WEIGHT MANAGEMENT

Chapter 7

TEST YOUR KNOWLEDGE

About what percentage of American adults are overweight?a. 15%b. 35%c. 65%

c. About 65% of American adults are overweight including more than 31% who are obese. The rate of obesity among adults has increased more than 75% since 1990

TEST YOUR KNOWLEDGE

People who are overweight get less sleep than people who are at a healthy body weight. True or false?

TRUE. It is unclear whether there is a cause and effect relationship between lack of sleep and increased body weight. But insufficient sleep may affect hormones, metabolism, and appetite. Adequate sleep may also help prevent eating in response to feelings of stress and low energy.

TEST YOUR KNOWLEDGE

Which of the following eating disorder is most common among Americans?a. Anorexiab. Bulimiac. Binge-eating disorder

c. A 2007 study reported that binge eating is more common than either anorexia or bulimia.

Weight management

The goal for wellness is to adopt healthy behaviors and achieve an appropriate body composition, not to conform to rigid standards of total body weight.

Managing body weight is not a mysterious process. The “secret” is balancing calories consumed with calories expended in daily activities.

Successful weight management requires a long term coordination of many aspects of wellness lifestyle, including: proper nutrition, adequate physical activity and stress management.

Health implications of overweight and obesity

One of the major controllable risks factors for heart disease

Increases the risk of cardiovascular disease, hypertension, certain forms of cancer, diabetes, gallbladder disease, respiratory problems, joint diseases, skin problems, impaired immune function and sleep disorders.

Factors contributing to excess body fat

Genetic factors Genes influence body size and shape, body fat distribution, and metabolic rate.

Also affect the ease with which weight is gained as a result of overeating and where on the body extra weight is added.

The tendency to develop obesity may be inherited, but the expression of this tendency is affected by environmental influences.

Factors contributing to excess body fat

Physiological factors Metabolism and energy balance

Resting metabolic rate (RMR) is the energy required to maintain vital body functions while the body is at rest.

RMR accounts for 55 – 75% of daily energy expenditure Energy to digest food 5 – 15 % 20 – 40% expended during physical activity The RMR varies among individuals Exercise has a positive effect on metabolism An energy balance equation is the key to weight

management Hormones

Hormonal changes contribute to the amount and location of body fat.

Leptin, a hormone secreted by body fat cells is carried to the brain and lets it know how big or small are fat stores allowing the brain to regulate appetite and metabolic rate

Hunger is not the primary reason of overeating.

Factors contributing to excess body fat

Lifestyle factors Eating

Many people have eating habits that contribute to weight gain.

Eating out Large food portions Foods high in fat, sugar and calories and low in nutrients

Physical activity Most people drive to work, sit all day, relax in front of a

TV, surf the Internet, play video games rather than bicycle, practice sports or do yard work or chores around the house

60% of the incidence of overweight can be linked to excessive television viewing.

Factors contributing to excess body fat

Psychological factors Many people use food as a means of coping with stress and negative emotions

When eating becomes the primary means of regulating emotions, binge eating or other unhealthy eating patterns can develop.

Obesity is highly associated with socioeconomic status The prevalence of obesity goes down as the income level goes up.

Obesity is also linked to cultural and family values.

Adopting a healthy lifestyle for succesful weight management

Most weight problems are lifestyle problems.

100 years ago diet was very different, and people had to do much more exercise.

Today we eat more calories, fat and refined sugars, and fewer carbohydrates.

We also do far less exercise

Permanent weight loss is not something you can start and stop

Healthy behaviors should be maintained throughout your life. Diet and eating habits Physical activity and exercise Think positively and mange your emotions effectively Find ways to deal with stress and challenges in your

life.

Diet and eating habits

Dieting: Involves some form of food restriction and self deprivation

Diet: Your daily food choices. It is important to develop a diet that you enjoy and that enables you to maintain a healthy body composition. For weight management you may need to pay special

attention to calories, portion sizes, energy density, fat and carbohydrate intake and eating habits.

Total calories

The precise number of calories needed to maintain weight will vary from individual to individual based on heredity, fitness status, level of physical activity and other factors.

Crash diets are not recommended You need to consume enough food

to meet your need for essential nutrients

It is important to adopt a level of food intake that you can live with over the long term.

Portion sizes

Most of us underestimate the amount of food we eat.

Limiting portion sizes is critical for weight management

This is the easiest method of monitoring and managing total food intake.

When eating out, order the smallest-sized items on the menu. Take some home. Share it with a friend.

Energy Density

Foods low in energy density include: Fruits and vegetables Whole grain fruits.

Foods high in energy density include: Meat Ice-cream Potato chips Crackers Low-fat cakes Cookies

Strategies for lowering energy density include Eat fruit with breakfast and for dessert

Add extra vegetables to sandwiches, casseroles, stir-fry dishes, pizza, pasta dishes and fajitas

Start meals with a bowl of broth-based soup, include a green salad or fruit salad.

Snack on fresh fruits and vegetables rather than crackers, chips or other energy-dense snack foods.

