Weight Management: Overweight, Obesity, & Underweight.
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Transcript of Weight Management: Overweight, Obesity, & Underweight.
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.
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
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
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.
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.
Overweight
Set-Point Theory The body’s natural regulatory centers
maintain homeostasis at set point.
The human body tends to maintain a certain weight.
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.
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”.
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.
Buy a lot of McDonald’sfood and get a big, fat
ass, absolutely free.
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.
.LAZINESS
IS NOT A HANDICAP.
Obesity: Risk Factors
Genetics Family history of obesity Psychological factors Social and cultural factors Medical Illnesses Medications Alcohol consumption Smoking Cessation
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.
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
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
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.
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
Problems with Obesity
Dangerous Interventions Fad Diets
False theories Inadequate diets Can be a danger to health
Treatment Modalities
Diet – (proper “Healthy” nutrition)
Exercise Behavior
therapy/modification/change Pharmacotherapy Surgery
Treatment Modalities
Diet vs proper nutrition
Exercise Behavior
therapy/modification/change Pharmacotherapy Surgery
“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!
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
Why Weight Loss Programs Do Not Work
Negative Impact
Temporary
Perfect- Orientation
Project Mentality
Do not Address Cause
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
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
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
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
Predicting Weight Loss
Positive Affirmations
Strong Motivation
Supportive Environment
Appropriate Behaviors
Changes in Body Shape
Predicting Weight Loss
Positive Affirmations
Self esteem
Self confidence/efficacy
Good attitude
Positive outlook
Predicting Weight Loss
Strong Motivation
Desire or want
Belief it is possible
Commitment to doing it
Positive attitude
Persistence
Predicting Weight Loss
Supportive Environment
Family and friends
Support group or
organization
Professional
Predicting Weight Loss
Appropriate Behaviors
Healthy eating
Exercise that produces
goal
Changing problem
behaviors
Predicting Weight Loss
Changes in Body Shape
Body Composition changes
Circumference changes
“Looks better”, Cloths fit better,
etc.
Predicting Weight Loss
Positive Affirmations
Strong Motivation
Supportive Environment
Appropriate Behaviors
Changes in Body Shape
“ I was going to buy the book “THE POWER OF POSITIVE THINKING” and then I thought what the hell good would that do!”
Treatment Modalities
Diet – proper “Healthy” nutrition
Exercise Behavior
therapy/modification/change Pharmacotherapy Surgery
Well keep
looking,
keep looking!
I see no reason why you should not engage in
strenuous activity
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."
THE 100 METER MOSEY
Exercise
Time minutes
% o
f ca
lori
es e
xpen
ded
100%
FAT
Carbohydrate
0 5 10 20
Three more, two more, one more, okay!...Five
million leg lifts right leg first! Ready
Exercise
Two short sessions/day or one long session?
Exercise
Two short sessions/day or one long session?
Yes!
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
“My mother started walking five miles a day when she was 60”.
“She's 77 now and I have no idea where she is”.
Treatment Modalities Diet – proper nutrition Exercise Behavior therapy modification/change
Pharmacotherapy Surgery
To make a long story short, what
ever you are doing…STOP IT!
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.
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.
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
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.
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.
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.
“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.”
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.
Treatment Modalities Diet – proper nutrition Exercise Behavior therapy
modification/change Pharmacotherapy Surgery
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.
“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…”
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.
Treatment Modalities Diet – proper nutrition Exercise Behavior therapy
modification/change Pharmacotherapy
Surgery
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.
Predicting Weight Loss
Positive Affirmations
Strong Motivation
Supportive Environment
Appropriate Behaviors
Changes in Body Shape
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.
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.
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.
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
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
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
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!
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
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)
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.
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.
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.
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
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.
Underweight Incidences of underweight and
associated health problems are less prevalent than overweight and obesity problems.
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.
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.