Obesity BMI between 25.0 and 30.0 falls within the

Obesity
has become a wide epidemic and has the potential to decrease the quality of
life of an individual. Obesity is defined by the Centers for Disease Control and
Prevention (CDC) weight higher than the weight considered healthy for a given
height is considered overweight or obese (2017). Body mass index (BMI) is
derived from the mass and height of an individual. An adult whose BMI between
25.0 and 30.0 falls within the overweight range (CDC, 2017). According to CDC,
statistics more than one-third of U.S. adults are obese (2017). Results from a
mixture of causes and contributing factors, including single factors being
behavior and genetics. Behaviors can incorporate diet, physical activity, and
medication. An extra contribution factor is a society which includes the food
and physical activity conditions, education and skills, and food marketing (CDC,
2017). Individuals who have obesity, compared with those with normal or healthy
weight, are at a higher risk for many serious diseases and health consequences.
Obesity is a concern since it is related to more poor health issues, lessens
the quality of life, and it is main cause of death in the U.S. and worldwide,
including diabetes, heart disease, stroke, and some types of cancer (CDC, 2017).
On the other hand, health consequences include the following: high blood
pressure, type 2 diabetes, coronary heart disease, stroke, gallbladder disease,
osteoarthritis, sleep apnea, respiratory problems, and body pain (CDC, 2017). Moreover,
obesity can have an effect on the musculoskeletal system and limit the range of
motion. Tomlinson et al. (2016) stated obesity is associated with limited
muscle performance and improves the probability of developing disabilities such
as mobility, strength, postural and dynamic balance limitation. Increases
mechanical stress to the muscular-skeletal system through conveying the idle
mass of elevated amounts of fat tissue evident in obesity.

Gait
cycle is the period of time from one heel stroke to the next heel strike of the
same limb. Gait is the analysis of walking or movement in foot patterns. Force
plates gather data in the anterior-posterior direction, the medial-lateral
direction, and the vertical direction, as well as moments about all 3 axes. The
gait cycle has two phases stance and swing phase. The stance phase begins when
the heel of one stroke the ground and ends when the toe of the same leg lifts
off. The swing phase is the period between a toe off on one foot at heel
contact on the same foot. Other variables include stride length, stride rate,
cycle time, cadence, and speed. Stride parameters can also be studied during
gait analysis. Hamil and Knutzen (2009) state stride parameters during gait
involve sequences in which the body is supported by one leg and then the other.

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During
locomotion, stride is the time between two consecutive discrete events. In
contrast, Hamil and Knutzen (2009) define a stride as the interval from one
event on one limb until the same event on the same limb in the following
contact (320). Contemplating stride parameters are one part of how researchers
observe negative changes in gait affecting factors, for example, slower
velocity and cadence; or a decrease in swing phase, and shortening of step
length. Additionally, inquire about in gait analysis has been utilized to
ponder the development designs in obese individuals; and how the loading of
lower extremities and the foot is affected.

Balance
is another component affected by obesity. Hamil and Knutzen (2009) states balance
is the ability of an individual to assume and maintain a stable position is
referred to as balance; and while in a stable or balanced position, an
individual may subject to external forces (439). Balance is associated with the
center of gravity and center of mass since it can refer when particles or mass
are evenly distributed on the body. Hamil and Knutzen (2009) state that if the
center of mass is the point about which the mass is evenly distributed then it
must also be the balancing point of the body (423). Also, the center of
pressure and center of gravity are both identified with balance and are reliant
on the position of the body as for the supporting surface. One way adjust
balanced is important to human movement is keeping control during locomotion. Mignardot
et al. (2013) addresses the principle of balance control is to cancel the
generated torque by continuously readjusting the center of pressure under the center
of mass with an adapted contraction of the triceps surae muscle (1). Taylor and
Francis state that plantar pressure distribution can provide information
pertaining to dynamic loading of the lower limb, as well as information
specific to each region in contact with the ground (1).  For example, elevated plantar pressures have
been linked with foot ulcerations in diabetic patients (Mickle et al. 2006). While
research has been done in this area to contemplate how plantar pressure
provides information about dynamic loading of the lower limb, the effects of
obesity on plantar pressure and center of mass have been examined also.

Despite
the fact that there are studies that research show how obesity affects the
psychological system, different studies are interested in researching how
obesity influences locomotion. In clinical biomechanics, research has been led
on how obesity affects functional movement. Regions of study incorporate gait
and balance. Muller et al. (2016) state that obesity in adults are associated
with changes in gait pattern and loading of the lower extremities, and these
individuals are more likely to suffer from overuse injuries at the lower
extremities than normal-weight persons (2). Overuse injuries could bring about
injuries to soft tissue and joints encompassing the bones. For example, Muller
et al. (2016) include other studies have discovered that some of these injuries
incorporate the midfoot region which is affected the most obese contrasted with
normal weight male and female adults (2). While obesity can cause overuse
injuries in the lower extremities, balance alongside functional movements are
affected also.

