Download Chapter 1 – Title of Chapter

Chapter 9-1
Chapter 9 – Weight Management: Overweight, Obesity, and Underweight
Learning Objectives
After completing Chapter 9, the student will be able to:
9.1
Describe how body fat develops and why it can be difficult to maintain weight gains and losses.
a. Define overweight and obesity using the body mass index.
b. Explain fat cell development and its role in obesity.
c. Discuss the role of lipoprotein lipase in obesity.
d. Discuss the set point theory of obesity.
Review some of the causes of obesity.
a. Discuss the role of genetics, leptin, and ghrelin in the development of obesity.
b. Identify environmental causes of obesity.
Discuss the physical, social, and psychological consequences of overweight and obesity.
a. Explain the risks of fad diets, dietary supplements, and herbs in the treatment of obesity.
Explain the risks and benefits, if any, of aggressive ways to treat obesity.
a. Explain the drugs used to treat obesity and their side effects.
b. Discuss the risks and benefits of surgery for obesity.
Outline reasonable strategies for achieving and maintaining a healthy body weight.
a. List diet planning strategies for successful weight loss.
b. Explain the role of exercise in weight management.
Summarize strategies for gaining weight.
a. Explain weight-grain strategies.
Contrast the differences between popular fad diets and weight-loss diets based on sound nutrition.
9.2
9.3
9.4
9.5
9.6
H9
Glossary
Chapter Key Terms
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behavior modification: the changing of behavior by the manipulation of antecedents (cues or
environmental factors that trigger behavior), the behavior itself, and consequences (the penalties or rewards
attached to behavior).
brite adipocytes: white fat cells with brown fat cell characteristics; also called beige adipocytes.
brown adipose tissue: masses of specialized fat cells packed with pigmented mitochondria that produce
heat instead of ATP.
clinically severe obesity: a BMI of 40 or greater or a BMI of 35 or greater with additional medical
problems. A less preferred term used to describe the same condition is morbid obesity.
epidemic (ep-ih-DEM-ick): the appearance of a disease (usually infectious) or condition that attacks many
people at the same time in the same region.
o epi = upon
o demos = people
fad diets: popular eating plans that promise quick weight loss. Most fad diets severely limit certain foods
or overemphasize others (for example, never eat potatoes or pasta, or eat cabbage soup daily).
gene pool: all the genetic information of a population at a given time.
ghrelin (GRELL-in): a protein produced by the stomach cells that enhances appetite and decreases energy
expenditure.
o ghre = growth
leptin: a protein produced by fat cells under direction of the ob gene that decreases appetite and increases
energy expenditure.
o leptos = thin
lipoprotein lipase (LPL): an enzyme that hydrolyzes triglycerides passing by in the bloodstream and
directs their parts into the cells, where they can be metabolized or reassembled for storage.
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-2
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obesogenic (oh-BES-oh-JEN-ick) environment: all the factors surrounding a person that promote weight
gain, such as increased food intake, especially of unhealthy choices, and decreased physical activity.
set point: the point at which controls are set (for example, on a thermostat). The set-point theory that
relates to body weight proposes that the body tends to maintain a certain weight by means of its own
internal controls.
successful weight-loss maintenance: achieving a weight loss of at least 10 percent of initial body weight
and maintaining the loss for at least 1 year.
underweight: body weight lower than the weight range that is considered healthy; generally defined as
BMI <18.5.
weight management: maintaining body weight in a healthy range by preventing gradual weight gains over
time and losing weight if overweight, and by preventing weight losses and gaining weight if underweight.
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-3
Lecture Presentation Outline
Key to instructor resource annotations (shown to the right of or below outline topics):
Website
= Available for download from book companion website: HN = student handout
IM
= Included in this instructor’s manual: CS = case study, WS = worksheet, CA = classroom activity
Introductory/whole chapter resources: PL figure JPEGs; Test Bank; IM WS 9-8, CA 9-1
I.
Overweight and Obesity (Figure 9-1)
A. Fat Cell Development – Explain how fat cells develop, including:
1. Fat cell numbers (Figure 9-2)
a. Hyperplastic obesity
b. Apoptosis
2. Fat cell size
a. Hypertrophic obesity
B. Fat Cell Metabolism – Explain fat cell metabolism, including:
1. Lipoprotein lipase
2. Gender differences
C. Set-Point Theory
II. Causes of Overweight and Obesity
A. Genetics and Epigenetics
1. Explain and discuss epigenetics
2. Leptin – Define and explain leptin (Figure 9-3)
3. Ghrelin – Discuss ghrelin
4. Uncoupling Proteins – Explain uncoupling proteins
a. White adipose tissue
b. Brown adipose tissue
B. Environment – Explain the environmental influence over obesity, including:
1. Overeating
2. Physical Inactivity
IM HN 9-1
III. Problems of Overweight and Obesity
A. Health Risks – Discuss health risks associated with overweight and obesity
1. Overweight in Good Health – Overweight people who are in good health may not need to lose weight
2. Obese or Overweight with Risk Factors – Obese or overweight people with risk factors could improve
health by losing weight; risk factors include:
a. Hypertension
b. Cigarette smoking
c. High LDL
d. Low HDL
e. Impaired glucose tolerance
f. Family history of heart disease
g. Men  45 years, women  55 years
3. Obese or Overweight with Life-Threatening Condition – Obese or overweight people with the
following life-threatening-conditions may improve health by losing weight:
a. Heart disease
b. Type 2 diabetes
c. Sleep apnea
B. Perceptions and Prejudices
IM CA 9-2
1. Social Consequences
a. Prejudices and discrimination
b. Judged on appearance
c. Stereotypes
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license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-4
2.
