WEIGHT MANAGMENT

Zia Imran 2015 year 1

• Normal Weight:(desirable,healthy,ideal) is a weight which is appropriate for the maintenance of good health for a particular individual at a particular time.

• Over Weight is a weight 10-20% above average i.e;ideal body weight. or BMI > 25.

• Obesity is an excess body fat with weight 20% above average. or BMI >30 .

• Under Weight is weight 10-15% below average. or BMI < 18.5.

• Body Mass Index :BMI is an index of weight

in relation to height, calculated mathematically

by dividing weight in kilograms by the square

of the height in meters.

• E.g.; wt in kg

ht in meters 2

Ideal Body Weight:

“ideal” wt based on height:

Men :106 lbs for the first 5 feet of height and 6 lbs for each additional inch.

Example: height is 5feet 8 inches

The ideal body wt would be about 154lbs

Women :100 lbs for the first 5 feet of height and 5 lbs for each additional inch.

Example: height is 5feet 4 inches

The ideal body weight would be 120 lbs

Waist to Hip Ratio : can give an indication of

risk.

waist measurement (cm)

hip measurement (cm)

A ratio greater than 1.0 in men &

0.8 in women

Indicates risk for certain diseases.

• CAUSES OF OBESITY IN PAKISTAN • In Pakistan obesity level among rural areas is found to be 9% in

males and 14% in women,while in urban ares the obesity level is found to be 22% in males and 37% in females.The higher obesity level in urban area is due to their changing lifestyle,high fat and CHO rich food and lack of exercise.(nov 5 2011 study)

• Increased intake of energy dense food that are high in fats,salts and sugars but less in vitamins,minerals and other micronutrients.

• Decrease activity due to the increasingly sedentary nature of many forms of work.

• Changing modes of transportation

• Increasing urbanization.

ETIOLOGiC FACTORS

Calorie/Energy imbalance: more calories than burned.

1 lb fat =3500 calories.

Eating 500 calories extra per day for 7 days will produce a wt gain of 1 pound.(500 x 7 = 3500)

Eating 1000 calories extra per day for 7 days will produce a wt gain of 2 pound.(1000 x 7 = 7000)

Energy Balance

• ENERGY NUTRIENT VALUES:

The energy nutrients are carbohydrates(CHO),Fats,and Proteins.

A food calorie value is determined by its content of CHO,Fats and Proteins.

1gm CHO--------------4 Kcal

1gm Prot---------------4Kcal

1gm Fats---------------9Kcal

1gm alcohol-----------7 Kcal

• Energy Balance:

• If energy intake exactly equal expenditure ,a person is in energy balance or energy equilibrium state and his/her weight remains stable.

• Positive energy balance: If energy intake exceeds expenditure it is called Positive energy balance. An increase in body energy content means either an increase in lean body mass (growth) or an increase in body fat deposition or both.

• Negative Energy Balance: energy output exceeds intake. Individuals in negative energy balance lose energy and this is reflected in their weight loss.

Expenditure is Greater than Consumption.

Body frame profile:

(apple (intra-abdominal/truncal obesity) verses

pear shaped hips and thighs)

•

Carrying more weight around hips and having a narrower waist puts a person at A lower risk of developing diabetes, heart disease, and other complications of metabolic Syndrome.

Presence of central obesity (intra-abdominal fat)

leads to an increase in the development of obesity because excess fat is converted to LDL(low density lipoprotein{bad cholesterol}) in the liver.

Etiologic Factors(cont)

• Consumption of caloric density foods

Calorie dense food:also called energy dense food,contains high levels of calories per serving.Some of these foods contain “empty calories” in that they provide energy from calories without other significant nutritional value.

E.g; cakes,cookies,candies,cola drinks,some fast foods. Nutrient dense food: contains high levels of nutrients,such as

proteins,CHO,fats,vitamins and minerals. E .g; fresh fruits and vegetables,lean meats are nutrient dense

also.Many cereals like bread oats are aso nutrient dense because hey have been ENRICHED WITH ADDED VITAMINS AND MINERALS.

.

