ACE 6th Edition Chapter 12: Considerations for Clients with Obesity
ACE 6th Edition Chapter 12: Considerations for Clients with Obesity 1

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Chapter Goals:

  • Be able to describe the major factors that will contribute to obesity.
  • Discuss the main components of a plan for behavioral weight loss. 
  • Know the main points of dietary strategies for weight loss and weight maintenance.
  • Be able to talk about the role of physical activity and exercise in preventing and treating overweight and obesity. 

Introduction

We often have obesity and overweight being described simply as the result of imbalances between the consumption of calories and the expended calories. 

Obesity was primarily present in high-income countries but is now in all countries. 

Many factors can cause obesity today, and trainers and other people need to know these causes and how we may try to prevent them.

Possible Causes of Obesity

It is mostly clear that obesity will come about when the energy in is greater than the energy put out, but the actual contribution to these two factors is what is very important to know. 

Environmental Factors

This includes things like the availability, quantity, and energy density of the foods we consume and the combination of those with the amount of time spent sitting or the availability of facilities. 

Stress

Stress is known to cause many diseases and disorders like obesity and other eating disorders. With chronic stresses, we see hunger is stimulated and specifically for foods high in calories.

Genetics

Basically, we have some specific genes that are impossible for us to control, and they put us at increased risk for obesity. This is true for a small number of people dealing with obesity. It is thought to have much to do with the rise in obesity levels in the US.

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Hormones

We have many hormones that play roles in fat for the body. The regulation of energy metabolism is a main role of our hormones, and when compromised, we see poor metabolism. Sometimes these hormone problems can come about due to the many other factors of obesity, and once the hormones are dwindling, they are hard to recover. 

Some of the hormones that play major roles in obesity and cause some of the effects are:

  • Leptin
  • Adiponectin
  • Some immune hormones
  • And the hormones used for regulating the appetite.

Sleep

Obesity has a high relation to inadequate sleep quantity and poor sleep quality. Many people also will have sleep apnea due to obesity. Once someone has obesity, they may develop obstructive sleep apnea, likely affecting the quantity and quality of sleep achieved later. 

Energy balance

The actual intake of more calories than we burn will lead to obesity for obvious reasons. This is definitely one of the main causes of obesity. 

Nutritional Guidelines

Eating low calorie diets is the first way that many people try to lose weight, but the things that occur during these restrictions are complex and intertwined. 

It is important for personal trainers to really recognize their scope of practice when discussing things in the realm of nutrition. 

The ADA recommends reducing their fat and carbs intake to obtain a caloric deficit of 500 – 1,000 calories daily and produce weight loss of around 1 – 2 pounds weekly. But, in reality, not all weight loss will be fat. 

Some other components of weight loss programs will be:

  • Controlling the size of the portions when we eat
  • Eating more often throughout the day
  • Consuming foods that are nutrient-dense and low in the density of energy

The goal when losing weight should be to preserve the amount of lean body tissue we have; to do this, we should at least meet the protein requirements of 45 – 56 grams per day, or 10 – 35% of the total calorie goal.

Exercise Guidelines

Since many people that are overweight and obese will walk to increase their energy expenditure, it is important to know the linear relationship between walking speeds of 1.5 – 4.4 mph and energy expenditure. 

When someone walks faster, they expend more energy but cannot walk as far. 

This relationship, of course, exists with all forms of exercise, but few people understand it. 

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Due to this relationship, the emphasis for people that are obese and overweight should be placed on the total distance walked and not the speed at which it’s done. Slower but longer workout times will always be preferred for these clients. 

Mobility and balance problems are likely to exist with these clients too, and we should note that some exercise equipment and options for physical activity may not be good for these individuals. 

Cardiorespiratory Training

We are going to utilize the FITT training principles. These stand for the frequency, intensity, time, and type of exercise done. 

Frequency for obese and overweight individuals will have the goal of being active as many days as they can and with the goal of at least five days throughout the week. Clients that are consistently doing moderate exercise intensities for a minimum of three days per week for at least 20 minutes at a time will start in the base training phase.

The intensity of exercise should be moderate. This helps us maximize energy expenditure by not going too hard and burning out quicker but still working harder than the light activity levels. The talk test is utilized again to see the level at which someone works. 

The time for exercise will be 30 – 60 minutes each day, which can be done in one session or shorter bouts throughout the day. 

The type of exercise done will be the lower impact varieties of exercise and the rhythmic kinds that use our larger muscle groups. 

Muscular Training

The use of muscular training may not produce the best results and changes in scale weight, but we will see some optimal changes when it comes to the expending of energy and other benefits. 

Muscle is known to burn more calories than fat, so when you build more muscle, you actually increase your energy expenditure at rest and when working. This is very beneficial in the long run. 

We will use the FITT principles again to examine what is needed for muscular training.

The frequency will be doing muscular training 2 – 3 days per week with a rest day between sessions. 

Intensity will be a moderate level again, and this is usually 60 – 70% of someone’s one rep max for 8 – 12 reps and 2 – 4 sets per exercise. Muscular strength should be the focus for obese clients. 

For the time being, this will depend entirely on the number of exercises done and the many other resistance training variables in the program. Usually, the sessions are best when 20 – 30 minutes of activity are done. 

The type of exercise will be those that use all major muscle groups using the free weights and machines. 

Exercise and Weight Management

Exercise plays an important role in reducing excess body weight and achieving stability in your weight. It is really just as important as nutrition in this sense.

Research shows a very strong relationship exists between the volume of cardio and muscular training and the amount of total and regional fat loss. 

It is generally accepted that people can lose weight, but most cannot maintain significant levels of weight loss over time. The exact amount of exercise needed to reduce or keep weight is unclear due to flaws in the designed research. The overall consensus is that more exercise is better. 

The ideal goal to show your clients is that combining a healthy eating plan and an exercise regimen will bring the best results for their weight loss journey and health in general. 

Behavior Approaches Weight loss.

Some of the following strategies are beneficial to implement with your clients.

Caloric Reduction – Personalized calorie goals will produce 500 – 1,000 calorie deficits daily from baseline through reduced intake and increased physical activity. Some tips used are:

  • Assess the caloric intake to cut around 500 calories. 
  • Practice controlling portion sizes.
  • Reduce calorie-dense foods.
  • Increase the intake of fruits and vegetables.

Physical Activity – Increase the number of moderate-intensity activities. Some tips are:

  • Start with 50 minutes per week of cardio.
  • Increase until you get to 150 minutes per week.
  • For the best results, go all the way to 200 and 300 minutes per week.
  • Perform muscle training a minimum of two times a week.
  • Increase non-exercise activity throughout the day.

Behavioral Strategies – Implement some behavior strategies for adherence to your diet and activity goals. 

  • Practice self-monitoring.
  • Avoid situations with temptation through the control of stimuli. 
  • Spend more of your time around active people.
  • Practice substituting behaviors. 
  • Set SMART goals with specific plans.

ACE 6th Edition Chapter 12: Considerations for Clients with Obesity 2
ACE CPT Chapter 1: Role and scope of practice for the personal trainer 2
ACE 6th Edition Chapter 12: Considerations for Clients with Obesity 3

Tyler Read

Tyler Read, BSc, CPT. Tyler holds a B.S. in Kinesiology from Sonoma State University and is a certified personal trainer (CPT) with NASM (National Academy of sports medicine), and has over 15 years of experience working as a personal trainer. He is a published author of running start, and a frequent contributing author on Healthline and Eat this, not that.

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