PET3932 – SECTION 2EXAM 4 STUDY GUIDEOverweight, 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 “Bigger” athletes Obese, high or low LBM, high FM 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 markingwith 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