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7 Weight Management Copyright © 2017 Cengage Learning. All Rights Reserved. Causes of Obesity • Genetics and weight – Genes influence eating behavior – Impact body composition – Affect risk of obesity • 30% to 70% chance of obesity for individuals with at least one obese parent – Complex interactions among genes – Interrelated with environment factors Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Causes of Obesity: Genetics and Weight (cont’d.) • Lipoprotein lipase (LPL) – Cell surface enzyme that hydrolyzes triglycerides and promotes fat storage – Higher level of LPL activity in fat cells of obese people • Makes fat storage efficient Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Causes of Obesity: Genetics and Weight (cont’d.) • Leptin – Protein (hormone) coded for by obesity (ob) gene – What is the role of leptin, and what is leptin resistance? • Ghrelin – Hormone that stimulates appetite and promotes efficient energy storage Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Causes of Obesity: Genetics and Weight (cont’d.) • Fat cell development – Fat cells increase in size and often in number with increased fat storage – Compared to healthy-weight people, obese people have: • More fat cells • Larger fat cells – What happens to the number and size of fat cells with weight loss? Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Fat Cell Development Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Causes of Obesity: Genetics and Weight (cont’d.) • Set-point theory – Idea that body weight is physiologically regulated • A certain “set-point” weight is maintained – Decrease in metabolic rate with weight loss • Intestinal bacteria – Intestinal microbiota may influence energy balance and/or chronic disease risk Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Causes of Obesity (cont’d.) • Environmental stimuli – Overeating • • • • Readily available high-kcalorie foods Large portion sizes Energy-dense foods (e.g., fast foods) Legislation requires chains (20+ locations) to provide kcalorie information on menus Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Causes of Obesity: Environmental Stimuli (cont’d.) • Learned behavior – What is the difference between hunger and appetite? – What are satiation and satiety? – Food behavior is linked to emotional needs Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Causes of Obesity: Environmental Stimuli (cont’d.) • Physical inactivity – Sedentary screen time – Technology replaces activity at home, work, and school, in transportation • Neighborhood obstacles to physical activity and healthy foods • Aspects of the built environment • What are food deserts? Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Copyright © 2017 Cengage Learning. All Rights Reserved. Obesity Treatment: Who Should Lose? • Weight-loss advice does not apply equally to all overweight people • Many factors should be considered – Extent of overweight, age, health, genetics, etc. • Must weigh the benefits and risks of weight loss Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Inappropriate Obesity Treatments • Over-the-counter (OTC) weight-loss products – Weight-loss pills, powders, and other dietary supplements – Dietary supplements are not associated with successful weight loss and maintenance • Other gimmicks (all ineffective) – Steam and sauna baths, brushes, sponges, wraps, creams, and massages Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Aggressive Treatments of Obesity • Obesity drugs – Assist with modest weight loss • As part of a long-term, comprehensive weight-loss program – Must consider risks of long-term use – FDA-approved drugs for weight loss (Table 7-2) Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Aggressive Treatments of Obesity (cont’d.) • Surgery – Most effective treatment for clinically severe obesity (morbid obesity) – Popular procedures: • Gastric bypass • Gastric banding – Laparoscopic weight-loss surgery • Significant, long-term weight loss; shortens recovery; less invasive than open surgery Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Reasonable Strategies for Weight Loss • Obesity treatment should integrate healthy eating patterns, physical activities, supportive environments, and psychosocial support • Successful strategies embrace small changes, moderate and sustained losses, and reasonable goals Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Reasonable Strategies for Weight Loss (cont’d.) • Reasonable goals to reduce weight to lower disease risk: – Reduce body weight by about 5% to 10% over 6 months – Maintain a lower body weight over the long term – At a minimum, prevent further weight gain Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Reasonable Strategies for Weight Loss (cont’d.) • A healthful eating plan – A realistic energy intake • Provides less energy than the person needs to maintain present body weight • Not too restrictive • Men: 1500-1800 kcalories per day • Women: 1200-1500 kcalories per day Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Copyright © 2017 Cengage Learning. All Rights Reserved. Reasonable Strategies for Weight Loss: A Healthful Eating Plan (cont’d.) • Nutritional adequacy – Difficult to achieve on <1200 kcal/day – Nutrient-dense food selections: • Fruits, vegetables, legumes, whole