Cases
of such results have been found through research, and Hills et al. (2001)
express that persistent loading of the musculoskeletal system of the obese has
been implicated in predisposition to pathological gait patterns, loss of
mobility and subsequent progression of disability, to a range of orthopedic
conditions that include knee osteoarthritis and diabetic foot pathology (1674).
These are just a portion of the outcomes found through a portion of the few
studies on obesity, yet other researchers have difficulty demonstrating similar
findings and conclusive information. A few researchers believe that further
examination should be conducted in order to decide whether obesity has a huge
impact on gait and balance. Regardless of whether adequate information can be
given to help a relationship amongst obesity and functional movement or not,
does obesity directly affects gait and balance.

Studies
have been led on how obesity affects gait and balance. Researchers have
presumed that there is insignificant information assembled from the outcomes to
decide how obesity affects locomotion. Also, researchers believe that different
components play into negative walking patterns in gait and balance. A few
researchers are not persuaded that high levels of body fat in the obese
individuals negatively affect the variables in gait patterns. For instance,
Kerrigan et al. (1995) led a study on measured versus predicted displacement of
the sacrum during gait as a tool to measure biomechanical gait performance in
ten normal volunteers at variable speeds. S.C. Wearing et al. reviews the
biomechanics of restricted movement in adult obesity and compares Kerrigan’s et
al. study to a few studies that hypothesize “movement resulting from greater
limb dimensions have also been predicted to reduce the mechanical efficiency of
walking in the obese, thereby increasing the metabolic cost of the task”
(2006). Nonetheless, Wearing et al. finds that these biomechanical studies of
gait in obese individuals give insignificant information to suggest that such
mechanical changes happen during walking of the fact Kerrigan et al.
demonstrates the vertical displacement of the pelvis was a strong predictor of
oxygen utilization in normal weight individuals (Wearing et al. 2006). Wearing
et al. find that obesity does not influence each part of gait and a few
discoveries are more substantial than others.

Another
part of locomotion Wearing et al. failed to find supporting evidence is a negative
correlation between obesity and balance. They believe there are a few studies
that can give critical data and prompt to conclusive findings. Studies have
been led on how obesity affects the center of pressure and balance, and as
indicated by Wearing et al. this area of study lacks significant findings to
decide whether obesity does have a direct effect. Wearing et al. (2006) states
that in a study including postural balance it was found that there was no distinction
in the area of the location of the center of pressure during bipedal stance in
38 obese and 34 non-obese adults when measured by means of a force platform
(15). In this study, Gravante et al. conduct an investigation on the comparison
of ground reaction forces between obese and young adults during quiet standing
on a baropodometric platform.  Gravante
et al. (2006) suggests that despite obese subjects present with an increase
waist-to-hip circumference ration, the distribution of body fat did not appear
to result in an anterior displace of the center of mass during quiet stance
(15). It is an example of how Wearing et al. claim that researchers can gather
data, however, the data is not significant to obtain a valuable interpretation
of the results.

On
the contrary, a few researchers have found what they believe to be critical
data that demonstrates that obesity has an impact on gait and balance. These
researchers find value in data they acquire from their study and conclude that
the date is critical to give stepping-stones for understanding more about the
issue. Not only do these researchers believe that this information is
significant for understanding the issue better, however they believe the
information can give better insight for improving injury prevention and better
recovery program. In spite of the fact that, very little research has been
directed on the negative impacts of obesity on gait and balance, research in
this area is still growing and getting specific to the different locomotion
issues affected by obesity. For example, Mueller et al. led a study on the
effects of obesity on foot loading characteristics in gait for children between
the ages of one and twelve years of age. Hence Mueller et al. the purpose of
their study was to examine the effect of different body mass and identify characteristics
foot loading patterns in normal-weight, overweight, and obese children on
plantar pressure distribution characters during gait (2016).

Mueller
et al. directed the study on children between the ages of one to twelve years
old. They measured plantar pressure during stance and gathered gait
measurements on an instrumental walkway. Moreover, Mueller et al. calculated
contact area, arch index, peak pressure, and force time integral for the total
right for-mid and hindfoot. After performing the tests, Muller et al.
discovered that the mean walking speed demonstrated no contrasts between
normal-weight, overweight, or obese children. In any case, the outcomes showed
a higher foot contact area, arch index, peak pressure, and force time integral
in overweight and obese children (2016). 
The outcomes in this study demonstrated that different parts of the foot
of normal-weight, overweight, and obese children are affected differently
during gait based on weight. Moreover, the outcomes established that a few
characteristics of foot loading during stance were significant than others. As
indicated by Mueller et al. (2016), the outcomes introduced in this study can
be significant because they express that the presented plantar pressure values
could moreover serve as a reference data to identify abnormal foot loading
patterns in children.

