Obesity is considered to be a common, pronounced and complex metabolic disorder, a physiological process that can affect the normal functioning of the entire organism. This nutritional disorder is manifested by an excess of adipose tissue or an excessive ratio of adipose tissue to other soft tissues in the organism. It not only seriously affects human health, but also has the trend of global epidemic. A large number of epidemiological studies show that: obesity, especially centripetal obesity with excessive accumulation of abdominal fat, has an important relationship with the occurrence of more than 20 diseases such as insulin resistance, hyperlipidemia, hypertension, cardiovascular diseases, cerebrovascular accidents, diabetes and certain tumors. For the judgment of obesity, at present the more applied is the body mass index method and the body fat % method. Generally, it is believed that adult obesity is more than 20% for men and 30% for women.
Obesity to health hazards increasingly get people’s attention, therefore, for the obesity rehabilitation treatment has been the medical community, rehabilitation community, sports community and other social sectors are facing an urgent problem.
1, the mechanism of obesity
The cause of obesity is fundamentally due to the body’s caloric intake exceeds the body’s caloric consumption, excess heat in the body into a large number of fat storage. The body consumes energy mainly from sugar and fat catabolism energy supply. Obese people rely more on sugar oxidation for energy supply rather than fat, which is likely because obese people have reduced lipid oxidation capacity and excessive fat storage are closely related.
The central mechanism of obesity formation, there is an important “adjustment point hypothesis”. This hypothesis believes that the nerve center (hypothalamus) has a weight “adjustment point”. Under normal circumstances, when weight gain is higher than the “adjustment point”, food intake decreases and the metabolic level of the whole body increases; when weight is lower than the “adjustment point”, energy consumption drops sharply and food intake increases. The mechanism of obesity is quite complex, and its occurrence should be a whole, chain reaction, not a single factor can decide, so in the study of obesity, not only to consider the role of its single factor, but also to consider its overall effect.
2, obesity general need to check the index
Because the cause of obesity may be caused by different factors, so, in order to confirm the diagnosis of obesity is simple obesity or secondary obesity, obese people are suffering from other chronic diseases, in addition to the obese patients’ self-report, but also to carry out some necessary checks.
The main examinations are.
(1) measure height, weight, subcutaneous fat, calculate whether it belongs to obesity and obesity degree. Body composition analyzer can also be used to measure the percentage of body fat to determine the degree of obesity.
(2) Blood pressure measurement to see if the patient has hypertension.
(3) Perform lipid analysis, check indicators such as cholesterol, triglycerides, high-density lipoprotein, etc., to see if there is hyperlipidemia.
(4) Perform electrocardiogram, cardiac function, fundus and microcirculation examination to see if there is coronary artery disease and vascular sclerosis.
(5) Measurement of fasting glucose, glucose tolerance, and serum insulin to see if there is diabetes mellitus.
(6) Perform liver function tests and liver ultrasound to see if there is fatty liver.
(7) Measure urinary 17-ketosteroids and urinary 17-hydroxyderm steroid excretion, if these two indicators are outside the normal range and accompanied by centripetal obesity, hypertension, purple skin, sexual disorders, etc., it is secondary obesity of cortisolism.
(8) Measure estradiol, testosterone, follicular estrogen and luteinizing hormone to determine whether it is secondary obesity of hypogonadism.
(9) Perform cranial radiographs and CT scans. If it shows frontal bone or other intracranial hyperplasia with severe headache, it is secondary obesity with intracranial plate hyperplasia.
(10) Perform basal metabolic rate measurement, check serum protein-bound iodine, thyroid iodine uptake rate, blood triiodothyronine, and blood thyroxine. If the above examination indexes are lower than the normal value and accompanied by pale skin, slow heart rate and high blood lipid, it is secondary obesity of hypothyroidism.
Determine whether it is simple obesity or secondary obesity is very important, it involves whether to carry out according to the general principle or to treat promptly for the cause, because the two solutions are completely different, if all treat according to simple obesity, it will miss the disease. In addition, check obesity at the same time diagnose whether to suffer from other chronic diseases, is also in order to identify evidence treatment. This paper mainly makes a review of the physical therapy rehabilitation treatment of simple obesity.