grains • Fish • Unsaturated oils, low-/non-fat dairy (moderate amounts) – Dietary supplement with ≤100% of Daily Values for minerals/ vitamins Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Reasonable Strategies for Weight Loss: A Healthful Eating Plan (cont’d.) • Small portions – Less food at each meal – Prepared meal plans can assist with portion control • Lower energy density – Fruits, vegetables, broth-based soups Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Energy Density Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Reasonable Strategies for Weight Loss: A Healthful Eating Plan (cont’d.) • Sugar and alcohol – Limit intakes • Meal spacing – Flexible – Total quantity consumed should be controlled • Adequate water – Substitute for nutrient-poor kcaloric beverages Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Reasonable Strategies for Weight Loss (cont’d.) • Physical activity – More likely to lose more fat, retain more muscle, and regain less weight when physical activity is combined with energy restriction – Reduces abdominal obesity; improves blood pressure, insulin resistance, fitness of heart and lungs Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Copyright © 2017 Cengage Learning. All Rights Reserved. Reasonable Strategies for Weight Loss: Physical Activity (cont’d.) • Energy expenditure – Directly increases energy output – Energy spent on various activities differs (Table 6-2 in Chapter 6) • Basal metabolic rate (BMR) – Elevated following vigorous physical activity – Rises over time as more lean tissue is added Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Reasonable Strategies for Weight Loss: Physical Activity (cont’d.) • Appetite control • Psychological benefits – Curbs emotional eating – Reduces stress – Improves body image – Improves self-esteem Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Reasonable Strategies for Weight Loss: Physical Activity (cont’d.) • Choosing activities – What kind of physical activity is best for health? – Total energy expenditure is the main factor • Spot reducing – Fat is released from fat cells all over the body, not just in the area being exercised – Resistance exercise improves tone Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Reasonable Strategies for Weight Loss (cont’d.) • Behavior and attitude – Behavior-modification therapy • Manipulating antecedents, the behavior itself, and consequences – Becoming aware of behaviors • Keep a diary • Technology tools for tracking daily food and physical activity – Applications for smart phones, social media sites Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Food and Activity Diary Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Reasonable Strategies for Weight Loss: Behavior and Attitude (cont’d.) • Making small changes – Focus on learning desired behaviors and eliminating unwanted behaviors – Set small, time-specific goals – Box 7-1 provides suggested strategies Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Reasonable Strategies for Weight Loss: Behavior and Attitude (cont’d.) • Cognitive skills – Changes to conscious thoughts with the goal of improving adherence – Problem-solving skills; correction of falsenegative thoughts • Personal attitude – Identify stressors that trigger overeating – Practice problem-solving skills Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Reasonable Strategies for Weight Loss (cont’d.) • Weight maintenance – Key: accept that this is a lifelong endeavor – Long-term success behaviors (Table 7-6) • • • • Self-efficacy 1 hour physical activity daily Weekly weight monitoring Consistently low-kcal, high-fiber, high-water eating patterns • Quick attention to lapses Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Copyright © 2017 Cengage Learning. All Rights Reserved. Strategies for Weight Gain • Underweight affects ~2% of U.S. adults • Physical activity to build muscles – Focus on resistance training with increased energy intake • Energy-dense foods – Choose high-kcalorie items from each food group Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Strategies for Weight Gain (cont’d.) • Three meals daily • Large portions – More food at each meal • Extra snacks • Juice and milk – Increase kcalories with beverages – High-protein, high-kcal formulas for people who are underweight due to illness Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Copyright © 2017 Cengage Learning. All Rights Reserved. Nutrition in Practice: Fad Diets • Freedom of the press allows unfounded claims in books or on the Internet • Fad diets work through kcal restriction – Most sample menus provide ~1200 kcal/day • Often inadequate in vitamins and minerals • Particularly ineffective for weight maintenance Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Nutrition in Practice: Fad Diets (cont’d.) • Macronutrient compositions of fad diets – Long term, any low-kcal diet produces about the same degree of weight loss – Somewhat higher protein intakes (1.2 to 1.6 g/kg/day) may improve diet adherence • Plain yogurt, peanut butter, walnuts, other nuts, skinless chicken, low-fat cheese, seafood • Most people need specific instructions and meal plans like those offered by fad diets Copyright © 2017 Cengage Learning. All Rights Reserved. © Cengage Learning 2017 Copyright © 2017 Cengage Learning. All Rights Reserved.