Transcript
Page 1: Weight Management: Overweight, Obesity, & Underweight

Weight Management: Overweight, Obesity, & Underweight

Page 2: Weight Management: Overweight, Obesity, & Underweight
Page 3: Weight Management: Overweight, Obesity, & Underweight

Overweight

Overweight (BMI 25-29.9) and obesity (≥ 30) are widespread health problems that are continuing to increase.

Many refer to overweight and obesity as an epidemic.

For good health, weight management is important.

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Page 5: Weight Management: Overweight, Obesity, & Underweight

Overweight

Fat Cell Development Fat cell numbers

Fat cell numbers increase most rapidly in later childhood and early puberty.

Fat cell numbers increase in times of positive energy balance.

Hyperplastic obesity

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Fig. 9-2, p. 283

During growth, fat cells increase in number.

Hyper-plastic

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

Hypertro-phic

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

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Overweight

Fat Cell Development Fat cell size

Fat cell sizes increase when energy intake exceeds expenditure.

Hypertrophic obesity

The adverse effects of fat in non-adipose tissue are called lipotoxicity.

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Overweight

Fat Cell Metabolism Lipoprotein lipase promotes fat

storage. Gender differences

Men are at increased risk for developing central obesity and women are at increased risk for lower body fat.

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Overweight

Set-Point Theory The body’s natural regulatory centers

maintain homeostasis at set point.

The human body tends to maintain a certain weight.

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Causes of Obesity

Obesity may not be as simple as food intake exceeding metabolic needs.

Some factors, such as overeating and inactivity, are within our control.

Genetic, hormonal and emotional factors may require professional intervention.

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Causes of Obesity Genetics

Leptin (also called the ob protein) Protein that acts as a hormone to

increase energy expenditure and decrease appetite

Produced by fat cells under the direction of the ob gene

May be deficient in obese individuals More research is needed.

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“I'm in shape”.

“Round is a shape”.

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Causes of Obesity

Environment – The gene pool of our population remains relatively unchanged. Overeating

Present and past eating influences current body weight.

Increased availability of convenient food, large portions, and energy-dense foods

Physical Inactivity Modern technology replaces physical activities. Physical activity is important to allow people to eat

enough food to get needed nutrients.

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Buy a lot of McDonald’sfood and get a big, fat

ass, absolutely free.

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Page 18: Weight Management: Overweight, Obesity, & Underweight

Causes of Obesity

Environment – The gene pool of our population remains relatively unchanged. Overeating

Present and past eating influences current body weight.

Increased availability of convenient food, large portions, and energy-dense foods

Physical Inactivity Modern technology replaces physical activities. Physical activity is important to allow people to eat

enough food to get needed nutrients.

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Page 20: Weight Management: Overweight, Obesity, & Underweight

.LAZINESS

IS NOT A HANDICAP.

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Obesity: Risk Factors

Genetics Family history of obesity Psychological factors Social and cultural factors Medical Illnesses Medications Alcohol consumption Smoking Cessation

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Problems with Obesity

Obesity problems depend on many factors such as the extent of overweight, age, health status and genetic makeup.

Risk factors may differ among individuals.

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Makes a point about a topicGive a man a fish and he will eat for a day.

   Teach him how to fish, and

he will sit in a boat and drink beer all day.

Let’s just say you weigh too much and the less said about your future the better

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Problems with Obesity

Health Risks Obese or overweight people with the

following life-threatening-conditions may improve health by losing weight:

Heart disease Type 2 diabetes Sleep apnea

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Problems with Obesity Perceptions and Prejudices

Social Consequences Prejudices and discrimination Judged on appearance rather than character Stereotyped as lazy and lacking self-control

Psychological Problems Feelings of rejection, shame and depression are

common. Ineffective treatments can lead to a sense of

failure.

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Fig. 9-4, p. 289

I am fat and unhappy.

I lose a little weight, but then regain it (and sometimes more).

I want to be happy.

If I lose weight, I will be happy.

I try too hard to reach an unrealistic goal.

