Weight management

1. Weight management Chapter 11

2. Introduction • National Institutes of Health • 66% of American adults are overweight • Including more than 33% of adult men and 35% of adult women are obese. • 2015 • 75% of adults will be overweight and 41% will be obese • 2030 • Estimated that the entire American adult population will be overweight or obese

3. 3 Figure 11-1 Obesity prevalence, by age and sex, of American adults

4. Basic Concepts of Weight Management • 1 pound of fat = 3500 calories • Body Composition • Fat-free mass or Lean Body Mass • Body Fat • Subcutaneous fat 3-5% of total fat in men, 8-12% in women • Visceral fat-(storage) –Located behind the abdominal wall • Depends on many factors: • Gender • Age • Heredity • Metabolism • Diet • Activity level • Women: <8% at risk, Average 23%, > 32% at risk • Men: < 5% at risk, Average 15%, > 25% at risk

5. Energy Balance • Crucial to keep a healthy ratio of fat and lean body mass • Energy • Consumption and/or expenditure of calories • Control over intake of calories • Negative energy balance • Positive energy balance • Neutral energy balance

6. Figure 1.2 The energy balance equation

7. Evaluating Body Weight and Body Composition • Overweight – total body weight above recommended range for good health • Obesity – a more serious degree of overweight • Height-Weight charts • Body Mass Index (BMI) • BMI = [Weight / Height in inches (squared)] X 703

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9. Body Composition Analysis • Hydrostatic (underwater) weighing and BOD POD • Most accurate • Skinfold measurements • Thickness of fat under the skin • Electrical Impedance Analysis • Electricity prefers lean tissue • Scanning procedures • CT scan, MRI, Dual-energy X-ray, Dual-photon absorptiometry, Infrared reactance and total body electrical conductivity

10. Excess Body Fat and Wellness • The Health Risks of Excess Body Fat • Obese individuals have a mortality rate twice that of non-obese • Reduces life expectancy by 10-20 years • Associated with: Unhealthy cholesterol and triglycerides, impaired heart function, and death from cardiovascular disease • Other health factors: hypertension, cancer, impaired immune function, gallbladder and kidney disease, skin problems, impotence, sleep disorder back pain, arthritis • Strong association – Type II diabetes

11. Figure 11.4 Diabetes mellitus

12. Body Fat Distribution and Health • Apple shape • Android obesity • Upper regions of their bodies • Increase risk of high blood pressure, diabetes, early-onset heart disease, stroke, and cancer • Pear shape • Gynoid obesity • Fat storage in the hips, buttocks and thighs • Assessed by measuring waist circumference • Risk if total waist measurement is more than 40 inches for men and 35 inches for women

13. Body Image • Collective picture of the body as seen through the mind’s eye. • Perceptions • Images • Thoughts • Attitudes • Emotions

14. Problems Associated with Very Low Levels of Body Fat • Less than 8-12% for women and less than 3-5% for men. • Extreme has been linked to problems with: • Reproductive • Circulatory • Immune system disorders • Female Athlete Triad • Abnormal eating patterns • Amenorrhea • Decreased bone density

15. Factors Contributing To Excess Body Fat • Genetic Factors • Nutrigenomics • Study of how nutrients and genes interact • 25 to 40% of an individual’s body fat • 600 genes have been linked to obesity • Physiological Factors • Metabolism (RMR) • Hormones • Fat Cells

16. Lifestyle Factors • Eating • Physical Activity • Psychosocial factors • Emotions • Distraction from difficult feelings • Helps regulate emotions • Coping strategies • Socioeconomic status • Family and cultures

17. Adopting A Healthy Lifestyle For Successful Weight Management • “Normal” body weight • Diet and Eating Habits • Total Calories • MyPyramid suggestions • Best approach for weight loss is combining an increase of exercise with moderate calorie restriction • Do not go on a crash diet

18. Adopting A Healthy Lifestyle For Successful Weight Management (Continued) • Portion Sizes • Energy (calorie) Density • Eating Habits • Processed foods • “Fat-free” • Stick to recommendations by: • Dietary Guidelines for Americans • MyPyramid • DASH Diet

19. Physical Activity and Exercise • 30 minutes or more of moderate-intensity physical activity, everyday • Walking • Gardening • Housework • Walking 1 mile in 15-20 minutes

