OBESITY MANANGEMANT --FRANKLIN

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obesity

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WEIGHT LOSS TRAINING JENEPHER Physiotherapist Al-Jahra hospital

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Contents 1. Obesity in Kuwait 2. Orthopaedics problems and over weight 3. Causes of obesity 4. Body mass index {BMI} 5. Waist hip ratio 6. Basal metabolic rate in relation with weight loss 7. Body composition analysis 8. Factor affecting BMR 9. Weight loss training 10. Cardiorespiratory training 11. Weight training 12. Flexiblity training 13. Weight loss Diet

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What are overweight and obesity ? Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity. It is defined as a person's weight in kilograms divided by the square of his height in meters (kg/m 2 ).

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Obesity Rate In Kuwait Hits 80 % Surgeons Discuss Latest Scientific Information KUWAIT CITY, Dec 21 : The rate of obesity in Kuwait has reached 80 %, Al-Qabas daily quoted Consultant of General Surgery at Mubarak Al-Kabeer Hospital and Associate Professor at the Department of Surgery, Faculty of Medicine, Kuwait University Dr Mosa’a Khurshid as saying. Khurshid was speaking at the 9th Kuwait Annual Conference of Surgeons which was held during Dec 18-20 at the Crystal Hall in Sheraton Hotel . ARAB TIMES 21-12-2011

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Orthopaedic conditions and Obesity Introduction Most of obese patients age group of 30-45 yrs old suffer from joint or musculoskeletal discomfort due to mechanical strains. Many aspects of the relationship between orthopedic conditions and obesity have a high level of evidence based support. Understanding the interaction between weight,weight loss and arthritis, especially osteoarthritis, may prove crucial to the optimal management and prevention of some very common orthopaedic conditions

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Treating the cause is important than treating complications

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Obesity and Osteoarthritis The association between obesity and osteoarthritis is strongest for the knee joint in Women 12-15 % due mechanical strain. The proportion of osteoarthritis attributable to obesity in middle aged women is estimated to be 63% and in male 37% Twin studies confirm ‘s that the risk of knee osteoarthritis increases by 35% for every 5-kg of weight gain

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Dr.Mirtz andGreene conducted a review of recent evidence regarding the relationship between overweight/obesity and LBP . Results suggest that Individuals with BMI <30 are at minimal risk of developing LBP. BMI between 30 and 40 are at moderate risk . patients with BMI >40 are at high risk . Attention to overall weight loss is important as every pound adds strain to the muscles and ligaments in the back. In order to compensate for extra weight, the spine can become tilted and stressed unevenly.

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What causes obesity and overweight? The fundamental cause is an energy imbalance between calories consumed and calories expended . Globally, there has been: -increased intake of energy-dense foods that are high in fat, salt and sugars but low in vitamins, minerals and other micronutrients. Decrease in physical activity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization. Changes in dietary and physical activity patterns are often the result of environmental and social changes .

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Concepts of Physical Fitness 14e 11 Creeping Obesity Physical activity decreases and leads to a decrease In metabolic rate. If energy expenditure drops more than energy intake, weight gain will occur.

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BODY MASS INDEX BMI equals a person's weight (mass) in kilograms divided by the square of the person's height in metres . BMI= MASS (KG) HEIGHT(meter)*2 E.g : If a person weight is 75 kg and height 165 cm BMI= 75 = 75 = 22.72 1.65*2 3.3 BMI Classification < 18.5 underweight 18.5–24.9 normal weight 25.0–29.9 overweight 30.0–34.9 class I obesity 35.0–39.9 class II obesity ≥ 40.0 class III obesity

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Waist/Hip Ratio Indicates relative amounts of visceral fat vs. subcutaneous fat Waist/hip ratio - divide the waist circumference by the hip circumference WAIST HIP RATIO acceptable unacceptable excellent good average high extreme male < 0.85 0.85 - 0.90 0.90 - 0.95 0.95 - 1.00 > 1.00 female < 0.75 0.75 - 0.80 0.80 - 0.85 0.85 - 0.90 > 0.90

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WAIST MEASUREMENT Measurements should be taken midway between the inferior margin of the last rib and the crest of the ilium in a horizontal plane. HIP MEASUREMENT widest part of the trochanters (buttocks ). How to measure W.H RATIO ?

