Download - Weight Management: Overweight, Obesity, and Underweight Chapter 9

Weight Management: Weight Management: Overweight, Obesity, Overweight, Obesity,

and Underweightand UnderweightChapter 9

Overweight and ObesityOverweight and Obesity

Major health problem in the U.S. 66% of Adults 33% of Children Growing concern worldwide

Prevalence especially high amongwomen, poor, blacks, and Hispanics

BMI of 25 or greater Epidemic is worldwide

Not merely among industrialized countries

Overweight and ObesityOverweight and Obesity

BMI > 25

1993: Most states had prevalence rates lessthan 15 percent, with a couple reporting ratesless than 10 percent; no state had prevalencerates greater than or equal to 20 percent.

<10%10%–14%15%–19%

Key:

No Data 20%–24%25%–29%≥ 30%

BMI > 25

<10%10%–14%15%–19%

Key:

20%–24%25%–29%≥ 30%

No Data

1998: Most states had prevalence rates lessthan 20 percent, with none reporting rates lessthan 10 percent; seven states had prevalencerates greater than or equal to 20 percent.

BMI > 25

<10%10%–14%15%–19%

Key:

20%–24%25%–29%≥ 30%

No Data

2003: More than half the states hadprevalence rates greater than 20 percent,with four states reporting prevalence ratesgreater than or equal to 25 percent.

BMI > 25

<10%10%–14%15%–19%

Key:20%–24%25%–29%≥ 30%

No Data

2008: Only one state had prevalence ratesless than 20 percent; more than half the stateshad prevalence rates greater than 25 percent,with six states reporting prevalence ratesgreater than or equal to 30 percent.

BMI > 25

Fat Cell DevelopmentFat Cell Development

Energy in exceeds energy out Body fat stored in cells of adipose tissue Number and size of fat cells

Late childhood/early puberty fat cell numbers increase

Fat deposited in organs- inflammation, insulin resistance

Energy out exceeds energy in Fat cell size decreases; no change in

number

Energy in > Energy out

During growth, fat cells increase in number.

When energy intake exceeds expenditure, fat cells increase in size.

When fat cells have enlarged and energy intake continues to exceed energy expenditure, fat cells increase in number again.

With fat loss, the size of the fat cells shrinks but not the number.

Stepped Art

Fat Cell DevelopmentFat Cell Development

Fat Cell MetabolismFat Cell Metabolism

Lipoprotein lipase (LPL) stores triglycerides LPL activity in obese > than lean people Men- abdomen Women- breasts, hips, thighs

Hormone-sensitive lipase (HSL) releases and breaks down triglycerides

Weight regain: After wt. loss, LPL production increases. Fat oxidation is less efficient than fat storage.

Causes of Overweight & Causes of Overweight & Obesity – Genetics & Obesity – Genetics &

EpigeneticsEpigenetics Causative role of genetics

Genetic influences do seem to be involved Genetics may determine predisposition to

obesity Genes interact with:

Diet and physical activitySatiety and energy balance

Human genome


EpigeneticsEpigenetics Obesity gene

Codes for the protein leptinActs as a hormone in hypothalamusPromotes negative energy balanceSuppresses appetite Increases energy expenditure

Locations of leptin secretion

With leptin treatment, this mouse lost a significant amount of weight but still weighs almost one and a half times as much as a normal mouse.

Without leptin, this mouse weighs almost three times as much as a normal mouse.


EpigeneticsEpigenetics Obesity gene that codes for leptin- protein

that suppresses appetite Genetic deficiency of leptin or genetic

mutation- rare in obese people Leptin resistance

Leptin rises with BMI, declines with dieting Roles in the body

Energy regulation Immune system, RBC’s, female fat reserves


EpigeneticsEpigenetics Adiponectin

Secreted by adipose tissue Inverse correlation with body fat Inhibits insulin resistance, inflammation, CHD

Ghrelin Acts in hypothalamus, secreted by stomach Promotes positive energy balance Inverse correlation with body weight


EpigeneticsEpigenetics PYY

GI cells secrete in proportion to kcalories consumed

Signals satiety and decreases food intake Ideal diet

Maintain satiating hormones-leptin, PYY, CCK Minimize appetite stimulating hormone ghrelin Low in fat and rich in fiber

