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Weight Management. Chapter. Weight Management. Overweight and Obesity Defined Health Implications of Overweight and Obesity Factors Contributing to Excess Body Fat Adopting a Healthy Lifestyle for Successful Weight Management Physical Activity and Exercise Thoughts and Emotions

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Weight management1
Weight Management

Overweight and Obesity Defined

Health Implications of Overweight and Obesity

Factors Contributing to Excess Body Fat

Adopting a Healthy Lifestyle for Successful Weight Management

Physical Activity and Exercise

Thoughts and Emotions

Approaches to Overcoming a Weight Problem

Body Image

Eating Disorders

Overweight and obesity defined
Overweight and Obesity Defined

About 69% of American adults over the age of 20 are overweight

Too much body fat can have negative effect on health and well-being

Visceral fat: Fat located around the major organs, also called intra-abdominal fat

Subcutaneous fat: Fat located under the skin

Overweight and obesity defined1
Overweight and Obesity Defined

Overweight: Body weight above the recommended range for good health

Obesity: Severely overweight, characterized by an excessive accumulation of body fat; may also be defined in terms of some measure of total body weight

Figure 9 1 obesity prevalence by age and sex of american adults 2009 2010
FIGURE 9.1Obesity prevalence, by age and sex of American adults, 2009–2010

SOURCE: Flegal, K. M., et al. 2012. Prevalence of obesity and trends in the distribution of body mass index among U.S. adults, 1999–2010. Journal of the American Medical Association 307(5): 491–497.

Table 9 1 vital statistics weight of americans age 20 and older 2009 2010
TABLE 9.1Vital Statistics: Weight of Americans Age 20 and Older: 2009–2010

Body mass index
Body Mass Index

Useful for estimating a person’s weight status and for classifying the health risks

BMI based on the concept that weight should be proportional to height

Easy to calculate and rate

Body weight status categorized as underweight, healthy weight, overweight, or obese

Figure 9 2 body mass index bmi
FIGURE 9.2Body mass index (BMI)

SOURCE: Ratings from National Heart, Lung, and Blood Institute. 1998. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. Bethesda, Md.: National Institutes of Health.

Health implications of overweight and obesity
Health Implications of Overweight and Obesity

As overweight and obesity rates rise in the US, prevalence of health conditions associated with overweight rise

82% rise in the prevalence of diagnosed diabetes between 1995 and 2010

Estimated that more than 112,000 premature deaths annually in the US due to inactivity and overweight

Health implications of overweight and obesity1
Health Implications of Overweight and Obesity

Obesity is one of six major controllable risk factors for heart disease

Gaining weight found to be dangerous

Even modest weight loss has positive impact on health

Genetic factors
Genetic Factors

Genes influence body size and shape, fat distribution, metabolic rate, and tendency to gain weight

Tendency to develop obesity may be inherited, but expression of tendency affected by environmental influences

Physiological factors
Physiological Factors

Metabolism a key physiological factor in regulation of body fat and body weight

Hormones also play a role

Metabolism and energy balance

Metabolism is processes by which food energy and nutrients are made available to and used by the body

Energy to maintain vital body functions while body is at rest is RMR

RMR about 65-70% of daily energy expenditure

Physiological factors1
Physiological Factors

Resting metabolic rate (RMR): Energy required (in calories) to maintain vital body functions, including respiration, heart rate, body temperature, and blood pressure, while the body is at rest

RMR dictated by many factors, including genes and behavior

Higher RMR means that a person burns more calories while at rest and can take in more calories without gaining weight

Figure 9 3 the energy balance equation
FIGURE 9.3The energy-balance equation

Physiological factors2
Physiological Factors


Hormones play role in accumulation of body fat, especially for women

Leptin secreted by the body’s fat cells and lets the brain know how big or small the body’s fat stores are

Lifestyle factors
Lifestyle Factors


People underestimate portion sizes

Americans’ average calorie intakehas increased by 18% since 1983

Lifestyle factors1
Lifestyle Factors

Physical activity

On average, Americans exercise 15 minutes and watch 170 minutes of TV and movies each day

Psychosocial factors

Binge eating: A pattern of eating in which normal food consumption is interrupted by episodes of high consumption

Diet and eating habits
Diet and Eating Habits

Total calories

USDA suggests approximate daily energy intakes based on gender, age, and activity level

The best approach for weight loss is to increase physical activity and decrease calorie intake

Portion sizes

Limiting portion sizes critical for weight management

Diet and eating habits1
Diet and Eating Habits

Energy (calorie) density

Energy density: number of calories per ounce or gram of weight in a food

Fresh fruits and vegetables are low in energy density

Eating habits

Eat small, frequent meals

Consume majority of calories during the day

Figure 9 4 high fiber low calorie breakfast cereal
FIGURE 9.4High-fiber, low-calorie breakfast cereal

Table 9 2 examples of foods low in energy density
TABLE 9.2Examples of Foods Low in Energy Density

Physical activity and exercise
Physical Activity and Exercise

Physical activity burns calories and keeps the metabolism geared to use food for energy rather than storing it as fat

All physical activity helps manage weight

Short bouts of activity throughout the day can produce many of the same health benefits as continuous physical activity

People who lose weight and don’t regain it typically burn about 2800 calories per week through exercise

Physical activity
Physical Activity


Start a regular exercise program that includes cardiorespiratory exercise, resistance training, and stretching