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Apple-shaped fat individuals are exposed to a greater risk of developing obesity-related diseases, as the fat is intra-abdominal and distributed around their stomach and chest. Cardiovascular diseases and hypertension Type 2 diabetes Respiratory diseases (sleep apnea syndrome) O A,LBP The pear-shaped overweight persons are at greater risk of mechanical problems, as most of their body fat is distributed around their hips, thighs and bottom. Low back strain B/L O.A.KNEES N

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IN recent decades the appl e pattern fat distribution are common in women it may due to hormonal imbalances . IN Men Latest studies show that men's tendency towards the pear format has increased in the past 30 years . According to researches as Dr.John R. Lee, M.D (specialist in natural progesterone therapy) According to Dr. Jesse Hanley and Dr. Peter , it seems that modern life exposes people to increased amounts intake of estrogen and estrogen-like substances . Sources of these substances can be plastics, plastic drinking bottles, commercially raised beef, chicken and meat, personal care products, pesticides, herbicides, birth control pills, spermacide, detergent, canned foods and liquors. The problem is that increased estrogen levels in men Abnormality in body shape in Recent decades

Basal Metabolic Rate :

Basal Metabolic Rate BMR is the amount of daily  energy expended by humans at REST

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Factors affecting the BMR Age - metabolism slows with age Growth - infants and children have higher energy demand Gender - generally, men have faster metabolisms than women Genetic predisposition - Metabolic rate may be partly decided by genes. Amount of lean muscle tissue - More lean body mass leads to high BMR Hormonal and nervous controls - hormonal imbalance( eg : thyroid) can influence how quickly or slowly the body burns calories. Crash dieting, starving or fasting - eating too few kilojoules encourages the body to slow the metabolism to conserve energy; BMR can drop by up to 15 per cent. There is also loss of lean muscle tissue, which further contributes to the drop in BMR Drugs - like caffeine or nicotine, can increase the BMR for short time.

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The most commonly used one is the Mifflin - St Jeor equation : BMR = 10 * weight(kg) + 6.25 * height(cm) - 5 * age(y) + 5 (man) BMR = 10 * weight(kg) + 6.25 * height(cm) - 5 * age(y) - 161     ( woman) An average male may have a BMR of around 2000 kcal per day, while an average female may have a BMR of around 1500 kcal per day .

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This flow chart help us to find Estimated calorie requirements for men

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This flow chart help us to find Estimated calorie requirements for Women

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why people put on weight in 30 - 40yrs Average decreases of BMR 2.9 and 2.0 percent per decade, respectively, for men and women of normal weight (BMI of 18.5 to 25.0 ) were calculated more recently (Roberts and Dalall, 2011; Food and Nutrition Board/Institute of Medicine, 2011). The decreases were 3.1 and 1.9 % per decade among overweight men and women, respectively (Roberts and Dalall, 2011).

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HOW TO INCREASE THE BMR OR METABOLIC RATE ? 1.Increasing the physical activity 2.Increasing softlean mass by weight training 3.Some drugs are available in markets to increase the BMR(phentermine (an amphetamine) had side effects 4.Green tea improve BMR 5. Happy and active life will raise the BMR 6.Keep your Thyroid hormone in balance 7. Researchers in Germany report that cold water consumption increases the rate at which people burn calories. 8. Eat small, frequent meals. Will increase BMR Increasing Metabolic Rate will help you to reduce weight

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COMPOSITION OF BODY The body is composed of water, protein, minerals, and fat.

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In this method A mild undectable current is sent through electrodes through the body. The current passes through the body through the fat freemass which contains Water 73%. Through the bio electric feed back , amount of fat free mass is estimated. Then calculate fat mass and % of body fat Fat mass=body weight –fat free mass Body composition analysis There are many methods are avaliable to find the body composition. Common methods used nowadays are Bioelectrical Impedance Analysis{BIA} method.

