Weight Management: Overweight, Obesity, and Underweight

1. Weight Management: Overweight, Obesity, and Underweight Chapter 9

2. Overweight and Obesity • Major health problem in the U.S. • Prevalence continues to increase • Defined by BMI of 25 or greater • Epidemic is worldwide

3. Fat Cell Development • Energy in exceeds energy out • Stored in fat cells of adipose tissue • Body fat • Number and size of fat cells • Energy out exceeds energy in • Fat cell size decreases; no change in number

4. Fat Cell Metabolism • Lipoprotein lipase (LPL) activity • Storage of triglycerides • Obese people vs. lean people • Activity in varying body regions • Enzyme activity releasing and breaking down fat • Fat oxidation is not efficient

5. Causes of Overweight & Obesity – Genetics & Epigenetics • Causative role of genetics • Genetic influences do seem to be involved • Genetics may determine predisposition to obesity • Human genome • Obesity gene • Codes for the protein leptin • Locations of leptin secretion

6. Causes of Overweight & Obesity – Genetics & Epigenetics • Obesity gene • Genetic deficiency of leptin or genetic mutation • Leptin resistance • Roles in the body • Energy regulation • Others

7. Causes of Overweight & Obesity – Genetics & Epigenetics • Adiponectin • Secreted by adipose tissue • Inverse correlation with body fat • Benefits • Ghrelin • Promotes positive energy balance • Inverse correlation with body weight • Roles in the body beyond energy regulation

8. Causes of Overweight & Obesity – Genetics & Epigenetics • PYY • GI cells secrete in proportion to kcalories consumed • Signals satiety and decreases food intake • Ideal diet • Maintain satiating hormones • Minimize appetite stimulating hormones • Low in fat and rich in fiber

10. Causes of Overweight & Obesity – Genetics & Epigenetics • Uncoupling proteins • Proteins involved in energy metabolism • Two types of fat • White adipose tissue • Brown adipose tissue • Uncoupling proteins found in both types of fat • Influence basal metabolic rate (BMR)

11. Causes of Overweight & Obesity – Environment • Encountered daily circumstances • Interaction between environment and genetics • Overeating • Present and past eating and activity patterns influence current body weight • Availability • Serving sizes • Physical inactivity • Life requires little exertion • Inactivity contributes to weight gain and poor health • DRI for prevention of weight gain

12. Problems of Overweight and Obesity – Health Risks • Three indicators • BMI • Waist circumference • Disease risk profile • Factors taken into account • Beneficial weight loss • Health status • Motivation

13. Problems of Overweight and Obesity – Health Risks • Overweight in good health • Sometimes health is not the motivation for weight loss • Obese or overweight with risk factors • Two or more risk factors • Obese or overweight with life-threatening condition • Recommendation to lose weight

14. Problems of Overweight and Obesity – Perceptions & Prejudices • Most obese people do not successfully lose weight and maintain the loss • Social consequences • Jobs, school, and in social situations • Psychological problems

15. Problems of Overweight and Obesity – Dangerous Interventions • Intervention dangers • Diet books and weight-loss programs • Little success with weight loss maintenance • Fad diets • Weight-loss products • Herbal products • Laws for dietary supplements • Other gimmicks

16. Aggressive Treatments for Obesity – Drugs • Strategies for weight reduction depend on: • Degree of obesity • Risk of disease • Use drugs as part of long-term comprehensive weight-loss programs • Assist with modest weight loss • Drugs approved by FDA for obesity • Sibutramine • Orlistat • Phentermine and diethylpropion • Other drugs

17. Aggressive Treatments for Obesity – Surgery • Clinically severe obesity • 200,000 surgeries performed each year • Reduces food capacity of stomach • Effectively limits food intake • Reduce production of ghrelin • Health-related benefits • Long-term safety and effectiveness • Liposuction

19. Weight Loss Strategies • Successful strategies • Small changes • Moderate losses • Reasonable goals • Reasonable rate of weight loss • Benefits of modest weight loss • Incorporation of healthy eating and physical activity

20. Wt Loss Strategies – Eating Plans • Be realistic about energy intake • Provide less energy than is needed • Goal: nutritional adequacy without excess • Breakfast frequency • Nutritional adequacy • Minimum of 1200 kcalories a day • Eat small portions • Eat less food at each meal; structured meal replacement plans • Feel satisfied, not stuffed • Lower energy density

21. Wt Loss Strategies – Eating Plans • Remember water • Assistance with weight management • Focus on fiber • Low in energy and high in nutrients; require effort to eat • Choose fats sensibly • Energy density and satiation • Select carbohydrates carefully • Artificial sweeteners • Watch for empty kcalories • Fat, sugar, and alcohol

22. Wt Loss Strategies – Physical Activity • Best approach to weight management • Moderate physical activity plus activities of daily life • Combination of diet and physical activity • Lose more fat • Retain more muscle • Regain less weight • Reduction of abdominal fat

23. Wt Loss Strategies – Physical Activity • kCalorie expenditure • Body weight, intensity, and duration • Greater the energy deficit, greater the fat loss • Discretionary kcalorie allowance • Metabolism • Speeds up with activity • Immediate and long-term benefits

24. Wt Loss Strategies – Physical Activity

25. Wt Loss Strategies – Physical Activity • Body composition • Fat decreases and lean body mass increases • Strength-training exercises • Appetite control • Delayed appetite • Inappropriate appetite • Psychological benefits • Self-esteem • Choosing activities • Spot reducing

26. Wt Loss Strategies – Environmental Influences • Factors surrounding eating experience and the food itself • Atmosphere • Pleasant and comfortable equals more food • Accessibility • Less effort needed to obtain food, more food eaten • Socializing • Distractions

27. Wt Loss Strategies – Environmental Influences • Presence • Sight, smell, or thought of food can prompt eating • Multiple choice • Large assortments of foods increase consumption • Package and portion sizes • Serving containers

28. Weight Loss Strategies – Behavior & Attitude • Behavior modification • Positive, matter-of-fact attitude • Become aware of behaviors • Keep record • Change behaviors

29. Weight Loss Strategies – Behavior & Attitude • Cognitive skills • Problem solving • Cognitive restructuring • Personal attitude • Understand personal relationship with food • Sound emotional health • Support groups

30. Weight Loss Strategies – Weight Maintenance • Successful weight loss • Plateau • Prevalence of successful weight loss • Difficult to determine • Weight loss • Components of successful weight loss • Changes in metabolism • Takes more to prevent weight regain than to prevent weight gain

31. Preventing Weight Gain • Preventing weight gain would benefit many people • Strategies are similar to losing weight • Start earlier

32. Public Health Programs • Possibly change environment through public health law • Stretch beyond individual

33. Underweight • Affects no more than 5% of U.S. adults • Weight gain is a matter of health • Weight gain may be difficult • Demand for energy contributes to underweight • Difficult to gain weight • Learn new habits and like new foods • Underweight vs. anorexia nervosa

34. Weight-Gain Strategies • Key diet planning strategies • Energy-dense foods • Exercise