Moderate-intensity endurance exercise can burn a significant number of calories

Regular physical activity makes weight management easier

Thoughts and emotions
Thoughts and Emotions

Low self-esteem and negative emotions that accompany it are significant problems

Set realistic goals and engage in positive self-talk and problem solving

Coping strategies

Many people use eating as a way to cope

Analyze eating habits with fresh eyes

Approaches to overcoming a weight problem
Approaches to Overcoming a Weight Problem

Doing it yourself

Focus on adopting a healthy lifestyle

Combine modest cuts in energy intake with exercise, and avoid very-low-calorie diets

Negative energy balance of 250 to 1,000 calories per day will produce weight loss

Maintaining weight loss can be a bigger challenge than losing weight

Diet books
Diet Books

Use books that advocate a balanced approach to diet plus exercise and nutritional advice

Reject any book that:

Advocates an unbalanced diet

Claims to have a “secret” or “scientific breakthrough”

Uses gimmicks

Promises fast weight loss

Diet books1
Diet Books

Many diets cause weight loss if maintained

Difficulty is finding a safe and healthy pattern of food choices and physical activity that result in long-term maintenance of body weight

Dietary supplements and diet aids
Dietary Supplements and Diet Aids

FTC: More than half of advertisements for weight loss products make representations that are likely to be false

Hidden and undisclosed ingredients are becoming problems in weight loss products

Formula drinks and food bars

Herbal supplements

Dietary supplements and diet aids1
Dietary Supplements and Diet Aids

Other supplements

Dietary fiber acts as a bulking agent in the large intestine, not the stomach, so it doesn’t have a pronounced effect on appetite

Popular dietary supplements include conjugated linoleic acid, carnitine, chromium, pyruvate, calcium, B vitamins, chitosan, and a number of products labeled “fat absorbers,”“fat blockers,” or “starch blockers”

Table 9 3 safety and effectiveness of common over the counter weight loss pills
TABLE 9.3Safety and Effectiveness of Common Over-the-Counter Weight-Loss Pills

Weight loss programs
Weight Loss Programs

Noncommercial weight-loss programs

Take Off Pounds Sensibly (TOPS) and Overeaters Anonymous (OA)

These programs provide group support

Commercial weight-loss programs

Typically provide group support, nutrition education, physical activity recommendations, and behavior modification advice

Commercial weight loss programs
Commercial Weight-Loss Programs

A responsible and safe weight-loss program should have the following:

Be safe and balanced

Promote slow, steady weight loss

Offer physician evaluation/monitoring

Clinical weight-loss programs

Usually in hospital or other medical setting

The cost of a clinical program is usually high, but insurance often covers part of the fee

Prescription drugs
Prescription Drugs

Appetite suppressants reduce feelings of hunger or increase feelings of fullness

Most appetite suppressants approved only for short-term use

Sibutramine and orlistat (Xenical) approved for longer-term use

There are side effects

The latest federal guidelines advise trying lifestyle modifications for at least 6 months before trying drug therapy


About 6% of Americans are severely obese, meaning they have a BMI of 40 or higher

Bariatric surgery may be recommended for patients with a BMI greater than 40 or greater than 35 with obesity-related illnesses

Roux-en-Y gastric bypass

Vertical banded gastroplasty (VGB/Lap-Band)

Liposuction involves the removal of small amounts of fat from specific locations

Psychological help
Psychological Help

If concerns about body weight and shape develop into eating disorder, professional help is recommended

Therapists should have experience in weight management, body image issues, eating disorders, addictions, and abuse issues

Body image
Body Image

Body image: Mental representation a person holds about her or his body consisting of perceptions, images, thoughts, attitudes, and emotions about the body

Severe body image problems

Body Dysmorphic Disorder (BDD)

Body image may bear little resemblance to fact

Body image1
Body Image

Acceptance and change

Weight management needs to take place in a positive and realistic atmosphere

Hazards of excessive dieting and over concern about body weight need to be countered by change in attitude

Eating disorders
Eating Disorders

Eating disorder: Serious disturbance in eating patterns or eating-related behavior characterized by a negative body image and concerns about body weight

Eating disorders affect more than ten million American females and one million males

A growing number of people, especially adolescent girls and young women, experience eating disorders

Eating disorders1
Eating Disorders

Anorexia nervosa: Eating disorder characterized by refusal to maintain body weight at a minimally healthy level and intense fear of gaining weight or becoming fat; self-starvation

Eating disorders2
Eating Disorders

Bulimia nervosa: Eating disorder characterized by recurrent episodes of binge eating and purging to prevent weight gain

Purging: The use of vomiting, laxatives, excessive exercise, restrictive dieting, enemas, diuretics, or diet pills to compensate for food that has been eaten and that the person fears will produce weight gain

Eating disorders3
Eating Disorders

Binge-eating disorder: An eating disorder characterized by binge eating and a lack of control over eating behavior in general

Affects 2% of American adults

Characterized by uncontrollable eating without any compensatory purging behaviors

Binge eaters are almost always obese

Eating disorders4
Eating Disorders

Borderline Disordered Eating

Some symptoms of eating disorders but do not meet full diagnostic criteria for eating disorder

Treating eating disorders

Must address problematic eating behaviors and misuse of food to manage emotions

Milder patterns may benefit from nutrition checkup with a registered dietitian