Asia Pacific Journal of Multidisciplinary Research | Vol. 2, No.

1 | February 2014
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Management of Obesity: Implication For Aging Athletes
1
ORIAKHI UNITY, 2DR. S .O. AIBUEKU, 3AIDEYAN OSARENMWANTA DANIEL
[email protected]
Department Of Health, Environmental Education and Human Kinetics
Faculty of Education, University of Benin, Benin City
NIGERIA

Abstract - The overall goal of this study was to provide insight into the management of obesity in aging athletes.
Obesity is seen as an imbalance in energy expanded and energy intake and a leading cause of death worldwide
with increasing prevalence in adults and children. It is also viewed as one of the most serious public health
problems of the 21st century. It has been observed that diets, physical activities and medical options are ways of
managing obesity for aging athletes. It was therefore concluded that physical activities, diets and medical
management could reduce type-2 diabetes, coronary diseases, hypertension, respiratory disorders, gall bladder
disease, certain types of cancers, cholesterol, disability and early death as consequences of obesity. It was
recommended that developing and designing regular physical activities, diets, medical options are ways to
manage obesity.

Keywords: Obesity, Aging Athletes, Physical activities, Diets & Medical

I. INTRODUCTION height in metres exceed 30kg/m2 (World Health Organization,

In today’s health-conscious society, there is a growing 2000).
awareness of obesity globally. For various reasons, many Human physical performance is notably reduced with
people are becoming not just overweight, but obese as well. aging, although, the effects of aging are often compounded by
Obesity and overweight have in the last decade become a disuse. The good news, however, is that, many of the diseases
global problem, back in 2005 approximately 1.6 billion adults and infirmities exclusively attributed to aging are more
over the age 15+ were overweight at least 400 million adults accurately related to the effects of sedentary living. Sedentary
were obese and at least 20 million children under the age of 5 seniors decline twice as fast as their active counterparts and
years were overweight (Medical News, 2004). It further their highest level of conditioning affects their overall level of
maintained that, if the current trends continue by 2015 decline (Hill, 2001). A growing subset of aging athletes has
approximately 2.3 billion adults will be overweight and more maintained higher functional capacity and quality of life
than 700 million will be obese. Obesity is a concern because of through exercise. Exercise improves quality of life of aging
its implication for the health of an individual as it increases the athletes by decreasing body fat and obesity rates, increasing
risk of many diseases and health conditions which includes: muscle strength, improving balance, gait and mobility,
coronary heart diseases, type 2 diabetes, endometrical cancer, decreasing the likelihood of falling, improving psychological
stroke, liver, gall bladder disease, sleep apnea, respiratory health, reducing arthritis pain and reducing the risk of
problems, osteo-arthritis and gynaecological problems developing coronary heart disease, hypertension, osteoporosis,
(abnormal menses, infertility), these condition can cause or cancer and diabetes (Hunter, McCarthy & Bamman, 2004). The
contribute to premature death and substantial disability overall goal of this paper is to provide insight into the use of
(Medical News, 2014). physical activities, diet and medical as ways to manage obesity.
Obesity is caused by a positive balance between calorie
intake and energy expenditure which determines a person’s Classes of Obesity
weight. If a person eats more calories than he or she burns World Health Organization (2000) submitted that Body
(metabolizes), the person gains weight (the body will store the Mass Index is an indicator to classify obesity. Therefore, body
excess energy as fat) contrary the person loses weight mass index is the individual’s body mass divided by the square
(Jerry,2014).The most common cause of obesity are overeating of his or her height, typically expressed in metric.
and physical inactivity. Ultimately, body weight is the result of BMI Classes
genetics, metabolism, environment, behaviour and culture. 30.0 -34.9 Class I obesity
Haslam and James (2005) maintained that obesity was widely 35.0 – 49.9 Class II obesity
