Contents

1. Obesity in Kuwait
2. Orthopaedics problems and over weight
3. Causes of obesity
4. Body mass index {BMI}
5. Waist hip ratio
6. Basal metabolic rate in relation with weight loss
7. Body composition analysis
8. Factor affecting BMR
9. Weight loss training
10. Cardiorespiratory training
11. Weight training
12. Flexiblity training
13. Weight loss Diet
 ?

Overweight and obesity are defined as abnormal or

excessive fat accumulation that may impair health.

Body mass index (BMI) is a simple index of weight-for-

height that is commonly used to classify overweight
and obesity. It is defined as a person's weight in
kilograms divided by the square of his height in meters
(kg/m2).
Obesity Rate In Kuwait Hits 80 % Surgeons Discuss
Latest Scientific Information

KUWAIT CITY, Dec 21: The rate of obesity in Kuwait has

reached 80 %, Al-Qabas daily quoted Consultant of General
Surgery at Mubarak Al-Kabeer Hospital and Associate
Professor at the Department of Surgery, Faculty of Medicine,
Kuwait University Dr Mosa’a Khurshid as saying.
Khurshid was speaking at the 9th Kuwait Annual Conference
of Surgeons which was held during Dec 18-20 at the Crystal
Hall in Sheraton Hotel.

ARAB TIMES
21-12-2011
 Orthopaedic conditions and Obesity
Introduction
Most of obese patients age group of 30-45 yrs old suffer from joint
or musculoskeletal discomfort due to mechanical strains.

Many aspects of the relationship between orthopedic conditions and

obesity have a high level of evidence based support.

Understanding the interaction between weight,weight loss and

arthritis, especially osteoarthritis, may prove crucial to the optimal
management and prevention of some very common orthopaedic
conditions
Treating the cause is important than treating complications
 Obesity and Osteoarthritis
The association between obesity and osteoarthritis is
strongest for the knee joint in Women 12-15 % due
mechanical strain.

The proportion of osteoarthritis attributable to obesity in

middle aged women is estimated to be 63% and in male
37%

Twin studies confirm ‘s that the risk of knee osteoarthritis

increases by 35% for every 5-kg of weight gain
Dr.Mirtz andGreene conducted a review of recent evidence
regarding the relationship between overweight/obesity and LBP .
Results suggest that

Individuals with BMI <30 are at minimal risk of

developing LBP.

BMI between 30 and 40 are at moderate risk.

patients with BMI >40 are at high risk .

Attention to overall weight loss is important as every pound adds

strain to the muscles and ligaments in the back. In order to
compensate for extra weight, the spine can become tilted and
stressed unevenly.
What causes obesity and overweight?

The fundamental cause is an energy imbalance between calories

consumed and calories expended.
Globally, there has been:
-increased intake of energy-dense foods that are high in fat, salt
and sugars but low in vitamins, minerals and other micronutrients.

Decrease in physical activity due to the increasingly sedentary

nature of many forms of work, changing modes of transportation,
and increasing urbanization.

Changes in dietary and physical activity patterns are often the

result of environmental and social changes .
Creeping Obesity

Physical activity
decreases and
leads to a
decrease
In metabolic rate.

If energy
expenditure
drops more than
energy intake,
weight gain will
occur.

Concepts of Physical Fitness 14e 11

 BODY MASS INDEX

BMI equals a person's weight (mass) in kilograms divided by

the square of the person's height in metres.

BMI= MASS (KG)

HEIGHT(meter)*2 BMI Classification
< 18.5 underweight
E.g: If a person weight is 75 kg and 18.5–24.9 normal weight
height 165 cm 25.0–29.9 overweight
30.0–34.9 class I obesity
BMI= 75 = 75 = 22.72
35.0–39.9 class II obesity
1.65*2 3.3
≥ 40.0 class III obesity
 WAIST HIP RATIO
Waist/Hip Ratio Indicates relative amounts of visceral fat vs.
subcutaneous fat

Waist/hip ratio - divide the waist circumference by the hip

circumference

acceptable unacceptable
excellent good average high extreme
male < 0.85 0.85 - 0.90 0.90 - 0.95 0.95 - 1.00 > 1.00
female < 0.75 0.75 - 0.80 0.80 - 0.85 0.85 - 0.90 > 0.90
 How to measure W.H RATIO ?

