Weight Management

Chapter 9

Current Trends

• National Institutes of Health• More than 67% of American adults are

overweight• Around 33-34% of American adults are

obese• Obesity has doubled between 1971 and

2006• By 2015, 75% of adults will be overweight,

41% will be obese

Prevalence of Healthy Body Weight

Gender Women 35%Men 32%

Ethnicity White 35%Latino 26%African American 29%

Age 20–39 years 40%40–59 years 31%60+ years 28%

Health status People with disabilities 29%People with diabetes 12%

ALL ADULTS 34%Source: National Center for Health Statistics

Overweight and Obesity• Overweight = characterized by a

body weight that falls above the range associated with minimum mortality; weighing 10% or more over recommended weight or having a BMI over 25

• Obesity = severely overweight, with an excess of body fat; weighing 20% or more over recommended weight or having a BMI over 30

Health Implications of Overweight and Obesity

• 33% rise in type 2 diabetes• 100,000+ premature deaths annually• Obesity is one of the six major

controllable risk factors for heart disease

• Weight loss of 5-10% in obese individuals can reduce the risk of certain diseases

Factors Contributing to Excess Body Fat: Genetic

Factors• Genetic factors influence body size and

shape, body fat distribution, and metabolic rate

• Genetic contribution to obesity is estimated at 25–40%

• Hereditary influences must be balanced against contribution of environmental factors

• Genetics is what can happen, our choices is what does happen!!

PHYSICAL APPEARANCE• We are all products of heredity and environment. What we

get from our parents and what we do with what we get!• Somatotype – Your physical appearance, body build.

• Endomorph – A “pear-shaped” appearance. Short legs and arms, most of body weight centered around hips and abdomen.

• Mesomorph – Solid, muscular, large-boned physique. Most of body weight is away from the abdominal area. Wide shoulders, narrow hips, well-muscled.

• Ectomorph – Slender bodies and a slight build. Very little body fat. Light musculature, long arms and legs. Bony in appearance, narrow chest and hips and generally linear in appearance.

• Most people have some characteristics of each body type, but one will dominate.

Fat Cell Theory

• Proponents of this theory believe that obese people have more fat cells and larger cells than the non-obese.

• Total number of fat cells increase• It is believed that once we produce fat cells, they

remain for life.• Any weight reduction would involve a reduction in

the size of the fat cell.• Evidence seems to suggest that fat cells do reach

a point where they can not get bigger, thus new cells are manufactured.

Physiological Factors• Metabolism – the sum of all the vital

processes by which food energy and nutrients are made available to and used by the body.• Resting Metabolic Rate (RMR) – The energy required to

maintain vital body functions. (heart, lungs, body) Accounts for about 55-75% of the energy used by the body.

• Thermal Effect of Food (TEF) – The energy required to digest food. Accounts for additional 5-15% of daily energy expenditure.

• Effect of Physical Activity – Energy expended during physical activity. Accounts for 20-40% of expended energy.

• This is the component that is the most variable and the one we can do the most about.

Factors That Affect Metabolic Rate

• RMR is higher in• Men• People with more muscle mass• People who exercise

• RMR is lower in• Women• People who are sedentary• People who have lost weight

Energy-Balance Equation

Factors Contributing to Excess Body Fat: Lifestyle

Factors• Eating—compared to the

past, Americans now• Consume more calories• Consume more refined and

simple carbohydrates• Eat out more often

• People underestimate portion sizes

National Geographic, August 2004

Monster Thick Burger

• 1,420 calories• 107 grams of fat• 2 – 1/3 slabs of

beef• 4 strips of bacon• 3 slices of cheese

CHICKEN CAESAR SALAD20 Years Ago Today

390 calories 1 ½ cups

How many calories are in today’s chicken Caesar salad?

CHICKEN CAESAR SALAD20 Years Ago Today

390 calories 1 ½ cups

790 calories3 ½ cups

Calorie Difference: 400 calories

How long will you have to walk the dog in order to burn those extra 400 calories?*  

*Based on 160-pound person

If you walk the dog for 1 hour and 20 minutes, you will burn approximately 400 calories.*

*Based on 160-pound person

Calories In = Calories Out

20 Years Ago Today

CHOCOLATE CHIP COOKIE

55 calories1.5 inch diameter

How many calories are in today’s large cookie?

CHOCOLATE CHIP COOKIE20 Years Ago Today

55 calories 1.5 inch diameter

275 calories3.5 inch diameter

Calorie Difference: 220 calories

How long will you have to wash the car to burn those extra 220 calories?*

*Based on 130-pound person

Maintaining a Healthy Weight is a Balancing ActCalories In = Calories Out

*Based on 160-pound person

If you wash the car for 1 hour and 15 minutes you will burn approximately 220 calories.*

Calories In = Calories Out

Diet and Eating Habits• 1 pound = 3500 calories

• If calorie intake = calorie output, weight remains the same.

• For weight loss, goal should be to lose 0.5 -2 pounds/week

Successful Weight Loss• A successful, long-term weight control program

involves three elements.• Diet – the number of calories consumed should be

reduced, along with the fat content of the diet. Watch portion sizes. Choose complex carbohydrates – fruits, vegetables and whole grains (Nutrient –dense foods) Or those foods which have a lower energy (calorie) density. An apple vs a pie of apple pie.

• Exercise – Goal is to expend 200-400 calories/day with exercise.

• Behavior Modification• Self-monitoring – Keep a food log, recording amounts and

circumstances of eating.• Food triggers – Identify those factors which trigger eating.

Boredom, anxiety, stress, exhaustion.• Develop techniques to control eating. Positive self-talk.

Goals. Stay busy. Plan meals. Control social bingeing.• Reinforce results with rewards.

