obesity is due to a combination of genetic, environmental, and behavioral factors that results in an energy imbalance to promote excessive fat storage.1 Obesity can be defined by a client's body weight, body fat percentages, and body mass index (BMI). The World Health Organization uses a BMI of >30 as the cutoff for class 1 obesity, with levels of >35 for class 2 and >40 for class 3.2 Waist circumference can be used with BMI to assess health risks related to obesity. Circumferences of ≥88 cm for women and ≥102 cm for men indicate greater risk for disease. Sedentary lifestyle is a significant risk factor for obesity and the primary cause of endurance impairments for individuals with obesity.3 Clients need regular examinations to assess blood pressure, blood glucose, and lipid levels. Clients benefit from interdisciplinary management that may include pharmacologic agents, nutritional counseling, and behavioral therapy.1
Comorbidities to Consider
Obesity Is an Increased Risk for:
|Type 2 diabetes ||Hirsutism |
|Heart disease ||Depression |
|Stroke ||Stress incontinence |
|Osteoarthritis ||Pregnancy complications |
|Asthma ||Surgical complications |
|Cancer ||Incontinence |
|Gallbladder disease ||Sleep apnea |
Keys to Examination of Clients
Take considerable time to talk with your clients with obesity to understand their previous experiences and beliefs about exercise before developing a plan. These individuals should be counseled on the benefits of an exercise program and must be allowed to help design their exercise program.
A medical history will help identify conditions that may limit their exercise tolerance.
Exercise activities may exacerbate existing degenerative conditions, cause chafing and skin disorders, and may make an individual susceptible to falling and heat intolerance.
Assess client's body composition, BMI, and waist circumference before the client begins an exercise program.
Recommended Baseline Testing of Fitness Levels
Based on the client's current functional status, determine a method for assessing the individual's exercise tolerance. The most common methods for clients with obesity are the half-mile walk, 6-minute walk, or the 10-meter walk.4,5
The client's heart rate, blood pressure, and perceived exertion levels should be regularly assessed at the outset of the exercise program.
Type: Walking, aquatic exercise, weight training
Intensity: Low to moderate intensities, 40%–70% of maximum
Duration: Up to 60 minutes
Frequency: Five to seven times per week.
Group exercise can be recommended for those clients with similar weight-loss challenges. Clients with morbid obesity may best start an exercise program using aquatic activities.3...