Introduction
Obesity is now being recognized by the world obesity federation as chronic relapsing, and progressive disease. The emphasis on the need for immediate intervention to prevent and manage this global epidemic has been widely recognized across the literature. The recognition of obesity as a disease encourages practitioners to research and review approaches with the most effective strategies. Thus, highlighting the urgent need to appeal to the public and government to allocate such resources, awareness, education, policies, and research to battle this 21st epidemic worldwide. Ultimately, with the expectation of providing better understanding, prevention, and treatment (Upadhyay et al., 2018).
c ( BMI= weight (kg)Height (M²), this is further divided into a number of categories demonstrated in figure 1.
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Category BMI range
Under weight 40
(Fig.1., Body mass Index categories. Morbid obesity BMI chart: Am I morbidly obese? Jet Medical Tourism®)
Obesity has exceptionally grown in prevalence worldwide over the past 30 years with rates doubling in adults and childhood (6-11 years old) obesity and rates tripling in adolescent (12-19 years old) obesity Upadhyay et al., 2018). it was estimated in 2015, that 107.7 million children and 603.7 million adults were defined as obese worldwide (Health Effects of Overweight and Obesity in 195 Countries over 25 Years, 2017). In addition, obesity is related to more than 30 medical conditions and accompanied by its high prevalence, the disease has a significant impact on morbidity, mortality, and expense of health care. BMI both directly and in directly contributes to the cost of health care, much of the cost attributable to treating type 2 diabetes and cardiovascular disease. The financial impact of obesity range as high as 209.7 billion in the United States and account for approximately 20% of annual health care spending (Spieker and Pyzocha, 2016). Similarly, In the United Kingdom, NHS and drug costs for treating obesity and its related morbidities account for approximately £6.6-7.4 billion annually. Agha, M. and Agha, R., 2017. The rising prevalence of obesity: part A: impact on public health. International journal of surgery. Oncology, 2(7), p.e17. Financial experts suppose effective weight loss could net savings of more than $610 billion in 20 years and the implementation of food taxes such as the sugar tax currently active in the UK would generate savings exceeding $17 billion (Spieker and Pyzocha, 2016). The UK sugar tax, in which all imported soft drinks with added sugar, are further taxed with a flat rate of 18p per liter for drinks containing 5-8 g of sugar per 100ml, and 24p per liter for drinks containing more than 8g of sugar per 100m. interventions such as these allow for the allocation of financial support into areas that prevent obesity such as awareness, education, and physical activity interventions, this was demonstrated as funding doubled to £320 million a year from 2017 for the primary physical education and sport premium - the Department for Education contributing £100 million and the Department of Health and Social Care contributing £60 million per year to the premium, with the Soft Drinks Levy funding contributing £415 million over the remainder of the current expenditure review period. Soft Drinks Industry Levy comes into effect - GOV.UK (www.gov.uk). Supporting the consensus that physical activity is an appropriate and effective approach to preventing and treating obesity and its associated morbidities. The following review will evaluate current research and literature, concerning physical activity and obesity; by describing, analyzing, and interpreting the quality of current studies; providing insight into the potential impact and recommendations for future investigations.
Obesity
How is obesity caused and what modern factors contribute?
Obesity occurs when an individual's energy expenditure in less than their energy intake from food consumption. WHO recognizes physical activity as a key determinant of energy expenditure; therefore fundamental to energy balance and weight management EB Document Format (who. int). Whilst the cause of obesity is energy expenditure there are numerous environmental factors; this is particularly apparent as there are large and well-recognized environmental differences across countries, which are likely to be moderators of the effects of globalization on obesity prevalence. Modern factors include socio-cultural ( e.g., cuisines, body size perception, and cultural traits), policy (e.g., political and governing systems), physical (e.g., built environment), and or economic (e.g., national wealth and distribution of wealth). Furthermore, biological differences between populations (e.g., in genetics, epigenetics, or the microbiome) creating obesity susceptibilities is also a possibility. Heterogeneity at the extremes can give insight into these potential modifiers (Jaacks et al., 2019).
