vendex and Obesity--Morbid

The aim of our study was to evaluate associations between maximum voluntary contraction torques of the lower limbs and body composition for subjects with severe obesity.. Body composition was evaluated by bioelectrical impedance analysis, and maximum voluntary contraction torques of the lower limbs were measured using an isokinetic dynamometer. One hundred thirty-two patients were enrolled (100 females and 32 males). Eighty-seven patients had a body mass index between 40 and 49.9 kg/m2 (the A group), and 45 patients had a body mass index between 50 and 59.9 kg/m2 (the B group).. Absolute extension and flexion torques had weak associations with fat-free mass but a moderate association with absolute extension torque and fat-free mass of the lower limbs. There were no significant differences between the A and B groups with respect to absolute extension and flexion torques. For the A group, absolute extension and flexion torques were moderately associated with fat-free mass and with fat-free mass of the lower limbs. For the B group, there were only moderate associations between absolute extension and flexion torques with fat-free mass of the lower limbs.. Our findings demonstrate that both groups exhibited similar absolute torque values. There were weak to moderate associations between absolute extension and flexion torques and fat-free mass but a moderate association with fat-free mass of the lower limbs. Individuals with severe obesity should strive for greater absolute torques, fat-free mass and especially fat-free mass of the lower limbs to prevent functional limitations and physical incapacity.

Topics: Adult; Anthropometry; Body Composition; Electric Impedance; Female; Humans; Lower Extremity; Male; Middle Aged; Muscle Contraction; Muscle Strength; Muscle Strength Dynamometer; Muscle, Skeletal; Obesity, Morbid; Reference Values; Severity of Illness Index; Statistics, Nonparametric; Torque

We examined the hypothesis that metabolic surgery-induced massive weight loss causes mass-driven and behavioral adaptations in the kinematics and kinetics of obese gait. Gait analyses were performed at three time points over ∼1 yr in initially morbidly obese (mass: 125.7 kg; body mass index: 43.2 kg/m(2)) but otherwise healthy adults. Ten obese adults lost 27.1% ± 5.1 (34.0 ± 9.4 kg) weight by the first follow-up at 7.0 mo (±0.7) and 6.5 ± 4.2% (8.2 ± 6.0 kg) more by the second follow-up at 12.8 mo (±0.9), with a total weight loss of 33.6 ± 8.1% (42.2 ± 14.1 kg; P = 0.001). Subjects walked at a self-selected and a standard 1.5 m/s speed at the three time points and were also compared with an age- and gender-matched comparison group at the second follow-up. Weight loss increased swing time, stride length, gait speed, hip range of motion, maximal knee flexion, and ankle plantarflexion. Weight loss of 27% led to 3.9% increase in gait speed. An additional 6.5% weight loss led to an additional 7.3% increase in gait speed. Sagittal plane normalized knee torque increased and absolute ankle and frontal plane knee torques decreased after weight loss. We conclude that large weight loss produced mechanical plasticity by modifying ankle and knee torques and gait behavior. There may be a weight loss threshold of 30 kg limiting changes in gait kinematics. Implications for exercise prescription are also discussed.

Topics: Adult; Ankle Joint; Biomechanical Phenomena; Exercise Test; Follow-Up Studies; Gait; Hip Joint; Humans; Kinetics; Knee Joint; Obesity, Morbid; Torque; Walking; Weight Loss

Any surgeon experienced with a laparoscopic approach to intra-abdominal surgery on morbidly obese patients is aware of the increased difficulty associated with the patients' obesity. We present a study of the mechanics of laparoscopic surgery that explains the difficulty subjectively experienced in terms of the decreased sensitivity felt by the surgeon as a result of the increased thickness of the abdominal wall and increasing force required for the repositioning of the tip of the operating instrument. We propose that the placement and angling of the trocar in the abdominal wall are of paramount importance in the successful and safe completion of laparoscopic procedures in obese patients.

Topics: Abdomen; Elasticity; Humans; Laparoscopes; Laparoscopy; Mathematics; Obesity, Morbid; Postoperative Complications; Radiography, Abdominal; Tomography, X-Ray Computed; Torque