineticist has many one on one sessions, with the individual in order to determine whether or not the exercise program is effective.

Biokineticists should ensure that individuals are adhering to their exercise programs by making use of log sheets and time tables in order to record completed/incompleted sessions.

The Biokineticist should revisit the program goals every 4-6 weeks in order to identify whether or not the goals are being reached and make adjustments accordingly by manipulating the FITT principles of Frequency, Intensity, Duration (Time) and Type of activity.

For more information contact a Biokineticist in your area.