20. Thinking and Emotions What do you think of yourself? Self-esteem Negative emotions “Ideal self” Beliefs and attitudes you hold

21. Coping Strategies • Adequate and appropriate strategies • Healthy lifestyles and proper stress management techniques will naturally and easily result in a reasonable body weight • Good nutrition • Good communication • Adequate exercise • Positive thinking and emotions • Effective coping strategies and behavior patterns

22. Approaches to Overcoming A Weight Problem • Doingit yourself • 0.5-2.0 pounds per week • Initial weight loss from fluids. • Very low calorie diets need to be avoided. • Diet Books: • Reject books with gimmicks or rotating levels of calories. • Accept books that advocate a balanced approach. • Diet Supplements and Diet Aids • Formula drinks and food bars • Herbal supplements • Other supplements

23. Weight-Loss Programs • Noncommercial • TOPS (Take Off Pounds Sensibly) • OA (Overeaters Anonymous) • 12-step program with spiritual orientation • Commercial • Online • Clinical

24. Weight-Loss Programs • Prescription Drug • Appetite Suppressants • Produce a 5-15% weight reduction by controlling appetite. • Once drugs are stopped most return to original heavy weight. • Good option for very obese who need help getting started - permanent life style change.

25. Surgery • Severely obese – • One in 50 adult Americans has “morbid obesity” • NIH recommends gastric bypass for individuals with a BMI of 40 or higher or are 100 pounds or more over recommended weight. • Roux-en-Y-gastric bypass • Vertical banded gastroplasty (VBG) • Lap-Band – variation of VGB • Adjustable band • Liposuction • Weight loss from surgery generally ranges between 40% and 70% of total body weight over a years time.

26. Body Image • Severe body image problems • Body dysmorphic disorder (BDD) • Affects about 2% of Americans • Usually before age 18 • Muscle dysmorphia • Knowing when the limits to healthy change have been reached. • Knowing the unrealistic cultural ideal. • Acceptance and change • Knowing what is a healthy lifestyle change

27. Eating Disorders Problems with body weight and weight control. Characterized by severe disturbances in body image, eating patterns, and eating-related behaviors. Disordered eating affects an estimated 10 million American females and 1 million males.

28. Eating Disorders • Anorexia Nervosa- Failure to eat enough food… • Affects 3 million people – 95% are female • Typically develops between the ages of 12 and 18 • Characteristics • Fear gaining weight. • Distorted self-image. • Compulsive behaviors and rituals. • Excessive exercise • Health Risks of Anorexia Nervosa • Stop menstruation • Intolerant of cold • Low blood pressure and heart rate • Dry skin • Hands and feet may swell and take on a blue tinge • Depression and suicide • Medical complications • Disorders of the cardiovascular, gastrointestinal, endocrine, and skeletal systems

29. Eating Disorders • Bulimia Nervosa - recurring episodes of binge eating followed by purging. • Begins in adolescence or young adulthood • Increasingly younger (11-12 years) and older (40-60 years) ages. • Characteristics: • Rapidly consumes food, then purges. • Done in secret. • After a binge - feels ashamed, disgusted and physically and emotional drained. • Health Risks: • Erodes tooth enamel • Deficient calorie intake • Liver and kidney damage • Cardiac arrhythmia • Chronic hoarseness • Esophageal tearing • Rupture of the stomach • Menstrual problems • Increased depression

30. Eating Disorders • Binge-Eating - Similar to Bulimia except no Purging behavior. • Eating patterns - very rapid, eating until uncomfortably full. • Often eat as a way of coping. • Likely to be obese. • High rates of depression and anxiety

31. Treating Eating Disorders • Combination of psychotherapy and medical management • Address both eating disorder, misuse of food and manage emotions • Anorexia Nervosa • Averting a medical crisis • Adequate body weight • Psychological aspects • Bulimia Nervosa • Stabilizing the eating patterns • Identify and changing the patterns of thinking • Improve coping skills • 2006, JAMA study found: • Topiramate (anti-seizure drug) helped with Bulimia Nervosa • Binge-Eating • Similar treatment protocol as Bulimia Nervosa

32. Weight Management Chapter 11