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Weight Management: Weight Management: Overweight, Obesity, Overweight, Obesity,
and Underweightand UnderweightChapter 9
Overweight and ObesityOverweight and Obesity
Major health problem in the U.S. 66% of Adults 33% of Children Growing concern worldwide
Prevalence especially high amongwomen, poor, blacks, and Hispanics
BMI of 25 or greater Epidemic is worldwide
Not merely among industrialized countries
Overweight and ObesityOverweight and Obesity
BMI > 25
1993: Most states had prevalence rates lessthan 15 percent, with a couple reporting ratesless than 10 percent; no state had prevalencerates greater than or equal to 20 percent.
<10%10%–14%15%–19%
Key:
No Data 20%–24%25%–29%≥ 30%
BMI > 25
<10%10%–14%15%–19%
Key:
20%–24%25%–29%≥ 30%
No Data
1998: Most states had prevalence rates lessthan 20 percent, with none reporting rates lessthan 10 percent; seven states had prevalencerates greater than or equal to 20 percent.
BMI > 25
<10%10%–14%15%–19%
Key:
20%–24%25%–29%≥ 30%
No Data
2003: More than half the states hadprevalence rates greater than 20 percent,with four states reporting prevalence ratesgreater than or equal to 25 percent.
BMI > 25
<10%10%–14%15%–19%
Key:20%–24%25%–29%≥ 30%
No Data
2008: Only one state had prevalence ratesless than 20 percent; more than half the stateshad prevalence rates greater than 25 percent,with six states reporting prevalence ratesgreater than or equal to 30 percent.
BMI > 25
Fat Cell DevelopmentFat Cell Development
Energy in exceeds energy out Body fat stored in cells of adipose tissue Number and size of fat cells
Late childhood/early puberty fat cell numbers increase
Fat deposited in organs- inflammation, insulin resistance
Energy out exceeds energy in Fat cell size decreases; no change in
number
Energy in > Energy out
During growth, fat cells increase in number.
When energy intake exceeds expenditure, fat cells increase in size.
When fat cells have enlarged and energy intake continues to exceed energy expenditure, fat cells increase in number again.
With fat loss, the size of the fat cells shrinks but not the number.
Stepped Art
Fat Cell DevelopmentFat Cell Development
Fat Cell MetabolismFat Cell Metabolism
Lipoprotein lipase (LPL) stores triglycerides LPL activity in obese > than lean people Men- abdomen Women- breasts, hips, thighs
Hormone-sensitive lipase (HSL) releases and breaks down triglycerides
Weight regain: After wt. loss, LPL production increases. Fat oxidation is less efficient than fat storage.
Causes of Overweight & Causes of Overweight & Obesity – Genetics & Obesity – Genetics &
EpigeneticsEpigenetics Causative role of genetics
Genetic influences do seem to be involved Genetics may determine predisposition to
obesity Genes interact with:
Diet and physical activitySatiety and energy balance
Human genome
Causes of Overweight & Causes of Overweight & Obesity – Genetics & Obesity – Genetics &
EpigeneticsEpigenetics Obesity gene
Codes for the protein leptinActs as a hormone in hypothalamusPromotes negative energy balanceSuppresses appetite Increases energy expenditure
Locations of leptin secretion
With leptin treatment, this mouse lost a significant amount of weight but still weighs almost one and a half times as much as a normal mouse.
Without leptin, this mouse weighs almost three times as much as a normal mouse.
