Weight Management

1. Weight Management Even though some folks may have a preoccupation with body image and weight loss, the statistics showing people that are overweight and obesity in the United States and world-wide continues to rise dramatically. Over the past ten years, obesity has increased here in the U.S. in every state, in both genders, across all ages, races, and all social and economic levels. “Lecture 8: Weight Management PowerPoint" by Dr. Michael Kobre, Achieving the Dream OER Degree Initiative, Tompkins Cortland Community College is licensed under CC BY 4.0

2. Overweight • Surveys show us that approximately half of the adults in the U.S. are now considered overweight, as defined by a Body Mass Index of 25 or greater. The numbers of overweight is especially high among women, the, blacks, and Hispanics and economically depressed.

3. Fat Cell Development • When looking at body composition, amount of Lipid in a person’s body reflects the number and the size of the adipose cells. The number of adipose cells increases most rapidly during the growing years of late childhood and early puberty. This is when we are of greatest risk to become obese and continue to stay obese later in life.

4. Fat Cell Development • Adipose cell number increases more rapidly in obese children than in lean children, and obese children entering their teen years may I some cases already have as many adipose storage cells as do adults of normal weight.

5. Fat Cell Development • With Lipid loss, the size of the adipose cells dwindles, but not their number. People can empty and shrink their adipose(fat) storage cells, but they cannot make those cells disappear. People with extra adipose cells tend to regain lost weight rapidly much more; with weight gain, their many adipose cells readily re-fill causing faster, more efficient weight gain.

6. Fat Cell Development Because of these facts, prevention of the development of obesity is most critical during our youthful growing years when adipose cells develop and multiply more quickly, increasing in numbers. Put simply, the more a child over-consumes, the faster and the more adipose cells develop and stay with the child as they age increasing their chance for developing obesity in later years.

7. Fat Cell Metabolism • The enzyme lipoprotein lipase (LPL) I the body is a molecule that promote fat storage in both adipose and muscle cells. Some people with high LPL activity store lipid especially efficiently. Because LPL is associated with adipose cell membranes and obese people have many fall cells, they generally have much more LPL activity causing them to store more lipid in their cells than lean people.

8. Fat Cell Metabolism • The activity of LPL is also partly controlled by gender-specific hormones estrogen in women and testosterone in men.

9. Fat Cell Metabolism • In women, adipose cells in the breasts, hips, and thighs produce abundant LPL, storing fat more in those body areas. In men, adipose cells in the abdomen produce abundant LPL. This helps explain why men tend to develop central obesity whereas women more readily develop higher levels of lower body fat when compared to men.

10. Fat Cell Metabolism • Differences between men ad women are also apparent in the activity of the enzymes controlling lipid breakdown in various parts of the body. The lower body is less active than the upper body in releasing lipid from storage. Consequently, women tend to have a more difficult time losing fat from the hips and thighs than from around the chest and abdomen.

11. Fat Cell Metabolism • Enzyme activity may also explain why people who lose weight may easily regain it. After weight loss, LPL activity increases. Apparently, weight loss serves as a (low fuel) signal to the gene that produces the LPL enzyme, saying “make more enzyme to refill empty adipose cells”.

12. Fat Cell Metabolism • Folks easily regain weight after having lost it because they are battling against enzymes that want to store fat. If a person has may adipose cells, the battle to lose weight is much harder. • This enzyme activity provides an explanation for the observation that some inner physiological mechanism seems to set a Person's weight or body composition at a fixed point and the body will make adjustments to restore that body composition set point.

13. Set Point Theory • Many internal physiological variables, such as blood glucose, blood PH levels, and body temperature, remain fairly stable under a variety of conditions. The hypothalamus and other regulatory centers in the brain and body constantly monitor and adjust physiological conditions to maintain homeostasis.

14. Set Point Theory • Researchers have confirmed that after weight gains or losses, our body adjusts its metabolism to try and restore our previous weight. Energy expenditure increases after weight gain to limit body mass gains and decreases after weight loss to preserve body mass.

15. Set Point Theory • Changes in energy expenditure differ from what we expected based on body composition and this helps to explain why it is so difficult for an underweight person to maintain weight gains and an overweight person to maintain weight losses.