Psychological Problems
a. Feelings of rejection, shame, and depression
b. Ineffective treatments can lead to a sense of failure (Figure 9-4)
C. Dangerous Interventions
1. Fad Diets
2. Weight-Loss Products
a. Ephedrine-containing products
b. Herbal laxatives
c. Current laws do not require safety tests and effectiveness tests
3. Other Gimmicks
IM HN 9-2, 9-3
IV. Aggressive Treatments for Obesity
A. Drugs
1. Orlistat
2. Phentermine, diethylpropion, and phendimetrazine
B. Surgery
1. Explain who is a candidate for surgery
2. Gastric surgery (Figure 9-5)
3. Liposuction
V. Weight-Loss Strategies
A. Changes, Losses, and Goals
1. Small changes
2. Moderate losses
3. Reasonable goals
B. Eating Patterns – Explain the following:
1. Be Realistic about Energy Intake (Figure 9-6)
a. 300-500 kcalories/day reduction for BMI between 27 and 35
b. 500-1000 kcalories/day reduction for BMI  35
2. Emphasize Nutritional Adequacy
3. Eat Small Portions
4. Slow Down
5. Lower Energy Density
6. Remember Water
7. Focus on Fiber
8. Choose Fats Sensibly
9. Select Carbohydrates Carefully
10. Watch for Other Empty kCalories
B. Physical Activity – Discuss the following:
1. Activity and Energy Expenditure
2. Activity and Discretionary kCalories (Figure 9-7)
3. Activity and Metabolism
4. Activity and Body Composition
5. Activity and Appetite Control
6. Activity and Psychological Benefits
7. Choosing Activities
a. Choose activities that you enjoy
b. Low to moderate intensity for long duration
c. Daily routines
8. Spot Reducing
a. Regular aerobic exercise
b. Strength training
c. Stretching
IM WS 9-1
IM WS 9-2
IM CS 9-1, 9-2, WS 9-3, HN 9-4
Website HN 9-7
IM CA 9-3
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-5
C. Environmental Influences – Explain how the following influence activity:
1. Atmosphere
2. Accessibility
3. Socializing
4. Distractions
5. Multiple Choices
6. Package and Portion Sizes
7. Serving Containers
D. Behavior and Attitude
Website HN 9-8; IM WS 9-4, 9-5, 9-6, CA 9-4
1. Behavior modification
2. Become Aware of Behaviors (Figure 9-8)
3. Change Behaviors
a. Do not grocery shop when hungry
b. Eat slowly
c. Exercise while watching television
4. Cognitive Skills
5. Personal Attitude
6. Support Groups
E. Weight Maintenance
1. Successful weight-loss maintenance
2. Vigorous exercise and careful eating plans
3. Frequent self-monitoring
F. Prevention
1. Eat regular meals and limit snacking
2. Drink water in place of high-kcalorie beverages
3. Select sensible portion sizes and limit daily energy intake to energy expended
4. Limit sedentary activities and be physically active
G. Community Programs (Table 9-4)
VI. Underweight (BMI  18.5)
A. Problems of Underweight – Discuss the problems associated with being underweight
B. Weight-Gain Strategies
1. Energy-Dense Foods
2. Regular Meals Daily
3. Large Portions
4. Extra Snacks
5. Juice and Milk
6. Exercising to Build Muscles
VII. Highlight: The Latest and Greatest Weight-Loss Diet—Again
IM CA 9-5, 9-6, WS 9-7, HN 9-5, 9-6
A. Fad Diets’ Appeal – Fad diets involve misconceptions and distortions of facts
1. Don’t Count kCalories – Fad diets often require strict elimination of certain foods
2. Follow a Plan
a. Specific instruction and examples are needed
b. Specific plans will not be helpful for long-term changes
3. The Real Deal – Healthy weight loss requires long-term changes
Case Studies
Case Study 9-1: Low-Energy-Density Dinner1
Christine C. is 49-year-old nurse who works full-time at a senior health care center. She is 65 inches tall and her
usual weight is 150 pounds. Over the past year, Christine has gained 12 pounds although she is not aware of any
major changes in her eating or exercise habits. She has set a goal to eat three balanced meals a day with no more
1
Contributed by Barbara Quinn.
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license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-6
than 500 calories per meal. Christine is tired and hungry from a long day at work. She is trying to decide between
the following items for a quick and easy dinner:
Canned beef chili with beans: 1 cup (247 grams), 305 kcalories, 11 grams fat, 6 grams dietary fiber, and 18 grams
protein.
Canned lentil vegetable soup: 1 cup (205 grams), 130 kcalories, 3 grams fat, 5 grams dietary fiber, and 6 grams
protein.
Cornbread: 1 piece (78 grams), 290 kcalories, 13 grams fat, 1 gram dietary fiber, 3 grams protein.
Sprouted whole-wheat bread: 2 slices (45 grams), 100 kcalories, 2 grams fat, 5 grams dietary fiber, 6 grams protein.
1.
2.
3.
4.
5.
6.
Use the formula discussed in this chapter to calculate the energy density of the four foods Christine is
considering for dinner.
Based on these calculations, which two foods provide the fewest calories “per bite”? Which two provide the
most calories “per bite”?
How might Christine use this information about energy density to help her select a satisfying meal within her
calorie goal?
What are some reasonable meals that Christine could prepare from these foods that would help her stay within
her kcalorie goal? (Use at least 2 of the 4 foods listed.)
What other foods might Christine consider adding to these convenience foods to create a more balanced meal
that remains low in energy density?
How might Christine use the serving size information on the Nutrition Facts label to help her with meal
planning?
Answer Key
1. Canned beef chili with beans: 305 kcalories/247 grams= 1.23; lentil vegetable soup: 130 kcal/205 grams = 0.63;
cornbread: 290 kcal/78 grams = 3.7; sprouted wheat bread: 100 kcal/45 grams = 2.2
2.
Fewest calories per bite (per gram) sprouted wheat bread and lentil vegetable soup. Most calories per bite (per
gram): cornbread and canned beef chili with beans.
3.
Answers will vary. Choosing more foods of lower energy density will enable Christine to eat satisfying portions
and still limit her kcalorie intake.
4.
Answers may include: lentil vegetable soup and sprouted wheat bread (230 kcalories); canned chili with beans
and sprouted wheat bread (405 kcal); lentil vegetable soup and cornbread (420 kcal).
5.
Answers will vary but should include the addition of a non-starchy vegetable, whole fruit, and/or low-fat or
non-fat milk.
6.
Answers will vary. It may help her to eat smaller portions and thus take in fewer kcalories; or help her
understand the importance of portion control when eating calorie-dense foods.
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-7
Case Study 9-2: Lifestyle Changes for Weight Loss
Sally is a 43-year-old mother of two who has gained 50 pounds over the past five years. She is 64 inches tall and
weighs 180 pounds with a BMI of 30.8. Her waist circumference is 37 inches. She acknowledges that she is not as
physically active as she would like to be. She also notes how recent stresses in her life have affected her sleep and
seem to have triggered her appetite for sweets. Sally’s father recently died from complications of type 2 diabetes and
her mother and sisters are overweight. Sally says she is very motivated to “not get diabetes” and is disturbed that her
recent physical exam revealed mildly elevated blood pressure, glucose, and cholesterol levels.