Proteins Regulating Appetite and Proteins Regulating Appetite and EnergyEnergy


EpigeneticsEpigenetics Uncoupling proteins

Proteins involved in energy metabolism Two types of fat

White adipose tissueBrown adipose tissue

Uncoupling proteins found in both types of fat Influence basal metabolic rate (BMR)

Causes of Overweight & Causes of Overweight & Obesity – EnvironmentObesity – Environment

Encountered daily circumstances Interaction between environment and

genetics Overeating

Present and past eating and activity patterns influence current body weight

Availability Serving sizes

Restaurant food

Selecting grapes with their high water content instead of raisins increases the volume and cuts the energy intake in half.

Even at the same weight and similar serving sizes, the fiber-rich broccoli delivers twice the fiber of the potatoes for about one-fourth the energy.

By selecting the water-packed tuna (on the right) instead of the oil-packed tuna (on the left), a person can enjoy the same amount for fewer kcalories.

Causes of Overweight & Causes of Overweight & Obesity – EnvironmentObesity – Environment

Physical inactivity Life requires little exertion

Modern technology Inactivity contributes to weight gain and poor

healthSedentary activities and weight gain

DRI for prevention of weight gain60 minutes of moderate activity every day

Problems of Overweight and Problems of Overweight and Obesity – Health RisksObesity – Health Risks

Three indicators BMI Waist circumference Disease risk profile

Factors taken into account

Beneficial weight loss Health status Motivation

Problems of Overweight and Problems of Overweight and Obesity – Health RisksObesity – Health Risks

Overweight but in good health motivation for weight loss

Obese or overweight with risk factors Two or more risk factors

Obese or overweight with life-threatening condition Recommendation to lose weight

Problems of Overweight and Problems of Overweight and Obesity – Perceptions & Obesity – Perceptions &

PrejudicesPrejudices Most obese people do not successfully lose

weight and maintain the loss Social consequences

Jobs, school, and in social situations Psychological problems

Embarrassment Other feelings

Fig. 9-6, p. 285

Problems of Overweight and Problems of Overweight and Obesity – Weight CyclingObesity – Weight Cycling

Problems of Overweight and Problems of Overweight and Obesity – Popular InterventionsObesity – Popular Interventions

Diet books and weight-loss programs Limited success with weight loss maintenance

Fad diets- cabbage soup, shakes only Weight-loss products

Meal replacements Herbal products No regulations for dietary supplements

Liposuction

Drug Treatments for ObesityDrug Treatments for Obesity

Strategies for weight reduction depend on: Degree of obesity Risk of disease

Use drugs as part of long-term comprehensive weight-loss programs Assist with modest weight loss

Four drugs approved by FDA for obesity

Drug Treatments for ObesityDrug Treatments for Obesity

Sibutramine Suppresses appetite Side effects- dry mouth, rapid heart rate, etc Warning from FDA

Orlistat Inhibits pancreatic lipase activity in GI tract

Blocks dietary fat digestion and absorption Side effects- gas, frequent BM’s, decreased

absorption of fat-sol. vitamins

Drug Treatments for ObesityDrug Treatments for Obesity Phentermine and diethylpropion

Enhance release of neurotransmitter norepinephrine Mood high, appetite low

Side effects- hyperactivity, insomnia Off-label use, “Stacking” Sudafed (pseudoephedrine) Claritin Benadryl

Diet Pills for sale onlineDiet Pills for sale online

http://www.webmd.com/diet/guide/herbal-remedies

http://www.thedietadvisors.com/adipozin.html

http://www.weightlossdietpills.com/?gclid=CJSlwpaCs6cCFQcBbAodkThW_w





How Appetite Suppressants How Appetite Suppressants Cause Weight LossCause Weight Loss

They are STIMULANTS (caffeine, ephedra, phentermine, chemicals that act like cocaine)

Appetite suppressants promote weight loss by tricking the body into believing that it is not hungry or that stomach is full.

They decrease appetite by increasing serotonin or catecholamine -- two brain chemicals that affect mood and appetite.

