PET3932 SECTION 2 EXAM 4 STUDY GUIDE Overweight Obesity Weight Loss Maintenance Read ACSM p 318 322 Bb handout on Weight Loss Regain Somatotypes a category to which people are assigned according to the extent to which their bodily physique conforms to a basic type Ectomorph skinny lean person Kasper Under normal weight low LBM Lean Body Mass low FM Fat Mass Mesomorph person with greater than average muscular development Kasper on steroids think M for Muscle Over weight high LBM low FM Endomorph person with great deal of body fat Obese Kasper with or without steroids Obese high or low LBM high FM Bigger athletes Basic calculation using LBM and FM LBM FM total mass scale weight 80 lbs 20 lbs 100 lbs total weight So this person would have 20 FM What is overweight A deviation in body weight from some standard or ideal weight usually related to height or body surface area Classification of disease risk based on BMI and waist circumference p 62 table 4 1 Classification vs BMI kg m2 Underweight 18 5 Normal 18 5 24 9 Overweight 25 0 29 9 high disease risk Obesity class I 30 0 34 9 high very high disease risk Obesity class II 35 0 39 9 very high disease risk Obesity class III 40 0 extremely high disease risk Important numbers that Kasper said to remember overweight is 25 obese is 30 How to calculate BMI example Patient height 5 11 weight 104 5 kg 5 11 71 inches 71 inches x 0 0254 1 80 meters 1 80 m 2 3 24 m2 104 5 kg 3 24m2 32 25 kg m2 What is obesity Excess body fat Will use BMI values to determine this Not the best way to define obesity we know excess fat is bad but we don t know exact BMI numbers to consider for obesity there are too many variables race background etc Percent of body fat that increases disease risk Also not the best way to define obesity reduction in percentage of body fat sometimes helps prevent disease risks but we do not have hard data to back this up yet Distribution of body fat that increases disease risk This is the best way to define obesity apple shape is worse than pear shape in terms of increasing disease risk distribution shape is a better indicator than just overall percentage of body fat Relationship between BMI CVD mortality risk of type 2 diabetes etc RR of death increases as BMI increases Age adjusted RR for type 2 diabetes increases as BMI increases Age adjusted RR for diabetes begins to increase at BMI values that are considered normal for men 24 kg m2 and women 22 kg m2 Relationship between BMI and percent body fat General rule the more weight a woman puts on the more likely it is that she put on fat mass Otherwise there is a lot of deviation error in this relationship not a strong correlation You can relate to this some guys may be extremely muscular yet they have the same BMI as some guys that are fat Muscles weigh more than fat so a high BMI doesn t mean there s automatically a high percent of body fat it might be muscle Fat distribution body shapes Android from Greek Andri man male Upper body Central Truncal trunk Male pattern apple shape big belly trunk area Gynoid from Greek Gyne woman Lower body Peripheral Female pattern pear shape big thighs hips ass lower body once women hit menopause they start putting body fat on the way a male would apple shape this increases their risk for CVD remember how apple shape is worse Waist circumference p 66 box 4 1 Correlates highly with visceral fat Strong association with risk of disease Simple and convenient method Standardized protocol for administration procedures All measurements should be made with a flexible yet inelastic tape measure The tape should be placed on the skin surface without compressing the subcutaneous adipose tissue If a Gulick spring loaded handle is used the handle should be extended to the same marking with each trial Take duplicate measures at each site and retest if duplicate measurements are not within 5 mm Rotate through measurement sites or allow time for skin to regain normal texture Dr Kasper s Basketball Theory If a patient has a big basketball belly you can t grab their fat very easily mostly skin Abdominal fat is associated with visceral fat however you are not able to grab what is the majority of their fat visceral b c of their stomach I know this may sound ridiculous but imagine trying to use a caliper on someone with a potbelly you re not going to be able to get their deep fat visceral only their taught skin on the outside subcutaneous The skin subcutaneous fat that you are able to grab is going to give a much lower BMI than what their actual BMI is Subcutaneous fat isn t nearly as bad as visceral fat that s why this is such a problem The correlation between waist circumference visceral fat A correlation of 0 74 which is pretty good considering it s hard to find direct correlations Risk criteria for waist circumference in adults p 66 table 4 3 Risk Category vs Waist Circumference Very low women 70 cm men 80 cm Low women 70 89 cm men 80 99 cm High women 90 110 cm men 100 120 cm Very high women 110 cm men 120 cm Note that the High category is consistent with ACSM Risk Stratification Threshold for Obesity On that note realize that once someone is in the high risk category you know that the patient s risks are going to increase so if a woman is at 90 cm or a male is at 100 cm waist circumference things need to change these are the numbers Kasper cares about When taking a patient s waist circumference measure in between the umbilicus belly button and xiphoid process lower part of the sternum Body Composition Although national standards have been developed and accepted for BMI waist circumference none exist for estimates of body fat percentage for health Depends on Performance Health Age Gender Lifestyle Interpretations of body fat percentage estimates are complicated by three factors No universal standards have been established and accepted No universally accepted criterion measurement method All measurement methods are indirect what is the error about 0 3 A consensus opinion for an exact percent body fat value associated with optimal health risk has yet to be defined however a range of 10 20 and 20 32 for men and women respectively has long been viewed as satisfactory for health p 72 Kasper hates these percentages basically b c there are so many variables age gender race etc you also can t base fitness or health risk just by percent body fat it s not that accurate Review p 73 table 4 5 p 74 table 4 6 to get the general idea about fitness categories Individualized approach