1.
Sally wonders how much of a role genetics plays in determining her weight. She has heard about a gene, called
ob, that codes for a protein that maintains homeostasis by regulating food intake and energy expenditure in
response to adipose tissue. What is the name of the protein?
a. adipocyte
b. ghrelin
c. leptin
d. obesocyte
e. insulin
2.
Sally considers taking herbal supplements to help her lose weight, reasoning that because they are natural, they
must be safe. What herbal stimulant sometimes taken for weight loss has been implicated in heart attacks and
seizures and has been banned by the FDA?
a. epinephrine
b. black cohosh
c. ephedrine
d. milk thistle
e. St. John’s wort
3.
Sally also considers taking medication to help her lose weight. In reading about these, she notices that the side
effects for one popular medication include GI cramping, gas, frequent bowel movements, diarrhea, and reduced
absorption of fat soluble vitamins. What medication has that profile?
a. lorcaserin hydrochloride
b. phentermine
c. diethylpropion
d. orlistat
e. phendimetrazine
4.
Sally’s friend, Monique, was morbidly obese and had surgery to help her lose weight. What should Sally know
about weight loss surgery?
a. About 25% of the excess weight will remain lost after 15 years.
b. Gastric banding suppresses hunger by changing production of gastrointestinal hormones.
c. The long-term safety and effectiveness of surgery depend, in large part, on compliance with dietary
instructions.
d. Advantages of gastric banding include being more durable, reliable, and effective.
e. Advantages of gastric bypass include being more flexible, less invasive, and safer.
5.
Based on the considerations discussed in your text, what would a reasonable six-month weight loss goal be for
Sally?
a. 10 pounds
b. 12 pounds
c. 14 pounds
d. 18 pounds
e. 20 pounds
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-8
6.
If Sally goes on a typical weight-loss diet for women, how many kcalories will it provide per day?
a. 800
b. 900
c. 1000
d. 1100
e. 1200
7.
Given her current BMI of 30.8, what should Sally’s goal for her daily kcalorie deficit be?
a. 100 to 200
b. 200 to 300
c. 300 to 500
d. 500 to 750
e. 750 to 1000
Answer Key
1. c
2.
c
3.
d
4.
c
5.
d
6.
e
7.
c
Classroom Activity 9-3: Snacking with a Purpose (Snack Comparison)2
Key concepts: Energy density; meal planning for weight loss/gain
Class size: Any
Instructions: Read the case scenario to students, present the high-calorie and low-calorie snack examples to them,
and then use the discussion questions to guide them in considering how the energy density of food choices can be
manipulated to promote weight gain or weight loss/maintenance.
Case scenario: You are a registered dietitian in an outpatient clinic. A mother brings her two young daughters in to
see you. One daughter is underweight and needs suggestions for high-calorie snacks to promote weight gain. The
other daughter is at a normal weight and struggles with wanting to eat snacks each time her sister does. The family is
asking for help with balancing low-calorie snack ideas with high-calorie snack ideas, using basically the same
groceries.
High-calorie snacks:
1 cup whole-milk yogurt mixed with ¼ cup granola
1 smoothie (1 cup berries, fresh or frozen, blended with
½ cup ice cream and 1 cup whole milk)
1 ½ cups cereal (low sugar) with 1 cup whole milk
½ English muffin spread with 2 tablespoons peanut
butter and ½ of a mashed banana
1 medium apple with ½ cup cottage cheese
1 cup trail mix (1/3 cup nuts, 1/3 cup dried fruit, 1/3 cup
cereal)
Low-calorie snacks:
1 cup low-fat yogurt
1 cup berries, fresh or frozen
¾ cup cereal (low sugar) with 1 cup skim milk
½ English muffin spread with 1 tablespoon jam
1 small apple and 1 low-fat cheese stick
¼ cup trail mix (1 tablespoon nuts, 1 tablespoon dried
fruit, 2 tablespoons cereal)
Discussion questions:
1. What additional suggestions do you have for snack ideas that use similar foods and can be modified to be higher
or lower in calories?
2. What types of beverages should be recommended to help with weight gain? And to prevent weight gain?
2
Contributed by Carrie King
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-9
3.
What other suggestions do you have for promoting well-balanced nutrition for each child while achieving their
weight goals?
Answer key:
1. Answers will vary.
2. For weight gain: whole or 2% milk, 100% fruit juice; possibly liquid nutrition supplements. For weight
management: skim milk, water; prefer whole fruit over drinking juice.
3. Answers will vary. Possible examples: nutrient-dense foods should be emphasized for both children; energydense foods should be emphasized for the underweight child.
Energy provided by snacks for instructor reference:
High-Calorie Snack
1 cup whole-milk yogurt mixed with ¼ cup
granola
1 smoothie (1 cup berries, fresh or frozen,
blended with ½ cup ice cream and 1 cup
whole milk)
1 ½ cups cereal (low sugar) with 1 cup whole
milk
½ English muffin spread with 2 tablespoons
peanut butter and ½ of a mashed banana
1 medium apple with ½ cup cottage cheese
1 cup trail mix (1/3 cup nuts, 1/3 cup dried fruit,
1
/3 cup cereal)
kcal
298
Low-Calorie Snack
1 cup low-fat yogurt
365
1 cup berries, fresh or frozen
91
300
¾ cup cereal (low sugar) with 1 cup skim milk
166
315
½ English muffin spread with 1 tablespoon
jam
1 small apple and 1 low-fat cheese stick
¼ cup trail mix (1 tablespoon nuts, 1
tablespoon dried fruit, 2 tablespoons cereal)
131
235
381
kcal
137
135
80
Classroom Activity 9-4: Food Diary and Examination of Eating Habits
Critical Thinking Questions3
1.
How can you modify an obseogenic environment?
2.
How does the presence of risk factors potentiate the development of chronic disease for the overweight
individual?
3.
Describe diet planning methods that would help to increase weight loss for overweight and obese individuals.
4.
Many individuals hope to lose weight in certain areas, a concept commonly known as “spot reducing.” Based
on your understanding of metabolism, is this a realistic goal?