Limit serving sizes of energy-dense foods such as butter, mayonnaise, cheese, chocolate, fatty meats, croissants, and snack foods that are fried, high in added sugars or contain trans fats.

Fat calories

Avoid overeating fatty foods, especially those high in saturated and trans fats.

Foods high in unhealthy fats include full-fat dairy products, fatty meats, stick margarine, deep fried foods and other processed foods.

Watch out for processed foods labeled “fat-free” or “reduced-fat” because they may be high in calories

Carbohydrates

Food rich in whole grains and fiber are lower in calorie density, saturated fat and added sugars and may promote feelings of satiety.

Choose a diet rich in complex carbohydrates from whole grains, vegetables, and fruits, and be more moderate in the consumption of starchy vegetables like white potatoes and corn.

Watch out for high-calorie beverages

Protein

Stay within the recommended intake of protein and favor plant sources of protein rather than high-fat animal products.

Eating habits

Eat small, frequent meals (4-5 meals per day)

Include breakfast and snacks on a regular schedule

Skipping meals leads to excessive hunger, feelings of deprivation and increased vulnerability to binge eating or snacking on high-calorie, high-fat or sugary foods.

Establish a regular pattern of eating, and set some rules governing food choices.

Considering some foods as off limits generally sets up a rule to be broken. The better rule is “everything in moderation”

LAB 7,1

Calculate your approximate daily caloric needs

Lab 7,2 optional for those who have as target weight loss or gain

Physical activity and exercise

Physical activity and exercise burn calories and keep the metabolism geared to using food for energy instead of storing it as fat.

Making significant cuts in

food intake is difficult to maintain, increasing your physical activity is a much better strategy

Physical activity

Even a small increase in activity level can help maintain your current weight or help you lose a moderate amount of weight.

Activity Cal/lb/min

Body weight

Min Total Calories

Cycling (13 mph)DancingDiggingDriving a carDoing houseworkPainting a houseShoveling snowSitting quietlySleeping and restingStanding quietlyTyping or writingWalking briskly

0.0710.0490.0620.0200.0290.0340.0520.0090.0080.0120.0130.048

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________________________________________________________________________

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Exercise

Includes cardio-respiratory endurance exercise, resistance training and stretching exercises.

Helps to increase the metabolic rate

Thoughts and emotions

The way you think about yourself and your world influences and is influenced by how you feel and how you act. People with low self-esteem mentally compare the actual self

to an internally held picture of the “ideal self” The more this two pictures differ, the larger the impact on self-

esteem and the more likely the presence of negative emotions.

Self talk Can either be positively motivating or self deprecating. Having realistic believes and goals and engaging in positive self-talk and problem solving is important for a healthy lifestyle.

Coping strategies

Eating Drugs Alcohol Smoking Gambling

Appropriate coping strategies help you deal with the stresses of life.

Attempt to find new coping strategies and begin to use food appropriately.

Approaches to overcoming a weight problem

Doing it yourself Combining modest cuts in

energy intake with exercise and avoiding very low calorie diets

A reasonable weight loss is 8 – 10% of body weight over 6 months

Include strategies than can be maintained over the long term.

Diet books

Reject books that advocate an unbalanced way of eating

Reject books based on a “scientific breakthrough” or that have a “secret to success”

Reject books that use gimmicks like matching eating to blood type, rotating levels of calories, combining foods in a special way to achieve weight loss.

Reject books that promise quick weight loss or that limit the selection of foods.

Accept books that advocate a balanced approach to diet plus exercise and offer sound nutrition advice.

Many diets cause weight loss if maintained, the real difficulty is to find a safe and healthy pattern of food choices and physical activity that results in long-term maintenance of a health.

Dietary Supplements and Diet Aids.

These products typically promise a quick and easy path to weight loss.

More thank half of advertisements for weight-loss products made representations that are likely to be false.

There is no quick and easy way to lose weight.

The most effective approach is to develop healthy diet and exercise habits and to make them a permanent part of your lifestyle.

Formula drinks and food bars Canned diet drinks Powders used to make shakes Diet food bars Snacks

Designed to achieve weight loss by substituting for some or all of the person’s daily food intake.

Use of these products results in rapid short term weight loss, but weight is typically regained because users don’t learn to change their eating and lifestyle behaviors.

Herbal supplements Herbs are considered dietary supplements

and there is little information about its effectiveness, proper dosage, drug interaction and side effects.

Chinese herbal weight loss preparation Toxic herb substituted by another compound

causing kidney damage and cancer among users

Other supplements Fiber: acts as a bulking agent in the large

intestine, not the stomach, so it doesn’t‘ have a pronounced effect on appetite. Some products contain 3 or fewer grams of fiber,

which does not contribute to the recommended daily intake.

Conjugated linoleic acid, carnitine, chromium, pyruvate, calcium, B vitamins, chitosan, “fat blockers”, “starch blockers” Research has not found these products to be

effective and many have potentially adverse side effects.