16. Causes of Obesity • Why is it that some people accumulate excess body fat? • The most likely answer is that they take in more food energy than they spend. But the answer falls short of explaining why this happens. Obesity has many interrelated causes.

17. Genetics • Researchers have observed that adopted children tend to be similar in weight to their biological parents, not to their adoptive parents. Studies also have shown that identical twins are two times more likely to weigh the same as fraternal twins-even when they are reared part from one another. Researchers are currently examining several different genes in search of answers to obesity related issues that affect people.

18. Leptin • Researchers have identified an obesity gene, called the ob gene. This gene is expressed in the adipose cells and codes for the protein Leptin. This protein acts as a hormone, primarily in the hypothalamus. Early research suggested that the protein leptin promotes a negative energy balance by suppressing appetite and increasing energy usage in the body.

19. Leptin • In the research laboratory setting, mice bred with a defective ob gene do not produce leptin and have weight levels up to three times as much as normal mice and have five times more body fat.

20. Leptin • When injected with a synthetic form of leptin, the mice lacking the OB gene rapidly lose body fat. • Leptin issues have been identified in humans as well. An error in the gene that codes for leptin was discovered in two extremely obese children diagnosed with barely detectable blood levels of leptin.

21. Leptin • Without leptin, the two children had little appetite control and were hungry all the time. • Given daily injections of leptin, one of these children lost a substantial amount of weight, helping confirm leptin’s role in regulating appetite and body weight.

22. Leptin • Research has shown that blood levels of leptin usually correlate with the amount of body fat. The more body fat, the more leptin. Obese people generally have high leptin levels and when people with low leptin levels gain weight, their leptin concentrations tend to increase.

23. Leptin • Researchers think that leptin rises in an effort to suppress appetite and inhibit fat storage, but its action is ineffective in obesity. Obesity appears to be associated with some type of insensitivity or resistance to leptin. It is possible that leptin or its receptors on cells are defective or other signals may override lepin’s action in the body of some people.

24. Leptin • Research is suggesting that leptin injections may induce weight loss in obese people. Interestingly, leptin may selectively reduce fat in locations of the body related to central obesity.

25. Environmental Causes of Obesity • Overeating: Conveince and Fast foods are major players in the development of obesity. Fast food is often high in fat, and a high fat diet directly promotes obesity. • Physical Inactivity: Escalators, autos, remote controls, and technology. One example, 100 years ago 30% of the energy used in farm and factory work was human powered. Today, with technology and automation, only around 1% of work is powered by humans.

26. Controversies In Obesity Treatments • It is estimated that at any given time, 30 to 40% of all U.S. people are trying to lose weight and spending upwards of $40 billion each year to try and do so. Very few succeed, and even fewer who try succeed permanently.

27. Elusive Goals • Many folks assume that every overweight person has the ability to achieve slenderness and should pursue that goal. • Less than 5% of all people who successfully lose weight maintain their losses for at least a year. In other words, the failure rate of sustained weight loss is 95%.

28. Elusive Goals • When a person is obese, encouraging weight loss through sensible food choices and regular physical activity may be justified if and when health benefits are recognizable.

29. Elusive Goals • Typically, the effort required reduce weight and make lifestyle changes may be great, but it is far less than the effort and consequences of living with a chronic disease caused by obesity. • Sometimes health benefits appear with even a small weight loss… A 60 year old man (or Woman) might for example gain some pain relief from arthritis of the lower extremities with just 5 lbs of weight loss.

30. Dangers of Weight Loss • People sometimes attach so many dreams of happiness to weight loss that they willingly risk huge sums of money for even the slightest chance of success. As a result, weight loss schemes flourish on the internet, in TV ads and everywhere. • There are tens of thousands of weight loss claims, treatments, and theories. Very few are effective and many can be dangerous or detrimental to health.

31. Dangers of Weight Loss • FAD DIETS: fad diets often sound good, but typically fall short of delivering on their promises. Many Fad diets promote fast and easy weight loss. • Some fad diets are hazardous to health. Adverse reactions can be as minor as headaches, nausea, and dizziness or in some cases as serious as death.

32. Dangers of Weight Loss • WEIGHT CYCLING: Many people who try to lose weight become trapped in weight cycling, the endless repeating rounds of weight loss and regain from “yo-yo” diet cycles. That is, people go on a diet, lose some weight, then go back to over-eating followed by repeated diets When people repeatedly lose weight and regain it over and over our body becomes even more efficient at making and replenishing fat stores we have lost while dieting repeatedly.