5.
Why are weight-loss accomplishments hard to define for the average individual?
6.
How does being underweight affect health? What factors would contribute to an individual becoming
underweight?
Answer Key
1. An obesogenic environment represents the direct/indirect influences that affect an individual’s daily struggle
with issues that “lead us to fatness.” When considering methods that would possibly modify this type of
environment, one should reflect on a variety of potential psychological and physiological interventions.
Psychological influences affect food-related behaviors. Society is based on interactions such that food intake
patterns are learned behaviors. Food not only provides sustenance but is seen as part of social communication.
Snacking patterns have become such a staple of social communication that they have contributed to the
formation of an obseogenic environment. By limiting snacking and/or selecting healthier snacks, one may be
able to modify this factor. Portion control coupled with healthier food choices will help to offset this type of
environment. Physiological interventions such as increased physical activity may likewise neutralize an
obseogenic environment. Addition of physical activities on a daily basis will increase energy expenditure and
divert time from sedentary pursuits (and the mindless eating that often accompanies them).
3
Contributed by Daryle Wane.
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-10
2.
Individuals who are overweight are already at risk for health problems. The presence of additional risk factors
such as smoking, significant family history, gender, and age dramatically increase the likelihood of health
problems. Smoking affects the entire body, leading to altered oxygenation status and the risk of cancer. A
significant family history inclusive of medical problems such as heart disease increases the likelihood from a
genetic standpoint that the individual will develop disease. In terms of gender and age, males and females of a
certain age (above 45 and 55, respectively) are more at risk for disease. Individuals who have hypertension
and/or alterations in glucose and lipid metabolism are prone to develop disease states. Certain risk factors can
be considered to be modifiable in that the individual has some control as to their relative influence if she or he
changes her/his behavior. Other risk factors are known as non-modifiable because the individual cannot change
the effects and/or outcomes.
3.
Portion control is key for successful weight loss. By using this method, one can realistically decrease caloric
consumption and build a foundation of food intake based on appropriate portion sizes. Visualization of portions
using commonly known objects such as a deck of cards for a serving of protein will help an individual to
objectively quantify food intake. Including water as a main source of fluids in the daily diet will help to increase
weight loss. In addition to decreasing the amount of food needed during a meal to achieve satiety, water
provides hydration to body cells. Limiting and/or stopping soda consumption will help to decrease empty
calories in the diet. Along with water intake, one should also increase fiber intake. Foods that are high in fiber
will also contribute to satiety as well as provide vitamins and minerals. Lastly, decreasing fat intake by making
realistic choices will help to increase weight loss. Limiting intake of high-fat processed or fast foods in the diet
is a key factor in decreasing caloric intake.
4.
Although the presence of fat in certain areas of the body has some association with gender (females typically
have more fat on their hips whereas males have more fat in their stomach area), the idea of spot reducing is
problematic based on metabolism. Fat in the body is released when needed for muscular work independent of
location. Therefore, spot reducing as a concept is not realistic. Working on specific locations of the body to help
tone up muscles requires a combination of aerobic exercise, flexibility training, and strength conditioning.
5.
The weight-loss business is a multibillion dollar industry that utilizes a combination of products and
psychological methods to induce weight loss. Part of the reason why weight loss accomplishments are hard to
define for the average individual is inconsistent criteria used to denote progress among these methods. There are
several factors to consider. The first is the length of time that the weight loss has been maintained. The second
is the amount of weight loss that has been achieved and maintained. Many people lose weight but are likely to
get caught up in a weight cycling pattern due to the fact that they have not really changed their eating behaviors.
Their weight loss is due in part to their participation in a method without changing their underlying behavior.
Thus, when they are no longer on the diet plan, they revert back to their prior eating patterns and gain the
weight back. Lastly, one must consider not only eating behaviors but the amount of physical exercise and
activity performed in conjunction with an eating pattern. If one does not have a balance of physical activity in
conjunction with dietary intake, then he or she will be more likely to gain weight despite an initial weight loss
due to diet.
6.
An individual who is underweight may have significant health concerns, for the body will not be able to sustain
metabolism in the absence of adequate fuel sources. If the person’s food intake is inadequate, her/his body will
break down nutrient stores (if available) to fuel itself. Cellular activity in the body will be compromised, leading
to alterations in energy balance. The functions of the body will be compromised, leading to risk for infection.
Nutrient deficiencies will arise.
While decreased dietary intake is commonly the etiology for an individual becoming underweight, consumption
of food can be mediated by other factors, most notably those related to disease processes. Acute as well as
chronic disease processes can affect nutrient intake and/or metabolism. Medical treatments such as
chemotherapy and radiation can lead to significant weight loss and malnutrition. Surgical interventions as a
result of diseases affecting the digestive tract can also affect nutrient absorption and metabolism. Psychological
problems manifesting in eating disorders can lead to an individual becoming underweight. The impact of
society on one’s perception of body image can have far-reaching effects on one’s health and well being.
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-11
IM Worksheet Answer Key
Worksheet 9-1: Weight Management Medications4
Medication
Classification
Clinical Indication
Megestrol
Orexigenic
Treatment of metastatic breast
acetate
agent
cancer, metastatic endometrial
(Megace)
cancer; stimulation of appetite and
promotion of weight gain in patients
with wasting due to AIDS or cancer
Dronabinol
Orexigenic
Prevention of nausea/vomiting
(Marinol)
agent
during cancer treatment; stimulation
of appetite in AIDS patients
Phentermine
(Adipex-P,
Ionamin)
Anorectic agent
Acceleration of weight loss in
overweight patients; used for a
limited period of time
Orlistat
(Xenical, alli)
Lipase inhibitor
Weight loss/maintenance in
overweight patients
1.
2.
3.
4.
5.
Monitoring Aspects
Monitor for side effects: increased
appetite and weight gain, swelling,
hyperglycemia, headache, breast
tenderness, impotence, decreased
sexual desire, elevated blood pressure
Monitor for interactions with alcohol
and other depressant medications;
side effects: dizziness,
lightheadedness, or fainting; mental
disturbances
Monitor for interactions with
antidepressant/-anxiety medications
or alcohol; monitor for need to
change insulin dosages in diabetic
patients; side effects: increased blood
pressure, heart palpitations,
restlessness, tremor, insomnia, etc.