3.The role of rehabilitation therapy in the treatment of obesity
For the rehabilitation treatment of obesity, the main method is to reduce the body fat reserve, to prevent excessive fat accumulation in the body, causing inconvenience to the human body, may also cause certain diseases. At present, the main weight loss methods are, drug weight loss, Chinese medicine acupuncture weight loss, diet weight loss and exercise weight loss. The damage of drugs to the human body is incalculable, acupuncture weight loss has certain effect, but it is easy to rebound, and the mechanism of action is not clear. Dietary weight loss tends to make people’s basal metabolic rate drop, and improper weight loss can easily cause malnutrition or cause some diseases. Exercise weight loss is from the perspective of energy consumption to lose weight, there is no negative effect, and, exercise weight loss can also improve the basal metabolic rate, enhance the human body, the main reduction is the fat content, but also to increase lean body mass, but to be persistent. At present, experts most respected weight loss method is: diet control plus aerobic exercise. Since it is aerobic exercise, there should be personalized exercise prescription to guide their weight loss process in order to minimize the damage.
4. obesity physical therapy rehabilitation exercise prescription development
(1) the development of obesity exercise prescription
① Exercise mode: choose rhythmic aerobic exercise with the participation of large muscle groups, such as walking, jogging, aerobics, bicycling and swimming, etc., which can help maintain energy balance, keep the weight of obese people from rebounding for a long time and improve cardiopulmonary function. Among them, bicycle and swimming is particularly suitable for obese people to lose weight.
② Exercise intensity: Research has proved that medium and low intensity long time exercise consumes more calories, therefore, exercise intensity is generally 60% to 85% of the maximum heart rate, or VO2max35% to 70%, or 3 to 6 Meters (METs).
③ Exercise time: each target intensity exercise time should last 40～60min. adjust the amount of exercise according to different age and physique with exercise intensity, middle-aged and old people, obese people with poor physique can carry out exercise items with lower intensity and relatively longer duration; young obese people with good physique can carry out exercise with greater intensity and relatively shorter duration. Because the body exists biorhythmic cycle, to participate in the same exercise, afternoon and evening than the morning more energy consumption of 20%, therefore, exercise and weight loss activities are easy to arrange in the afternoon or evening.
④ Exercise frequency: 5 to 7 times a week is more ideal. If obese people are allowed, aerobic exercise can also be done once a day in the morning and once in the evening to increase the consumption of calories and improve weight loss.
⑤ a sports exercise arrangements: each sports exercise content into the preparation, basic and end three parts. In general, the preparation part takes 5 to 10 minutes, the basic part takes more than 20 minutes, and the end part depends on the situation, probably also 5 to 10 minutes.
Exercise for weight loss is a long-term process that needs to be purposeful and planned. In the specific design of exercise prescription should refer to the daily energy consumption of daily life activities of obese people, 10% of their total amount as daily exercise, and then converted into specific exercise types and time, and then adjusted according to the efficacy and response after implementation.
(2) Recommendation: In the process of implementing the exercise weight loss program, attention should be paid to diet adjustment, and excessive caloric intake should be minimized on the basis of meeting the nutritional needs of the body.
Exercise for weight loss is based on aerobic exercise, but should also be combined with resistance strength exercises, i.e., to increase lean body mass on the basis of increased energy expenditure. Physical exercise should be adhered to for a long time in order to maintain the weight loss effect.
(3) Precautions: before the implementation of weight loss exercise prescription, obese people should be allowed to carry out general routine examination to understand the cardiac function and the presence of cardiovascular system syndrome; exercise intensity can be gradually reached within a few days, and it is best not to reach the established exercise intensity at the beginning of exercise; in the process of exercise prescription implementation, if there is an unexpected situation, exercise should be stopped immediately and go to the hospital.
In summary, the study of obesity mechanism in the medical community has been to the genetic level, but exactly which factors play the most important role, it is not yet possible to accurately conclude. To the treatment of obesity, research methods and kinds of many, at present think, as long as the scientific exercise and reasonable diet control combination, perseverance, will be able to achieve the effect of strong body, go to fat and reduce weight.