WAIST MEASUREMENT
Measurements should be taken midway
between the inferior margin of the last rib
and the crest of the ilium in a horizontal
plane.

HIP MEASUREMENT
widest part of the trochanters (buttocks).
Apple-shaped fat individuals are exposed to a
greater risk of developing obesity-related
diseases, as the fat is intra-abdominal and
distributed around their stomach and chest.

Cardiovascular diseases and hypertension

Type 2 diabetes
Respiratory diseases (sleep apnea syndrome)
O A,LBP

The pear-shaped overweight persons are at

greater risk of mechanical problems, as most of
their body fat is distributed around their hips,
thighs and bottom.
Low back strain
B/L O.A.KNEES
 Abnormality in body shape in Recent decades
IN recent decades the apple pattern fat distribution are common in
women it may due to hormonal imbalances.

IN Men
Latest studies show that men's tendency towards the pear format
has increased in the past 30 years . According to researches as
Dr.John R. Lee, M.D (specialist in natural progesterone therapy)

According to Dr. Jesse Hanley and Dr. Peter , it seems that modern
life exposes people to increased amounts intake of estrogen and
estrogen-like substances . Sources of these substances can be
plastics, plastic drinking bottles, commercially raised beef, chicken
and meat, personal care products, pesticides, herbicides, birth
control pills, spermacide, detergent, canned foods and liquors. The
problem is that increased estrogen levels in men
 Basal Metabolic Rate

BMR is the amount of daily energy expended by humans at

REST
Factors affecting the BMR
•Age - metabolism slows with age
•Growth - infants and children have higher energy demand
•Gender - generally, men have faster metabolisms than women
•Genetic predisposition - Metabolic rate may be partly decided by
genes.
•Amount of lean muscle tissue - More lean body mass leads to high
BMR
•Hormonal and nervous controls - hormonal imbalance(eg: thyroid)
can influence how quickly or slowly the body burns calories.
•Crash dieting, starving or fasting - eating too few kilojoules
encourages the body to slow the metabolism to conserve energy;
BMR can drop by up to 15 per cent. There is also loss of lean muscle
tissue, which further contributes to the drop in BMR
•Drugs - like caffeine or nicotine, can increase the BMR for short
time.
The most commonly used one is the Mifflin - St Jeor
equation:

BMR = 10 * weight(kg) + 6.25 * height(cm) - 5 * age(y) +

5 (man)

BMR = 10 * weight(kg) + 6.25 * height(cm) - 5 * age(y) -

161 (woman)

An average male may have a BMR of around 2000 kcal

per day,
while an average female may have a BMR of around 1500
kcal per day.
This flow chart help us to find Estimated calorie requirements for men
This flow chart help us to find Estimated calorie requirements for Women
 WHY PEOPLE PUT ON WEIGHT IN 30 - 40YRS

Average decreases of BMR 2.9 and 2.0 percent per decade,

respectively, for men and women of normal weight (BMI of 18.5
to 25.0 ) were calculated more recently (Roberts and Dalall, 2011;
Food and Nutrition Board/Institute of Medicine, 2011).

The decreases were 3.1 and 1.9 % per decade among overweight
men and women, respectively (Roberts and Dalall, 2011).
Increasing Metabolic Rate will help you to reduce weight

HOW TO INCREASE THE BMR OR METABOLIC RATE ?

1.Increasing the physical activity

2.Increasing softlean mass by weight training
3.Some drugs are available in markets to increase the
BMR(phentermine (an amphetamine) had side effects
4.Green tea improve BMR
5. Happy and active life will raise the BMR
6.Keep your Thyroid hormone in balance
7. Researchers in Germany report that cold water
consumption increases the rate at which people burn
calories.
8. Eat small, frequent meals. Will increase BMR
 COMPOSITION OF BODY
The body is composed of water, protein, minerals, and fat.

WATER

MINERALS

FAT PROTEIN
 TOTAL
BODY
WEIGHT

Fat free
Fat mass
mass

LEAN BODY
MASS

MINERALS
SOFT LEAN
MASS

TOTAL BODY
WATER PROTEIN
Body composition analysis
There are many methods are avaliable to find
the body composition. Common methods used nowadays are
Bioelectrical Impedance Analysis{BIA} method.