• High calorie density food

If a food is of high energy density, then a little of it provides a lot of energy(calories).e.g high fat foods.

• Low calorie density food :Foods with high water and fiber will have lower calorie density.

• Grapes have fewer calorie density than raisins in a given volume.

• Nutrient Density Of Foods: refers to the concentration of nutrients in a food compared with the foods calorie content.

• If the food is high in calories and low in nutrients, the nutrient density of a food is low.

• If the food is low in calories and high in nutrients, the nutrient density of food is high e.g;cantaloupe (melon) low in calories high in vitamin C.

• Empty Calories means that food contain calories and almost no nutrients e.g. sugar, cola drink.

High nutrient density Low nutrient density Empty calories

Health Consequences of Obesity

• Coronary heart disease.

• Type 2 diabetes.

• Cancers (endometrial, breast, and colon)

• Hypertension (high blood pressure)

• Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)

• Stroke.

• Liver and Gallbladder disease.

• Sleep apnea and respiratory problems.

Goals of weight management

• A more appropriate goal is a modest weight loss of

5-10% of initial body weight or drop of 1 or 2 BMI

units (approx 10-15 lbs below current wt).

• Compared with dramatic wt loss, modest wt loss is

more attainable, easier to maintain over a long

time.

• A more appropriate wt mgt goal for clients unable

to lose wt is to prevent additional wt gain.

Strategies for Weight Loss and Management

• Nutritional therapy

• Increased physical activity

• Behavior therapy

• Surgery

• Combination of these options..

• Nutritional Therapy

• :Decrease calories IN and Increase calories OUT: is the most effective way of achieving weight loss and maintaining a desired weight.

For overwt clients a BMI of 27-35 a decrease of 300-500-calories /d will lead to ½ -1 lb loss/week.

For clients with BMI of >35 a calorie deficit of 500-1000/d will result in 1-2 lb wt loss/week.

How Should the Diet be Modified?

Balanced diet

Low in fat and simple sugars

High in complex CHO and fiber

Moderate protein

Calorie deficit of 500 calories / day.

Avoidance of junk food ,use skim milk, avoid red

meats.

The Diet Therapy is effective when weight loss has

been maintained for a period of at least 2 yrs.

Weight control requires a lifestyle commitment

with education, activity and family support.

• FAD DIETS

• However a fad diet is simply a weight loss diet that becomes very popular (often quickly) and then may fall out of favor (sometimes just as quickly).

• EXAMPLE OF SOME POPULAR FAD DIETS

• 3-day diet

• Cabbage soup die

• Grape fruit diet

• Atkins diet

• South beach diet

• Fad diets can cause health problems Because they often cut out key foods, fad diets may cause

the following symptoms: • Dehydration • Weakness and fatigue • Nausea and headaches • Constipation • Inadequate vitamin and mineral intake. • Fad diets that severely restrict food groups or nutrients

may also mean that a person miss out on the protective health effects that a balanced eating plan provides

• .THE ANSWER IS A BALANCED EATING PLAN.

• Eat plenty of vegetables, legumes and fruits. • Include a variety of cereals (including breads, rice, pasta and noodles),

preferably wholegrain. • Include lean meat, fish, poultry or alternatives. • Include milk, yoghurts, cheeses or alternatives. • Drink plenty of water. • Limit saturated fat and moderate total fat intake. • Choose reduced fat varieties of foods where possible. • Choose foods low in salt. • Limit alcohol intake, if you choose to drink. • Consume only moderate amounts of sugars, and food and drinks

containing added sugars. In particular, limit sugar-sweetened beverages.

• IT'S CALLED A BALANCED EATING PLAN AND IT'S NOTHING NEW. COMBINED WITH MODERATE PHYSICAL ACTIVITY, IT WILL CHANGE LIFE.

Increasing Physical Activity

• It promotes wt loss and preserve or increase lean body

mass.

• Increase metabolic rate

• Reduces abdominal fat

• Increase activity with or without wt loss lowers blood

pressure and triglycerides, increase HDL(good

cholesterol) and improve glucose tolerance.

Recommendations for Increasing Activity:

A variety of aerobic activities are available but walking is the most appropriate physical activity for obese clients.

