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Chapter 9 – Weight Management: Overweight and Underweight OVERWEIGHT / OBESE: More than 50% of adults in the U.S. are overweight or obese 15% of children 6-19 years are obese FAT CELL DEVELOPMENT Obesity develops when a person's fat cells increase in size, number, or both The number of fat cells increases rapidly during the growth years (childhood, puberty) People with a large number of fat cells are more likely to regain lost weight rapidly Obese people have more LPL (lipoprotein lipase) activity in their fat cells than lean people SET POINT THEORY Body weight may be physiologically regulated Even after dieting, the body strives to be at a certain weight because the body adjusts its metabolism CAUSES OF OBESITY: 1. GENETICS When both parents are obese, there is a high likelihood that the children will be obese too Twins separated at birth are likely to be of similar weight as adults Leptin (Obesity gene) – suppresses appetite and increases energy expenditure Ghrelin – stimulates appetite and promotes efficient energy storage. Ghrelin levels are high in underweight people and people with eating disorders. Levels are also high while on low calorie diets. 2. ENVIRONMENT Overeating – There is an abundance of high-calorie, high-fat, inexpensive foods in the United States. Physical Inactivity – The main cause of obesity! 60 minutes of moderately intense physical activity per day is recommended. DANGEROUS INTERVENTIONS FOR OBESITY 1. FAD DIETS Most people do not maintain weight loss for very long Promise a “quick” weight loss May be harmful Do not encourage healthy long-term lifestyle changes 1 2. OVER THE COUNTER DRUGS Majority of users are women 10% of users are of normal weight Most are not approved by the FDA 3. HERBAL PRODUCTS AND DIETARY SUPPLEMENTS Few have proved to be effective St. John’s Wort – inhibits the uptake of serotonin and suppresses appetite Ephedrine – implicated in several deaths 4. OTHER GIMMICKS Hot baths, steam and sauna baths Cellulite treatments AGGRESSIVE TREATMENTS OF OBESITY: 1. MEDICATIONS Most have potential side-effects Weight usually returns when person quits taking the medication Sibutramine – suppresses appetite Orlistat – blocks dietary fat digestion and absorption by 30% 2. GASTRIC SURGERY Limits food intake by reducing the size of the stomach and suppressing hunger by reducing production of . Most people achieve lasting weight loss of more than 50% of excess body weight Effectiveness depends on compliance with dietary instructions High risk of complications ESSENTIAL COMPONENTS OF A WEIGHT LOSS PLAN: 1. Balanced Diet Eat a variety of foods, including all food groups 2. Realistic Calorie Intake At least 1,200 calories per day Most weight loss plans provide 1,200-1,800 calories per day * It takes calories to make a pound To lose 1 pound a week, subtract 500 calories from daily intake To lose 2 pounds a week, subtract 1,000 calories from daily intake 2 3. Small Portions Even low-fat foods can contribute to weight gain The amount eaten at meals should leave you satisfied, not full Focus on foods with low energy density 4. Balance of carbohydrates, protein, and fats 5. Limit “empty calorie” foods such as sugar and alcohol 6. Adequate Water Intake Water can help satisfy thirst Dilutes metabolic wastes generated by the breakdown of fat 7. Regular Physical Activity Daily exercise is best for weight loss (try to burn at least 2,000 calories per week) Speeds up the BMR Helps with appetite control Psychological Benefits (which may control eating) 8. Behavior Modification Some people may require psychological counseling Repeat visits for diet counseling are usually needed Support groups are helpful Recording eating and exercise behaviors are helpful UNDERWEIGHT Affects no more than 5% of U.S. adults STRATEGIES FOR WEIGHT GAIN: Consume energy-dense foods Exercises that build muscle At least three meals a day Large Portions High calorie snacks Juice and milk (beverages that contain calories) EATING DISORDERS: Eating disorders are psychological problems, best treated with the help of a licensed mental health counselor (preferably someone specializing in eating disorders). Eating disorders are not classified as nutritional problems. 3 1. ANOREXIA NERVOSA Self-induced starvation Can be life-threatening Weight becomes severely low Often affects young female athletes 2. BULIMIA Combination of bingeing and purging May be combined with anorexia May also abuse laxatives Can affect as many as 20% of college-age women Usually are of normal weight 3. BINGE-EATING DISORDER The most common type of eating disorder Not followed by purging or laxative use Usually associated with guilt after a binge Can consume large quantities of food (thousands of calories) at one sitting 4