33. Yo Yo dieting • This increased weight gain efficiency shows itself in a way familiar to many dieters who have lost and gained-and lost and gained again. With each attempt, it becomes harder and takes longer to lose weight and much easier and quicker to gain it back. In fact previous weight cycling history can predict a person’s success in maintaining weight loss (or lack of).

34. Yo Yo dieting • Fluctuations in body weight appear have been shown to increase the risks of chronic disease and even premature death.

35. Psychological Problems • Some of the nation’s most popular diet and weight-loss programs have misled consumers with unsubstantiated claims and deceptive testimonials.

36. Psychological Problems • Most programs assume that the problem can be solved simply by applying willpower and hard work. If determination were the only factor, the success rate would be far greater than 5%.

37. Psychological Problems • Overweight people may readily assume the blame for their failures to lose weight and maintain the losses when in fact, the weight loss programs or fad diets have failed. Ineffective treatment and its associated sense of failure may add to a person’s psychological burden.

38. Aggressive Treatments of Obesity • When treating obesity, the degree and the risk of the underlying disease should guide which strategies might be most appropriate in weight reduction.

39. Drugs • With our new understandings of obesity’s possible genetic basis and acceptance of its classification as a chronic disease, drug treatment research has gained much ground in recent years.

40. Drugs • The challenge, is to develop an effective drug that can be used over time without adverse side effects or the potential for abuse to help an obese person gain health. • Unfortunately, no such magic drug exists that will treat every obese person.

41. Drugs • Typically, some drug treatments and a good life-style program can help obese people to approximately 10 percent of their initial weight and help to maintain that loss for at least a year. • Because weight regain commonly occurs with the discontinuation of drug therapy, treatment must be long term. Yet, long term use of drugs may poses risks.

42. Drugs • Because the human lifespan is long we don’t yet know whether a person would benefit more from maintaining a 20 pound excess taking drugs or if taking a drug for a decade to keep the 20 pounds off will pose increased side affects that would hinder health more than if the person just maintained the extra weight without the drug’s possible side effects..

43. Other Drugs • Several new drugs are currently under study, including some and block neuropeptide Y and others that stimulate uncoupling proteins. The use of leptin to treat obesity is also promising.

44. OTC Drugs • Phenylpropanolamine containing products such as Acutrin, Dex-A-Diet, Dexatrim, Thin-Z, Unitrol, and others have reported side effects that include: dry mouth, rapid pulse, nervousness, sleeplessness, hypertension, irregular heartbeats, kidney failure, seizures, and strokes.

45. Herbal Products • During their search for weight-loss magic, some folks turn to “natural” herbal products. St. John’s Wort, for example, contains some substances that enhance serotonin and thus suppress appetite. In addition to the many cautions that accompany the use of any herbal remedies, consumer should be aware that St. John’s wort is often prepared in combination with the herbal stimulant ephedrine.

46. Herbals • In some cases ephedrine containing supplements have been implicated in several cases of heart attacks and seizures and have been linked to about three dozen deaths. It is important to keep in mind that there is no magic weight loss formula.

47. Other Gimmicks • Over the years many weight loss gimmicks have been released and sold. These gimmicks and their advertising make big promises but don’t help with weight loss either. If you pay close attention, you can usually catch the company’s disclaimer stating “these results are not typical”. Many people believe we can “speed up” our metabolism using hot baths so that pounds can be lost in hours. Steam baths hot baths and saunas or rubber suits do not melt fat off the body, although they may dehydrate people so that they lose water weight but, not fat.

48. Surgery • Surgery as approach to weight loss may be justified in some very specific cases of clinically severe obesity when a person’s weight is putting their health at extreme risk.

49. Surgery • The long term safety and effectiveness of gastric surgery depend, in large part on compliance with dietary instructions. Common immediate post surgical complications include infections, nausea, vomiting, and dehydration; over the long term, vitamin and mineral deficiencies and psychological problems are common. Lifelong medical supervision is necessary for those who choose surgery

50. Surgery • Another surgical procedure, “liposuction” a cosmetic procedure has little effect on body weight but can alter body shape slightly in specific areas but does nothing to increase a person’s fitness or health levels.