Stepped Art

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Problems with Obesity

Dangerous Interventions Fad Diets

False theories Inadequate diets Can be a danger to health

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Treatment Modalities

Diet – (proper “Healthy” nutrition)

Exercise Behavior

therapy/modification/change Pharmacotherapy Surgery

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Treatment Modalities

Diet vs proper nutrition

Exercise Behavior

therapy/modification/change Pharmacotherapy Surgery

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“Dieting” and Dollars Dieting? Today ~40% of women, ~25%

of men Nationwide, 55% trying to maintain

current weight. Approximately 45 million Americans

diet each year. 80% of adult women have dieted $40 billion annually trying to lose

weight or maintain weight. ~1 to 2 billion on weight lose

programs.

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WHO EVER INVENTED DIETS SHOULD BE TAKEN OUT

AND SHOT!

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Types of Weight Loss Diets

Low Carbohydrate aka High Protein

Low Fat aka High Carbohydrate

Very Low Calorie aka Modified Fast

Novelty Diets

Weight Loss Programs

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Why Weight Loss Programs Do Not Work

Negative Impact

Temporary

Perfect- Orientation

Project Mentality

Do not Address Cause

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Consequences of Dieting

Decrease in rate of weight loss

Loss of lean tissue with fat loss

Decrease in metabolism, 10-40%

Decrease in Protein turnover

Preoccupation with food

Increase in irritability, moodiness

Tires easier, less physical activity

Apathy, depression

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Re-feeding after Weight Loss

Increase in pre-dieting food intake

Preference for high fat foods

Regain in weight, but greater increase in % BF

Metabolism slow to return to normal

Regain Weight quicker with each diet

Increase in abdominal fat deposits

Less likely to return to pre-diet physical activity

Decrease in self-efficacy/esteem

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Recognizing an Unsound Diet

Promotes Quick Weight LossLimits Food SelectionTestimonials or Famous People/PlacesExpensive Supplements or ProductsNo Attempt to Permanently change eating or

physical activityCritical of Scientific Community‘ They know more, or something new

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Characteristics of a Sound Diet

Nutritionally adequate yet low in calories

Fit into current lifestyle

Foods that are liked

Slow rate of weight loss

Followed for life

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Predicting Weight Loss

Positive Affirmations

Strong Motivation

Supportive Environment

Appropriate Behaviors

Changes in Body Shape

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Predicting Weight Loss

Positive Affirmations

Self esteem

Self confidence/efficacy

Good attitude

Positive outlook

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Predicting Weight Loss

Strong Motivation

Desire or want

Belief it is possible

Commitment to doing it

Positive attitude

Persistence

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Predicting Weight Loss

Supportive Environment

Family and friends

Support group or

organization

Professional

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Predicting Weight Loss

Appropriate Behaviors

Healthy eating

Exercise that produces

goal

Changing problem

behaviors

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Predicting Weight Loss

Changes in Body Shape

Body Composition changes

Circumference changes

“Looks better”, Cloths fit better,

etc.

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Predicting Weight Loss

Positive Affirmations

Strong Motivation

Supportive Environment

Appropriate Behaviors

Changes in Body Shape

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“ I was going to buy the book “THE POWER OF POSITIVE THINKING” and then I thought what the hell good would that do!”

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Page 49: Weight Management: Overweight, Obesity, & Underweight

Treatment Modalities

Diet – proper “Healthy” nutrition

Exercise Behavior

therapy/modification/change Pharmacotherapy Surgery

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Well keep

looking,

keep looking!

I see no reason why you should not engage in

strenuous activity

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Exercise In response to the question whether

diet plus exercise is more effective than diet alone in causing weight loss, the conclusion of the consensus panel was as follows "---

“in most studies exercise does not significantly increase initial weight loss over and above that obtained with diet only. However, in almost all studies the diet plus exercise group lost somewhat more weight than the diet alone condition."

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THE 100 METER MOSEY

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Exercise

Time minutes

% o

f ca

lori

es e

xpen

ded

100%

FAT

Carbohydrate

0 5 10 20

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Three more, two more, one more, okay!...Five

million leg lifts right leg first! Ready

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Exercise

Two short sessions/day or one long session?

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Exercise

Two short sessions/day or one long session?

Yes!

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Exercise Two short sessions/day or one long session?

Yes!

Mode: Walking, Daily Activity Frequency: 5 - 7 times / week Duration: 40-60 minutes 20-30 minutes X 2 Intensity: Moderately

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“My mother started walking five miles a day when she was 60”. 