Obesity and physical activity
Obesity once established is difficult to reverse, if this is established in childhood or adolescence it is likely to persist into adult life and further increased the risks of morbidities such as CVD, Type 2 diabetes, and certain cancers. Preventing obesity is therefore essential. Poor lifestyle behaviors such as diet and physical inactivity are the most well-known determinants of obesity, understanding risk factors and how they contribute to the disease is vital to informing interventions that aim to prevent and treat obesity. This will allow an understanding of the most effective strategies and thus encourage more elaborate guidelines to counteract and manage the precipitous rise in obesity. Current evidence shows that multi-component interventions are effective in obesity prevention however, relatively few interventions are available in the UK. Prevention of overweight and obesity in early life | Proceedings of the Nutrition Society | Cambridge Core. It is recommended that individuals engage in adequate levels of physical activity throughout their lives, different types and amounts of physical activity achieve different health outcomes. However adult guidelines recommend Each week, adults should accumulate at least 150 minutes of moderate-intensity activity (brisk walking or cycling), or 75 minutes of vigorous-intensity activity (running), and children Should engage in moderate-to-vigorous intensity physical activity for an average of 60 minutes per day across the week Chapter 1 - The UK Physical Activity Guidelines | CPD for General Practitioners (heiw. wales). Those living with obesity are recommended to follow current exercise prescription guidelines of a minimum of 300 minutes of moderate-intensity exercise to achieve weight loss. However, due to a lack of evidence in current literature the most efficacious exercise prescription to improve, cardiorespiratory fitness (CRF), metabolic health, and anthropometry in this population remains unidentified. https: online library.Wiley.comdoipdf10.1111obr.13137
Effects of obesity on health, well-being, and lifestyle
Obesity may negatively impact an individual's quality of life with effects on physical, mental, psychosocial, and economic wellbeing. It has been estimated that obesity has a greater negative impact on quality of life than 20 years of age The effect of obesity on health outcomes - ScienceDirect. As figure 2. outlines, obesity is associated with conditions such as fibromyalgia, reduced cardio-pulmonary fitness, and sleep disorders; conditions such as these physically limit an individual's functional ability. Consequently, a vicious cycle emerges; the presence of these physical restrictions and pain related, present a barrier to participation in physical activity, which may otherwise improve their condition and is necessary for individual satisfaction and wellbeing. Furthermore, the lack of physical activity may further present barriers to social and psychological well-being, increasing the risk of developing mental illnesses such as depression and anxiety. This may impact the individual's ability and desire to engage in good lifestyle choices such as healthy eating and physical activity, as It is common for mental illness to induce eating disorders and increased sedentary behavior, progressing obesity as an illness The impact of obesity on quality of life - ScienceDirect. Quality of life is arguably the most important reason for seeking any medical intervention from the patient's perspective. The effect of obesity on health outcomes - ScienceDirect
Morbidities Relation to obesity Impact on physical activity
Type 2 diabetes It is consistently shown that obesity is associated with reduced glucose tolerance and type 2 diabetes mellitus. Approximately half of those in the US with type 2 diabetes are obese. Notably, studies have shown that overweight or obesity was the leading predictor of type 2 diabetes mellitus (Dixon, 2010). The use of daily physical activity and exercise prevention interventions, present a 90% reduction in the risk of type 2 diabetes. Type 2 diabetics report an improvement in their overall insulin sensitivity and improved skeletal muscle proteins and enzymes related to glucose metabolism and insulin signaling. Therefore, highlights the importance of introducing structured physical activity and exercise plans into diabetes medical management. (Anderson and Durstine, 2019)
Cardiovascular disease Many cardiovascular illnesses are associated with obesity, these include; most commonly Congestive heart failure, hypertension, angina, and myocardial infarction. It has been estimated that for every 10 pounds of weight gain there is a 20% increase in hypertension and that about 70% of unexplained hypertension is from obesity (Meldrum, Morris, and Gambone, 2017)
Other cardiovascular implications as a result of obesity include cardiovascular Dyslipidaemia, left ventricular hypertrophy, coagulopathy, chronic inflammation, and endothelial dysfunction. (Lee and Yoon, 2018).