In this method

A mild undectable current is sent through electrodes

through the body.
The current passes through the body through the fat freemass
which contains Water 73%.
Through the bio electric feed back ,amount of fat free mass is
estimated.
Then calculate fat mass and % of body fat
Fat mass=body weight –fat free mass
BODY COMPOSITION ANALYZER {BIA}
 FOOD ENERGY
INTAKE EXPENDITURE

WEIGHT LOSS:
FOOD INTAKE ENERGY EXPENDITURE

FOOD INTAKE ENERGY EXPENDITURE

FOOD INTAKE ENERGY EXPENDITURE

WEIGHT LOSS
weight loss should be concentrated on reduction of
body fat and improve the muscle mass(soft lean
mass)which improves the Resting Metabolic Rate
(RMR)and prevent weight gain for longtime.

•Each pound of fat our body stores represents 3,500

calories of unused energy.
•In order to lose 1 pound, you have to create a calorie
deficit of 3,500 calories by either taking in 3,500 less
calories over a period of time than you need or doing 3,500
calories worth of exercise.
•It is recommended that no more than 2 pounds (7,000
calories) be lost per week for lasting weight loss.
This is a control guide for weight loss
 IMPORTANCE OF DIET IN WEIGHT REDUCTION
A balanced diet should be part of any weight control plan. A diet
high in complex carbohydrates and moderate in protein and fat
will complement to an exercise program.

vegetables & fruits (4 servings),

Bread & cereals (4 servings),
milk & milk products (2 - 4 depending on age)
Meat & fish (2).
Experts recommend that daily intake should not fall < 1200
calories unless you are under a doctor's supervision. weekly
weight loss should not exceed 2 pounds.
 EXERCISES TO REDUCE WEIGHT.

Before going to start exercise program patient should consult the

physician For general medical fitness consultation

Exercise programme should designed individually for every person’s

physical Condition By physiotherapist

The pts with orthopaedic problems should advised Low impact

training to avoid further joint injury

Weight training for beginners should start with the cable workouts .It
prevent injuries of joints.
Most of the patients are comfortable with cable workout s
Circuit weight training can be done with four or five workouts for
one set
 Procedures to start exercises
1.Pre Warm up
Just walk or do any aerobic active exercises at
minimal speed, It s to prepare the body for exercises.
2.Pre stretch
active self stretching of all joints and muscle .Its to
lengthen the muscles for sternous physical activity. Also
prevents soft tissue injuries
3.Warm up
This is more faster than pre warm up.( Any cardio
respiratory exercise up 10 to 15 mins at moderate intensity).
This is to raise the body Temperature ,which raise the metabolic
rate and cause maximum energy expense.
4. Cardiorespiratory or weight training
5. post stretching.
to prevent muscular pain and relaxiation of muscles
Stretching promote flexiblity and prevent soft tissue injuries
Stretching should be done before and after the exercise
4.Cardiorespiratory training

Timing and intensity depends on individual.It consist of 3

phases.Total time of cardio training is divided in to
1.Warm up phase
2.sternous training phase
3.cool down phase.

For weight loss– Cardio training should be done 60-90 minutes

Cardio respiratory workouts. Machine/active
1. walking, jogging,running.
2.swimming.
3.cycling
4.recumbent bike
5.elliptical trainers
6.arc trainers
Cardiorespiratory workouts are increase the calorie expense
leads to Weight loss
 How to prescripe cardio training ?
Cardio Exercise Prescription (35years old)

Intensity of Exercise
1. Estimate your own maximal heart rate (MHR)
MHR= 220 minus age (220 – age)
MHR= 220 - 35 = 185 bpm

2. Resting Heart Rate (RHR) = 72 bpm

3. Heart Rate Reserve (HRR) = MHR – RHR

HRR =185- 72 = 113 beats

4. Training Intensities (TI) = HRR x TI + RHR

60% TI = 113x .60 + 72 = 139 bpm

70% TI = 113 x .70 + 72 = 151 bpm
85% TI = 113 X .85 + 72 = 168 bpm
 Weight loss Cardiorespiratory training
Slower, intensity 60% training intensity is good for weight
reduction.

