Weight Management

1. Weight Management Chapter 9

2. Current Trends • National Institutes of Health • More than 67% of American adults are overweight • Around 33-34% of American adults are obese • Obesity has doubled between 1971 and 2006 • By 2015, 75% of adults will be overweight, 41% will be obese

3. Prevalence of Healthy Body Weight Source: National Center for Health Statistics

4. Overweight and Obesity • Overweight = characterized by a body weight that falls above the range associated with minimum mortality; weighing 10% or more over recommended weight or having a BMI over 25 • Obesity = severely overweight, with an excess of body fat; weighing 20% or more over recommended weight or having a BMI over 30

5. Health Implications of Overweight and Obesity • 33% rise in type 2 diabetes • 100,000+ premature deaths annually • Obesity is one of the six major controllable risk factors for heart disease • Weight loss of 5-10% in obese individuals can reduce the risk of certain diseases

6. Factors Contributing to Excess Body Fat: Genetic Factors • Genetic factors influence body size and shape, body fat distribution, and metabolic rate • Genetic contribution to obesity is estimated at 25–40% • Hereditary influences must be balanced against contribution of environmental factors • Genetics is what can happen, our choices is what does happen!!

7. PHYSICAL APPEARANCE • We are all products of heredityand environment. What we get from our parents and what we do with what we get! • Somatotype – Your physical appearance, body build. • Endomorph – A “pear-shaped” appearance. Short legs and arms, most of body weight centered around hips and abdomen. • Mesomorph – Solid, muscular, large-boned physique. Most of body weight is away from the abdominal area. Wide shoulders, narrow hips, well-muscled. • Ectomorph – Slender bodies and a slight build. Very little body fat. Light musculature, long arms and legs. Bony in appearance, narrow chest and hips and generally linear in appearance. • Most people have some characteristics of each body type, but one will dominate.

8. Fat Cell Theory • Proponents of this theory believe that obese people have more fat cells and larger cells than the non-obese. • Total number of fat cells increase • It is believed that once we produce fat cells, they remain for life. • Any weight reduction would involve a reduction in the size of the fat cell. • Evidence seems to suggest that fat cells do reach a point where they can not get bigger, thus new cells are manufactured.

9. Physiological Factors • Metabolism – the sum of all the vital processes by which food energy and nutrients are made available to and used by the body. • Resting Metabolic Rate (RMR) – The energy required to maintain vital body functions. (heart, lungs, body) Accounts for about 55-75% of the energy used by the body. • Thermal Effect of Food (TEF) – The energy required to digest food. Accounts for additional 5-15% of daily energy expenditure. • Effect of Physical Activity – Energy expended during physical activity. Accounts for 20-40% of expended energy. • This is the component that is the most variable and the one we can do the most about.

10. Factors That Affect Metabolic Rate • RMR is higher in • Men • People with more muscle mass • People who exercise • RMR is lower in • Women • People who are sedentary • People who have lost weight

11. Energy-Balance Equation

12. Factors Contributing to Excess Body Fat: Lifestyle Factors • Eating—compared to the past, Americans now • Consume more calories • Consume more refined and simple carbohydrates • Eat out more often • People underestimate portion sizes

13. National Geographic, August 2004

14. Monster Thick Burger • 1,420 calories • 107 grams of fat • 2 – 1/3 slabs of beef • 4 strips of bacon • 3 slices of cheese

15. CHICKEN CAESAR SALAD 20 Years Ago Today How many calories are in today’s chicken Caesar salad? 390 calories 1 ½ cups

16. CHICKEN CAESAR SALAD 20 Years Ago Today 390 calories 1 ½ cups 790 calories 3 ½ cups Calorie Difference: 400 calories

17. How long will you have to walk the dog in order to burn those extra 400 calories?* *Based on 160-pound person

18. Calories In = Calories Out If you walk the dog for 1 hour and 20 minutes, you will burnapproximately 400 calories.* *Based on 160-pound person

19. CHOCOLATE CHIP COOKIE 20 Years Ago Today 55 calories 1.5 inch diameter How many calories are in today’s large cookie?

20. CHOCOLATE CHIP COOKIE 20 Years Ago Today 55 calories 1.5 inch diameter 275 calories 3.5 inch diameter Calorie Difference: 220 calories

21. Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out How long will you have to wash the car to burn those extra 220 calories?* *Based on 130-pound person

22. Calories In = Calories Out If you wash the car for 1 hour and 15 minutes you will burn approximately 220 calories.* *Based on 160-pound person

23. Diet and Eating Habits • 1 pound = 3500 calories • If calorie intake = calorie output, weight remains the same. • For weight loss, goal should be to lose 0.5 -2 pounds/week

24. Successful Weight Loss • A successful, long-term weight control program involves three elements. • Diet – the number of calories consumed should be reduced, along with the fat content of the diet. Watch portion sizes. Choose complex carbohydrates – fruits, vegetables and whole grains (Nutrient –dense foods) Or those foods which have a lower energy (calorie)density. An apple vs a pie of apple pie. • Exercise – Goal is to expend 200-400 calories/day with exercise. • Behavior Modification • Self-monitoring – Keep a food log, recording amounts and circumstances of eating. • Food triggers – Identify those factors which trigger eating. Boredom, anxiety, stress, exhaustion. • Develop techniques to control eating. Positive self-talk. Goals. Stay busy. Plan meals. Control social bingeing. • Reinforce results with rewards.

