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Chapter 14. Weight management. Introduction. National Institutes of Health 66% of American adults are overweight Including more than 33% of adult men and 35% of adult women are obese. 2015 75% of adults will be overweight and 41% will be obese 2030

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introduction
Introduction
  • National Institutes of Health
    • 66% of American adults are overweight
    • Including more than 33% of adult men and 35% of adult women are obese.
    • 2015
      • 75% of adults will be overweight and 41% will be obese
    • 2030
      • Estimated that the entire American adult population will be overweight or obese

Weight Management

figure 14 1 prevalence of overweight and obesity among american adults age 20 74
Figure 14-1 Prevalence of overweight and obesity among American adults age 20-74

Weight Management

basic concepts of weight management
Basic Concepts of Weight Management
  • 1 pound of fat = 3500 calories
  • Body Composition
    • Fat-free mass or Lean Body Mass
    • Body Fat
      • Subcutaneous fat 3-5% of total fat in men, 8-12% in women
      • Visceral fat-(storage) –Located behind the abdominal wall
        • Depends on many factors:
          • Gender
          • Age
          • Heredity
          • Metabolism
          • Diet
          • Activity level
    • Women: <8% at risk, Average 23%, > 32% at risk
    • Men: < 5% at risk, Average 15%, > 25% at risk

Weight Management

energy balance
Energy Balance
  • Crucial to keep a healthy ratio of fat and lean body mass
    • Energy
    • Consumption and/or expenditure of calories
    • Control over intake of calories
    • Negative energy balance
    • Positive energy balance
    • Neutral energy balance

Weight Management

evaluating body weight and body composition
Evaluating Body Weight and Body Composition
  • Overweight – total body weight above recommended range for good health
  • Obesity – a more serious degree of overweight
  • Height-Weight charts
  • Body Mass Index (BMI)
    • BMI = [Weight / Height in inches (squared)] X 703

Weight Management

assessment of body weight
Assessment of Body Weight
  • National Institutes of Health
    • Under 18.5 is classified underweight
    • Between 18.5 and 24.9 is healthy
    • Greater than 25 is overweight
    • Greater than 30 is obese
    • Under 17.5 is sometimes used as a diagnostic criterion for anorexia nervosa
  • BMI Measurement. Example: 5’3” tall (63 inches), 130 pounds

1. Divide your body weight in pounds by 2.2 to convert the amount to kilograms.

      • 130 / 2.2 = 59.1

2. Multiply height (in inches) by 0.0254 to convert to meters

      • 63 X 0.0254 = 1.6

3. Multiply the result of step 2 by itself to get the square of the height measurement

1.6 X 1.6 = 2.56

4. Divide the result in step 1 by the result in step 3 to determine your value for BMI

      • BMI = 59.1 / 2.56 = 23.0

Alternative equation based on pounds and inches

BMI = [weight / (height X height)] X 703

Weight Management

body composition analysis
Body Composition Analysis
  • Hydrostatic (underwater) weighing and BOD POD
    • Most accurate
  • Skinfold measurements
    • Thickness of fat under the skin
  • Electrical Impedance Analysis
    • Electricity prefers lean tissue
  • Scanning procedures
    • CT scan, MRI, Dual-energy X-ray, Dual-photon absorptiometry, Infrared reactance and total body electrical conductivity

Weight Management

excess body fat and wellness
Excess Body Fat and Wellness
  • The Health Risks of Excess Body Fat
    • Obese individuals have a mortality rate twice that of non-obese
      • Reduces life expectancy by 10-20 years
      • Associated with: Unhealthy cholesterol and triglycerides, impaired heart function, and death from cardiovascular disease
      • Other health factors: hypertension, cancer, impaired immune function, gallbladder and kidney disease, skin problems, impotence, sleep disorder back pain, arthritis
      • Strong association – Type II diabetes