perceived as a symbol of wealth and fertility at other times in > 40.0 Class III obesity
history and still in some parts of the world. They further Management of Obesity
stressed that obesity is a medical condition in which excess Obesity can be managed through Medical Management,
body fat has accumulated to the extent that it may have adverse Physical Activities Management and Diets Management.
effect on health, leading to reduce life expectancy increased
health problem. People are considered obese when their Body Medical Management
Mass Index (BMI), a measurement obtained by dividing the Medications should only be considered for patients with
person’s weight in kilogram by the square of the person’s BMI greater than 30 or greater 27 if they have co-morbidities
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 Asia Pacific Journal of Multidisciplinary Research | Vol. 2, No. 1 | February 2014
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and have failed to lose weight on a programme of diet, exercise the portal circulation also act directly to inhibit insulin
and behaviour therapy (Arome, 1998) sibutramine is a novel clearance by the liver resulting in hyperinsulinemia. High
agent that inhibits the reuptake of serotomin, norepinephrine levels of insulin in the presence of elevated glucose tend to
and dopamine (Wechster & Leopold, 2003). It does not promote reduction in insulin sensitivity and hasten the
stimulate secretion of serotomin. Its effects on food intake are development of non insulin dependent diabetes mellitus. The
caused by increased noradregenic and serotonergic activity in increase in blood pressures as insulin is thought increases
the central nervous system (Berke & Morden, 2000). sodium retention in the kidney. Thus, high level of abdominal
Sibutramine has been shown to reduce energy intake, obesity is directly related to dyslipidemia (elevated level of
specifically during lunch time (Palan & Wadden 2002). There LDF and triglycerodes), hypertension, hyperinsulinamia,
have been multiple studies done to examine whether adding reduced glucose sensitivity and ultimately non-insulin
medications will improve the results of lifestyle modification. dependent diabetes mellitus. Physical activity reduces
In a study done with sibutramine, results showed a weight loss beneficial metabolic changes that limit the progression of this
of 3 to 9kg greater than placebo when both interventions were underlying disease process. The major benefit of physical
combined with a low intensity programme of lifestyle activity is that it leads to specific reduction in the levels of
modification (Phalan & Wadden, 2002). abdominal obesity Ross & Janssen, 1999). The enhanced
Bariatrice surgery can be an option for some obese lipolytic activities of these fat cells allow fatty acids to be
individual’s if the patient has a BMI > 40kg/m2, BMI of 35 to released and metabolized more readily than fat depots. While
40kg/m2 who have a high risk of co-morbid conditions or have overall weight loss from exercise is limited, studies have
significantly obese related physical conditions that interfere indicated that changes in abdominal fat levels can occur
with their lifestyle. There are two procedures commonly without corresponding weight loss or total fat loss. Studies
performed. One is vertical banded gastroplasty, in which a have also demonstrated that physical activity has a direct effect
small pouch with a restricted outlet is constructed along the on improving overall metabolic profiles (e.g normalization of
lesser curvature of the stomach. The second is gastric bypass, insulin levels and improved glucose homeostasis). In a review
in which a proximal gastric pouch is constructed whose outlet of Kelly and Goodpaster (1999) studies, the improvement in
is a y-shaped limb of the small intestine (Fujioka, 2002). Life insulin action were found to occur without concomitant
long medical surveillance is necessary after surgical therapy changes in weight or body composition while there appear to
(Wechsler & Leopold, 2003). The risk of death following be some chronic adaptations that occur as a result of regular
bariatric surgery is between 1% and 2% in most series, but is exercise performed over a period of time, there are also
significantly higher in patients with respiratory insufficiency of observations that indicate that some benefits are related to the
obesity (Sugerman, 2001). acute effects following individual bouts of activity.