Causes of Overweight & Causes of Overweight & Obesity – Genetics & Obesity – Genetics &
EpigeneticsEpigenetics Obesity gene that codes for leptin- protein
that suppresses appetite Genetic deficiency of leptin or genetic
mutation- rare in obese people Leptin resistance
Leptin rises with BMI, declines with dieting Roles in the body
Energy regulation Immune system, RBC’s, female fat reserves
Causes of Overweight & Causes of Overweight & Obesity – Genetics & Obesity – Genetics &
EpigeneticsEpigenetics Adiponectin
Secreted by adipose tissue Inverse correlation with body fat Inhibits insulin resistance, inflammation, CHD
Ghrelin Acts in hypothalamus, secreted by stomach Promotes positive energy balance Inverse correlation with body weight
Causes of Overweight & Causes of Overweight & Obesity – Genetics & Obesity – Genetics &
EpigeneticsEpigenetics PYY
GI cells secrete in proportion to kcalories consumed
Signals satiety and decreases food intake Ideal diet
Maintain satiating hormones-leptin, PYY, CCK Minimize appetite stimulating hormone ghrelin Low in fat and rich in fiber
Proteins Regulating Appetite and Proteins Regulating Appetite and EnergyEnergy
Causes of Overweight & Causes of Overweight & Obesity – Genetics & Obesity – Genetics &
EpigeneticsEpigenetics Uncoupling proteins
Proteins involved in energy metabolism Two types of fat
White adipose tissueBrown adipose tissue
Uncoupling proteins found in both types of fat Influence basal metabolic rate (BMR)
Causes of Overweight & Causes of Overweight & Obesity – EnvironmentObesity – Environment
Encountered daily circumstances Interaction between environment and
genetics Overeating
Present and past eating and activity patterns influence current body weight
Availability Serving sizes
Restaurant food
Selecting grapes with their high water content instead of raisins increases the volume and cuts the energy intake in half.
Even at the same weight and similar serving sizes, the fiber-rich broccoli delivers twice the fiber of the potatoes for about one-fourth the energy.
By selecting the water-packed tuna (on the right) instead of the oil-packed tuna (on the left), a person can enjoy the same amount for fewer kcalories.
Causes of Overweight & Causes of Overweight & Obesity – EnvironmentObesity – Environment
Physical inactivity Life requires little exertion
Modern technology Inactivity contributes to weight gain and poor
healthSedentary activities and weight gain
DRI for prevention of weight gain60 minutes of moderate activity every day
Problems of Overweight and Problems of Overweight and Obesity – Health RisksObesity – Health Risks
Three indicators BMI Waist circumference Disease risk profile
Factors taken into account
Beneficial weight loss Health status Motivation
Problems of Overweight and Problems of Overweight and Obesity – Health RisksObesity – Health Risks
Overweight but in good health motivation for weight loss
Obese or overweight with risk factors Two or more risk factors
Obese or overweight with life-threatening condition Recommendation to lose weight
Problems of Overweight and Problems of Overweight and Obesity – Perceptions & Obesity – Perceptions &
PrejudicesPrejudices Most obese people do not successfully lose
weight and maintain the loss Social consequences
Jobs, school, and in social situations Psychological problems
Embarrassment Other feelings
Fig. 9-6, p. 285
Problems of Overweight and Problems of Overweight and Obesity – Weight CyclingObesity – Weight Cycling
Problems of Overweight and Problems of Overweight and Obesity – Popular InterventionsObesity – Popular Interventions
Diet books and weight-loss programs Limited success with weight loss maintenance
Fad diets- cabbage soup, shakes only Weight-loss products
Meal replacements Herbal products No regulations for dietary supplements
Liposuction
OTC
Drug Treatments for ObesityDrug Treatments for Obesity
Strategies for weight reduction depend on: Degree of obesity Risk of disease
Use drugs as part of long-term comprehensive weight-loss programs Assist with modest weight loss
Four drugs approved by FDA for obesity
Drug Treatments for ObesityDrug Treatments for Obesity
Sibutramine Suppresses appetite Side effects- dry mouth, rapid heart rate, etc Warning from FDA
Orlistat Inhibits pancreatic lipase activity in GI tract
Blocks dietary fat digestion and absorption Side effects- gas, frequent BM’s, decreased
absorption of fat-sol. vitamins
Drug Treatments for ObesityDrug Treatments for Obesity Phentermine and diethylpropion
Enhance release of neurotransmitter norepinephrine Mood high, appetite low
Side effects- hyperactivity, insomnia Off-label use, “Stacking” Sudafed (pseudoephedrine) Claritin Benadryl
Diet Pills for sale onlineDiet Pills for sale online
http://www.webmd.com/diet/guide/herbal-remedies
http://www.thedietadvisors.com/adipozin.html
http://www.weightlossdietpills.com/?gclid=CJSlwpaCs6cCFQcBbAodkThW_w
How Appetite Suppressants How Appetite Suppressants Cause Weight LossCause Weight Loss
They are STIMULANTS (caffeine, ephedra, phentermine, chemicals that act like cocaine)
Appetite suppressants promote weight loss by tricking the body into believing that it is not hungry or that stomach is full.
