Chapter 5

1. CHAPTER OUTLINE Chapter 5 Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Weight Management

2. Overweight: Excess body weight against a given standard, such as height or recommended percent body fat; less than obese Obesity: A chronic disease characterized by excessive body fat in relation to lean body mass; usually at least 30% above recommended body weight Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Key Terms

3. 5.1 Percentage of U.S. Adults Who Are Overweight and Obese

4. 5.2 Definitions for CDC’s Obesity Trends among U.S. Adults between 1985 and 2003 • Obesity: Having a very high amount of body fat in relation to lean body mass, a Body Mass Index (BMI) of 30 or higher, or being 30 pounds or more overweight • Body Mass Index (BMI): A measure of an adult’s weight in relation to his or her height, specifically the adult’s weight in kilograms divided by the square of his or her height in meters

5. No Data <10% 10%–14% 15–19% 20%–24 % ≥25% 5.2 Obesity* Trends among U.S. AdultsBRFSS, 1985 *Based on a BMI ≥ 30 or 30 lbs overweight

6. No Data <10% 10%–14% 15–19% 20%–24 % ≥25% 5.2 Obesity* Trends among U.S. AdultsBRFSS, 1990 *Based on a BMI ≥ 30 or 30 lbs overweight

7. No Data <10% 10%–14% 15–19% 20%–24 % ≥25% 5.2 Obesity* Trends among U.S. AdultsBRFSS, 1995 *Based on a BMI ≥ 30 or 30 lbs overweight

8. No Data <10% 10%–14% 15–19% 20%–24 % ≥25% 5.2 Obesity* Trends among U.S. AdultsBRFSS, 2000 *Based on a BMI ≥ 30 or 30 lbs overweight

9. No Data <10% 10%–14% 15–19% 20%–24 % ≥25% 5.2 Obesity* Trends among U.S. AdultsBRFSS, 2003 *Based on a BMI ≥ 30 or 30 lbs overweight

10. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Health Consequences of Obesity • Obesity is a risk factor for • Hypertension • Congestive heart failure • High blood lipids • Atherosclerosis • Stroke • Thromboembolitic disease • Varicose veins

11. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Health Consequences of Obesity • Obesity is a risk factor for • Type 2 diabetes • Osteoarthritis • Gallbladder disease • Sleep apnea • Ruptured intervertebral disks • Arthritis • Cancer (breast, colon, and prostate)

12. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Tolerable Weight • Many people want to lose weight so they will look better—that’s a noteworthy goal • The problem, however, is that they have a distorted image of what they would really look like if they reduce to what they think is their ideal weight • Hereditary factors play a big role and only a small fraction of the population have the genes for a “perfect body”

13. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Tolerable Weight • The media has the greatest influence on people’s perception of what constitutes ideal body weight • Most people use fashion, fitness, and beauty magazines to determine what they should look like

14. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Tolerable Weight • The “ideal” body shapes, physiques, and proportions seen in these magazines are rare and essentially achieved only through airbrushing and medical reconstruction

15. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Tolerable Weight • Many individuals, and primarily young women, go to extremes in an attempt to achieve these unrealistic figures • Failure to attain a “perfect body” may lead to eating disorders in some individuals

16. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Tolerable Weight • As people set their own target weight, they should be realistic • Attaining an excellent body-fat value is extremely difficult for some

17. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Tolerable Weight • An excellent body fat value is extremely difficult to maintain, unless people are willing to make a commitment to a VIGOROUS LIFETIME EXERCISE PROGRAM AND TO PERMANENT DIETARY CHANGES • Few people are willing to do that – thus, the moderate percent body fat category may be more realistic for many people

18. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Tolerable Weight • A question you should ask yourself is: Are you happy with your weight? • Part of enjoying a higher quality of life is being happy with yourself • If you are not, you either need to do something about it or learn to live with it!

19. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Tolerable Weight • If you are above the moderate percent body fat category, you should try to come down and stay in this category, for health reasons: this is the category in which there appears to be no detriment to health

20. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Tolerable Weight • If you are in the moderate category but would like to be lower, you need to ask yourself a second question: How bad do I want it? • Do you want it bad enough to implement lifetime exercise and dietary changes? • If you are not willing to change, you should stop worrying about your weight and deem the moderate category as “tolerable” for you

21. 5.3 Differences Between Self-Reported and Actual Energy Intake and Physical Activity in Overweight People

22. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Critical Thinking • Do you consider yourself overweight? • If so, how long have you had a weight problem, what attempts have you made to lose weight, and what has worked best for you?

23. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Impact of Excessive Weight • 65 million Americans are overweight or consider themselves to be overweight • Of these, 30 million are obese • 50% of all women and 25% of all men are on diets at any given moment • People spend $40 to $50 billion yearly attempting to lose weight and another $30 billion on diet food sales

24. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Ideal vs. RecommendedBody Weight • No such thing as “ideal” weight • “Recommended” weight is a better term • Recommended weight varies among people • Two overweight individuals at the same weight—if one has risk factors due to genetics or dietary habits, this individual is at higher risk for disease and a lower weight may be recommended

25. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Diet Crazes • Fad diets continue to appeal to people of all shapes and sizes • These diets may work for a while but their success is usually short lived • “When I get the latest fad diet, I imagine a trick birthday cake candle that keeps lighting up and we have to keep blowing it out” -Kelly Brownell (foremost weight management researcher)

26. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Low-Carb/High-Protein (LCHP) DietsA few studies suggest that, short-term, LCHP diets are more effective for weight loss than carbohydrate-based diets. These results are preliminary and controversial.In LCHP diets: • A large amount of weight loss is water and muscle protein, not body fat. Some of this weight is quickly regained when regular dietary habits are resumed

27. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Low-Carb/High-Protein (LCHP) Diets • Few people are able to stay with LCHP diets for more than a few weeks at a time; the majority stop dieting before the targeted program completion • LCHP dieters are rarely found in a national weight-loss registry of people who have lost 30 pounds and kept them off for a minimum of six years • Food choices are severely restricted in LCHP diets; with less variety, individuals tend to eat less (800 to 1,200 calories/day) and thus lose more weight

28. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Low-Carb/High-Protein (LCHP) Diets • LCHP diets may promote heart disease, cancer, and increase the risk for osteoporosis • LCHP diets are fundamentally high in fat (about 60 percent fat calories) • LCHP diets are not recommended for people with diabetes, high blood pressure, heart disease, or kidney disease • LCHP diets do not promote long-term healthy eating patterns

29. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management How to Recognize Fad Diets • Are nutritionally unbalanced • Are based on testimonials • Were developed according to “confidential research” • Promote rapid and “painless” weight loss • Promise miraculous results

30. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management How to Recognize Fad Diets • Restrict food selection • Require the use of selected products • Use liquid formulas instead of foods • Misrepresent salespeople as individuals qualified to provide nutrition counseling • Fail to provide information on risks associated with weight loss and diet use

31. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management How to Recognize Fad Diets • Do not involve physical activity • Do not encourage healthy behavioral changes • Are not supported by the scientific community or national health organizations • Fail to provide information for weight maintenance upon completion of diet phase

32. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Eating Disorders • Anorexia nervosa, bulimia nervosa, binge-eating disorder: physical and emotional conditions thought to stem from individual, family, and social pressures • Eating disorders are increasing steadily in most industrialized nations where society encourages low-calorie diets and thinness

33. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Eating Disorders • Intense fear of becoming fat does not disappear even when losing extreme weight • Individuals clip images from magazines to use as their ideal body goal • Articles on dangers of eating disorders fail to deter behavior in these individuals; instead, they look for ideas in these articles to use in their search for a "perfect body"

34. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Key Term • Anorexia nervosa: An eating disorder characterized by self-imposed starvation to achieve and maintain very low body weight

35. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Anorexia Nervosa • Individuals suffering from anorexia nervosa: • Refuse to maintain body weight over a minimal normal weight • Perceive themselves as overweight even when emaciated • Deny their condition • Have an intense fear of gaining weight even though underweight • May fear weight gain more than death by starvation

36. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Key Term • Bulimia nervosa: An eating disorder characterized by a pattern of binge eating and purging in an attempt to lose weight and maintain low body weight

37. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Bulimia Nervosa • Bulimics usually are healthy-looking, well-educated, and near recommended body weight • They seem to enjoy food and often socialize around it • They have emotional challenges, rely on others, lack self-confidence • For them, recommended weight and food are abnormally important

38. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Bulimia Nervosa • People suffering from bulimia nervosa: • Fear gaining weight • Have recurrent episodes of binge eating • Feel stress after binge eating • Practice self-induced vomiting, fasting, and excessive exercise and misuse laxatives and medications • Evaluate themselves based on body shape and weight

39. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Key Term • Binge-eating disorder: An eating disorder characterized by uncontrollable episodes of eating excessive amounts of food within a relatively short time

40. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Binge-Eating Disorder • Eating an unusually large amount of food • Eating until uncomfortably full • Eating out of control • Eating much faster than usual during binge episodes • Eating alone due to embarrassment by how much food is consumed • Feeling disgusted, depressed, or guilty after overeating

41. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Energy-Balancing Equation • Weight maintenance: Calories in = calories out • Weight gain: Calories in > calories out • Weight loss: Calories in < calories out

42. 5.4 Components of Total Daily Energy Requirement

43. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Critical Thinking • Is there a difference in the amount of food that you are now able to eat compared with the amount that you ate in your mid- to late-teen years? • If so, to what do you attribute these differences? • What actions are you taking to account for the difference?

44. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management 1 pound of fat:3,500 calories

45. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Traditional Weight-Loss Concepts • Balancing food intake against output allows a person to achieve recommended body weight • Overweight people just eat too much • It really does not matter to the human body how much (or little) fat is stored • Some truth to these statements, but still open to debate and research

46. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Setpoint Theory • A weight-regulating mechanism, located in the hypothalamus of the brain, regulates how much the body should weigh • Setpoint sets the amount of body fat it considers necessary and works tirelessly to maintain it • Setpoint functions like a thermostat: it detects fluctuations in weight and makes adjustments in energy metabolism and appetite

47. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Setpoint Theory • The setpoint has a profound effect on amount of food you eat • As you lose weight, it signals hunger • As you gain weight, it reduces appetite • As you overeat, triggers body to “waste” • As you don’t eat enough, triggers body to “conserve”

48. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Setpoint Theory • Two most common obstacles to weight loss • Genetics • Lifestyle • Setpoint illustrates how genetics and lifestyle overlap • The setpoint range is determined by genetics • Where the individual ends up in the range is a result of lifestyle

49. Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Research and Setpoint • The body resists maintenance of altered weight • Obese and lifetime non-obese individuals were used • Following a 10% weight loss, body attempted to regain the lost weight, burning up to 15% fewer calories • Following a 10% weight gain, the body attempted to lose weight, burning 10–15% more calories than expected • Results imply that after a 10% weight loss, a person would have to eat less or exercise more to account for the estimated deficit of 200 to 300 daily calories

50. Setpoint increases with Constant dieting Excessive fat intake High sugar intake Metabolic and body composition changes associated with aging Setpoint decreases with Aerobic exercise Smoking (more detrimental than the extra weight) Overweight vs. Obesity Tolerable Weight The Weight Loss Dilemma Eating Disorders Physiology of Weight Loss Exercise: The Key to Weight Management Losing Weight the Sound and Sensible Way Daily Food Logs Behavior Modification & Weight Management Factors That May Influence the Setpoint