Other
research related to the significance of how obesity affects locomotion is
equipped towards the center of pressure and balance. Researchers have looked
into how the risk of injury and loss of control relates to the center of
pressure and balance in obese individuals. These studies have looked at the
attributes of people who are overweight, obese, and those who are considered of
normal-weight based on body mass index. For instance, Mignardot et al. led a
study comparing the motor control behavior of obese individuals to normal
weight individuals through the examination of a whole body reaching task. In
this task, the subjects were asked to reach an object placed in an outer body
area (2013). Furthermore, Mignardot et al. state they conducted this study
because they wanted to determine whether or not obese patients showed an
alternate spatio-temporal pattern of motor response for performing the whole
body reaching task than the normal weight individuals (2013). Additionally,
they needed to perceive how these would-be factors that would introduce
themselves as falls risk in daily activities.

After
the tests were conducted Mignardot et al. found a significant relationship
between their independent and dependent variables. Mignardot et al. expressed
that the outcomes demonstrated that obesity decreased movement speed, strongly
increased the center of mass displacement and brought an important
spatio-temporal desynchronization of the focal and postural components of the
movement during the transition between the descending and ascending movement
(2013). These outcomes were essential since they figure out what variables may
affect the loss of balance. Be that as it may, Mignardot et al. presume that
extra information would be expected to give more detailed explanations for the
increase in the risk of loss of balance. They contend that additional
characteristics specific to the pathology must be resolved all the more
precisely for future studies (Mignardot et al. 2013). This study alongside
others concludes that while their research presents huge discoveries, more
research is needed to support their theory.

Hardly
any studies have been published on the effects of obesity on gait and balance.
Some researchers believe that studies distributed do not give significant
information to make a solid determination about the connection between the
negative effects of obesity on gait and balance. In the meantime, different
researchers believe differently. They believe the studies do give critical
information and are important for giving data towards future research. Each
study conducts diverse research on how obesity affects balance and gait. The
outcomes assembled from these studies cannot give a reason for each factor
affecting balance and gait in obese individuals. Different factors will always
be needed to be taken into account and can only provide so much information about
the cause and effect.

In
any case, the information gave from the outcomes is critical because it can
give signs for improvement or information for future research. In spite of the
fact that there are few studies on the effects of obesity on locomotion, research
in clinical biomechanics has demonstrated that obesity does have a direct
effect on gait and balance. Besides, these studies provide insight on how fall
risks injuries, damage to soft tissues, and loss of balance control may be related.
For instance, Mickle et al. (2006) did an investigation on the impacts of
excess mass on plantar pressure in young children during gait. Body mass index
and plantar pressure were measured in five male and 12 female pre-school
children who were classified as overweight or obese without any health
disorders. As per Mickle et al. the overweight and obese children showed
altogether larger contact areas and forces than their non-overweight
counterparts for the total foot, heel, midfoot, and forefoot regions when
walking (2006). It is proposed that continued bearing of excess mass as a
result of obesity may cause structural damage to the navicular and cuneiform
bones and place excess strain upon the ligaments that hold the medial
longitudinal arch in place if they are exposed to these increased force-time
integrals throughout their obesity (Mickle et al. 2006).  Mickle et al. (2006) concluded the
discoveries from their studies give additional proof that childhood overweight
and obesity places increased loading on the lower limbs, which may if
accumulated throughout childhood and adulthood, from into musculoskeletal
disorders.

Research
on the effect of obesity on gait and balance has been conducted on adults. The
research in this study has been equipped particularly towards the impacts of
obesity on plantar pressure and balance. In the study, A.P. Hills et al.
conduct research on the plantar pressure differences between obese and normal
weight in adults. The study comprised of thirty-five males and females who were
subjected to complete a protocol used the basic locomotor tasks of standing and
walking. Qualities of the participants were taken into consideration in the
study. A body mass index of greater than or equal to 30 kg/m2 was used to
classify 17 men and 18 women from the group as obese, and none of the
participants presented displayed limitations in locomotion that demonstrated
osteoarthritis (Hills et al. 2001). Pressure distribution was measured under
the feet of obese and normal-weight participants during standing and walking.
Hills et al. (2001) found that mean pressure values of the obese men and women
were higher under all anatomical landmarks during half body weight standing and
walking. Hill et al. interpret higher mean plantar pressure during walking and
a positive correlation in mid-foot peak pressure and BMI in obese adults as
significant values. Also, Hills et al. find the study presents significant
outcomes because the research gives objective information regarding functional
limitation particular to foot mechanics in standing and walking activities
(2001). The study performed with adults alongside with other study performed on
children on how the impacts of obesity on gait and balance can interface issues
related with the lower extremity of the individual. In biomechanics, center of
pressure is the term given to the point of application of the ground reaction
force vector. Examination of the center of pressure is a popular study on human
postural control and gait. During walking the center of pressure is close to
the heel at the time of heelstrike and moves anteriorly throughout the step,
being located near the toe at toe-off center of pressure measurement are
commonly fathered through the use of force plate. As these studies have
indicated obesity does have an impact on balance and stability in an
individual. In any case, more investigation is needed to be conducted to show
more evidence on where gait is affected

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