Monitor for improvement of blood
glucose in diabetic patients; monitor
for compliance with fat-restricted diet
and daily multivitamin supplement;
monitor liver function
FDA (Food and Drug Administration)
Yes
See “Monitoring Aspects” column of table.
For medications used to promote weight loss or gain, the clinician would monitor the patient’s weight, assess
body composition using appropriate techniques, and check for edema/dehydration (changes in fluid balance). If
the medication is being used to counteract wasting, a gain of weight (not attributable to fluid retention) would
indicate the medication is working. If it is being used to promote weight loss, then loss of weight at a reasonable
rate, improvement in blood lipid profile, reduction in blood pressure (for hypertensive patients), and
improvement in glycemic control (for diabetic patients) are indications that the medication is benefiting the
patient.
Sample pricing: Megestrol acetate = $52.99 for 100 40-mg tablets; Marinol = $441.97 for 60 2.5-mg capsules;
Adipex-P = $76.97 for 30 37.5-mg tablets; Xenical = $279.91 for 60 120-mg capsules; alli = $54.79 for “starter
pack” with 90 60-mg capsules
Worksheet 9-2: Clinical Application—Bariatric Surgery5
1. Answers will vary. An example of a reliable information source is Medline Plus
(http://www.nlm.nih.gov/medlineplus/).
2. A gastric bypass is a surgical procedure in which a route for food which bypasses the stomach, duodenum, and
part of the jejunum is created. The surgeon staples off most of the stomach to create a small pouch, and then
attaches this pouch directly to the small intestine. This results in both a restriction of the quantity of food that
4
Sources for answer key: Medline Plus: Drugs, Supplements, and Herbal Information. Accessed 4 April 2012 & 8
Nov. 2006, from: http://www.nlm.nih.gov/medlineplus/druginformation.html. Drugstore.com: Drug Information.
Accessed 4 April 2012, from: http://www.drugstore.com.
5 Source for answer key: National Institute of Diabetes & Digestive & Kidney Diseases. Weight-control Information
Network: Gastrointestinal Surgery for Severe Obesity. Accessed 4 April 2012 & 8 Nov. 2006 from:
http://win.niddk.nih.gov/publications/gastric.htm.
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-12
3.
4.
5.
6.
7.
8.
9.
can be eaten at one time and a reduction in the amount of energy-yielding and other nutrients absorbed from the
food.
Criteria include either (a) BMI of 40 or more (100 pounds overweight for men, or 80 pounds for women) or (b)
BMI of 35-39.9 and 1 or more serious comorbidities, plus an understanding of and willingness to comply with
the required lifestyle changes post-surgery.
$20,000 to $25,000
This depends on the patient’s state of residence and insurance provider.
Short term: bleeding, infection, leaks where intestines are sewn, embolism; long term: hernia, strictures,
“dumping syndrome,” anemia due to iron or vitamin B12 deficiencies, osteoporosis due to reduced calcium
absorption
Patients must take vitamin/mineral supplements to prevent deficiencies.
Most patients lose eight for 18 to 24 months after surgery, and many maintain a weight loss of 60%-70% of
their excess weight for 10 years or more. This weight loss may relieve comorbid conditions such as
hypertension, diabetes, and sleep apnea.
Answers will vary.
Worksheet 9-3: Strategies to Healthier Weight (Internet Exercise)
1. b
6. b
2. d
7. d
3. a
4. d
5. a
Worksheets 9-4, 9-5, 9-6, and 9-7 – Answers will vary.
Worksheet 9-8: Chapter 9 Crossword Puzzle
1. gastric bypass
5. fad diet
2. breakfast
6. set point
3. energy density
7. ghrelin
4. modification
8. behavior
9. lipoprotein lipase
10. sixty
11. leptin
12. two
13. orlistat
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-13
Worksheet 9-1: Weight Management Medications
Medication
Megestrol
acetate
(Megace)
Classification
Orexigenic
agent
Dronabinol
(Marinol)
Orexigenic
agent
Phentermine
(Adipex-P,
Ionamin)
Orlistat
(Xenical, alli)
Anorectic agent
Clinical Indication
Monitoring Aspects
Lipase inhibitor
For each of the medications listed above, look up both the clinical indications and the monitoring aspects associated
with a client taking this drug for his or her respective weight management issue.
After you have found the information, consider the following questions:
1.
Which government agency is involved in the regulation of these medications?
2.
Is ongoing monitoring required for the use of these medications?
3.
What adverse effects could occur if a client is taking these medications?
4.
How would you evaluate whether the client is improving with respect to treatment?
5.
How expensive are the medications?
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-14
Worksheet 9-2: Clinical Application—Bariatric Surgery
Consider the following scenario: Someone told you that she was considering having a “gastric bypass” and asked
you to explain to her exactly what that meant in terms of the surgical procedure and nutritional management. When
considering these questions, identify the resources that are available to people on the Internet.
1.
How would you go about finding out about the surgical procedure?
2.
What is meant by the term “gastric bypass”?
3.
What criteria are used to determine if an individual should have this type of procedure?
4.
How much does this procedure cost?
5.
Will insurance cover the procedure?
6.
What are the complications associated with this type of procedure?
7.
What type of nutritional management will occur post procedure?
8.
What will be the long-term effects of this type of procedure?
9.
First, think of the answers that would be provided by a healthcare provider to a client and secondly, think of the
answers that a client might obtain independent of a healthcare provider. How would the answers differ? How
would you determine the resources’ scientific reliability and validity?
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-15
Worksheet 9-3: Strategies to Healthier Weight (Internet Exercise)
Go to the following website to answer questions 1-6: http://www.cdc.gov/healthyweight/losing_weight/index.html.
Click on and read through, “Lose Weight,” “Getting Started” and “Improving Your Eating Habits.”
1.
a.
b.
A weight loss of 5% does not offer any health benefits.
True
False
2.
a.
b.
c.
d.
One pound is equal to ____ calories.
100
500
1,200
3,500
3.
a.
b.
A healthy weight loss goal is to lose about one to two pounds per week.
True
False
4.
a.
b.
c.
d.
Which habit is most likely to help you avoid weight gain?
standing while eating
skipping one meal a day
finishing what’s on your plate
having fruit for dessert
5.
a.
b.
Healthy weight loss can improve general mood.
True
False
6.
a.
b.
Setting one general goal such as, “Eat Less,” is a good strategy to weight loss.
