Download Weight Management

Weight Management
Chapter 9
Healthy Body Weight
• National Institutes of Health
• More than 67% of American adults are
overweight
• More than 32% of American adults are obese
• Obesity has doubled since 1960
• At current rates, all American adults will be
overweight by 2030
Prevalence of Healthy Body
Weight
Gender
Ethnicity
Age
Health status
ALL ADULTS
Women
35%
Men
32%
White
35%
Latino
26%
African American
29%
20–39 years
40%
40–59 years
31%
60+ years
28%
People with disabilities
29%
People with diabetes
12%
Source: National Center for Health Statistics
34%
Overweight and Obesity
• Overweight = characterized by a body
weight that falls above the range
associated with minimum mortality;
weighing 10% or more over recommended
weight or having a BMI over 25
• Obesity = severely overweight, with an
excess of body fat; weighing 20% or more
over recommended weight or having a BMI
over 30
Health Implications of
Overweight and Obesity
• 33% rise in type 2 diabetes
• 100,000+ premature deaths annually
• Obesity is one of the six major controllable
risk factors for heart disease
• Weight loss of 5-10% in obese individuals
can reduce the risk of certain diseases
Factors Contributing to Excess
Body Fat: Genetic Factors
• Genetic factors influence body size and shape,
body fat distribution, and metabolic rate
• Genetic contribution to obesity is estimated at
25–40%
• Hereditary influences must be balanced against
contribution of environmental factors
• Genetics is what can happen, our choices is
what does happen!!
PHYSICAL APPEARANCE
• We are all products of heredity and environment. What we
get from our parents and what we do with what we get!
• Somatotype – Your physical appearance, body build.
• Endomorph – A “pear-shaped” appearance. Short legs and arms,
most of body weight centered around hips and abdomen.
• Mesomorph – Solid, muscular, large-boned physique. Most of body
weight is away from the abdominal area. Wide shoulders, narrow
hips, well-muscled.
• Ectomorph – Slender bodies and a slight build. Very little body fat.
Light musculature, long arms and legs. Bony in appearance,
narrow chest and hips and generally linear in appearance.
• Most people have some characteristics of each body type,
but one will dominate.
Fat Cell Theory
• Proponents of this theory believe that obese people
have more fat cells and larger cells than the nonobese.
• Total number of fat cells increase
• It is believed that once we produce fat cells, they
remain for life.
• Any weight reduction would involve a reduction in the
size of the fat cell.
• Evidence seems to suggest that fat cells do reach a
point where they can not get bigger, thus new cells
are manufactured.
Physiological Factors
• Metabolism – the sum of all the vital processes
by which food energy and nutrients are made
available to and used by the body.
• Resting Metabolic Rate (RMR) – The energy required to maintain
vital body functions. (heart, lungs, body) Accounts for about 5575% of the energy used by the body.
• Thermal Effect of Food (TEF) – The energy required to digest
food. Accounts for additional 5-15% of daily energy
expenditure.
• Effect of Physical Activity – Energy expended during physical
activity. Accounts for 20-40% of expended energy.
• This is the component that is the most variable and the one we can
do the most about.
Factors That Affect Metabolic
Rate
• RMR is higher in
• Men
• People with more muscle mass
• People who exercise
• RMR is lower in
• Women
• People who are sedentary
• People who have lost weight
Energy-Balance Equation
Factors Contributing to Excess
Body Fat: Lifestyle Factors
• Eating—compared to the past,
Americans now
• Consume more calories
• Consume more refined and
simple carbohydrates
• Eat out more often
• People underestimate portion
sizes
National Geographic, August 2004
Monster Thick Burger
• 1,420 calories
• 107 grams of fat
• 2 – 1/3 slabs of
beef
• 4 strips of bacon
• 3 slices of cheese
CHEESEBURGER
20 Years Ago
333 calories
Today
How many calories are
in today’s cheeseburger?