Physical Activities Management Diets Management

Physical activity provides protection against the health Diets management of obesity and overweight is the
risks of obesity and primarily by reducing or reversing the cornerstone of weight loss therapy. Most of the dietary
development of a progressive disease process known as insulin- regimens proposed weight loss focus on energy content and
resistance syndrome or syndrome x. This syndrome is closely macronutrient composition. It is the energy content that
associated with obesity and is characterized by the clustering in determines the efficiency of the dietary regimens. Obesity
insulin resistance and hyperinsulinemia, dyslipidemia essential treatment guidelines issued by the National Institute of Health
hypertension, glucose intolerance and an increase risk of non- (NIH) recommended that persons who are overweight or who
insulin dependent diabetes mellitus and cardiovascular disease have class I obesity and who have two or more risk factors
(Timar, Sesetier & Levy, 2000). Prior to describing the should reduce their energy intake of 500kcal/day (National
moderating influence of physical activities, the general Institute of Health, 1998). Person with class II and Class III
mechanisms underlying insulin resistance syndrome will first obesity should strive for 500 – 1000kcal/day reduction. With a
be described. reduction of 500kcal/day energy intake, a weight reduction of
While research is still accumulating on the specific 0.5g/week can be achieved.
mechanism, the general disease process is related to the
presence of abdominal body fat particularly visceral fat Type of Diets
(Campbell & Kraeger, 1997). Abdominal body fat is In general, there are four types of dietary regimens used in
characterized by increase responsiveness to lipoprotein lipase. the treatment of obese persons. These are: Low-calorie diet
Owing to its high lipolytic activity abdominal adipocytes (LCD); Low – fat diet; Low – carbohydrate diet; and Very low
readily release Free Fatty Acid (FFA) into the circulation. – calorie diet (VLCD).
These FFA are carried directly to the liver through the portal
Circulation Density where they are converted into Very Low Low-calories Diets
Density Lipoprotein (VLDL) and ultimately LDL cholesterol. Low calories diets are high in carbohydrate (55-60%), low
The high level of FFA may also lead to enhanced lipid in fat (less than 30% of energy intake), and high in fibre and
oxidation and reduce glucose oxidation. These changes can have a low-glycemic index. Alcohol and energy-dense snacks
result in sensitivity to insulin. The increased levels of FFA in should be avoided. LCD has been shown in 34 randomized

