Understanding Weight Management and Eating Disorders: A Comprehensive Overview

1. Weight Management & Eating Disorders

2. Introduction • National Institutes of Health • 66% of American adults are overweight • Including more than 32% who are obese • In 2030 it is… • Estimated that the entire American adult population will be overweight or obese

3. Prevalence of overweight and obesity among Americans(Figure 14-1)

4. Basic Concepts • Calorie – energy measurement; the body gains energy from calories when nutrients in food are broken down. 1 pound of fat = 3500calories • Metabolism – means by which your body releases the energy in food and uses it to build and repair body tissue. • Basal Metabolism – amount of energy needed by the body when at rest and fasting to carry out basic life functions such as: • Breathing • Circulation • Maintaining body temperature

5. Basal Metabolism • Basal Metabolism varies with and is determined by: • age • size • gender • physical activity • body type For example: A more muscular person will generally have an increased basal metabolism than a non-muscular person with the same weight. • Basal Metabolic Rate (BMR) – the rate at which the body uses energy to support its basal metabolism. For Example: Males have a faster BMR than females due to more muscular bodies and larger bones.

6. The Energy Balance Scale

7. Energy Balance • Remember energy is calories • Negative energy balance – Eating less calories than the body uses • Weight LOSS will happen • Positive energy balance – Eating more calories than the body uses • Weight GAIN will happen • Neutral energy balance – Eating the same amount of calories that the body uses • Weight remains the same

8. Evaluating Body Weight and Body Composition • Height-Weight charts - provide only an indirect measure of body fat and health • Not a True measurement of health • Only takes into account frame size, gender and age • Body Mass Index (BMI)– based on the concept that weight should be proportional to height. Can also be used in conjunction with waist circumference/waist-to-hip ratio. • Body weight in kilograms / square of height in meters • Weight in pounds X 704 / Height in inches (squared) • Does not take into account fat-free weight. Can be very inaccurate for shorter people (under 5’), muscular athletes, and older adults with little muscle mass. • Waist-to-Hip Ratio - assessed by measuring waist circumference and hip circumference • Risk if total waist measurement is more than 40 inches for men and 35 inches for women

10. BMI Weight Classifications Underweight – under the recommended range of good health • BMI under 18.5 Healthy Weight – within the recommended range • BMI between 18.5 and 24.9 Overweight –above recommended range for good health • BMI over 25. Obesity – a more serious degree of overweight • BMI over 30

11. Assessment of BMI Measurement. Example: 5’6” tall, 150 pounds • Multiply weight (in pounds) by 704 • 150 pounds X 704 = 105,600 • Multiply height (in inches) by height (in inches) • 66 inches X 66 inches = 4,356 • Divide the answer in step 1 by the answer in step 2 to obtain a value for BMI • BMI = 105,600 / 4,356 = 24.2

12. Evaluating Body Weight and Body Composition • Body Composition – a measure of the body components • Fat vs. Lean tissue • Finds the fat percentage in the body • A True measurement of health

13. Methods of Determining Percent Body Fat • Hydrostatic (underwater) weighing • 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

14. 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

15. Body Fat Distribution and Health • Apples • Fat storage in the upper regions of body • Increase risk of high blood pressure, diabetes, early-onset heart disease, stroke, and cancer • Pears • Fat storage in the hips, buttocks and thighs

16. Factors Contributing To Excess Body Fat • Genetic Factors • 300 genes have been linked to obesity • If one parent is obese, children have a 40% risk • If both parents are obese, children have and 80% risk of being obese • Adoptees were found to be more like those of the biological parent

17. Factors Contributing To Excess Body Fat • Physiological Factors • Metabolism • Hormonal changes at puberty, during pregnancy, and at menopause contribute to the amount and location of fat accumulation. Other hormones regulate appetite. • Fat Cells determine the amount of fat the body can store.

18. Lifestyle Factors Contributing to Excess Body Fat • Eating – the average calorie intake per day has increased by 300 calories since 1970. • Physical Activity – among Americans is declining, beginning in childhood throughout adulthood. • Psychosocial factors • Emotions • Coping strategies • Obesity is strongly associated with socioeconomic status.

19. Problems Associated with Very Low Levels of Body Fat • Low body fat is considered less than 8-12% for women and less than 3-5% for men. • Extremely low body fat has been linked to problems with: • Reproductive cycle • Circulatory system • Immune system disorders • Female Athlete Triad • Abnormal eating patterns • Amenorrhea (no menstruation) • Decreased bone density

20. Dieting in America • Most commonly used methods: • Fad diets • Yo-yo dieting • Not eating * All of these are ineffective for Long-Term weight loss.

21. Why? • They are nutritionally unbalanced • They are not functional. • They lead to quick weight re-gain once off the diet. • They are dangerous. • Large weight fluctuations can lead to Heart Disease. • Can cause dehydration. • They can be habit forming. (diet pills) • They can lead to a loss of muscle.

22. To Lose Weight Healthily: • Eat fewer calories than the body uses. • This will cause the body to use the energy already stored as fat. • Eat healthy foods in smaller portions. • Be sure eat enough calories for your energy needs • If you do not eat enough the body will begin to break down muscle tissue. • This can lead to fast weight re-gain. • Exercise to burn energy. * This combination is the only method that is safe for long term weight loss.