Weight Management

body fat distribution and health
Body Fat Distribution and Health
  • Apple shape
    • Android obesity
    • Upper regions of their bodies
    • Increase risk of high blood pressure, diabetes, early-onset heart disease, stroke, and cancer
  • Pear shape
    • Gynoid obesity
    • Fat storage in the hips, buttocks and thighs
  • Assessed by measuring waist circumference
    • Risk if total waist measurement is more than 40 inches for men and 35 inches for women

Weight Management

body image
Body Image
  • Collective picture of the body as seen through the mind’s eye.
    • Perceptions
    • Images
    • Thoughts
    • Attitudes
    • Emotions

Weight Management

problems associated with very low levels of body fat
Problems Associated with Very Low Levels of Body Fat
  • Less than 8-12% for women and less than 3-5% for men.
  • Extreme has been linked to problems with:
    • Reproductive
    • Circulatory
    • Immune system disorders
  • Female Athlete Triad
    • Abnormal eating patterns
    • Amenorrhea
    • Decreased bone density

Weight Management

factors contributing to excess body fat
Factors Contributing To Excess Body Fat
  • Genetic Factors
    • Nutrigenomics
      • Study of how nutrients and genes interact
    • 25 to 40% of an individual’s body fat
    • 600 genes have been linked to obesity
  • Physiological Factors
    • Metabolism (RMR)
    • Hormones
    • Fat Cells

Weight Management

lifestyle factors
Lifestyle Factors
  • Eating
  • Physical Activity
  • Psychosocial factors
    • Emotions
      • Distraction from difficult feelings
      • Helps regulate emotions
      • Coping strategies
  • Socioeconomic status
  • Family and cultures

Weight Management

adopting a healthy lifestyle for successful weight management
Adopting A Healthy Lifestyle For Successful Weight Management
  • “Normal” body weight
  • Diet and Eating Habits
    • Total Calories
      • MyPyramid suggestions
      • Best approach for weight loss is combining an increase of exercise with moderate calorie restriction
      • Do not go on a crash diet

Weight Management

adopting a healthy lifestyle for successful weight management continued
Adopting A Healthy Lifestyle For Successful Weight Management (Continued)
  • Portion Sizes
  • Energy (calorie) Density
  • Eating Habits
    • Processed foods
    • “Fat-free”
    • Stick to recommendations by:
      • Dietary Guidelines for Americans
      • MyPyramid
      • DASH Diet

Weight Management

physical activity and exercise
Physical Activity and Exercise
  • 30 minutes or more of moderate-intensity physical activity, everyday
    • Walking
    • Gardening
    • Housework
    • Walking 1 mile in 15-20 minutes

Weight Management

thinking and emotions
Thinking and Emotions

What do you think of yourself?

Self-esteem

Negative emotions

“Ideal self”

Beliefs and attitudes you hold

Weight Management

coping strategies
Coping Strategies
  • Adequate and appropriate strategies
  • Healthy lifestyles and proper stress management techniques will naturally and easily result in a reasonable body weight
    • Good nutrition
    • Good communication
    • Adequate exercise
    • Positive thinking and emotions
    • Effective coping strategies and behavior patterns

Weight Management

approaches to overcoming a weight problem
Approaches to Overcoming A Weight Problem
  • Doingit yourself
      • 0.5-2.0 pounds per week
      • Initial weight loss from fluids.
      • Very low calorie diets need to be avoided.
    • Diet Books:
      • Reject books with gimmicks or rotating levels of calories.
      • Accept books that advocate a balanced approach.
    • Diet Supplements and Diet Aids
      • Formula drinks and food bars
      • Herbal supplements
      • Other supplements

Weight Management

weight loss programs
Weight-Loss Programs
  • Noncommercial
    • TOPS (Take Off Pounds Sensibly)
    • OA (Overeaters Anonymous)
      • 12-step program with spiritual orientation
  • Commercial
  • Online
  • Clinical

Weight Management

weight loss programs1
Weight-Loss Programs
  • Prescription Drug
    • Appetite Suppressants
    • Produce a 5-15% weight reduction by controlling appetite.
    • Once drugs are stopped most return to original heavy weight.
    • Good option for very obese who need help getting started - permanent life style change.