The body primarily uses fat and carbs for fuel.

The ratio of these fuels will shift depending on the activity.

For higher intensity exercise, such as fast-paced running, the
body will rely more on carbs for fuel than fat. That's because the
metabolic pathways available to break down carbs for energy are
more efficient than the pathways available for fat breakdown.
For long, slower exercise, fat is used more for energy than carbs.
Weight training for weight loss is important because the muscle mass reduced
Gradually by age it leads to decreased BMR causing weight gain
 WEIGHT LOSS TRAINING
by
Weight training
Weight training can used two ways for weight reduction
1.Increase the BMR -By Increasing the mass of the muscle
2.To spend energy - equal to cardiorespiratory training

1.To Increase the BMR—(STRENGTH TRAINING)

To decrease the weight of the body we have to raise the
BMR.
BMR is depends amount of SOFT LEAN MASS(MUSCLE)
To increase the BMR we have to increase the size(mass)
of the muscle.
For that maximal resistance minimal repitation training
used.
It will give long time result by raising BMR
 STRENGTH TRAINING
Frequency
Muscles usually need between 48-72 hours to complete .

Two or three strength training sessions a week provide excellent

results.

Repetitions

The standard strength training protocol for repetitions is 8 to 12

repetitions with 75 percent of your maximum resistance. And 3 to 5
sets.

A sound strength training program should include exercises for all

major muscle groups.

Do your best to exercise larger muscle groups first, followed by

medium and smaller muscle groups.
2.TO SPEND ENERGY- CIRCUIT TRAING or ENDURANCE
TRAINING

Circuit weight training is a form of resistance training which is

designed to be easy to follow and target strength building as
well as muscular endurance and more calorie burn in short
time.

An exercise "circuit" is one completion of all prescribed

exercises in the program. When one circuit is complete, one
begins the first exercise again for another circuit. Traditionally,
the time between exercises in circuit training is short, often with
rapid movement to the next exercise.
This type of training low or medium 45 to 65% of 1RM.

This will increase the endurance and help to burn more calorie
s as like cardio respiratory trainings
 Dieting
Diet for weight loss is the part of the dietician but understanding the
diet part in weight loss is very important.

In general
• Low caloric diet such as fruits and vegitables should be encouraged.
• Avoid fatty food like meat an fried foods should be avoided.
• Amount of food taken should be reduced.
• Junk foods should be avoided.
EATING HABITS SHOULD BE CHANGED
1. Avoid watching TV or using mobile while eating food. If we take food
without concentration, our brain can’t sense the amount of food taken
inside so we overload the stomach.
2.how to reduce the amount of food intake ?
* sit in dining table with food.
* chew the food well and concentrate and enjoy the aroma from
food.
 2.how to reduce the amount of food intake ?continued...
• Take small plate than regular one you used.
• Take one half of quantity of food as like ur regular food.
• It will looks like as like ur regular food amount
• Fill the plates with foods made of low calorie value food
• Take atleast 20 – 30 min to eat
3.EAT only three times per day and avoid coffee with milk and sugar.
4.Dont skip or reduce breakfast, it leads to excessive intake at lunch
5.Eat less for dinner

95% OF DIET PLAN FOR REDUCING WEIGHT ARE ENDING IN FAILURE

AND IT LEADS TO EXCESSIVE INTAKE OF FOOD AND FURTHER WEIGHT
GAIN THAN BEFORE . BUT CHANGING THE EATING PATTERN IS THE
ONLY SOLUTION FOR CONSISTANT WEIGHT LOSS AND MAINTAINING
THE IDEAL WEIGHT
Conclusion

FOR WEIGHT LOSS

We have to prescribe proper cardioresiratory training with training
intensity of 60% up to 60 to 90 minutes. Weekly three to four session .

weight training programme is must and it should be done at 75-85% of 1RM.and

3-5 sets. Weekly two or three sessions of weight training should be given

WEIGHT LOSS DIET

- diet plays a important role in weight loss its about 50 %
So dietician consultaion is very much important in weight loss.
Changing the eating habits are more important for prolong
success.
There are some successful diet plans are avaliable for over
weight persons without medical complications.
E.g. General motors diet plan