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BODY COMPOSITION ANALYZER {BIA}

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FOOD INTAKE ENERGY EXPENDITURE WEIGHT LOSS: FOOD INTAKE FOOD INTAKE FOOD INTAKE ENERGY EXPENDITURE ENERGY EXPENDITURE ENERGY EXPENDITURE BAD GOOD VERY GOOD

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WEIGHT LOSS weight loss should be concentrated on reduction of body fat and improve the muscle mass(soft lean mass)which improves the Resting Metabolic Rate (RMR) and prevent weight gain for longtime. Each pound of fat our body stores represents 3,500 calories of unused energy. In order to lose 1 pound, you have to create a calorie deficit of 3,500 calories by either taking in 3,500 less calories over a period of time than you need or doing 3,500 calories worth of exercise . It is recommended that no more than 2 pounds (7,000 calories) be lost per week for lasting weight loss.

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This is a control guide for weight loss

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IMPORTANCE OF DIET IN WEIGHT REDUCTION A balanced diet should be part of any weight control plan. A diet high in complex carbohydrates and moderate in protein and fat will complement to an exercise program. vegetables & fruits (4 servings), Bread & cereals (4 servings), milk & milk products (2 - 4 depending on age) Meat & fish (2). Experts recommend that daily intake should not fall < 1200 calories unless you are under a doctor's supervision. weekly weight loss should not exceed 2 pounds.

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EXERCISES TO REDUCE WEIGHT . Before going to start exercise program patient should consult the physician For general medical fitness consultation Exercise programme should designed individually for every person’s physical Condition By physiotherapist The pts with orthopaedic problems should advised Low impact training t o avoid further joint injury Weight training for beginners should start with the cable workouts .It prevent injuries of joints.

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Most of the patients are comfortable with cable workout s Circuit weight training can be done with four or five workouts for one set

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Procedures to start exercises 1.Pre Warm up Just walk or do any aerobic active exercises at minimal speed, It s to prepare the body for exercises. 2.Pre stretch active self stretching of all joints and muscle .Its to lengthen the muscles for sternous physical activity. Also prevents soft tissue injuries 3.Warm up This is more faster than pre warm up.( Any cardio respiratory exercise up 10 to 15 mins at moderate intensity). This is to raise the body Temperature ,which raise the metabolic rate and cause maximum energy expense. 4. Cardiorespiratory or weight training 5. post stretching. to prevent muscular pain and relaxiation of muscles

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Stretching promote flexiblity and prevent soft tissue injuries

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Stretching should be done before and after the exercise

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4.Cardiorespiratory training Timing and intensity depends on individual.It consist of 3 phases.Total time of cardio training is divided in to 1.Warm up phase 2.sternous training phase 3.cool down phase. For weight loss– Cardio training should be done 60-90 minutes Cardio respiratory workouts. Machine/active 1. walking, jogging,running. 2.swimming. 3.cycling 4.recumbent bike 5.elliptical trainers 6.arc trainers

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Cardiorespiratory workouts are increase the calorie expense leads to Weight loss

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Cardio Exercise Prescription (35years old) Intensity of Exercise 1. Estimate your own maximal heart rate ( MHR ) MHR= 220 minus age (220 – age) MHR= 220 - 35 = 185 bpm 2. Resting Heart Rate (RHR) = 72 bpm 3. Heart Rate Reserve (HRR) = MHR – RHR HRR =185- 72 = 113 beats 4. Training Intensities (TI) = HRR x TI + RHR 60% TI = 113x .60 + 72 = 139 bpm 70% TI = 113 x .70 + 72 = 151 bpm 85% TI = 113 X .85 + 72 = 168 bpm How to prescripe cardio training ?

