ACE 6th Edition Chapter 12: Considerations for Clients with Obesity
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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 the dietary strategies for weight loss and weight maintenance.
    • Be able to talk about the role of physical activity and exercise in the prevention and treatment of overweight and obesity. 

    Introduction

    Many times, we have obesity and overweight being described simply as the result of imbalances between the consumption of calories, and the calories that are expended. 

    Obesity used to be primarily present in high-income countries, but now it is in all countries. 

    There are many factors that can cause obesity today, and it is important for trainers and other people to know these causes and the ways in which 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 the 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 the foods that are high calorie.

    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 amount of people dealing with obesity. It is thought to have a lot to do with the rise in obesity levels for the US.

    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 to obesity, and once the hormones are dwindling, they are hard to recover. 

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    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, it is possible that they develop obstructive sleep apnea, and this is likely to affect the quantity and quality of sleep achieved later. 

    Energy balance

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

    The ADA recommends that people reduce their intake of fat and carbs in order for them to obtain a caloric deficit of 500 – 1,000 calories every day and produce wight loss of around 1 – 2 pounds each week. But, in reality, not all weight loss is going to 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, and to do this we should at least meet the protein requirements of 45 – 56 grams per day, or a 10 – 35% of 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 they will be unable to walk as far. 

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

    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 its 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 one 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 for us to maximize the energy expenditure by not going too hard and burning out quicker, but to still work harder than the light levels of activity. The talk test is utilized again to see the level at which someone is working. 

    The time for exercise is going to be a goal of 30 – 60 minutes each day, and this can be done in one session per day, or in shorter bouts throughout the day. 

    The type of exercise done is going to be the lower impact varieties of exercise and the rhythmic kinds that are using our larger muscle groups. 

    Muscular Training

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

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

    We are going to use the FITT principles again to look into what is needed for muscular training.

    Frequency is going to be doing muscular training for 2 – 3 days per week with a rest day in between each session. 

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

    For the time, this will depend entirely on the amount 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 is going to be those that use all major muscle groups using the free weights and machines. 

    Exercise and Weight Management

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

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

    It is generally accepted that people are able to lose weight, but most are not able to 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 designed research. The overall consensus is that more exercise is better. 

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

    Behavior Approaches to Weight loss

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

    Caloric Reduction – Personalized calorie goals will be producing a 500 – 1,000 calorie deficits daily from baseline through reductions in intake and increases in 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 people that are active.
    • 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

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