CHEESEBURGER
20 Years Ago
Today
333 calories
590 calories
Calorie Difference: 257 calories
Maintaining a Healthy Weight is a Balancing Act
Calories In = Calories Out
How long will you have to lift weights in order
to burn the extra 257 calories?*
*Based on 130-pound person
Calories In = Calories Out
If you lift weights for 1 hour and 30 minutes,
you will burn approximately 257 calories.*
*Based on 130-pound person
FRENCH FRIES
20 Years Ago
Today
210 Calories
2.4 ounces
How many calories are in
today’s portion of fries?
FRENCH FRIES
20 Years Ago
210 Calories
2.4 ounces
Calorie Difference: 400 Calories
Today
610 Calories
6.9 ounces
Maintaining a Healthy Weight is a Balancing Act
Calories In = Calories Out
How long will you have to walk leisurely in
order to burn those extra 400 calories?*
*Based on 160-pound person
Calories In = Calories Out
If you walk leisurely for 1 hour and 10 minutes
you will burn approximately 400 calories.*
*Based on 160-pound person
Diet and Eating Habits
• 1 pound = 3500 calories
• If calorie intake = calorie output,
weight remains the same.
• For weight loss, goal should be to lose
0.5 -2 pounds/week
Successful Weight Loss
• A successful, long-term weight control program involves
three elements.
• Diet – the number of calories consumed should be reduced,
along with the fat content of the diet. Watch portion sizes.
Choose complex carbohydrates – fruits, vegetables and whole
grains (Nutrient –dense foods) Or those foods which have a
lower energy (calorie) density. An apple vs a pie of apple pie.
• Exercise – Goal is to expend 200-400 calories/day with exercise.
• Behavior Modification
• Self-monitoring – Keep a food log, recording amounts and
circumstances of eating.
• Food triggers – Identify those factors which trigger eating.
Boredom, anxiety, stress, exhaustion.
• Develop techniques to control eating. Positive self-talk. Goals.
Stay busy. Plan meals. Control social bingeing.
• Reinforce results with rewards.
Physical Activity and Exercise
• Physical activity—increase daily physical
activity to at least 30 minutes per day; to
lose weight or maintain weight loss, 60–90
or more minutes per day is recommended
• Exercise
• Endurance exercise burns calories
• Strength training builds muscle mass, which
can increase metabolic rate
National Geographic, August 2004
Diet and Eating Habits
• Fat calories—keep total fat intake moderate, and
limit intake of saturated and trans fats
• Carbohydrate—emphasize whole grains,
vegetables, fruits, and other high-fiber foods; limit
consumption of foods high in refined
carbohydrates, added sugars, and easily digestible
starch
• Protein—meet recommended intake of 10–35% of
total daily calories
• Eating habits—eat meals and snacks on a regular
schedule
Doing It Yourself
• Physical activity is a critical component of healthy
weight management
Approaches to Overcoming a
Weight Problem
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Doing it yourself
Diet books
Dietary supplements and diet aids
Weight-loss programs
Prescription drugs
Surgery
Psychological help
Diet Books
• Reject books that
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Advocate unbalanced ways of eating
Claim to be based on a secret
Use gimmicks
Promise quick weight loss
Limit the selection of foods
• Accept books that advocate a balanced
diet plus exercise
Popular Diet Plans
• Any diet that cuts calories causes weight loss
• Low-carbohydrate diets have not been proven safe
over the long-term
• Low-fat diets should focus on nutrient dense foods,
especially whole-grains, fruits, and vegetables
• Diets with many restrictions have high drop-out
rates
• People who have been successful at long-term
weight loss track food intake and engage in 60 or
more minutes of physical activity per day
Dietary Supplements and Diet
Aids
• Dietary supplements are subject to fewer
regulations than over-the-counter
medications; they have not been proven
safe and effective
• FTC: More than half of advertisements for
weight-loss products make representations
that are likely to be false
Surgery
• Surgical intervention may be recommended
for some people who have a BMI of 40 or
higher or who are 100 or more pounds
overweight
• Gastric bypass surgery modifies the
gastrointestinal tract by changing the size of
the stomach or how the intestine drains,
thereby restricting the amount of food that
can be eaten
• Surgery has a high rate of complications
Surgery
Adjustable gastric banding
Source: National Institutes of Health
Roux-en-Y gastric bypass
Body Image
• Dissatisfaction
with weight and
shape is
common in
people with
eating disorders
Body Image
• Body image = the mental representation a
person holds about her or his body
• It consists of perceptions, images, thoughts,
attitudes, and emotions
• Media images are linked to negative body
image
• Different cultures have different ideas of the
“ideal” body type
BMI of Miss America Pageant Winners
The data shows a steady decline in winners’ BMI from a range of 20–25 in the 1920s
to below 18.5, considered undernutrition by WHO and represented by the horizontal
line.