“She's 77 now and I have no idea where she is”.

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Treatment Modalities Diet – proper nutrition Exercise Behavior therapy modification/change

Pharmacotherapy Surgery

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To make a long story short, what

ever you are doing…STOP IT!

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Behavior therapyBehavior modification

To lose weight and keep it off, you need to make changes in your lifestyle. But there's more to changing your lifestyle than choosing different foods and putting more activity into your day. It also involves changing your approach to eating and activity, which means changing how you think, feel and act.

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Behavior therapy A behavior modification program can

help make lifestyle changes

Behavior modification programs may include examining current habits to find out what factors or situations may have contributed to excess weight.

Exploring current eating and exercise habits gives a place to start when changing behaviors.

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Behavior therapy First identify those that are a

problem Choose those that you are willing to

change Take responsible for your behavior Have a plan to make better choices Remember the benefit Focus on the positive

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Behavior therapyHave a plan. People do NOT plan to fail,

they simply fail to plan! Work out a strategy that will gradually

change habits and attitudes. Consider how often and how long to

exercise.

Determine a realistic eating plan that includes plenty of water, fruits and vegetables.

Write it down and choose a start date.

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Page 66: Weight Management: Overweight, Obesity, & Underweight

Behavior therapySet realistic goals. Weight-loss goals can be process goals, such

as exercising regularly, or outcome goals, such as losing 20 pounds in four months.

Make sure process goals are realistic, specific and measurable. For example, you'll walk for 30 minutes a day, five days a week.

For outcome goals, aim to lose weight at a safe pace of 0.5 or 2 pounds a week. Losing weight more rapidly means losing water weight or muscle tissue, rather than fat.

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Behavior therapyAvoid food triggers. (Cues) Distract from the desire to eat with

something positive, such as calling a friend, taking a walk, reading a book (not a recipe book).

Practice saying ”No” to unhealthy foods and big portions.

Eat when actually hungry — not when the clock says it's time to eat.

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“This is my relaxation tape– it’s the sound of ocean waves crashing

onto the shore, snatching my teacher’s body

off hisbeach chair and carrying him out to

sea.”

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Page 70: Weight Management: Overweight, Obesity, & Underweight

Treatments of Obesity

Individuals with clinically severe obesity and major medical problems may benefit from drugs or bariatric surgery.

But changing and improving eating and exercise habits offer the greatest benefit.

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Treatment Modalities Diet – proper nutrition Exercise Behavior therapy

modification/change Pharmacotherapy Surgery

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Problems with Obesity Dangerous Interventions

Weight-Loss Products Ephedrine-containing products

inhibit serotonin and suppress the appetite. Supplements containing Ephedra have been banned by the FDA due to potential health risks.

Herbal laxatives do not prevent absorption.

Current laws do not require safety tests and effectiveness tests for these products.

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“To help you lose weight, take one aspirin every day. Take it for a jog, then take it to the gym,

then take it for a bike ride…”

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Treatments of Obesity

Drugs Sibutramine suppresses the appetite

and is most effective when used with a reduced kcalorie diet and increased physical activity. There are many side effects.

Orlistat blocks fat digestion and absorption. There are many side effects including anal leakage.

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Treatment Modalities Diet – proper nutrition Exercise Behavior therapy

modification/change Pharmacotherapy

Surgery

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Treatments of Obesity Surgery

Surgery is an option for those who have tried weight loss programs and failed, have a BMI ≥ 35, and are having health problems due to their weight.

Gastric surgery has short-term and long-term problems and requires compliance with dietary instructions.

Liposuction is a popular procedure that is primarily cosmetic but poses risk.

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Predicting Weight Loss

Positive Affirmations

Strong Motivation

Supportive Environment

Appropriate Behaviors

Changes in Body Shape

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Weight-Loss Strategies A life-long eating plan for good

health, which includes nutritionally adequate eating, reasonable expectations, regular physical activity, and permanent lifestyle changes, is best for achieving permanent weight loss.

Weight loss of 0.5-2 pounds per week or 10% of body weight in six months is safe.

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Weight-Loss Strategies

Eating Plans Be Realistic about Energy Intake

300-500 kcalories/day reduction for BMI between 27 and 35

500-1000 kcalories/day reduction for BMI ≥ 35

Dietary Guidelines should be followed. Diet should be nutritionally adequate

while avoiding excessive consumption. Smaller portions are recommended to

feel satisfied, not stuffed.