Participation in physical activity is linked to cardiovascular improvements such as lower systolic blood pressure, and lower blood catecholamine levels at rest and at all submaximal exercise levels, consequently assisting in the prevention and treatment of CVD risk factors. Studies have shown the application of daily PA and exercise prevention interventions supports an 80% reduction in cardiovascular disease risk. Physical activity and exercise participation enhances function, by increasing myocardial strength and oxygen supply; whilst decreasing myocardial oxygen demand. Other cardiovascular improvements associated with daily PA and exercise include lower systolic blood pressure and lower blood catecholamine levels at rest and at all submaximal exercise levels, hence aiding in the prevention and treatment of CVD risk factors (Anderson and Durstine, 2019).
Cancer A clear connection between increased BMI and the risk of many cancers has been illustrated; these cancers include the uterus, breast, colon, rectum, esophagus, kidney, pancreas, brain, lymphoma, and gall bladder. Furthermore, obesity has been seen to increase the aggressiveness of prostate cancer, increasing the likelihood of it reoccurring. (Meldrum, Morris and Gambone, 2017)
Regular physical activity and exercise have been found to reduce the incidence of cancers such as colon, breast, lung, and endometrial cancers, studies have shown a 33% reduction in cancers with physical activity intervention(Lugo et al., 2019). Physical activity also appears to reduce all-cause mortality and cancer-related mortality with a reduction of 7-17% among patients with breast and colon cancer. In addition, Physical activity and exercise may improve functional ability and quality of life for cancer patients during cancer therapy and during recovery (Anderson and Durstine, 2019).
Musculoskeletal Obesity has been connected to musculoskeletal disorders including; physical disability, chronic generalized pain, osteoporosis, fibromyalgia, degenerative arthritis, flat feet, and back pain (Dixon, 2010).
Physical activity and exercise enhance bone health by increasing bone mineral density and causing physiological systems to function at optimal ability. Physical activity and exercise interventions are recommended for the prevention and treatment of osteoporosis and a decrease the risk of bone fractures (Anderson and Durstine, 2019).
Psychological issues The uprising of obesity is associated with a range of psychological issues, including mental disorders such as Poor body image and self-esteem, binge eating disorder, depression, anxiety, and psychological disturbances which may further lead to social isolation. As with obesity-related metabolic disorders, be inclined to occur in the most vulnerable individuals. Obesity has also been linked to lower educational attainment (Lee and Yoon, 2018). Furthermore, obesity has been shown to have a physical impact on the brain and cause Neurological Idiopathic intracranial hypertension (Pseudotumor cerebri) (Lee and Yoon, 2018).
PA and exercise stimulate molecular changes in numerous brain regions, enhancing functional and structural neural properties. The portions of the brain most adaptable to change memory learning, emotion, etc. are the first enhanced by PA and exercise. Therefore, neurological discrepancies and mental health conditions improve with PA and exercise. This, in turn, prevents or reduces other health conditions associated with poor stress management, anxiety, and depression. Furthermore, physical activity and exercise are anticipated to delay and reduce the risk of developing conditions such as dementia and Parkinson`s disease. Physical activity and exercise are recommended as a preventative measure for cognitive decline and part of a treatment management plan (Anderson and Durstine, 2019)
Other obesity is known to cause or negatively impact the following:
- fertility and endocrine problems such as precocious puberty, polycystic ovary syndrome (females), and hypogonadism (males) (Lee and Yoon, 2018).