True
False
Go to the following website to learn about portion sizes and then answer question 7:
http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000337.htm
7.
Which food item portion is matched correctly with the description of its recommended size?
a. one serving of meat or poultry – tennis ball
b. one-half cup cooked rice or pasta – six dice
c. one medium apple – golf ball
d. two tablespoons of peanut butter – ping-pong ball
e. one serving cheese – rounded handful
f. one-fourth cup dried fruit or nuts – deck of cards
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-16
Worksheet 9-4: Eating Attitudes Test
Answer these questions using the following responses:
A = Always
U = Usually
O = Often
S = Sometimes
R = Rarely
Response
_____
Score*
_____ 1.
I am terrified about being overweight.
_____
_____
2.
I avoid eating when I am hungry.
_____
_____
3.
I find myself preoccupied with food.
_____
_____
4.
I have gone on eating binges where I feel that I may not be able to stop.
_____
_____
5.
I cut my food into very small pieces.
_____
_____
6.
I am aware of the calorie content of the foods I eat.
_____
_____
7.
I particularly avoid foods with a high carbohydrate content.
_____
_____
8.
I feel that others would prefer if I ate more.
_____
_____
9.
I vomit after I have eaten.
_____
_____
10. I feel extremely guilty after eating.
_____
_____
11. I am preoccupied with a desire to be thinner.
_____
_____
12. I think about burning up calories when I exercise.
_____
_____
13. Other people think I am too thin.
_____
_____
14. I am preoccupied with the thought of having fat on my body.
_____
_____
15. I take longer than other people to eat my meals.
_____
_____
16. I avoid foods with sugar in them.
_____
_____
17. I eat diet foods.
_____
_____
18. I feel that food controls my life.
_____
_____
19. I display self-control around food.
_____
_____
20. I feel that others pressure me to eat.
_____
_____
21. I give too much time and thought to food.
_____
_____
22. I feel uncomfortable after eating sweets.
_____
_____
23. I engage in dieting behavior.
_____
_____
24. I like my stomach to be empty.
_____
_____
25. I enjoy trying new rich foods.
_____
_____
26. I have the impulse to vomit after meals.
_____
*Scoring:
N = Never
Total score
3 for never, 2 for rarely, 1 for sometimes, 0 for always, usually and often.
Total scores under 20 points indicate abnormal eating behavior.
Source: J. A. McSherry, Progress in the diagnosis of anorexia nervosa, Journal of the Royal Society of Health 106
(1986): 8-9. (Eating Attitudes Test developed by Dr. Paul Garfinkel.)
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-17
Worksheet 9-5: Exploring Eating Habits
To explore your eating habits, check all the answers that describe your food intake patterns. Then, consider possible
areas for improvement.
When do I usually eat?
_______ At mealtime.
_______ While studying.
_______ While preparing meals or clearing the table.
_______ When spending time with friends.
_______ While watching TV or participating in other activities.
_______ Anytime.
Where do I usually eat?
_______ At home at the kitchen or dining room table.
_______ In the school cafeteria.
_______ In fast-food places.
_______ In front of the TV or while studying.
_______ Wherever I happen to be when I’m hungry.
Why do I usually eat?
_______ It’s time to eat.
_______ I’m hungry.
_______ Foods look tempting.
_______ Everyone else is eating.
_______ Food will get thrown away if I don’t eat it.
_______ I’m bored or frustrated.
Changes I want to make:
Source: U.S. Department of Agriculture, Dietary Guidelines and Your Health: Health Educator’s Guide to Nutrition
and Fitness (Washington, DC, US Government Printing Office, 1992).
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-18
Worksheet 9-6: Exploring Food and Activity Choices
Does your BMI fall between 18.5 and 24.9? If so, you may want to maintain your weight. If not, you may need to
gain or lose weight to improve your fitness and health. Determine whether these food and activity choices are typical
of your lifestyle.
Food and activity choices
Frequency per week
Promote weight gain:
Drink plenty of juice.
Eat energy-dense foods.
Eat large portions.
Eat peanut butter crackers between meals.
Eat three or more large meals a day.
Promote weight loss:
Drink plenty of water.
Eat nutrient-dense foods.
Eat slowly.
Eat small portions.
Limit snacks to healthful choices.
Limit television watching.
Participate in physical activity.
Select low-fat foods.
Share a restaurant meal or take home leftovers.

On the average, do your lifestyle choices promote weight gain, weight loss, or weight maintenance?
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-19
Worksheet 9-7: Evaluation of a Commercial Weight-Loss Program
1.
Describe the food program promoted by the organization. Is the program flexible enough to allow people with
different foodways and lifestyles to use it successfully? Is it adaptable and easy to follow? Does it provide
variety? Does the program provide for weight maintenance after goal weight is achieved?
2.
Describe how the plan works. Does it require substantial registration fees, mandatory purchase of various items
or foods, attendance at a minimum number of meetings?
3.
Evaluate whether the plan offers a nutritionally sound way to lose weight. What characteristics make it sound or
unsound?
4.
Describe any “case histories” you might overhear or learn about and your impressions of them. Do the stories
sound authentic? Do they sound as though the person’s weight loss was achieved sensibly? Do they present
facts? Do they contain any “magic bullets”?
5.
Describe your overall impressions of the meeting, telling whether they were positive or negative and why. If
you had a weight problem, would you consider membership in this organization?
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-20
Worksheet 9-8: Chapter 9 Crossword Puzzle
1
2
3
4
5
6
7
8
9
10
11
12
13
Across:
Eating _____ is associated with maintaining a
healthy weight.
3. Foods with high _____ help to promote weight gain.
7. Protein that regulates appetite
9. Enzyme that plays a key role in the development of
obesity
12. Maximum number of pounds recommended as safe
weight loss in one week
13. FDA-approved drug that blocks fat absorption
2.
Down:
Considered to be the most reliable of the weight loss
surgeries
4. Techniques that address behaviors associated with
losing weight (2nd word of answer; 1st word is #8)
5. Weight-loss plan that promises quick results and
can be dangerous
6. Theory that the body maintains weight at a
particular level, like a thermostat
8. Techniques that address behaviors associated with
losing weight (1st word of answer; 2nd word is #4)
10. DRI to prevent weight gain is moderate physical
activity for _____ minutes daily
11. Protein that regulates energy balance in response to
the level of adipose tissue
1.