25. Physical Activity and Exercise • Physical activity—increase daily physical activity to at least 30 minutes per day; to lose weight or maintain weight loss, 60–90 or more minutes per day is recommended • Exercise • Endurance exercise burns calories • Strength training builds muscle mass, which can increase metabolic rate

26. National Geographic, August 2004

27. Diet and Eating Habits • Fat calories—keep total fat intake moderate, and limit intake of saturated and trans fats • Carbohydrate—emphasize whole grains, vegetables, fruits, and other high-fiber foods; limit consumption of foods high in refined carbohydrates, added sugars, and easily digestible starch • Protein—meet recommended intake of 10–35% of total daily calories • Eating habits—eat meals and snacks on a regular schedule

28. Doing It Yourself • Physical activity is a critical component of healthy weight management

30. Approaches to Overcoming a Weight Problem • Doing it yourself • Diet books • Dietary supplements and diet aids • Weight-loss programs • Prescription drugs • Surgery • Psychological help

31. Diet Books • Reject books that • Advocate unbalanced ways of eating • Claim to be based on a secret • Use gimmicks • Promise quick weight loss • Limit the selection of foods • Accept books that advocate a balanced diet plus exercise

32. Popular Diet Plans • Any diet that cuts calories causes weight loss • Low-carbohydrate diets have not been proven safe over the long-term • Low-fat diets should focus on nutrient dense foods, especially whole-grains, fruits, and vegetables • Diets with many restrictions have high drop-out rates • People who have been successful at long-term weight loss track food intake and engage in 60 or more minutes of physical activity per day

33. Dietary Supplements and Diet Aids • Dietary supplements are subject to fewer regulations than over-the-counter medications; they have not been proven safe and effective • FTC: More than half of advertisements for weight-loss products make representations that are likely to be false

34. Surgery • Surgical intervention may be recommended for some people who have a BMI of 40 or higher or who are 100 or more pounds overweight • Gastric bypass surgery modifies the gastrointestinal tract by changing the size of the stomach or how the intestine drains, thereby restricting the amount of food that can be eaten • Surgery has a high rate of complications

35. Surgery Adjustable gastric banding Roux-en-Y gastric bypass Source: National Institutes of Health

36. Body Image • Dissatisfaction with weight and shape is common in people with eating disorders

37. Body Image • Body image = the mental representation a person holds about her or his body • It consists of perceptions, images, thoughts, attitudes, and emotions • Media images are linked to negative body image • Different cultures have different ideas of the “ideal” body type

38. Acceptance and Change • Most Americans are unhappy with some aspect of their appearance • Recognize the limits of change • Small amounts of weight loss can significantly reduce health risks

39. Eating Disorders • Society has created tremendous pressure for individuals to be thin. • More than two-thirds of women between the ages of 12 and 23 have felt dissatisfied with their body image and feel pressure to conform to the “ideal” body size and shape. • Weight reduction, often takes over thoughts and energies. Some feel weight loss makes them more attractive, accepted and successful. • The pursuit of thinness can result in serious and sometimes life-threatening eating disorders.

40. Eating Disorders • Anorexia Nervosa – Condition is marked by suppression of appetite and intentional caloric deprivation or self-starvation. • May have intense fear of becoming overweight and weight loss does not detensify that fear. • There is a psychological distortion of body image, as the anorexic sees him/herself as fat, even if extremely underweight. • Weight loss is pursued through extreme limitation of calories, fasting, strenuous exercise, use of laxatives and diuretics and sometimes self-induced vomiting. • Disorder sometimes begins at the onset of puberty. • Problems include CV problems, gastrointestinal problems, body can use organs for protein due to lack of fat, amenorrhea (suppression of menstrual cycle), anemia, calcium loss, brittle bones, swollen joints and light-headedness. Eventually heart failure can occur.

41. Eating Disorders • Bulimia Nervosa – This is known as the binge-purge syndrome. • It is marked by high amounts of food/calorie consumption (1,000-60,000 calories), followed by self-induced vomiting and/or use of laxatives and diuretics. • Compulsive exercise also may be a characteristic of bulimia. • Bulimia differs from anorexia in that the individual may maintain a normal body weight due to the binges experienced. This allows the bulimic to hide the problem, making it more difficult to identify. • Eating disorders are mental disorders and must be treated as such. • Causes and contributing factors are complex and professional help is necessary.

42. Eating Disorders • Binge-Eating Disorders – Individuals typically experience episodes of out of control eating. • Common characteristics include: • Eating much more rapidly than normal • Eating until uncomfortably full • Eating large quantities of food even when not hungry • Eating alone to hide the quantity of food being ingested • Feeling disgusted, depressed, or guilty after overeating • They do not purge their bodies after eating, thus different from bulimia.

43. Who Is At Risk? • Estimated 1 in every 100 teenage girls are anorexic • Anorexia usually occurs in adolescent women (90% of all reported cases) • Estimated 1 in every 5 college-bound females is bulimic • College campuses have a higher incidence of people with eating disorders • Upper middle class women who are extremely self-critical are also more likely to become anorexic • Activities such as dance and dance team, gymnastics, figure skating, track and cheerleading tend to have higher incidences of eating disorders • Wrestlers and body builders are also at risk due to unsafe practices to “make weight” before competition.

44. TREATMENT • Be supportive. Provide information about eating disorders. • Be a good listener. • Encourage professional help. Person may need counseling, medical treatment or hospitalization. • Be prepared for denial resistance and even hostility. • Realize that the person’s responsibility is his/hers, not yours. Eating Disorders Therapy/Programs ISU Counseling Center ISU Health Services ISU Nutrition Mission Anorexia Nervosa and Related Eating Disorders, Inc. – www.anred.com