SOURCE: Rubinstein, S., and B. Caballero. 2000. Is Miss America an undernourished role model? Journal of American Medical Association 283(21):
1569. Used with permission from the American Medical Association.
Acceptance and Change
• Most Americans are unhappy with some
aspect of their appearance
• Recognize the limits of change
• Small amounts of weight loss can
significantly reduce health risks
Eating Disorders
• Society has created tremendous pressure for
individuals to be thin.
• More than two-thirds of women between the ages of
12 and 23 have felt dissatisfied with their body image
and feel pressure to conform to the “ideal” body size
and shape.
• Weight reduction, often takes over thoughts and
energies. Some feel weight loss makes them more
attractive, accepted and successful.
• The pursuit of thinness can result in serious and
sometimes life-threatening eating disorders.
Eating Disorders
• Anorexia Nervosa – Condition is marked by suppression
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of appetite and intentional caloric deprivation or self-starvation.
May have intense fear of becoming overweight and weight loss
does not detensify that fear.
There is a psychological distortion of body image, as the
anorexic sees him/herself as fat, even if extremely underweight.
Weight loss is pursued through extreme limitation of calories,
fasting, strenuous exercise, use of laxatives and diuretics and
sometimes self-induced vomiting.
Disorder sometimes begins at the onset of puberty.
Problems include CV problems, gastrointestinal problems, body
can use organs for protein due to lack of fat, amenorrhea
(suppression of menstrual cycle), anemia, calcium loss, brittle
bones, swollen joints and light-headedness. Eventually heart
failure can occur.
Eating Disorders
• Bulimia Nervosa – This is known as the binge-purge
syndrome.
• It is marked by high amounts of food/calorie
consumption (1,000-60,000 calories), followed by selfinduced vomiting and/or use of laxatives and diuretics.
• Compulsive exercise also may be a characteristic of
bulimia.
• Bulimia differs from anorexia in that the individual may
maintain a normal body weight due to the binges
experienced. This allows the bulimic to hide the
problem, making it more difficult to identify.
• Eating disorders are mental disorders and must be
treated as such.
• Causes and contributing factors are complex and
professional help is necessary.
Eating Disorders
• Binge-Eating Disorders – Individuals typically
experience episodes of out of control eating.
• Common characteristics include:
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Eating much more rapidly than normal
Eating until uncomfortably full
Eating large quantities of food even when not hungry
Eating alone to hide the quantity of food being ingested
Feeling disgusted, depressed, or guilty after overeating
They do not purge their bodies after eating, thus different
from bulimia.
Who Is At Risk?
• Estimated 1 in every 100 teenage girls are anorexic
• Anorexia usually occurs in adolescent women (90% of all
reported cases)
• Estimated 1 in every 5 college-bound females is bulimic
• College campuses have a higher incidence of people with eating
disorders
• Upper middle class women who are extremely self-critical are
also more likely to become anorexic
• Activities such as dance and dance team, gymnastics, figure
skating, track and cheerleading tend to have higher incidences
of eating disorders
• Wrestlers and body builders are also at risk due to unsafe
practices to “make weight” before competition.
TREATMENT
• Be supportive. Provide information about eating disorders.
• Be a good listener.
• Encourage professional help. Person may need counseling,
medical treatment or hospitalization.
• Be prepared for denial resistance and even hostility.
• Realize that the person’s responsibility is his/hers, not yours.
Eating Disorders Therapy/Programs
ISU Counseling Center
ISU Health Services
ISU Nutrition Mission
Anorexia Nervosa and Related Eating Disorders, Inc. –
www.anred.com