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trials to reduce body weight by 8% during 3-13 month period composition based on a subject’s taste preference can achieve
(Strychar,2006).Overweight or obese patients tend to better compliance.
underestimate their energy intake. To help them overcome this,
portion controlled or prepackaged meals that make up the Implication of Obesity to Aging Athletes
required energy intake is available. Replacement meals are Nearly 50 million adults or 27% of the adult population are
available as drinks, nutrition bars, or prepackaged meals. A 4 – obese and more than 108 million adults (61%) are either obese
year study demonstrated weight loss improvement in blood or overweight (U.S. Department of Health and Human Services,
sugar and blood pressure for persons taking meal replacements 2002). The Centre for Disease Control and Prevention reported
diets (Hechtner-mors, Distchuneit, Johnson, Suchard & Adler, between 1991 and 1998, obesity rate for U.S adults aged 60-69
2000). years increased to 45% (Mokdad, Serdula, Dietz, Bowman,
Marks & Koplan, 1999). Studies in aging athletes of both sexes
Low-Fats Diets find that body composition changes occur but overall measures
These diets reduce the daily intake of fat to 20 – 25% of of body composition (weight, percent intra-abdominal fat) are
total energy intake. For a person on a 1500 calorie diet, this superior compared to age-matched sedentary control. Pollock,
translated to 30-37g of fat, which can be counted using food Mengelkoch & Graves (1997) measured body compositon in 27
label from packages. Alternatively, a dietician can provide the male aging track athletes and followed them for 20 years. Body
person with a specific menu plan that has reduced fat. weight remained stable in the male athlete who remained active,
According to a meta-analysis of 16 trials, low-fat diet used over yet percent body fat increased by about 3% per decade. Ryan,
2-12 months resulted in mean weight loss of 3.2kg and Nicklas & Elahi (1996), van Pelt, Davy & Stevenson (1998)
improved cardiovascular risk factors (Astrup, Ryan, Grunwald, studied different groups of female aging athletes. They found
storgaard, Saris, Melanson & Hill, 2000). that athletes had lower percent body fat and total fat mass than
younger controls although both groups had body mass index
Low-carbohydrate Diet (BMIs) of < 25kg/m2. The female aging athletes had increases
The carbohydrate content of the diet is an important in intra-abdominal fat with age, but were lower than in older
determinant of short-term (less than 2 weeks) weight loss. controls. Subcutaneous fat did not increase with age in the
Low-carbohydrate (60-150g of carbohydrate/day) and very low older athletes.
carbohydrate diet (0 to < 60g) have been popular for many Meanwhile, no specific studies on metabolic syndrome on
years. Glycogen utilization occurs when carbohydrate intake is aging athletes have been published. However, aging athletes
restricted. When the carbohydrate intake is less than 50g/day, have improved glucose tolerance, enhanced insulin sensitivity
ketosis will develop from glycogenolysis, resulting in fluid loss. and lower waist-to-hip ratios compared to sedentary older
Many of the current low-carbohydrate diets (e.g. Atkins diet) adults. Seals, Hagberg, Hurley, Dalsky, Ehsari & Holloszy
limit carbohydrate intake to 20g/day but allow unrestricted (1984) found that aging athletes (average of 60 years) had
amounts of fat and protein. A meta-analysis of five trials found normal glucose tolerance ingestion) compared to older,
that weight loss at 6 months favouring low-carbohydrate over untrained men. The aging athletes blood glucose and insulin
low-fat diet is not sustained at 12 months (Nordmann, levels were as low as the young (averagr of 60 years). Hagberg
Nordmann, Briel, Keller, Yancy, Brehm & Bucher, 2006). & Rogers, (1995) found out that endurance – trained master
Very Low-calorie Diet (VLCD) athletes (runners and triathletes with an average age of 63.5)
VLCDs are diets with energy content of 200-800kcal/day. had enhanced insulin sensitivity and a lower waist-to-hip ratio
Diets below 200/cal/day are starvation diets. VLCDs are not to sedentary older men. These data suggest regular endurance
recommended for general use, as there are significant adverse activity may prevent abdominal obesity and insulin resistance
effects such as electrolyte unbalance, low blood pressure and that are frequent in aging individual.
increased risk of gallstones. It needs to be supervised by trained
medical personnel. In a meta-analysis of 80 weight loss studies, CONCLUSIONS AND RECOMMENDATIONS
mean weight loss of 5 to 8.5kg (5-9%) was observed during the Obesity in one of the killer diseases world-wide and it
first 6 months from interventions involving a reduced-energy currently affects all ages. Many people consider obesity to be a
diet and/or weight loss medications with weight plateaus at cosmetic problem. Obesity increases the risk of many diseases
approximately 6 months, with maintenance of 3-6kg (3-6%) of and health conditions which includes: coronary heart disease,
weight loss at 48 months (Franz, VanWormer & Crain, 2007). type 2 diabetes, certain type of cancer, hypertension, stroke
A randomized controlled trial comparing four weight loss diets sleep apnea, liver, gall bladder and a host of other diseases, this
with different compositions of fat, carbohydrate and protein condition can cause or contribute to premature death or
found no difference in outcomes, with a 2 to 4kg weight loss substantial disabilities. Most studies agreed that physical
with all diets after a year (Sacks, Bary & Carey, 2009). They activities, diet and medical are ways to manage obesity.
further maintained that after 2 years, all calories – restricted
diets result in equal weight loss irrespective of the It is hereby recommended that developing and designing
macronutrient composition. In contrast, all studies found that exercise and diet plan that is right for fitness level and eating
dietary adherence is an important determinant of weight loss habit. A day should be set aside which will be called “obesity
(Strychar,2006). Thus, choosing a diet with a micronutrients day”. This will go a long way to raise people’s consciousness.

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