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ACE-CPT · Chapter 12

Considerations for Clients with Obesity

How obesity develops, why energy balance is complex, and how trainers design safe nutrition, exercise, and behavior-change programs to help clients lose weight and keep it off.

30Theory Quiz
35Case Studies
65Total Q's

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Energy Balance · Causes · Hormones · Nutrition · Training · Goals · Behavior

Chapter 12 Theory Quiz

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Chapter 12 Case Studies

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Mifflin-St. Jeor REE (most testable formula)

SexEquation (kcal/day)
Males(10 × kg) + (6.25 × cm) − (5 × age) + 5
Females(10 × kg) + (6.25 × cm) − (5 × age) − 161
Conversions & contextlb → kg ÷ 2.2 · in → cm × 2.54 · REE ≈ 75% of total energy expenditure (TEE)

Cardiorespiratory FITT

F≥3–5 days/week
IModerate, below VT1 (talk test; RPE 12–13 / 20, 3–4 / 10)
T30–60 min/day (shorter bouts OK)
TLow-impact, rhythmic, large-muscle

Muscular FITT

F2–3 days/week, rest day between
I60–70% 1-RM, 8–12 reps, 2–4 sets
T20–30 min full body
TAll major groups; free weights/machines

Activity Dose–Response

GoalAmount
Prevent weight gain / modest loss150–250 min/week
Clinically significant loss250–300 min/week (~2,000 kcal/wk) ≈ 20 mi/wk
~150 min/week (no diet change)4.4–6.6 lb (2.0–3.0 kg) loss
225–420 min/week11–16.5 lb (5.0–7.5 kg) loss (12–18 wks)
Maintain reduced weight>300 min/week; ACSM ~60 min/day

Pharmacology & Surgery

PharmacotherapyBMI ≥30, or ≥27 + ≥1 comorbidity
PhentermineShort-term only, <3 months
FDA discontinue<5% loss after 16 weeks
Bariatric surgeryBMI ≥40, or ≥35 + ≥1 comorbidity
Surgery regain~5–20% regain weight

Key Numbers

Energy balance~3,500 kcal per 1 lb fat; 500 kcal/day deficit ≈ 1 lb/week; ADA: 500–1,000 kcal/day deficit → 1–2 lb/week
Weight stability<3% change = stable; ≥5% = clinically significant
Realistic goal5–15% loss (5–10% improves comorbidities); ~2–3 lb/month
Protein RDA46–56 g/day, or 10–35% of calories

Hormones & Causes

GhrelinStomach "hunger hormone" — stimulates appetite
Peptide YY / CCK / GLP-1Gut hormones that produce satiety (reduce appetite)
BMI heritability40–70%; genes <5% of variation; activity cuts genetic risk ~40%
OSA58% of moderate-to-severe cases due to obesity
NEATNon-exercise activity thermogenesis; excess sitting = +100 kcal/day