An initial goal may be to walk 30 min/d for 3 days a week, building to 45 min/d of more intense walking for at least 5 d/week.

“The best exercise is the one that uses the maximum number of large muscles.”

• Behavior Therapy

• Changing your eating and physical activity habits can be difficult at first. But once you've started, it's easy to sustain. Here are a few tips to help ease the transition: Combine an active lifestyle with healthy eating.

• Make small, achievable, lifelong changes to your lifestyle and eating habits.

• Fill up on low-calorie nutritious foods.

• Keep portions moderate in size.

• Eat until you have had enough – not until you are full.

• Do your best to avoid eating when you are not hungry.

• Recognize that on some days you might be hungrier than on other days.

• Eat slowly and enjoy your food.

• Eat regular meals including breakfast, lunch and dinner.

• Reduce the amount of 'extra' or 'sometimes' foods that you eat.

• Examples of 'sometimes' foods include biscuits, cakes, desserts, pastries, soft drinks and high fat snack items such as crisps, pies, pasties, sausage rolls, other takeaway foods, and chocolate.

Medication

Medications used to treat obesity are indicated

for clients who are not able to lose 1lb per

week after 6 months of lifestyle changes.

Side effects include:

dry mouth,anorexia,insomnia,constipation,and

increased diastolic blood pressure.

Medications is contraindicated for clients with

cardiac history, renal or liver dysfunction

,hypertension, pregnancy or who are lactating.

Surgery

GASTRIC STAPLING: a surgical procedure on

the stomach to induce weight loss by reducing

the size of the stomach; also known as

GASTROPLASTY.

• GASTRIC BYPASS: a surgical procedure that

routes food around the stomach.

• Complications of gastric bypass and

gastroplasty:

Nausea,vomitting,bloating,heartburn,staple

disruption,obstruction,dumping syndrome.

UNDERWEIGHT

An underweight person has a BMI of < 18.5 with

subsequent ill effects on health.

Causes: inadequate consumption of nutrients

because of depression,anorexia nervosa,some

disease or infection,poverty.It can also be

caused by excessive activity,wasting of certain

tissues,poor absorption of nutrients.

DANGERS :

It may lower ones resistance to infection and if carry to extreme can cause death.

It can cause complications in pregnancy and various nutritional deficiencies.

• TREATMENT

• Under weight client is treated by a high calorie diet or by a high calorie diet combined with phsycological counselling if the condition is pshycological in origin.

• restore weight to a reasonable level on BMI,height frame and energy requirements.

• Increase the intake of calories

• Increase the intake of high density food.

• Incorporate physical activity to maintain muscle tone, and gain strength.

• Drink fluids and include them as a source of energy

• e.g;milk shakes, juices.

• Supplemental feeding may be required vie the enteral or parenteral route to meet dietary goals.

• For underweight clients

• Gain weight in a healthy manner

Add healthy choices(EG adding nuts cheese as side dishes)

Go nutrient dense(avoide eating lot of empty calories and junk food)

Snack away(eg;enjoy snack that contain plenty of protein and healthy carbohydrates)

Eat mini meals(eat small meals throughout day)

Bulk up(weight lifting and yoga can help in gaining weight by building muscle)

• SAMPLE BREAKFAST MENU for reducing weight

Normal (calories) Reduced(calories)

• Fruit juice –120 Fresh Fruit—60

• Fried Egg—120 Boiled egg—75

• 2 Bread slices—160 1 Bread slice—80

1 cup whole milk—150 1cup skimmed milk90

Total calories 595 309

Difference =290 calories

Instead of

this

kcal Try this kcal Calories

saved

Chicken

qorma(3 oz)

Mutton biryani

(2 cups)

Beef burger

1medium

Paratha 60gms

French

fries(20)

Potato samosa

1

300

680

400

340

250

250

Roast

chicken(3 oz)

Plain

rice(2cups)

Egg sandwich

Chapatti 60g

Boiled potato

1 medium

2 whole wheat

biscuits12g

each)

165

320

240

160

80

80

135

360

160

180

170

170

Quick tips for reducing calorie intake

Thank You