Physical Activity and Exercise

• Physical activity—increase daily physical activity to at least 30 minutes per day; to lose weight or maintain weight loss, 60–90 or more minutes per day is recommended

• Exercise• Endurance exercise burns calories• Strength training builds muscle mass,

which can increase metabolic rate

National Geographic, August 2004

Diet and Eating Habits• Fat calories—keep total fat intake moderate, and

limit intake of saturated and trans fats• Carbohydrate—emphasize whole grains, vegetables,

fruits, and other high-fiber foods; limit consumption of foods high in refined carbohydrates, added sugars, and easily digestible starch

• Protein—meet recommended intake of 10–35% of total daily calories

• Eating habits—eat meals and snacks on a regular schedule

Doing It Yourself• Physical activity is a critical component of

healthy weight management

Approaches to Overcoming a Weight

Problem• Doing it yourself• Diet books• Dietary supplements and diet aids• Weight-loss programs• Prescription drugs• Surgery• Psychological help

Diet Books• Reject books that

• Advocate unbalanced ways of eating• Claim to be based on a secret• Use gimmicks• Promise quick weight loss • Limit the selection of foods

• Accept books that advocate a balanced diet plus exercise

Popular Diet Plans• Any diet that cuts calories causes weight loss• Low-carbohydrate diets have not been proven safe

over the long-term• Low-fat diets should focus on nutrient dense foods,

especially whole-grains, fruits, and vegetables• Diets with many restrictions have high drop-out rates• People who have been successful at long-term weight

loss track food intake and engage in 60 or more minutes of physical activity per day

Dietary Supplements and Diet Aids

• Dietary supplements are subject to fewer regulations than over-the-counter medications; they have not been proven safe and effective

• FTC: More than half of advertisements for weight-loss products make representations that are likely to be false

Surgery • Surgical intervention may be

recommended for some people who have a BMI of 40 or higher or who are 100 or more pounds overweight

• Gastric bypass surgery modifies the gastrointestinal tract by changing the size of the stomach or how the intestine drains, thereby restricting the amount of food that can be eaten

• Surgery has a high rate of complications

Surgery

Adjustable gastric banding Roux-en-Y gastric bypassSource: National Institutes of Health

Body Image

• Dissatisfaction with weight and shape is common in people with eating disorders

Body Image• Body image = the mental representation

a person holds about her or his body• It consists of perceptions, images,

thoughts, attitudes, and emotions• Media images are linked to negative

body image• Different cultures have different ideas of

the “ideal” body type

Acceptance and Change

• Most Americans are unhappy with some aspect of their appearance

• Recognize the limits of change• Small amounts of weight loss can

significantly reduce health risks

Eating Disorders• Society has created tremendous pressure for

individuals to be thin. • More than two-thirds of women between the ages

of 12 and 23 have felt dissatisfied with their body image and feel pressure to conform to the “ideal” body size and shape.

• Weight reduction, often takes over thoughts and energies. Some feel weight loss makes them more attractive, accepted and successful.

• The pursuit of thinness can result in serious and sometimes life-threatening eating disorders.

Eating Disorders• Anorexia Nervosa – Condition is marked by suppression

of appetite and intentional caloric deprivation or self-starvation. • May have intense fear of becoming overweight and weight loss

does not detensify that fear. • There is a psychological distortion of body image, as the

anorexic sees him/herself as fat, even if extremely underweight.• Weight loss is pursued through extreme limitation of calories,

fasting, strenuous exercise, use of laxatives and diuretics and sometimes self-induced vomiting.

• Disorder sometimes begins at the onset of puberty.• Problems include CV problems, gastrointestinal problems, body

can use organs for protein due to lack of fat, amenorrhea (suppression of menstrual cycle), anemia, calcium loss, brittle bones, swollen joints and light-headedness. Eventually heart failure can occur.

Eating Disorders• Bulimia Nervosa – This is known as the binge-purge

syndrome.• It is marked by high amounts of food/calorie

consumption (1,000-60,000 calories), followed by self-induced vomiting and/or use of laxatives and diuretics.

• Compulsive exercise also may be a characteristic of bulimia.

• Bulimia differs from anorexia in that the individual may maintain a normal body weight due to the binges experienced. This allows the bulimic to hide the problem, making it more difficult to identify.

• Eating disorders are mental disorders and must be treated as such.

• Causes and contributing factors are complex and professional help is necessary.

Eating Disorders• Binge-Eating Disorders – Individuals typically

experience episodes of out of control eating. • Common characteristics include:

• Eating much more rapidly than normal• Eating until uncomfortably full• Eating large quantities of food even when not hungry• Eating alone to hide the quantity of food being ingested• Feeling disgusted, depressed, or guilty after overeating• They do not purge their bodies after eating, thus

different from bulimia.

Who Is At Risk?• Estimated 1 in every 100 teenage girls are anorexic• Anorexia usually occurs in adolescent women (90% of all

reported cases)• Estimated 1 in every 5 college-bound females is bulimic• College campuses have a higher incidence of people with

eating disorders• Upper middle class women who are extremely self-critical

are also more likely to become anorexic• Activities such as dance and dance team, gymnastics, figure

skating, track and cheerleading tend to have higher incidences of eating disorders

• Wrestlers and body builders are also at risk due to unsafe practices to “make weight” before competition.

TREATMENT• Be supportive. Provide information about eating disorders.• Be a good listener.• Encourage professional help. Person may need counseling,

medical treatment or hospitalization.• Be prepared for denial resistance and even hostility.• Realize that the person’s responsibility is his/hers, not yours.

Eating Disorders Therapy/ProgramsISU Counseling CenterISU Health ServicesISU Nutrition Mission

Anorexia Nervosa and Related Eating Disorders, Inc. – www.anred.com