Weight Management

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 Approaches to Overcoming a Weight Problem Body Image Eating Disorders

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 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 9.1Obesity 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 9.1Vital Statistics: Weight of Americans Age 20 and Older: 2009–2010

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 9.2Body 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 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 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 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 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 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 9.3The energy-balance equation

Physiological Factors Hormones 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 Eating People underestimate portion sizes Americans’ average calorie intakehas increased by 18% since 1983

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 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 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 9.4High-fiber, low-calorie breakfast cereal

TABLE 9.2Examples of Foods Low in Energy Density

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 Exercise 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 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 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 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 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 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 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 9.3Safety and Effectiveness of Common Over-the-Counter Weight-Loss Pills

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 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 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

Surgery 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 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: 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 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 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 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 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 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 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

Weight Management