Weight loss programs Non-commercial weight-loss programs

Support groups TOPS: Take Off Pounds Sensibly OA: Overeaters Anonymous

Do not advocate any particular diet Recommend seeking professional advice OA is a 12 step program with a spiritual orientation

that promotes abstinence from compulsive overeating.

Weight – loss programs Commercial weight loss programs

Weight watchers NutriSystem Jenny Craig L.A. Weight Loss LAIN Slender Quest

Provide group support, nutrition education, physical activity recommendations and behavior modification advice. Some also make available packaged foods.

Weight-loss programs A reasonable weight loss program should have

the following features: Safe and balanced diet Physical activity and exercise strongly encouraged Promote slow, steady weight loss Offer physician evaluation and monitoring Plans for weight maintenance after the weight-loss

phase. Provide information of fees and costs, including

those of supplements and prepackaged foods, as well as data on risks and expected outcomes of participating in the program.

Weight – loss programs Online Weight-loss programs

Many sites offer online self assessment for diet and physical activity habits, as well as a meal plan

Provides an alternative to in person diet counseling and can lead to weight loss for some people

Weight – loss programs Clinical weight – loss programs

Designed to help those who are severely obese These programs typically involve a closely

monitored very low calorie diet.

Prescription drugs Appetite suppressants usually work by increasing levels of

catecholamine or serotonin, two brain chemicals that affect mood and appetite.

Other drugs work lowering the calorie consumption by blocking fat absorption in the intestines. They might also reduce the absorption of fat soluble vitamins and antioxidants.

Potential side effects include Sleepiness Nervousness Euphoria Increased blood pressure and heart rate Headaches Constipation or diarrhea Dry mouth Insomnia.

Should only be used for short term periods

Surgery Gastric bypass surgery

Severe obesity is a serious medical condition often complicated by other health problems such as diabetes, sleep disorders, heart disease and arthritis.

Gastric bypass surgery may be recommended for people with a BMI greater than 40

Gastric bypass surgery modifies the gastrointestinal tract by changing either the size of the stomach or the way the intestine drains.

Roux en Y gastric bypass Vertical banded gastroplasty

Liposuction Involves the removal of small amounts of fat

from specific locations It is not a method for treating obesity.

Psychological help

When concern about body weight and shape have developed into an eating disorder, professional help is recommended.

Body Image

The perceptions, images, thoughts, attitudes and emotions as seen through the minds eye.

Body image problems Those who have a negative body image

are more likely to diet restrictively, eat compulsively or develop some other form of disordered eating.

BDD: Body Dimorphic Disorder Sufferers are overly concerned with physical

appearance Spend hours everyday thinking concerned with

physical appearance Often focus on what they perceive to be slight

“flaws” of the face or head Can lead to depression, social phobia and suicide

Muscle dismorphia Disorder experienced by some

bodybuilders in which they see themselves as small and out of shape despite being very muscular

Let bodybuilding interfere with their work and relationships

May use steroids and other potentially dangerous drugs

Eating disorders Characterized by severe disturbances

in eating patterns and eating related behavior Anorexia nervosa Bulimia nervosa Binge-eating disorder

One feature in common: Dissatisfaction with body image and body

weight Created by distorted thinking, including

perfectionist beliefs, unreasonable demands for self control and excessive self criticism.

Anorexia nervosa A person with anorexia does not eat enough

food to maintain a reasonable body weight. Typically develops between 12 and 18 years. People with anorexia have an intense fear of

gaining weight or becoming fat Many engage in compulsive behaviors or

rituals that help them keep from eating Commonly use vigorous and prolonged

physical activity to reduce body weight Are typically introverted, emotionally

reserved and socially insecure. Women with anorexia often stop

mestruating

Bulimia nervosa Implies binge eating followed by purging During a binge, a bulimic person may consume anywhere

from 1000 to 60.000 calories within few hours, followed by an attempt to get rid of the food by purging, usually vomiting or using laxatives or diuretics.

Health effects include tooth decay, esophageal damage and chronic hoarseness, menstruation irregularities, depression, liver and kidney damage and cardiac arrhythmia.

Binge-eating disorder Involves uncontrollable eating

without any compensatory purging behaviors.

Eating more rapidly than normal Eating until uncomfortably full Eating when not hungry Preferring to eat alone. Compulsive overeaters rarely

eat because of hunger. Instead they use food to cope with stress, conflict and other difficult emotions or to provide solace or entertainment.

Acceptance and change

There are limits to the changes that can be made to body weight and body shape, both of which are influenced by heredity

The hazards of excessive dieting and over-concern about body weight need to be countered by a change in attitude.

Creating an individual weight management plan

Assess your motivation and commitment Think about the reasons you want to lose weight Your reasons should be self focused.

Set reasonable goals Assess your current energy balance

Create a negative energy balance Increase your level of physical activity

Its usually best to exercise more rather than eat less. Make changes in your diet and eating habits

Make small changes in your diet that you can maintain for a lifetime. Put your plan into action

Write a journal Get other’s help Think positively

Lab 7.3

Checking for body image problems and eating

disorders