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Weight-Loss Strategies

Eating Plans Eat foods of lower energy density, that are

high in fiber, high in water and low in fat. Water is important to increase fullness and

reduce hunger. Complex carbohydrates offer abundant

vitamins, minerals and fiber with little fat. Choose fats sensibly and reduce the

quantity of fat. Watch empty kcalories from sugar and

alcohol.

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Meal Planning

Plan meals throughout the day Eat a variety o Foods (at each

meal) Center Meals around the

carbohydrate foods Minimize the addition of FAT all

the time and sugar at any one time Don’t worry about protein

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Plan Meals thru the Day

Think about what you are going to eat

instead of eating by habit or impulse!

Eat more earlier when more active

Eat less later when less active

i.e. a little often vs. a lot at once

The later you eat, the lighter you eat

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Eat a Variety of Foods(at Each Meal)

Provides more nutrition Each member of the family can

choose what they want at that time Controls eating one food in excess Exposes a person to different foods Makes a better meal

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Center Meals around the Carbohydrate Foods

Answers the question “What am I supposed to eat”? Provides the best source of energy. Provides a lot of most nutrients,

(including fiber) Low in fat, and has the ‘good’ type

and contains no cholesterol. Most have protein, certainly enough. Are not fattening--fats are!

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Page 88: Weight Management: Overweight, Obesity, & Underweight

Minimize FATS and SUGAR

Fats are fattening Fats can lead to other health problems ‘Minimize’ fat intake, don’t eliminate it Sugar in large amounts is a problem Sugar is an enjoyable taste and may

displace foods with more nutrition and be concentrated

Fat and Sugar mix well with each other: the real problem

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Don’t worry about PROTEINS

Important for growth (height) and development

Needed in smaller amount than most people think (.8 grams/kilogram BW)

Can be gotten from a variety of carbohydrate foods as well as the protein foods (meat, dairy)

Use as a part of the meal, not as the meal (eat lean, less and last)

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Weight-Loss Strategies

Physical Activity An individual’s body weight as well as intensity and

duration of activity influence energy expenditure. Physical activity increases the amount of

discretionary kcalories that can be consumed. Metabolic rates can rise with daily vigorous activity. Activity can decrease body fat and increase lean

body mass. Exercise may help to curb appetite. Activity can reduce stress and improve self-esteem.

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Weight-Loss Strategies

Physical Activity • Choosing Activities

Choose activities that you enjoy and are willing to do regularly.

Low to moderate intensity for long duration is recommended.

Daily routines can incorporate energy activities. Spot Reducing

Regular aerobic exercise and weight loss will help trouble spots.

Strength training can improve muscle tone. Stretching can help flexibility.

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Weight-Loss Strategies Behavior and Attitude

Behavior modification requires time and effort. Awareness of behavior is the first key. Changing behaviors one at a time works best.

Do not grocery shop when hungry. Eat slowly. Exercise while watching television.

Personal attitudes toward food and eating must be understood.

Support groups may be helpful for some people.

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Weight-Loss Strategies

Weight Maintenance Successful weight-loss maintenance

programs use different criteria so they are difficult to compare.

Vigorous exercise and careful eating plans are key.

Frequent self-monitoring is recommended. Weekly weight, food diary, exercise journal, circumference measurements

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Weight-Loss Strategies

Prevention Eat regular meals and limit snacking. Drink water in place of high-kcalorie

beverages. Select sensible portion sizes and limit

daily energy intake to energy expended.

Limit sedentary activities and be physically active.

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Underweight Incidences of underweight and

associated health problems are less prevalent than overweight and obesity problems.

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Underweight Problems of Underweight

Causes are diverse. Energy demands may be great and

foods are needed to support growth and physical activities.

Eating disorders are severe cases.

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Underweight Weight-Gain Strategies

Energy-dense foods can be included but choose fat wisely to avoid the associated cardiac risks.

Regular meals each day must become a priority. Use large portions and expect to feel full. Consume extra snacks between meals. Juice and milk are easy ways to increase

kcalories. Exercising to build muscles will support

increases in muscle mass.


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