The Physical Activity, Fitness and Function Working Group of the European Association for the Study of Obesity (EASO-PAFF) hosted an incredibly popular session at the 31st European Congress on Obesity in Venice, Italy. The scientific session was a collaboration between the European Association for the Study of Obesity and the European Coalition for People Living with Obesity and emphasised the key role that movement, physical activity and exercise play in managing the chronic disease of obesity. Co-Chair of the EASO PAFF, Dr Grace O’Malley commented “It is crucial that we ensure health professionals, policy makers and the public understand the essential role of physical movement in the prevention and management of obesity. The goal of physical activity in obesity management is for the myriad health gains that we get from being more active and reducing sedentary time. It is not for weight loss. EASO is committed to reframing the conversation around physical activity for health so that people living with obesity have access to the highest quality evidenced-based care and so that training of health professionals is enhanced”.
The session was opened by Prof. John Blundell (University of Leeds) a global expert on the influence of physical activity in appetite control. He emphasised that physical activity and sedentariness are extremely important for the control of body weight and body fat. He spoke about the mechanisms controlling the drive to eat and satiety. These mechanisms are important for understanding the level physical activity and sedentariness on body fat and body weight. When PA is high appetite is well controlled but when a person is sedentary appetite is poorly controlled and overconsumption can occur readily. This means that sedentary behaviour leads to an increase in fat mass and the opposite is true for highly active people. The effects are not just due to energy expenditure. However it is important to recognise that there is large variability between people and that effects cannot be guaranteed. High levels of sedentariness in society contributes to the prevalence of weigh gain and obesity.
Prof. Michel Oppert of Sorbonne University addressed the value of physical activity and exercise training in people with obesity in the context of bariatric surgery. He emphasized the fact that weight loss with exercise training in this setting was significant when compared to no exercise, although the magnitude of weight loss amounts only 2-3 kg on average, a small effect especially when compared to the effect on weight of surgery itself (20-30 kg weight loss in the first year post surgery). Compared to the relatively modest size of the effect on weight loss, other health benefits of exercise in this setting should not be overlooked. Exercise training has an important effect on physical fitness (cardiorespiratory fitness and muscle strength), on some cardiometabolic outcomes and on bone health. Therefore, the message in this particular setting should not be centered on weight loss only but on improving overall health and quality of life of patients. A major issue is the cost to the individual of engaging in a more physically active lifestyle and how to increase adherence in the long term.
Dr Battista from University of Padova highlighted the importance of cardiopulmonary exercise testing as part of the multidisciplinary evaluation of people with obesity and emphasised the pivotal role of cardiorespiratory fitness testing as a prognostic and diagnostic marker. In addition, she provided an insight on specific ventilatory, cardiovascular and peripheral limitations detectable with cardiopulmonary exercise test in people with obesity and underlined that an individualized exercise prescription alone or in association with dietary, pharmacological and surgical therapy, can improve cardiorespiratory fitness and functional limitations in people with obesity, addressing treatment also beyond weight loss.
Mari-Mette Graf from the European Coalition for People Living with Obesity encouraged attendees to discuss and support physical activity with their patients concluding that a holistic approach is paramount for treating and managing obesity.
“People with obesity are more than just numbers on the scale, or related to blood pressure. We carry our history, everyone is unique, but very often the weight of the stigma exceeds the numbers on the scale. Physical activity can be experienced as a tool leading people living with obesity from shame and pain to a stronger version of ourselves. When we are engaged and empowered through the process we benefit physically and psychologically”.