REHABILITATION OF OBESITY Michael yehud,1354

Victoria Chihai
WHAT IS REHABILITATION
The process of helping a person to reach the fullest physical, psychological, social,
vocational, avocational and educational potential consistent with his or her
physiologic or anatomic impairment, environmental limitations and desires and life
plans

What is Rehabilitation Medicine?

Branch of medical science concerned with the comprehensive evaluation and
management of patients with impairment and disability arising from neuromuscular,
musculoskeletal, cardiovascular and pulmonary disorders; also concerned with the
medical, social, vocational and psychological aspects arising from them
MEDICAL REHABILITATION TEAM
Composed mainly of:

Physiatrist
Physical Therapist
Occupational Therapist
Rehabilitation Nurse
sychologist
Speech and language therapist
Orthotist/prosthetist
Social worker
Patient
 FAMILIES
HIERARCHY OF PREVENTION OF OBESITY
Eat meals as a family in a fixed place and time.
Do not skip meals, especially breakfast.
No television during meals.
Use small plates, and keep serving dishes away from the table.
Avoid unnecessary sweet or fatty foods and soft drinks.
Remove televisions from children's bedrooms; restrict times for television viewing and video games.
COMMUNITIES
Increase family-friendly exercise and play facilities for children of all ages.
Discourage the use of elevators and moving walkways.
Provide information on how to shop and prepare healthier versions of culture-specific foods.
HEALTH CARE PROVIDERS
Explain the biologic and genetic contributions to obesity.
Give age-appropriate expectations for body weight in children.
Work toward classifying obesity as a disease to promote recognition, reimbursement for care, and willingness and ability to provide treatment.
INDUSTRY
Mandate age-appropriate nutrition labeling for products aimed at children (e.g., red light/green light foods, with portion sizes).
Encourage marketing of interactive video games in which children must exercise in order to play.
Use celebrity advertising directed at children for healthful foods to promote breakfast and regular meals.
GOVERNMENT AND REGULATORY AGENCIES
Classify obesity as a legitimate disease.
Find novel ways to fund healthy lifestyle programs,
Subsidize government-sponsored programs to promote the consumption of fresh fruits and vegetables.
Provide financial incentives to schools & educate that initiate innovative physical activity and nutrition programs.
Allow tax deductions for the cost of weight loss and exercise programs.
Provide urban planners with funding to establish bicycle, jogging, and walking paths.
Ban advertising of fast foods directed at preschool children, and restrict advertising to school-aged children.
WHY REHABILITATE?
Resolve the clinical symptoms
Return to activity
General fitness
From rehabilitation to prehabilitation
Decreases the chance of injury
HOW IS OBESITY TREATED:

1.Nutrition and Dieting

2.Physical Activity
3.Cognitive Behavioural Therapy
4.Psychological Support
Physicians should recognise where psychological or psychiatric issues interfere with successful
obesity management, e.g. depression. Psychological support and/or treatment will then form
an integral part of management; in special cases (anxiety, depression and stress), referral to a
specialist may be indicated. Self-help lay groups and the support of the obesity treatment
group may all be useful in this setting
5.Pharmacological Treatment
6.Bariatric and Metabolic Surgery
DIETARY THERAPY

Encourage low-calorie diets for overweight and obese adults.

As part of a low-calorie diet, fat reduction is a practical way to reduce

calories.

Reducing dietary fat alone without reducing total calories is not

sufficient for weight loss.

Reducing dietary fat along with dietary carbohydrates facilitates caloric

reduction.

An individually planned diet creating a deficit of 500 to 1,000 kcal per

day should be an integral part of any program aimed at achieving a
weight loss of 1 to 2 lb per week.
 PHYSICAL ACTIVITY

Exercise contributes modestly to weight loss in overweight and obese adults.

Physical activity may decrease abdominal fat.

Physical activity increases cardiorespiratory fitness.

Physical activity may help maintain weight loss.

Physical activity should be an integral part of weight loss therapy and weight maintenance.

Initially, encourage moderate levels of activity for 30 to 40 minutes per day, three to five days per week.

Set a long-term goal to accumulate at least 30 minutes or more of moderate-intensity physical activity on
most, preferably all, days of the week.
EXERCISE PRESCRIPTION:
Frequency and Duration Frequency
 –Optimal: 3 to 5 days per week
 –Start gradually, avoid burnout/fatigue
 –Less important than intensity or duration

Duration
 –Optimal: 20 to 30 min per day
 –One long bout or multiple shorter bouts
 –Inverse relationship between duration and intensity
 EXERCISE AND REHABILITATION FOR PEOPLE
WITH COMORBIDITIES
Exercise a major component of rehabilitation Used in rehabilitation programs for
–Cardiopulmonary disease
–Cancer
–Obesity
– diabetes
–Renal disease
–Osteoporosis
–Arthritis,
– chronic fatigue
– fibromyalgia
–Cystic fibrosis
 BEHAVIOR THERAPY
Behavior therapy is a useful adjunct to diet and physical activity.

Assess patient motivation and readiness to implement the weight

management plan and take steps to motivate patient for treatment.

Behavior strategies to promote diet and exercise should be used

routinely, as they are helpful in achieving weight loss and
 PHARMACOTHERAPY
Lifestyle therapy should be considered before drug therapy.

Weight loss drugs approved by the FDA may be used as part of a comprehensive weight loss program for patients with
2
a BMI ≥30 kg per m with no accompanying obesity-related risk factors or diseases, and for patients with a BMI ≥27 kg
2
per m accompanying obesity-related risk factors or diseases.

Avoid use of drugs without accompanying lifestyle modification.

Assess drug efficacy and safety continually.

Discontinue use if the drug is ineffective in weight loss or weight maintenance, or if there are serious adverse effects.

Pharmacotherapy cannot be expected to continue to be effective in weight loss or weight management after cessation
of drug therapy.
SURGERY
Weight loss surgery is an option in
carefully selected patients with
clinically severe obesity (i.e.,
persons with a BMI ≥40 kg per
2
m or with a BMI ≥35 kg per
2
m with comorbid conditions)
when less invasive methods have
failed and the patient is at high
risk for obesity-related morbidity
and mortality.
REFERENCES

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4122663/
https://pdfs.semanticscholar.org/96a8/da5d82e160a112084a4b92eea33368bf006
c.pdf
https://www.gov.uk/government/publications/adult-obesity-applying-all-our-
health/adult-obesity-applying-all-our-health
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644856/>
<https://www.mayoclinic.org/diseases-conditions/childhood-obesity/diagnosis-
treatment/drc-20354833>
https://slideplayer.com/slide/7402887/>
https://www.nhlbi.nih.gov/guidelines/obesity/ob_home.htm