23. 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

24. Adopting A Healthy Lifestyle For Successful Weight Management (Continued) • Portion Sizes • Energy (calorie) Density • Fat Calories • Carbohydrates • Simple Sugars and Refined Carbohydrates • Protein • Eating Habits

25. Physical Activity and Exercise • Accumulate 60 minutes or more of moderate-intensity physical activity, every day for normal weight individuals • Walking • Gardening • Housework • Walking 1 mile in 15-20 minutes • 60 minutes per day to avoid slow weight gain in adulthood • 60-90 minutes per day to lose weight or to prevent weight regain after losing weight

26. To Gain Weight Healthily • 1 pound of muscle tissue = approximately 700-800 calories • No hormone, vitamin, drug or protein supplement will increase muscle mass • A high intake of protein is not necessary since excess protein is broken down for energy or stored as fat • How to Gain Weight Healthily: • Eat a well-balanced diet with an excess of 500-1000 calories per day • Weight training is essential to stimulate the growth of muscle tissue

27. Body Image • Collective picture of the body as seen through the mind’s eye. • Perceptions • Images • Thoughts • Attitudes • Emotions • Body image issues must be dealt with when dealing with obesity issues and eating disorders.

28. Eating Disorders • Any person who has an Eating Disorder has problems with body weight and weight control • 0.5-2.0% of Americans suffer from anorexia and bulimia • Over 1 Million Americans develop anorexia or bulimia each year - 90% are female. • 10% of college-aged women have an eating disorder • Binge eating may affect 2-5% of all adults and 8% of those who are obese • 60% of binge-eating problems are female

29. Factors in Developing an Eating Disorder • One central feature – a dissatisfaction with body image and body weight • Heredity • Over 50% of the risk • Home environment • Hostile environment? • Lack of cohesion with members • Rigid or overprotective parents • “Perfectionist”

30. Anorexia Nervosa • Failure to eat enough food to maintain a reasonable body weight • Can be life-threatening • Characteristics of Anorexia: • Fear of gaining weight • Distorted self-image • Compulsive behaviors and rituals • Excessive dieting “Self-starvation” • Excessive exercise • Layering of clothing • Anti-social behavior • Depression

31. Health Risks of Anorexia • Stop menstruation • Intolerant of cold temperatures • Low blood pressure and heart rate • Dry skin • Hands and feet may swell and take on a blue tinge • Depression and suicide

32. Anorexia Medical Complications • Disorders of the: • Cardiovascular system • Gastrointestinal system • Endocrine system • Skeletal system

33. Bulimia Nervosa • Recurring episodes of “Binge eating followed by Purging” • Self-induced vomiting or laxative use • Begins in adolescence or young adulthood • Increasingly younger (11-12 years) and older (40-60 years) ages • Can be Life-threatening

34. Characteristics of Bulimia • Rapidly consumes food, then purges • Done in secret • Foraging and hoarding food • After a binge - feels ashamed, disgusted and physically and emotional drained • Constant preoccupation of food control • Weight fluctuations due to alternative gorging and fasting • Low self-esteem • “Perfectionist”

35. Health Risks of Bulimia • Erodes tooth enamel and gum disease • Deficient calorie intake • Swollen glands “Chipmunk Cheeks” • Liver and kidney damage • Cardiac arrhythmia • Chronic hoarseness • Esophageal tearing • Rupture of the stomach • Menstrual problems • Increased depression

36. 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

37. Treating Eating Disorders • Address both eating disorder, misuse of food and manage emotions • Anorexia Nervosa • Bulimia Nervosa • Binge-Eating

38. Correct Weight • The “right” weight for any individual should be the result of a healthy lifestyle.

39. Nutrition Unit Test • Eating Disorders definitions • Nutrition Basics • Super Six definitions • Calories, Fiber definitions • Nutrition Label identification • My Plate food categories • Weight Management • BMI, Body Composition, BMR definitions • Energy Balances (negative, positive, neutral)

40. Weight Management Chapter 14

41. Body Composition • Lean Body Mass • Body Fat • Essential fat - 3-5% of total fat in men, 8-12% in women • Nonessential fat-(storage) – Located just below the skin • Depends on many factors: • Gender • Age • Heredity • Metabolism • Diet activity level

42. Weight Cycling • YO-YO effect of dieting • Some feel that it may be harmful to both overall health and to efforts at weight lost. • Studies have not yet conclusively shown weight cycling be harmful.

43. Approaches to Overcoming A Weight Problem • Doing it 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. • Diet Supplements and Diet Aids • Formula drinks and food bars • Herbal • Dietary supplements

44. Weight-Loss Programs • Noncommercial Self-help groups • TOPS, and OA • Commercial • Online • Clinical

45. Overcoming a Weight Problem • Legitimate programs provide; • Nutritional Education • Emphasis on exercise and change in lifestyle • Individual and Group counseling • Self-Help groups • Registered dietitians • Physician monitored program

46. 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.

47. Surgery • Severely obese - BMI of 40 or higher or are 100 pounds or more over recommended weight. • Roux-en-Y-gastric bypass • Vertical banded gastroplasty (VBG) • Liposuction • Weight loss from surgery generally ranges between 40% and 70% of total body weight over a years time.

48. Psychological Help • Body Image • Severe body image problems • Body dysmorphic disorder (BDD) • Knowing when the limits to healthy change have been reached. • Knowing the unrealistic cultural ideal. • Acceptance and change • Can-do attitude

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

50. 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