Prescription Weight Loss Prescription Weight Loss Drugs/Surgery IndicationsDrugs/Surgery Indications

An option for the following individuals: People with a body mass index(BMI) of 30

and above with no obesity-related conditions.

A person with a BMI of 27 and above with obesity-related conditions, such as diabetes or high blood pressure.

http://www.webmd.com/diet/weight-loss-surgery/news/20110217/fda-oks-lap-band-surgery-for-more-patients




Surgical Treatments for Surgical Treatments for ObesityObesity

http://www.lapband.com/en/home/ http://www.webmd.com/diet/weight-loss-surger

y/news/20110217/fda-oks-lap-band-surgery-for-more-patients

Clinically severe obesity 200,000 surgeries performed each year Reduces food capacity of stomach Reduce production of ghrelin Health-related benefits Long-term safety and effectiveness

http://www.lapband.com/en/home/




Surgical Treatments for Surgical Treatments for ObesityObesity

Esophagus Surgical staples

Small stomach pouch

Stomach

Esophagus

Duodenum Gastric band

Jejunum

Stomach Port

Large intestine

In gastric bypass, the surgeon constructs a small stomach pouch and creates an outlet directly to the small intestine, bypassing most of the stomach, the entire duodenum, and some of the jejunum. (Dark areas highlight the flow of food through the GI tract; pale areas indicate bypassed sections.)

In gastric banding, the surgeon uses a gastric band to reduce the opening from the esophagus to the stomach. The size of the opening can be adjusted by inflating or deflating the band by way of a port placed in the abdomen just beneath the skin.

Small stomach pouch

Weight Loss StrategiesWeight Loss Strategies

Successful strategies Find individual rate of change Moderate losses Reasonable short-term / long-term goal weight Reasonable rate of weight loss

Benefits of modest weight loss Incorporate healthy eating and exercise

Weight Loss StrategiesWeight Loss Strategies

Weight Loss Strategies – Weight Loss Strategies – Eating PlansEating Plans

Be realistic about energy intake Must provide less energy than is needed

Avoid restrictive eatingAvoid rapid weight loss

Goal: nutritional adequacy without excessDeficit of 500 to 1000 kcalories per day

Breakfast frequency Inversely related to obesity

Weight Loss Strategies Weight Loss Strategies Eating Plans Eating Plans

Nutritional adequacy minimum ~1200 kcal/d Eat small portions

Eat less food at each meal Feel satisfied, not stuffed Structured meal replacement plans

Lower energy density Mind control

http://www.webmd.com/diet/default.htm

http://www.webmd.com/diet/default.htm


Remember water Assistance with weight management

Focus on fiber Low in energy and high in nutrients Require effort to eat

Speed of food consumption

Choose fats sensibly Energy density and satiation

Food Choices Slideshow Food Choices Slideshow http://www.webmd.com/diet/slideshow-fat-fi

ghting-foods

http://www.webmd.com/diet/slideshow-fat-fighting-foods

http://www.webmd.com/diet/slideshow-fat-fighting-foods


Volumetrics Select carbohydrates carefully

Artificial sweeteners Impact on energy intake

Watch for empty/hidden kcalories Fat, sugar, and alcohol

Weight Loss Strategies Weight Loss Strategies Physical ActivityPhysical Activity

Necessary for weight management Moderate physical activity plus activities of

daily life Combination of diet and physical activity

Lose more fat Retain more muscle Regain less weight

Reduction of abdominal fat


kCalorie expenditure Body weight, intensity, and duration

Greater the energy deficit, greater the fat loss

Discretionary kcalorie allowance (reward) Metabolism

Speeds up with activity Immediate and long-term benefits

Weight Loss Strategies – Weight Loss Strategies – Physical ActivityPhysical Activity

Energy allowance to maintain weight

Discretionary kcalorie allowance

Energy intake to meet nutrient needs

Sedentary person Active person

kCal

ori

es

2500

2000

1500

1000

500

0


Body composition Fat decreases, esp. abdominal fat Lean body mass increases Strength-training exercises

