October 16, 2021
3 min read
Hill JO, et al. Session I: Obesity & Lifestyle. Presented at: Cardiometabolic Health Congress; Oct. 14-17, 2021; National Harbor, Md. (hybrid meeting).
Hill reports co-founding Shakabuku LLC. Piercy reports no relevant financial disclosures. Wyatt reports receiving consultant fees from Gelesis, holding intellectual property rights for Energy Gap, performing contracted research for National Cattleman’s Beef Association and Novo Nordisk, owning an interest in DRHOLLY LLC, Roman Health and Shakabuku LLC and authoring the book State of Slim.
Regular physical activity is a critical part of maintaining weight loss, and providers should explore different methods to motivate their patients to be more active, according to three speakers at the Cardiometabolic Health Congress.
James O. Hill
“In our current environment, it is impossible for a population to have low rates of physical activity and low rates of obesity,” James O. Hill, PhD, professor and chair of the department of nutritional sciences and director of the Nutrition Obesity Research Center at the University of Alabama at Birmingham, said during the presentation. “If we’re going to be sedentary, we’re going to be obese. High levels of physical activity are necessary for most people to be successful in maintaining weight loss.:
CV benefits with physical activity
Physical activity can provide health benefits for all people, according to Katrina Piercy, PhD, RD, ACSM-CEP, FACSM, acting director of the division of prevention services in the office of disease prevention and health promotion at the U.S. Department of Health and Human Services.
“Physical activity can both independently reduce the risk of cardiovascular disease and can impact other factors which can affect CVD, including body weight, blood pressure, cholesterol and type 2 diabetes,” Piercy told Healio.
The HHS 2018 Physical Activity Guidelines Advisory Committee’s scientific report stated that higher amounts of physical activity were associated with decrease in incidence of CVD, stroke and heart failure, and the risk continues to decrease with increased physical activity up to five times higher than recommended levels. Additionally, researchers found a strong inverse dose-response relation between the amount of moderate or vigorous physical activity and CVD mortality, with the greatest benefit seen early on in the dose-response relationship. The report also found strong evidence for reduced risk for CVD mortality in people with hypertension and type 2 diabetes.
Piercy said the Physical Activity Guidelines for Americans provides recommendations for Americans of all ages to get a proper amount of physical activity to stay healthy. In general, adults should have at least 150 minutes of moderate-intensity aerobic activity and 2 days of muscle-strengthening activity each week.
Weight loss maintenance
While it is essential for people with obesity to lose weight, losing weight over the short term only is not enough. Hill said it is essential for people to maintain weight loss over the long term and cited physical activity as the key for weight loss maintenance.
One reason physical activity is essential for weight loss maintenance is it fills the energy gap. Energy expenditure decreases after weight loss, but people experience increased hunger due to changes in hormones and substrates. Instead of eating less to compensate, Hill said, people can participate in more physical activity.
“The more of that gap you fill with physical activity, the more likely you are to keep the weight off,” Hill said during the presentation.
Physical activity also corrects metabolic dysfunction in obesity and improves metabolic flexibility. Finally, exercise also matches up energy expenditure with appetite. Hill said people who participate in higher amounts of physical activity require greater energy intake, allowing a person to maintain body weight even if they’re eating more.
“Lots of data suggest that if we can increase physical activity, we increase people’s ability to regulate their appetite to meet their energy expenditure,” Hill said during the presentation.
Informing a patient how much physical activity they need to do is only the first step on their weight loss journey, according to Holly Wyatt, MD, professor and vice chair of clinical programs in the department of nutritional sciences at the University of Alabama at Birmingham. She said discussions should not only focus on what physical activity to do, but why it should be done.
“A lot of times, we use the reasons why we think they should (exercise), but we’re not very good at motivating them for why they will tend to do it,” Wyatt said during the presentation. “That’s equally as important as what to do and how they will do it.”
Providers can use extrinsic motivators, such as rewards, motivation from other people, and accountability; or intrinsic motivators, such as asking about a patient’s core values and identifying opportunities for growth. Wyatt said it is crucial to recognize that extrinsic motivators are helpful for short-term changes and intrinsic motivators are more effective for long-term changes.
There are several strategies providers can use to motivate patients, according to Wyatt. First, providers should “peel the onion,” and have a deep conversation with their patients to understand the reason why they want to lose weight. People who want to lose weight should set an emotional goal in addition to a logical and strategic goal, and then tie the two together. Finally, providers should encourage patients to steer away from a fear-based mindset and instead focus on the positive possibilities of weight loss.
“It’s one of the most powerful things people can do,” Wyatt said during the presentation. “Realizing what they actually want is what’s going to motivate them.”