Although the root causes of obesity have historically been attributed to poor diet and inactivity, more emphasis has been placed on the role of diet. On July 29th & 30th, the National Academies’ Roundtable on Obesity Solutions hosted a workshop entitled ‘Exploring the Role of Physical Activity in Obesity Treatment, Body Weight Management, and Related Health Outcomes in Adults.’. Research presented during the workshop made it clear that physical activity should be integrated into both the prevention and comprehensive treatments for obesity.
Biology, behavior, and environment of the patient all contribute to a patient’s attitudes and practice related to physical activity. To understand the outcomes of treatment of patients with obesity, understanding behavioral history and patterns are essential to creating realistic obesity treatment plans and targets for patients.
Physical inactivity is related to unhealthy weight gain across the life span, and in most cases, physical activity should be included in the development of obesity treatment plans. Physical activity guidelines from the American College of Sports Medicine, recommend 200 to 300 minutes of aerobic-type physical activity for long-term weight loss and maintenance of weight loss. However, responses vary among individual patients. As shown in the figure below, standardized exercise across individual participants demonstrate significant variability in changes in total adiposity.
Weight loss can vary by the type of weight being lost whether it be adipose tissue, lean tissue, or muscle mass. The rise in GLP-1 medication usage has prompted concerns about the excessive loss of lean tissue. Physical activity can be integrated into plans to protect against excessive lean tissue loss for patients using new obesity medications to counter these adverse effects. Recommendations and treatment plans need to be curated on a case-by-case basis to guide patients to the most strategy for them to include physical activity in their plan.
As work is being done to integrate physical activity into obesity treatment, conversations have also turned to the creation of a standard set of measures of physical activity. Alongside HL7 ("Health Level 7") International and an Expert Advisory Group, the Physical Activity Alliance has created the first ever PA FHIR Implementation Guide. A standard implementation guide for the integration of physical activity into a comprehensive obesity treatment plan could be a groundbreaking shift for the future of obesity treatment.
The goal of physical activity is to treat obesity, not to achieve weight loss. Even in the absence of weight loss, physical activity in people with obesity can reduce obesity-associated comorbidities. The type and duration of physical activity depends on the patient. There is no “one size fits all.”