Appetite control Delayed appetite from released stored fuel Exercise curbs appetite from boredom,

anxiety, depression


Psychological benefits Self-esteem

Choosing activities Ones you enjoy & are willing to do regularly Convenience Energy-expending daily activities

Spot reducing vs. strength training

Weight Loss Strategies– Weight Loss Strategies– Environmental Influences Environmental Influences

Factors surrounding eating experience and the food itself

Atmosphere Pleasant and comfortable equals more food

Accessibility Less effort needed to obtain food, more food

eaten

Weight Loss Strategies – Weight Loss Strategies – Environmental Influences Environmental Influences

Socializing Duration of meal Visual cues Distraction

Distractions Initiating eating Interfering with internal controls Extending duration of eating

Weight Loss Strategies – Weight Loss Strategies – Environmental Influences Environmental Influences

Presence Sight, smell, or thought of food can prompt

eating Multiple choice

Large assortments of foods increase consumption

Package and portion sizes Serving containers

Weight Loss Strategies – Weight Loss Strategies – Behavior & AttitudeBehavior & Attitude

Behavior modification Positive, matter-of-fact attitude

Become aware of behaviors Keep record

Change behaviors Set small, specific goals Practice, make new habits Reward

Eating not for HungerEating not for Hunger

See Emotional Eating Handouts Internet full of tips

Weight Loss Strategies – Weight Loss Strategies – Behavior & AttitudeBehavior & Attitude

Cognitive skills Problem solving Cognitive restructuring

Replace negative thoughts

Personal attitude Understand personal relationship with food Sound emotional health

Support groups- WW, TOPS, OA

Weight Loss Strategies – Weight Loss Strategies – Weight MaintenanceWeight Maintenance

Successful weight loss Plateau

Appropriate goal at this point

Prevalence of successful weight loss Difficult to determine

Weight loss Without formal program Maintained for at least a year

Weight Loss Strategies – Weight Loss Strategies – Weight MaintenanceWeight Maintenance

Components of successful weight loss Vigorous exercise regimens Careful eating patterns Frequent self-monitoring

Changes in metabolism Takes more to prevent weight regain than to

prevent weight gain

Preventing Weight Preventing Weight Gain/RegainGain/Regain

Strategies are similar to losing weight Read labels Watch portion size Change your grocery list Eat out less Ask yourself, “Am I hungry?” Exercise daily: Walk/bike more. Drive less.

Plant a garden.

Public Health ProgramsPublic Health Programs

Possibly change food environment through public health law

Stretch beyond individual Social networks Community institutions Government policies

Public Health ProgramsPublic Health Programs

UnderweightUnderweight

Affects no more than 5% of U.S. adults Weight gain is a matter of health

Individual matter Weight gain may be difficult

Physical conditioning combined with high energy intakes

Problems of UnderweightProblems of Underweight

Demand for energy contributes to underweight Physical activity Growth and development

Difficult to gain weight Adaptive thermogenesis

Learn new habits and like new foods Underweight vs. anorexia nervosa

Weight-Gain StrategiesWeight-Gain Strategies

Key diet planning strategies Adequacy and balance

Energy-dense foods Regular meals daily Large portions Extra snacks Juice and milk

Exercise

Highlight 9Highlight 9

The Latest and Greatest Weight-Loss Diet – Again

Fad DietsFad Diets

Outrageous claims No requirements to prove the claims Do not have to support with credible

researchDistorted research

Numerous fad diet plans

Fad Diets’ AppealFad Diets’ Appeal

Market for weight-loss products is huge Greatest appeal

Tend to ignore dietary recommendations Sophisticated and often erroneous

explanations Too much rat data Tend to work for short time

Fail to produce long-lasting results

““Don’t Count Calories?!”Don’t Count Calories?!”

Claim to disregard kcalories Designed to have low energy intake

Tend to lack varietyMonotonous

Often recommend dietary supplement Follow a plan Most fad diets cannot support optimal health

over time

Dieting vs. Living HealthyDieting vs. Living Healthy

Fad diet “magical powers” Tipping the energy balance equation to

greater energy expenditure Weight loss

Long-term lifestyle changes Healthy plan

Flexibility and variety

Download - Weight Management: Overweight, Obesity, and Underweight Chapter 9

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