- pulmonary conditions including sleep apnea, asthma, and exercise intolerance (Lee and Yoon, 2018)
- Gastrointestinal problems including Gastroesophageal reflux, non-alcoholic fatty liver disease, steatohepatitis, gallstones, and constipation(Lee and Yoon, 2018)
- Dermatology conditions such as stretch marks, dermatologic Acanthosis nigricans, hidradenitis suppurativa, intertrigo, and furunculosis (Lee and Yoon, 2018)Obesity prevents certain medical procedures from being performed including surgery due to the physical weight itself, or due to the increased risk of complications. Regular physical activity and exercise can improve PCOS in over weight and obese women due to increasing the frequency of ovulation and improving the regulation of cycles, thus increasing the chance of conceiving. Similarly, in men, regular moderate exercise can help lose and maintain healthy weigh, which in turn will improve men`s sperm quality (yourfertility.org.au. 2021)
Commonly recognized as physical activities positive impact on the pulmonary system. Appropriate aerobic exercise can improve lung function by strengthening respiratory muscles. However, for optimal lung function, overweight or obese individuals must further increase activity and decrease BMI (Azad, et al.,2011).
Quality of life The Negative impact of obesity on quality of life remains apparent, not only by the current morbidities associated but the physical restrictions that may make daily living tasks difficult such as upkeep of personal hygiene showering and drying oneself may become extremely tiring. Moreover, obese individuals have often reported trouble completing daily housework requiring squatting, lifting, and bending(Anderson and Durstine, 2019). Studies have shown that more years are lost with earlier onset obesity and with a higher BMI and more in men than women. For example, women obese by between 20-39 years old, will lose 15-19 years of a healthy lifestyle and 6 years of life (Meldrum, Morris, and Gambone, 2017).
When physical activity and exercise are included as part of a medical management plan for those with chronic diseases including obesity, quality of life is improved. This is due to physical activity improving functional ability, reducing inflammation, muscular strength, and weight loss (Anderson and Durstine, 2019).
Mortality The risk of mortality increases with the gradual increase of BMI within the BMI range of 30 or above. The greatest risk for years lost is estimated to be among those obese as young adults, however, the risk of death related to obesity increases with age and BMI (Dixon, 2010).
Studies have shown with increases in physical activity and physical fitness are related to decreased all caused mortality. Furthermore, older men and women have considerably lower mortality risk, when moderate cardiorespiratory fitness levels are maintained (Anderson and Durstine, 2019) review and evaluation of current literature 1000
Typically, BMI is used as a screening tool to assess an individual`s weight and identify the risk of chronic conditions associated with high body fat. WHO and current guidelines recognize BMI as a logical measurement due to its being cost-effective and straightforward. However, while the BMI correlates with fat accumulation, the measurement cannot differentiate between fat mass and lean muscle mass. In addition, BMI is limited by the inability to reflect body fat distribution. Furthermore, healthy weight classification based on BMI differentiates depending on ethnicity and age ScienceDirect. Current literature offers a wealth of evidence from controlled studies indicating that participating in physical activity and exercise over a long period of time can result in weight loss by causing an energy deficit. Reviews including the golden standard for assessing evidence Cochrane review to support this with the suggestion that exercise does induce weight loss and the impact is even more effective when in combination with energy intake restriction. Despite these improvements, the majority of weight loss interventions fail to maintain weight loss in participants long term. Thus, raising the question of how to effectively change behavior to promote long-term adherence to maintaining weight loss. (The role of physical activity and exercise in obesity and weight management: Time for critical appraisal | Elsevier Enhanced Reader). Many of the current studies were 1-2 years in length. Therefore, suggesting the need for longer studies needed to fully understand the impact on gradual outcomes related to obesity (e.g., population-level weights.)
Furthermore, the risk of bias was high among studies due to lower rigor of study designs (e.g., simplistic pre-post designs) and high rates of losses to follow-up (e.g., one-time surveys), as well as a high risk of confounding Effectiveness of Policies and Programs to Combat Adult Obesity: a Systematic Review | SpringerLink. Analysis of current literature is limited and selection bias (I.e. using convenient sampling or including participants already partaking in weight management plans) may reduce the generalizability of the findings.
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