Etiological Assessment of Obesity: Factors That Affect Physical Activity

Continuing with citations from my article in Obesity Reviews on an aeteological framework for assessing obesity, we now turn to the some of the factors that can affect physical activity. Once we have established that weight gain in a given individual is not primarily driven by a change (decrease) in metabolic requirements, or primarily driven by ingestive behaviour, we turn to the issue of a decrease in physical activity as a drier of weight gain:

Barriers to Physical Activity

As with caloric intake, activity‐related caloric expenditure can vary from virtually zero (as in a bedridden individual) to several thousand calories a day (as in a competitive athlete). In considering physical activity, it is important to note that in sedentary individuals, the majority of activity thermogenesis results from non‐exercise activity thermogenesis (NEAT) simply from performing the acts of daily living, walking, posture and fidgeting. Any reduction in NEAT, even with no change in planned exercise frequency, duration or intensity, would result in reduced energy requirements. Evidence suggests that some individual’s resistance to weight gain is linked largely to their innate ability to spontaneously increase NEAT to defend against caloric excess.

As with nutrition, the factors that determine physical activity can be divided into four domains: socio‐cultural factors, biomedical factors, psychological factors and medications. Determining which of these domains is predominantly responsible for reduced physical activity or sedentariness can allow the clinician to specifically address those barriers in the management plan.

We will consider each of these factors in subsequent posts.

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