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-21
Handout 9-1: Proteins Involved in Regulation of Food Intake
and Energy Homeostasis
Protein
Concentration
Secreted from
Action
Adiponectin
Lower in obesity
Adipose tissue
Increases insulin
sensitivity
Ghrelin
Increases with fasting
Stomach
Stimulates appetite
Adipose tissue
Suppresses appetite
Decreases after a meal
Lower in obesity
Leptin
Higher in obesity
Increases energy
expenditure
Obestatin
Lower in obesity
Stomach
Suppresses appetite
Oxyntomodulin
Increases after a meal
Central nervous system
Suppresses appetite
GI tract
Pancreatic peptide (PP)
Increases after a meal
Pancreas
Suppresses appetite
PYY
Lower in obesity
Small intestine
Suppresses appetite
Adipose tissue, bone
marrow, and immune
system cells
Provides short-term
satiety
Adipose tissue
(specifically visceral)
Mimics glucoselowering effects of
insulin
Increases after a meal
Resistin
Visfatin
Higher in obesity
Higher in obesity
Opposes insulin
Sources: Adapted from S. S. Gropper, J. L. Smith, and J. L. Groff, Advanced Nutrition and Human Metabolism, 5th
ed. (Belmont, Calif.: Thomson Cengage, 2009) p. 299; M. H. Rokling-Andersen and coauthors, Effects of long-term
exercise and diet intervention on plasma adipokine concentrations, American Journal of Clinical Nutrition 86
(2007): 1293–1301; H. Xie and coauthors, Insulin-like effects of visfatin on human osteoblasts, Calcified Tissue
International 80 (2007): 201–210; M. E. Shills and coauthors, Modern Nutrition in Health and Disease, 10th ed.
(Philadelphia: Lippincott Williams and Wilkins, 2006); S. Tovar and coauthors, Central administration of resistin
promots short-term satiety in rats: A review, European Journal of Endocrinology 153 (2005): R1–R5; J. Berndt and
coauthors, Plasma visfatin concentrations and fat depot-specific mRNA expression in humans, Diabetes 54 (2005):
2911–2916.
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license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-22
Handout 9-2: Weight-Loss Consumer Bill of Rights (An Example)
1. Warning: Rapid weight loss may cause serious health problems. Rapid weight loss is weight loss of
more than 1½ to 2 pounds per week or weight loss of more than 1 percent of body weight per week
after the second week of participation in a weight-loss program.
2. Consult your personal physician before starting any weight-loss program.
3. Only permanent lifestyle changes, such as making healthful food choices and increasing physical
activity, promote long-term weight loss and successful maintenance.
4. Qualifications of this provider are available upon request.
5. You have a right to:
•
Ask questions about the potential health risks of this program and its nutritional content,
psychological support, and educational components.
•
Receive an itemized statement of the actual or estimated price of the weight-loss program,
including extra products, services, supplements, examinations, and laboratory tests.
•
Know the actual or estimated duration of the program.
•
Know the name, address, and qualifications of the dietitian or nutritionist who has reviewed and
approved the weight-loss program.
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-23
Handout 9-3: Selected Herbal and Other Dietary Supplements
Marketed for Weight Loss
Product
Bitter orange a (Citrus
aurantium, a natural flavoring
that contains synephrine, a
compound structurally similar
to epinephrine)
Chitosan b (pronounced
KITE-oh-san; derived from
chitin, the substance that
forms the hard shells of
lobsters, crabs, and other
crustaceans)
Chromium (trace mineral)
Claims
Stimulates weight loss;
provides an alternative
to ephedra
Research Findings
Little evidence available
Risks
May increase blood
pressure; may interact with
drugs
Binds to dietary fat,
preventing digestion
and absorption
Ineffective
Impaired absorption of fatsoluble vitamins
Eliminates body fat
Ineffective; weight gain
reported when not
accompanied by exercise
Conjugated linoleic acid
(CLA; a group of fatty acids
related to linoleic acid, but
with different cis- and transconfigurations)
Ephedrine c (amphetaminelike substance derived from
the Chinese ephedra herb ma
huang)
Fucoxanthin d (derived from
seaweed)
Hoodia (derived from cactus)
Hydroxycitric acid e (active
ingredient derived from the
rind of the tropical fruit
Garcinia cambogia)
Reduces body fat and
suppresses appetite
Some evidence in animal
studies, modest fat loss in
human studies
Headaches, sleep
disturbances, and mood
swings; hexavalent form is
toxic and carcinogenic
None known
Speeds body’s
metabolism
Short-term weight loss
and dangerous side effects
Speeds metabolism;
burns fat
Suppresses appetite
Inhibits the enzyme that
converts citric acid to
fat; suppresses appetite
No evidence available
Pyruvate f (3-carbon
compound produced during
glycolysis)
Yohimbine (derived from the
bark of a West African tree)
Speeds body’s
metabolism
Modest weight loss with
high doses
Promotes weight loss
Ineffective
Little evidence available
Ineffective
Insomnia, tremors, heart
attacks, strokes, and death;
FDA has banned the sale of
these products
None known
None known
Toxicity symptoms
reported in animal studies;
headaches, respiratory and
gastrointestinal distress in
humans
GI distress
Nervousness, insomnia,
anxiety, dizziness, tremors,
headaches, nausea,
vomiting, hypertension
a
Marketed under the trade names Xenadrine EFX, Metabolife Ultra, NOW Diet Support.
b
Marketed under the trade names Chitorich, Exofat, Fat Breaker, Fat Blocker, Fat Magnet, Fat Trapper, and Fatsorb.
c
Marketed under the trade names Diet Fuel, Metabolife, and Nature’s Nutrition Formula One.
d
Marketed under the trade name FucoThin.
e
Marketed under the trade names Ultra Burn, Citralean, CitriMax, Citrin, Slim Life, Brindleslim, Medislim, and
Beer Belly Busters.
f
Marketed under the trade names Exercise in a Bottle, Pyruvate Punch, Pyruvate-c, and Provate.
Note: The FDA has not approved the use of any of these products; most products are used in conjunction with a
1000- to 1800-kcalorie diet.
