Chapter 7

Elizabeth Lytle, MPH, BSN, RN Los Altos School District

Managing Your Weight

Learn About Weight Management

Why America’s weight gain

Define Overweight and obese

How To lose weight

UnderstandBody image

Eating disorders

America’s Weight Increase

17% of children

AND68% of adults

Multiple Reasons For Weight Gain

Added calories Bigger portions Fast food Physical inactivity Passive entertainment Genetics

Childhood development Emotional influences Social networks

Marriage and Children

Environment Influences Weight

Social Network

Overweight seek out relationships with others who are overweight

Studies find that when one person becomes obese, friends are more likely to become obese

IncomeThe less money you make, the more likely you are to be overweight

Race Minorities at higher risk for obesity

Body Image Is Influenced By Media

The gap between reality and the media’s portrayal of ‘ideal’ is growing

Women

Overestimate their weight

Less satisfied with body throughout life

Men Underestimate their weight

Defining Overweight And Obese

Category BMI

Overweight 25+

Obese 30+

Class 1 30-34.9

Class 2 35-39.9

Class 3 40+

Body-Mass Index (BMI) is one measure of weight related health related risks

Health risks begin at BMI of 25 and increase as BMI rises

Risk of dying of weight-related problems begins at BMI of 30

How To Gain Weight

Many adolescents and young adults need to gain weight

Add more variety to your foods

Eat more frequently by having small meals

Choose some calorie-rich foods

Drink juice instead of soda

Use a meal replacement as a snack

Exercise regularly

Obesity Kills

The effects of obesity on health are the equivalent of 20 years of aging

Disease

Links

Type 2 diabetes

Cancer

Heart disease and stroke

Emotional Toll

Guilt

Depression

Social Effects

Women less likely to marry, earn less, lower college graduation rate

Health Dangers Of Excess Weight

Hormones Regulate Appetite

LeptinProduced by fat cells

Slows metabolism

Ghrelin

Reduced by exercise

Released before meals

Stimulates appetite

OthersSerotonin produces satiety

Peptides from digestive tract

The Key To Weight Loss Is Simple

Consume Less and Exercise

But, keeping weight off is not simple

Ideas For Keeping Weight Off

Be patient and keep trying

Set a danger zone and act when necessary

Exercise 200-300 minutes each week

Monitor weight and food intake

Weight Loss Diets

High-Carbohydrate, Low Fat

Eat fewer calories without eating less food

Low-Carbohydrate, High-Protein

Eat fewer carbohydrates without eating fewer calories

Modified Carbohydrate

Focus on ‘good carbs’ and resist ‘bad carbs’

More Weight Loss Diets

Low-Calorie

Nothing forbidden, just limit amount eaten

Low-Carbohydrate

Low caloric intake based on proportioning food types

Be willing to try different diets. No one diet works for everyone.

Avoid Diet Traps

Very low-calorie diets

Diet pills• Talk to your doctor first

Diet foods• Often high in sugar

Yo-yo syndrome• On-again, off-again low-calorie dieting• Use exercise to curb weight gain when increasing calories

Recognize And Stop Emotional Eating

Three Steps To Curb Emotional Eating

1. Know your triggers

2.Put your body in charge, not your emotions; avoid getting very hungry, plan your eating

3. Focus on your feelings

Treatment For Severe Obesity

Drug Therapy

Xenical (orlistat)Alli (over the counter orlistat)Meridia (sibutramine)

Surgery

Gastric Bypass• Permanent bypass of stomach• Permanent weight loss common

Banding• Makes stomach size smaller• Adjustable• More likely to regain weight

Unhealthy Eating Behaviors

Extreme Dieting

Preoccupied with food and weight

At risk for anorexia nervosa

Compulsive Eating

Food addiction

Eat fast and eat a lot

Binge Eating

Eat large amount of food in short time

Binge at least twice a week for 6 months

Eat until over-full

Who Is At Risk For Eating Disorders?

Many more types of people are at risk

Athletes Nordic Skiers• Gymnasts Models• Dancers Performers

Factors that increase risk

Preoccupation with thin body

Perfectionism

Excessive cautiousness

Four Risk Factors For Adolescent Girls

Most likely to have an eating disorder if all four factors are present:

1. High BMI

2. Menarche before 6th grade

3. Extreme concern with weight or shape

4. Teasing by peers

Eating Disorder - Anorexia Nervosa

Two Types1. Restricting

2. Binge eating/purging

Features

Refusal to maintain normal body weight

Intense fear of gaining weight

Distorted body image – feeling fat when emaciated

Absence of three menstrual cycles

Eating Disorder - Anorexia Nervosa

Causes

Complex interaction of factors

Personal loss

Perfectionist personality

Effects

Brain changes• Abnormal cortisol, dopamine, serotonin, norepinephrine levels

Menstrual cycle stops

Adolescents do not have normal sexual maturation

Heart irregularities

Eating Disorder - Anorexia Nervosa

Treatment

Medical therapy for re-feeding

Multiple types of therapy

Possibly antidepressant medication

Outcome

Most people can return to normal weight

Return to normal eating behaviors takes a long time

Eating Disorder – Bulimia Nervosa

Two Types

1. Purging

2. Non-purging

Causes

Rigid diet that lasted from several weeks to a year or more

Obesity in adolescence

Recovery from anorexia

Depression

Characteristics Of Bulimia Nervosa

Repeated binge eating

Feeling lack of control over eating

Regular reliance on self-induced vomiting, laxative or diuretics

Strict dieting, fasting, vigorous exercise

Two bingeing episodes/week for at least 3 months

Preoccupation with body shape and weight

Eating Disorder – Bulimia Nervosa

Effects

Damage to teeth and gums

Dehydration

Electrolyte imbalances

Cardiac arrhythmia and death

Treatment Cognitive-behavioral therapy

Outcome

Recovery takes years

May have episodes of normal eating interspersed with bingeing