They decrease appetite by increasing serotonin or catecholamine -- two brain chemicals that affect mood and appetite.
Prescription Weight Loss Prescription Weight Loss Drugs/Surgery IndicationsDrugs/Surgery Indications
An option for the following individuals: People with a body mass index(BMI) of 30
and above with no obesity-related conditions.
A person with a BMI of 27 and above with obesity-related conditions, such as diabetes or high blood pressure.
http://www.webmd.com/diet/weight-loss-surgery/news/20110217/fda-oks-lap-band-surgery-for-more-patients
Surgical Treatments for Surgical Treatments for ObesityObesity
http://www.lapband.com/en/home/ http://www.webmd.com/diet/weight-loss-surger
y/news/20110217/fda-oks-lap-band-surgery-for-more-patients
Clinically severe obesity 200,000 surgeries performed each year Reduces food capacity of stomach Reduce production of ghrelin Health-related benefits Long-term safety and effectiveness
Surgical Treatments for Surgical Treatments for ObesityObesity
Esophagus Surgical staples
Small stomach pouch
Stomach
Esophagus
Duodenum Gastric band
Jejunum
Stomach Port
Large intestine
In gastric bypass, the surgeon constructs a small stomach pouch and creates an outlet directly to the small intestine, bypassing most of the stomach, the entire duodenum, and some of the jejunum. (Dark areas highlight the flow of food through the GI tract; pale areas indicate bypassed sections.)
In gastric banding, the surgeon uses a gastric band to reduce the opening from the esophagus to the stomach. The size of the opening can be adjusted by inflating or deflating the band by way of a port placed in the abdomen just beneath the skin.
Small stomach pouch
Weight Loss StrategiesWeight Loss Strategies
Successful strategies Find individual rate of change Moderate losses Reasonable short-term / long-term goal weight Reasonable rate of weight loss
Benefits of modest weight loss Incorporate healthy eating and exercise
Weight Loss StrategiesWeight Loss Strategies
Weight Loss Strategies – Weight Loss Strategies – Eating PlansEating Plans
Be realistic about energy intake Must provide less energy than is needed
Avoid restrictive eatingAvoid rapid weight loss
Goal: nutritional adequacy without excessDeficit of 500 to 1000 kcalories per day
Breakfast frequency Inversely related to obesity
Weight Loss Strategies Weight Loss Strategies Eating Plans Eating Plans
Nutritional adequacy minimum ~1200 kcal/d Eat small portions
Eat less food at each meal Feel satisfied, not stuffed Structured meal replacement plans
Lower energy density Mind control
http://www.webmd.com/diet/default.htm
Weight Loss Strategies – Weight Loss Strategies – Eating PlansEating Plans
Weight Loss Strategies – Weight Loss Strategies – Eating PlansEating Plans
Remember water Assistance with weight management
Focus on fiber Low in energy and high in nutrients Require effort to eat
Speed of food consumption
Choose fats sensibly Energy density and satiation
Food Choices Slideshow Food Choices Slideshow http://www.webmd.com/diet/slideshow-fat-fi
ghting-foods
Weight Loss Strategies – Weight Loss Strategies – Eating PlansEating Plans
Volumetrics Select carbohydrates carefully
Artificial sweeteners Impact on energy intake
Watch for empty/hidden kcalories Fat, sugar, and alcohol
Weight Loss Strategies Weight Loss Strategies Physical ActivityPhysical Activity
Necessary for weight management Moderate physical activity plus activities of
daily life Combination of diet and physical activity
Lose more fat Retain more muscle Regain less weight
Reduction of abdominal fat
Weight Loss Strategies Weight Loss Strategies Physical ActivityPhysical Activity
kCalorie expenditure Body weight, intensity, and duration
Greater the energy deficit, greater the fat loss
Discretionary kcalorie allowance (reward) Metabolism
Speeds up with activity Immediate and long-term benefits
Weight Loss Strategies – Weight Loss Strategies – Physical ActivityPhysical Activity
Energy allowance to maintain weight
Discretionary kcalorie allowance
Energy intake to meet nutrient needs
Sedentary person Active person
kCal
ori
es
2500
2000
1500
1000
500
0
Weight Loss Strategies Weight Loss Strategies Physical ActivityPhysical Activity
Body composition Fat decreases, esp. abdominal fat Lean body mass increases Strength-training exercises
Appetite control Delayed appetite from released stored fuel Exercise curbs appetite from boredom,