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-24
Handout 9-4: Recommendations for a Weight-Loss Diet
Nutrient
Recommended Intake
kCalories
For people with BMI ≥35
Approximately 500 to 1000 kcalories per day
reduction from usual intake
For people with BMI between 27 and 35
Approximately 300 to 500 kcalories per day
reduction from usual intake
Total fat
Saturated fatty acids
30% or less of total kcalories
a
8 to 10% of total kcalories
Monounsaturated fatty acids
Up to 15% of total kcalories
Polyunsaturated fatty acids
Up to 10% of total kcalories
Cholesterol a
300 mg or less per day
Protein
b
Approximately 15% of total kcalories
Carbohydrate c
55% or more of total kcalories
Sodium chloride
No more than 2400 mg of sodium or approximately
6 g of sodium chloride (salt) per day
Calcium
1000 to 1500 mg per day
Fiber c
20 to 30 g per day
a
People with high blood cholesterol should aim for less than 7 percent kcalories from saturated fat and
200 milligrams of cholesterol per day.
b
Protein should be derived from plant sources and lean sources of animal protein.
c
Carbohydrates and fiber should be derived from vegetables, fruits, and whole grains.
Source: National Institutes of Health Obesity Education Initiative, The Practical Guide: Identification,
Evaluation, and Treatment of Overweight and Obesity in Adults (Washington, D.C.: U.S. Department of
Health and Human Services, 2000), p. 27.
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-25
Handout 9-5: The Claims and Truths of Fad Diets
The Claim:
You can lose weight “easily.”
The Truth:
Most fad diet plans have complicated rules that require you to calculate protein
requirements, count carbohydrate grams, combine certain foods, time meal intervals,
purchase special products, plan daily menus, and measure serving sizes.
The Claim:
You can lose weight by eating a specific ratio of carbohydrate, protein, and fat.
The Truth:
Weight loss depends on expending more energy than you take in, not on the proportion of
energy nutrients.
The Claim:
This “revolutionary diet” can “reset your genetic code.”
The Truth:
You inherited your genes and cannot alter your genetic code.
The Claim:
High-protein diets are popular, selling more than 20 million books, because they work.
The Truth:
Weight-loss books are popular because people grasp for quick fixes and simple solutions
to their weight problems. If book sales were an indication of weight-loss success, we
would be a lean nation—but they’re not, and neither are we.
The Claim:
People gain weight on low-fat diets.
The Truth:
People can gain weight on low-fat diets if they overindulge in carbohydrates and proteins
while cutting fat; low-fat diets are not necessarily low-kcalorie diets. But people can also
lose weight on low-fat diets if they cut kcalories as well as fat.
The Claim:
High-protein diets energize the brain.
The Truth:
The brain depends on glucose for its energy; the primary dietary source of glucose is
carbohydrate, not protein.
The Claim:
Thousands of people have been successful with this plan.
The Truth:
Authors of fad diets have not published their research findings in scientific journals.
Success stories are anecdotal and failures are not reported.
The Claim:
Carbohydrates raise blood glucose levels, triggering insulin production and fat storage.
The Truth:
Insulin promotes fat storage when energy intake exceeds energy needs. Furthermore,
insulin is only one hormone involved in the complex processes of maintaining the body’s
energy balance and health.
The Claim:
Eat protein and lose weight.
The Truth:
For every complicated problem, there is a simple—and wrong—solution.
© 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a
license distributed with a certain product or service or otherwise on a password-protected website for classroom use.
Chapter 9-26
Handout 9-6: Guidelines for Identifying Fad Diets
and Other Weight-Loss Scams
Fad Diets and Weight-Loss Scams
They promise dramatic, rapid weight loss.
They promote diets that are nutritionally unbalanced
or extremely low in kcalories.
They use liquid formulas rather than foods.
They attempt to make clients dependent upon special
foods or devices.
They fail to encourage permanent, realistic lifestyle
changes.
They misrepresent salespeople as “counselors”
supposedly qualified to give guidance in nutrition
and/or general health.
They collect large sums of money at the start or
require that clients sign contracts for expensive, longterm programs.
They fail to inform clients of the risks associated with
weight loss in general or the specific program being
promoted.
They promote unproven or spurious weight-loss aids
such as human chorionic gonadotropin hormone
(HCG), starch blockers, diuretics, sauna belts, body
wraps, passive exercise, ear stapling, acupuncture,
electric muscle-stimulating (EMS) devices, spirulina,
amino acid supplements (e.g., arginine, ornithine),
glucomannan, methylcellulose (a “bulking agent”),
“unique” ingredients, and so forth.
They fail to provide for weight maintenance after the
program ends.
Healthy Diet Guidelines
Weight loss should be gradual and not exceed 2 pounds
per week.
Diets should provide:
 A reasonable number of kcalories (not fewer than
1000 kcalories per day for women and 1200 kcalories
per day for men)
 Enough, but not too much, protein (between the RDA
and twice the RDA)
 Enough, but not too much, fat (between 20 and 35%
of daily energy intake from fat)
 Enough carbohydrates to spare protein and prevent
ketosis (at least 100 grams per day) and 20 to 30
grams of fiber from food sources
 A balanced assortment of vitamins and minerals from
a variety of foods from each of the food groups
 At least 1 liter (about 1 quart) of water daily or 1
milliliter per kcalorie daily—whichever is more
Foods should accommodate a person’s ethnic background,
taste preferences, and financial means.
Programs should teach clients how to make good choices
from the conventional food supply.
Programs should teach physical activity plans that involve
expending at least 300 kcalories a day and behaviormodification strategies that help to correct poor eating
habits.
Even if adequately trained, such “counselors” would still
be objectionable because of the obvious conflict of interest
that exists when providers profit directly from products
they recommend and sell.
Programs should be reasonably priced and run on a pay-asyou-go basis.
They should provide information about dropout rates, the
long-term success of their clients, and possible diet side
effects.
They should focus on nutrient-rich foods and regular
exercise.
They should provide a plan for weight maintenance after
successful weight loss.
Sources: Adapted from American College of Sports Medicine, ACSM’s Guidelines for Exercise Testing and
Prescription (Baltimore: Williams & Wilkins, 1995), pp. 218–219; J. T. Dwyer, Treatment of obesity: Conventional
programs and fad diets, in Obesity, ed. P. Björntorp and B. N. Brodoff (Philadelphia: J.B. Lippincott, 1992), p. 668;
National Council Against Health Fraud Newsletter, March/April 1987, National Council Against Health Fraud, Inc.
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