Summary Clients With Nutritional
and Metabolic Concerns– minor PT
Book: Chapter 19
Clients with the conditions discussed in this chapter should be referred to their
physician for medical care and to an dietitian for medical nutrition therapy, as a
personal trainer’s role is limited to exercise program design and execution along with
lifestyle change support. Personal trainers must not diagnose or prescribe care and
should nog train clients with medical conditions outside of their knowledge and
experience; they should refer the client to an appropriate health care professional.
Overweight and Obesity
Obesity and overweight, in both children and adults, has become a ‘global epidemic’.
The most recent U.S. National Health and Nutrition Examination Survey (NHANES 2007-
2008) showed that 32,2% of U.S. men and 35,5% of U.S. women were obese (BMI
[body mass index] >30). This showed that 68.0% of the adult population (ages 20 and
older) were overweight (BMI > 25) or obese (BMI >30). These figures may increase
even more in the future.
The Office of the Surgeon General has reported several important findings:
1. Risk factors for heart disease, such as high cholesterol and high blood pressure,
occur with increased frequency in overweight children and adolescents
compared to those with a healthy weight.
2. Type 2 diabetes, previously considered an adult disease, has increased
dramatically in children and adolescents.
3. Overweight or obese adults, and this increases to 80% if one or more parent is
overweight or obese.
4. The most immediate consequence of overweight, as perceived by children
themselves, is social discrimination.
Overweight and obesity are a public health problem of significant concern, as the
condition of being overweight or obese raises the risk of morbidity from hypertension:
Hyperlipidaemia
Type 2 diabetes
Coronary heart disease (CHD)
Stroke
Gallbladder disease
Osteoarthritis
Sleep apnoea
Respiratory problems
Endometrial cancer
Breast cancer
Prostate cancer
Colon cancer
,Definitions of Overweight and Obesity and Important Differences
Overweight Obese
Is defined as a body mass index (BMI) of Is defined as a body mass index (BMI) of
25 to 29,9 kg/m2. > 30 kg/m2.
It is possible for an individual to become Those people have a significantly greater
overweight by simply decreasing his or excess of weight, particularly adipose
her activity level without consuming more tissue mass, than those who are
food each day. It is for this population, overweight. The percentage of adipose
those who are overweight, that early tissue as opposed to fat free tissue is
intervention with an exercise program and higher in persons who are obese. This
increased physical activity are important. means that people who are obese have
significantly increased their fat stores
without a concomitant increase in muscle
mass.
In general, persons who are obese are
more likely to have had a larger positive
energy balance over a longer period of
time than those who are overweight. A
positive energy balance, or consuming
more calories than are expended, will
result in an increase in body weight; a
negative energy balance, or the
consumption of fewer calories than are
expended, will result in a decrease in
body weight.
On the average, a person who is obese
has a higher resting metabolic rate and
expends more energy on activities than
those who are overweight or normal
weight. The reason is that moving a heavy
mass around requires
more energy. This is no excuses for
obese patients.
Persons who are obese must have a
strong emphasis on both cutting caloric
intake and increasing activity.
Body Mass Index: The BMI describes relative weight for height and significantly
correlates with total body fat content. The use of BMI has limitations with individuals
who are very muscular (overestimates body fat) and with persons such as those of
advanced age who have lost muscle mass (underestimates body fat).
The BMI should be used to assess overweight and obesity in addition to monitoring
changes in body weight. The BMI is calculated as weight (kg) divided by height
, squared (m2). To estimate BMI using pounds and inches, the calculation is (weight
[pounds] divided by height squared [inches2]) 703.
To select appropriate prevention strategies and design effective exercise programs, the
personal trainer must understand the complex and important differences between
overweight and obesity.
Clients who are overweight may benefit simply by increasing physical activity along with
some minor changes in their diets. Those who are obese should concentrate on both
reducing caloric intake and increasing physical activity.
Causes and Correlates of Overweight and Obesity
General’s Overweight and Obesity: Health Consequences reported that “body weight is
a combination of genetic, metabolic, behavioural, environmental, cultural, and
socioeconomic influences” and that behavioural and environmental factors contribute
largely to overweight and obesity.
These two factors may also “provide the greatest opportunity for actions and
interventions designed for prevention and treatment”
Environmental factors can include food availability, socioeconomic status, and
lack of access to exercise facilities such as a gym or a track.
Behavioural factors include eating patterns determined by individual preferences
and ethnic backgrounds, including overeating or binge eating, and activity
patterns.
Genetic and metabolic factors can include differences in resting metabolic rate,
levels of lipoprotein lipase and other enzymes, sympathetic nervous system
activity, and dietary-induced thermogenesis.
Fat Distribution
It is important not only to note whether a client falls into the overweight or obese
category, but also to discern the pattern of fat distribution. There are two types of fat
distribution;
Android obesity > Android obesity (apple-shaped body) is characterized by high
amounts of body fat in the trunk and abdominal areas. This presence of excess
fat in the abdomen, out of proportion to total body fat, acts as an independent
predictor of disease risk for type 2 diabetes, hypertension, and cardiovascular
disease (CVD).
Gynoid obesity >Gynoid obesity (pear-shaped body) denotes the condition in
which high amounts of body fat have been deposited in the hip and thigh areas.
Measuring Abdominal Fat
Waist circumference and waist/hip ratio may be better predictors of
atherosclerosis and CVD risk tan only BMI.
o There is a positive correlation between abdominal fat content and the
waist circumference measurement.
o For adults with BMI 25 – 24,9 kg/m2, have an increased risk of
developing type 2 diabetes, dyslipidaemia. hypertension and CVD, when