anxiety, depression
Weight Loss Strategies Weight Loss Strategies Physical ActivityPhysical Activity
Psychological benefits Self-esteem
Choosing activities Ones you enjoy & are willing to do regularly Convenience Energy-expending daily activities
Spot reducing vs. strength training
Weight Loss Strategies– Weight Loss Strategies– Environmental Influences Environmental Influences
Factors surrounding eating experience and the food itself
Atmosphere Pleasant and comfortable equals more food
Accessibility Less effort needed to obtain food, more food
eaten
Weight Loss Strategies – Weight Loss Strategies – Environmental Influences Environmental Influences
Socializing Duration of meal Visual cues Distraction
Distractions Initiating eating Interfering with internal controls Extending duration of eating
Weight Loss Strategies – Weight Loss Strategies – Environmental Influences Environmental Influences
Presence Sight, smell, or thought of food can prompt
eating Multiple choice
Large assortments of foods increase consumption
Package and portion sizes Serving containers
Weight Loss Strategies – Weight Loss Strategies – Behavior & AttitudeBehavior & Attitude
Behavior modification Positive, matter-of-fact attitude
Become aware of behaviors Keep record
Change behaviors Set small, specific goals Practice, make new habits Reward
Eating not for HungerEating not for Hunger
See Emotional Eating Handouts Internet full of tips
Weight Loss Strategies – Weight Loss Strategies – Behavior & AttitudeBehavior & Attitude
Cognitive skills Problem solving Cognitive restructuring
Replace negative thoughts
Personal attitude Understand personal relationship with food Sound emotional health
Support groups- WW, TOPS, OA
Weight Loss Strategies – Weight Loss Strategies – Weight MaintenanceWeight Maintenance
Successful weight loss Plateau
Appropriate goal at this point
Prevalence of successful weight loss Difficult to determine
Weight loss Without formal program Maintained for at least a year
Weight Loss Strategies – Weight Loss Strategies – Weight MaintenanceWeight Maintenance
Components of successful weight loss Vigorous exercise regimens Careful eating patterns Frequent self-monitoring
Changes in metabolism Takes more to prevent weight regain than to
prevent weight gain
Preventing Weight Preventing Weight Gain/RegainGain/Regain
Strategies are similar to losing weight Read labels Watch portion size Change your grocery list Eat out less Ask yourself, “Am I hungry?” Exercise daily: Walk/bike more. Drive less.
Plant a garden.
Public Health ProgramsPublic Health Programs
Possibly change food environment through public health law
Stretch beyond individual Social networks Community institutions Government policies
Public Health ProgramsPublic Health Programs
UnderweightUnderweight
Affects no more than 5% of U.S. adults Weight gain is a matter of health
Individual matter Weight gain may be difficult
Physical conditioning combined with high energy intakes
Problems of UnderweightProblems of Underweight
Demand for energy contributes to underweight Physical activity Growth and development
Difficult to gain weight Adaptive thermogenesis
Learn new habits and like new foods Underweight vs. anorexia nervosa
Weight-Gain StrategiesWeight-Gain Strategies
Key diet planning strategies Adequacy and balance
Energy-dense foods Regular meals daily Large portions Extra snacks Juice and milk
Exercise
Highlight 9Highlight 9
The Latest and Greatest Weight-Loss Diet – Again
Fad DietsFad Diets
Outrageous claims No requirements to prove the claims Do not have to support with credible
researchDistorted research
Numerous fad diet plans
Fad Diets’ AppealFad Diets’ Appeal
Market for weight-loss products is huge Greatest appeal
Tend to ignore dietary recommendations Sophisticated and often erroneous
explanations Too much rat data Tend to work for short time
Fail to produce long-lasting results
““Don’t Count Calories?!”Don’t Count Calories?!”
Claim to disregard kcalories Designed to have low energy intake
Tend to lack varietyMonotonous
Often recommend dietary supplement Follow a plan Most fad diets cannot support optimal health
over time
Dieting vs. Living HealthyDieting vs. Living Healthy
Fad diet “magical powers” Tipping the energy balance equation to
greater energy expenditure Weight loss
Long-term lifestyle changes Healthy plan
Flexibility and variety