Obesity and Gait Abnormalities

Table of Contents

1. Causes of Obesity
2. Body Mass Index
3. Disease States Linked to Obesity
4. Treatment
5. Gait Disturbance
7. Mobility Aids
8. Conclusion
9. Expert Contributions
10. References
11. Patient Resources


Obesity is one of the greatest epidemics of our time. Not only are adults suffering from an increase in obesity, but children are too. In the past two decades, the rate of obesity has risen dramatically, with over 35% of adults and 17% of children and adolescents suffering from the disease. (1) Obesity-related diseases can affect every organ system in the human body. The heart, lungs, endocrine and musculoskeletal system bear the greatest burden from an obese body habitus.

Causes of Obesity

While there are a number of factors that contribute to obesity, the bottom line comes down to math. The body must burn at least as many calories as it consumes, to maintain a steady body weight. When the number of calories consumed becomes greater than the number of calories burned, weight is gained. If this process continues to occur, over the course of an extended period of time, a person will gain weight. If the process is not corrected, the weight gain will spiral out of control until eventually the person becomes obese.

It seems simple enough: eat fewer calories than you burn and you will fend off obesity. While theoretically this is true, genetics, metabolism, the type and variety of physical activity undertaken and socioeconomic factors can play a big role in whether or not you develop obesity.

Body Mass Index

The management of weight is serious business. Having the tools to monitor and control body weight can allow you to minimize your risk of developing obesity and the side effects that come along with it.

Body mass index and waist circumference are used to gauge the health risks of your current weight, the severity of the obesity and/or the potential for long term health risks. The Center for Disease Control and Prevention defines obesity as a Body Mass Index (BMI) of 30 or higher. (2) The Body Mass Index is a calculated number that takes into account weight and height. Though BMI is highly reliable, it can be somewhat misleading in athletes. Increased muscle mass adds weight in the highly conditioned athlete which can artificially inflate the body mass index. The Center for Disease Control provides an easy way for everyone to track their BMI, in the comfort of their own home. (3)


Cardiovascular Disease and Stroke

The risk of cardiovascular disease increases with increased weight. Hypertension, elevated cholesterol and elevated triglycerides often go hand in hand with obesity. All of these diseases states act singularly and synergistically to increase your risk of cardiovascular disease and stroke. In turn, a decrease in body weight by as little as 20% can decrease your risk of suffering from cardiovascular disease by as much as 40%.

Obesity is a very serious and expensive medical diagnosis. The US spends over 150,000 billion dollars, annually, on obesity and obesity-related diseases.

Diabetes

Obese individuals are three times as likely to develop insulin resistance or type II diabetes as those of normal weight. Of those diagnosed with type II diabetes, greater than 80% of the patients are considered obese. The rate increases even further when a family history of type II diabetes is present. This startling link between the two disease states is being extensively studied, as the rate of obesity drives up the rate of type II diabetes. Every three seconds someone is diagnosed with type II diabetes. (4) Though a family history of type II diabetes is certainly a predisposing factor to suffering from the disease, the lack of physical activity and our increasingly sedentary lifestyle is certainly playing a role in the increasing rate of the disease. The bottom line is if you are able to prevent obesity, you can reduce your risk of acquiring type II diabetes by nearly 100%, which makes type II diabetes a completely avoidable disease state.

Cancer

Though the link between obesity and cancer is known, the etiology is believed to vary considerably. Excessive and prolonged levels of hormones, primarily estrogen are thought to increase the risk of a reproductive system cancer diagnosis. Secondarily, estrogen is believed to be tied to increased deposits of subcutaneous abdominal adipose tissue. This increased fat deposit is also linked to rising rates of obesity.

Sleep Apnea

The rate of patients diagnosed with sleep apnea has been dramatically increasing, over the past 2 decades. Sleep apnea, often secondary to obesity, increases the risk of hypertension, stroke, peripheral vascular disease and even sudden cardiac death.

What else…

Obesity is considered to be a broad sweeping etiologic factor in many other disease states, including:

• Varicose Veins
• Gout
• Gall Bladder Disease
• Pickwickian Syndrome
• Abdominal Hernia

Treatment

The treatment of obesity continues to be at the forefront of medical research. A multifaceted approach to management of the disease state starts with the prevention of the disease. For those individuals that are already suffering from obesity, a three-tiered approach includes:

• Nutrition
• Physical Activity
• Emotional Support

It is important to note that not all patients fit the same treatment mold. It often takes many attempts to find a weight loss program that works and is sustainable for a lifetime of weight management.

Gait Disturbance

One of the most important factors in managing obesity is encouraging an exercise plan. The majority of bariatric medicine specialists initiate walking plans for their patients. Though quite necessary, this can present a very specific set of problems. Clinically obese patients are often physically limited in their ability to ambulate. It is not uncommon for physicians to prescribe an ambulatory assistance device. The addition of a walker or cane, for stability, can be the physical impetus needed to get the obese patient up and moving. The long journey truly does start with a single step, in the case of obesity.

Fatigue

Obesity leads to deconditioning and deconditioning leads to fatigue. The greater the fatigue, the more difficulty the patient will have with ambulation. It is common to see an obese individual sitting on a bench in the mall or park, waiting for their companions to return. The sad reality is that obesity prevents physical activity and conditioning. The vicious circle need to be broken with the initiation of activity, but this is easier said than done.

Balance Problems

Nearly all individuals carrying increased weight have balance issues. Without the addition of movement to the treatment protocol, the patient will likely be unable to lose weight, reduce the risk of additional medical problems and subsequently reduce the risk of gaining back the lost weight. Often these balance issues may be addressed satisfactorily by adding a physical assistance devise, such as a walker or cane.

Mobility Aids

Carrying around extra weight, especially to the point of being diagnosed with obesity, can significantly alter your ability to ambulate. With one of the mainstays of obesity treatment being the initiation of an exercise program, it is important that you seek out a stability device to help you implement this component of your program.

A safe and effective method of walking should be the initial goal of treatment for the diagnosis of obesity. This can be easily accomplished with the addition of a mobility device, such as a walking cane or walker.

Conclusion

Obesity presents a specific set of challenges. The take away message is that obesity doesn’t have to rule your life. Opportunities to enhance your life, by adding the necessary lifestyle changes and ambulatory device, must be taken seriously and implemented as soon as you realize weight has become an issue.

Expert Contribtion

"Losing weight can be difficult because the metabolic rate of certain individuals is slower than others. This means that for some people, gaining weight is easier. You can gain an edge by following several important steps and utilizing aids to prevent weight gain and even lose weight. Greater weight puts dangerous stress on organs and joints so keeping a healthy level of fat in the body is important for longevity." - Marilyn Vine Weight Loss Information Booklet  

 

References

1. http://www.cdc.gov/obesity/data/facts.html
2. http://www.cdc.gov/obesity/adult/defining.html
3. http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html
4. http://www.diabeticcareservices.com/diabetes-education/diabetes-and-obesity

Patient Resources  http://www.nlm.nih.gov/medlineplus/obesity.html


Obesity and Gait Abnormalities is Written by: Dr. Elizabeth Lewis

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