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Weight loss Cardiorespiratory training The body primarily uses fat and carbs for fuel. The ratio of these fuels will shift depending on the activity. For higher intensity exercise , such as fast-paced running, the body will rely more on carbs for fuel than fat. That's because the metabolic pathways available to break down carbs for energy are more efficient than the pathways available for fat breakdown. For long, slower exercise, fat is used more for energy than carbs. Slower, intensity 60% training intensity is good for weight reduction.

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Weight training for weight loss is important because the muscle mass reduced Gradually by age it leads to decreased BMR causing weight gain

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WEIGHT LOSS TRAINING by Weight training Weight training can used two ways for weight reduction 1.Increase the BMR -By Increasing the mass of the muscle 2.To spend energy - equal to cardiorespiratory training 1.To Increase the BMR—(STRENGTH TRAINING) To decrease the weight of the body we have to raise the BMR. BMR is depends amount of SOFT LEAN MASS(MUSCLE) To increase the BMR we have to increase the size(mass) of the muscle. For that maximal resistance minimal repitation training used. It will give long time result by raising BMR

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STRENGTH TRAINING Frequency Muscles usually need between 48-72 hours to complete . Two or three strength training sessions a week provide excellent results. Repetitions The standard strength training protocol for repetitions is 8 to 12 repetitions with 75 percent of your maximum resistance. And 3 to 5 sets. A sound strength training program should include exercises for all major muscle groups. Do your best to exercise larger muscle groups first, followed by medium and smaller muscle groups.

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2.TO SPEND ENERGY- CIRCUIT TRAING or ENDURANCE TRAINING Circuit weight training is a form of  resistance training which is designed to be easy to follow and target strength building as well as muscular endurance and more calorie burn in short time. An exercise "circuit" is one completion of all prescribed exercises in the program. When one circuit is complete, one begins the first exercise again for another circuit. Traditionally, the time between exercises in circuit training is short, often with rapid movement to the next exercise. This type of training low or medium 45 to 65% of 1RM. This will increase the endurance and help to burn more calorie s as like cardio respiratory trainings

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Dieting Diet for weight loss is the part of the dietician but understanding the diet part in weight loss is very important. In general Low caloric diet such as fruits and vegitables should be encouraged. Avoid fatty food like meat an fried foods should be avoided. Amount of food taken should be reduced. Junk foods should be avoided. EATING HABITS SHOULD BE CHANGED 1. A void watching TV or using mobile while eating food. If we take food without concentration, our brain can’t sense the amount of food taken inside so we overload the stomach. 2.how to reduce the amount of food intake ? * sit in dining table with food. * chew the food well and concentrate and enjoy the aroma from food.

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2.how to reduce the amount of food intake ?continued... Take small plate than regular one you used. Take one half of quantity of food as like ur regular food. It will looks like as like ur regular food amount Fill the plates with foods made of low calorie value food Take atleast 20 – 30 min to eat 3.EAT only three times per day and avoid coffee with milk and sugar. 4.Dont skip or reduce breakfast, it leads to excessive intake at lunch 5.Eat less for dinner 95% OF DIET PLAN FOR REDUCING WEIGHT ARE ENDING IN FAILURE AND IT LEADS TO EXCESSIVE INTAKE OF FOOD AND FURTHER WEIGHT GAIN THAN BEFORE . BUT CHANGING THE EATING PATTERN IS THE ONLY SOLUTION FOR CONSISTANT WEIGHT LOSS AND MAINTAINING THE IDEAL WEIGHT

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C onclusion FOR WEIGHT LOSS We have to prescribe proper cardioresiratory training with training intensity of 60% up to 60 to 90 minutes. Weekly three to four session . weight training programme is must and it should be done at 75-85% of 1RM.and 3-5 sets. Weekly two or three sessions of weight training should be given WEIGHT LOSS DIET - diet plays a important role in weight loss its about 50 % So dietician consultaion is very much important in weight loss. Changing the eating habits are more important for prolong success. There are some successful diet plans are avaliable for over weight persons without medical complications. E.g. General motors diet plan

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Physicians add Years To LIFE Physiotherapists a dd LIFE To Those YEARS Thank you

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