Friday, March 30, 2018

April 2018 #obsm chat: Viewing Physical Activity Through the Lens of Obesity


Guest blog post written by Dr. David Creel


Imagine a pharmaceutical commercial touting that a drug improves mood, makes sleep more restful, helps our memory and concentration, decreases our potential of developing dementia, lowers our risk of colon and breast cancer, and makes our bones stronger. But there’s more--the health benefits of this product can also treat or help prevent the negative consequences of obesity. It improves insulin sensitivity, can normalize blood pressure, and prevents cardiovascular disease. And just when you were waiting to hear a long list of potential side effects spoken at the speed of an auctioneer’s voice, the commercial ends. Of course, I’m not referring to a drug, I’m talking about physical activity. Like some medications, exercise prevents disease, heals ailments, and gives us the best chance of living a long, energetic life. It’s an inexpensive endeavor with few side effects to speak of.
 
Despite these benefits, only 20 percent of American adults get the recommended 150 minutes per week of moderate to vigorous physical activity. Unfortunately, those with obesity are even less likely to exercise regularly. In our upcoming #obsm chat, we will discuss the role of physical activity in health and weight loss.

What does exercise mean to those with excess weight?

How many times have we heard it, or said it-- “To lose weight you’ve got to change the way you eat… and begin exercising.” For those with obesity, healthy eating and exercise are sometimes closely linked together. Go on a diet and start exercising, break the diet and stop. It’s a unique coupling of behaviors that has not been studied extensively. Think about it--we rarely hear someone say they blew their diet and stopped brushing their teeth or wearing their seatbelt. I would argue that professionals have put too many eggs in one basket when it comes to exercise. We’ve failed to promote exercise for all of the general health reasons noted above and instead hyper-promote it for weight loss.

Does exercise help with weight loss?

From a calorie perspective, exercise often pales in comparison to dietary changes. Many studies have shown that in the short-run exercise contributes little to weight loss. However, data from many longer-term studies show that 250 minutes per week or more of physical activity predicts who will maintain weight lost through traditional approaches. We know much less about the impact of exercise on weight loss after bariatric surgery.

Exercise challenges for those with obesity

When people feel like they must exercise to lose weight, it is easy to focus on intensity and burning calories rather the enjoyment of the activity and how much better we feel when we do it. This obviously makes exercise less appealing. As the severity of obesity increases, poor cardiorespiratory fitness, orthopedic issues, and ill-fitting exercise equipment further limit the variety of exercises people can perform. In fact, activities of daily living can be quite strenuous. According to a recent study we conducted, a majority of bariatric surgery candidates would be unable to push mow a small yard. Among those with a BMI of 50 or higher, two-thirds would find vacuuming to be at least moderately difficult.

How can we help people exercise more?

Some believe that weight loss leads to exercise. However, research doesn’t fully support this. Even after bariatric surgery, physical activity only increases modestly, on average. One study showed that 25% of patients were less active one year after bariatric surgery than before. So, if weight loss won’t do it, how can we promote more activity? Studies examining motivational factors for exercise suggest that people maintain an exercise regimen for at least one of the following two reasons:

1)      They like it. Therefore, it makes sense to help people find activities they enjoy and can fit into their lifestyle.

2)      They do it for the benefit. These are the people who view exercise as a medication.

Most people don’t enjoy the act of taking meds, but many do it anyway. If we can help people with exercise adherence in similar ways as we do with medication adherence (buying into its importance, scheduling, etc.) we may be on to something.

No matter our weight, many things compete for our time. Those with obesity have additional layers of physical and sometimes psychological obstacles to regular physical activity. In the upcoming Twitter chat (April 8, 2018 at 9 pm EST) we will discuss the following questions:

  1. What type of exercise-related education/resources help people with obesity?
  2. What are common mistakes healthcare professionals make when promoting exercise among those with obesity?
  3. For patients, does it help when your provider “practices what they preach?” For professionals, do you think you’re a better exercise counselor if you are committed to physical activity?
  4. High Intensity Interval Training has become quite popular. What are the pros/cons of undertaking this type of exercise for those with excess weight?
  5. How do you motivate patients/clients -- or what motivates you -- to move more? Any success stories?