Weight Management

surgery
Surgery
  • Severely obese –
    • One in 50 adult Americans has “morbid obesity”
    • NIH recommends gastric bypass for individuals with a BMI of 40 or higher or are 100 pounds or more over recommended weight.
    • Roux-en-Y-gastric bypass
    • Vertical banded gastroplasty (VBG)
    • Lap-Band – variation of VGB
      • Adjustable band
    • Liposuction
  • Weight loss from surgery generally ranges between 40% and 70% of total body weight over a years time.

Weight Management

psychological help
Psychological Help
  • Body Image
    • Severe body image problems
      • Body dysmorphic disorder (BDD)
        • Affects about 2% of Americans
        • Usually before age 18
      • Muscle dysmorphia
    • Knowing when the limits to healthy change have been reached.
    • Knowing the unrealistic cultural ideal.
  • Acceptance and change
    • Knowing what is a healthy lifestyle change

Weight Management

eating disorders
Eating Disorders

Problems with body weight and weight control.

Characterized by severe disturbances in body image, eating patterns, and eating-related behaviors.

Disordered eating affects an estimated 10 million American females and 1 million males.

Weight Management

eating disorders1
Eating Disorders
  • Once central feature – a dissatisfaction with body image and body weight created by distorted thinking.
  • Heredity
    • Over 50% of the risk
  • Turning points in life
    • Coping with stresses in one’s life

Weight Management

eating disorders2
Eating Disorders
  • Anorexia Nervosa- Failure to eat enough food…
  • Affects 3 million people – 95% are female
    • Typically develops between the ages of 12 and 18
  • Characteristics
    • Fear gaining weight.
    • Distorted self-image.
    • Compulsive behaviors and rituals.
    • Excessive exercise
  • Health Risks of Anorexia Nervosa
    • Stop menstruation
    • Intolerant of cold
    • Low blood pressure and heart rate
    • Dry skin
    • Hands and feet may swell and take on a blue tinge
    • Depression and suicide
  • Medical complications
    • Disorders of the cardiovascular, gastrointestinal, endocrine, and skeletal systems

Weight Management

eating disorders3
Eating Disorders
  • Bulimia Nervosa - recurring episodes of binge eating followed by purging.
  • Begins in adolescence or young adulthood
    • Increasingly younger (11-12 years) and older (40-60 years) ages.
  • Characteristics:
    • Rapidly consumes food, then purges.
    • Done in secret.
    • After a binge - feels ashamed, disgusted and physically and emotional drained.
  • Health Risks:
    • Erodes tooth enamel
    • Deficient calorie intake
    • Liver and kidney damage
    • Cardiac arrhythmia
    • Chronic hoarseness
    • Esophageal tearing
    • Rupture of the stomach
    • Menstrual problems
    • Increased depression

Weight Management

eating disorders4
Eating Disorders
  • Binge-Eating - Similar to Bulimia except no Purging behavior.
    • Eating patterns - very rapid, eating until uncomfortably full.
    • Often eat as a way of coping.
    • Likely to be obese.
    • High rates of depression and anxiety

Weight Management

treating eating disorders
Treating Eating Disorders
  • Combination of psychotherapy and medical management
  • Address both eating disorder, misuse of food and manage emotions
    • Anorexia Nervosa
      • Averting a medical crisis
        • Adequate body weight
      • Psychological aspects
    • Bulimia Nervosa
      • Stabilizing the eating patterns
      • Identify and changing the patterns of thinking
      • Improve coping skills
      • 2006, JAMA study found:
        • Topiramate (anti-seizure drug) helped with Bulimia Nervosa
    • Binge-Eating
      • Similar treatment protocol as Bulimia Nervosa

Weight Management