Overweight and Underweight Weight Management Overweight and Underweight

Dieting Bottom Line Energy Density Eat Less Burn More Portion Size

It’s The Calories Stupid Your body can convert all macronutrients to fat. 3000 calories equals a pound, no matter how the macronutrient is consumed. Spurlock ate 3000 extra calories a day and gained 25 pounds.

Increasing prevalence of obesity (BMI of 30 or greater) among U. S Increasing prevalence of obesity (BMI of 30 or greater) among U.S. adults

Fat Cells Let’s start with the fat cell.

Fat Cell Development Weight gain is not simply reversed. In weight gain, the number and size of fat cells increases. In weight loss, the size of fat cells decrease. Your stuck with those extra cells, making it easier to regain. And, they keep releasing LPL (lipoprotein lipase). It is better to limit weigh gain in the first place.

Fat Cell Metabolism Two factors that affect whether fat cells store fat. Lipoprotein lipase (LPL) Set-point theory

Fat Cell Metabolism Lipoprotein lipase (LPL) Tells fat cells to store fat Tells chylomicrons and VLDL to give the cells some fat (thus becoming LDL to HDL) Differs in activity in.. Obese versus trim individuals Areas of the body Men and women

Fat Cell Metabolism Set-point theory The body tends to maintain a certain weight by means of its own controls. If you eat more, metabolism increases If you eat less, metabolism decreases. What would this mean for methods to lose or gain weight?

Set Point Theory Why have the world's setpoints gone up dramatically over the course of the past 50-100 years? Why is the world getting bigger so much faster (are all of our setpoints 1,000lbs?) Why do the setpoints of indiginous peoples (like the Pima Indians) seem to change the moment they step into North America?

Causes of Obesity

Causes of Obesity First, we will talk about some of the causes of obesity that are genetic

Causes of Obesity These genetics may affect… How much we eat How we digest/metabolize food.

“Genetics loads the gun, behavior pulls the trigger.”

http://www.time.com/time/health/article/0,8599,1839708,00.html

Genetics of how much we eat. There are a great number of proteins/chemicals in the body associated with stimulating or inhibiting food intake. www.phoenixpeptide.com/allobesity/index.html

Causes of Obesity Some of the main suspects that control how much we eat. Leptin Ghrelin PYY

Causes of Obesity Genetics Leptin Ghrelin PYY

Causes of Obesity PYY: signals “I’ve had enough food” Genetics Leptin Ghrelin PYY Leptin : plenty of stores, so don’t eat Ghrelin: secreted by stomach to say “eat”

Causes of Obesity Genetics of how we digest/metabolize food. Where we store fat is clearly genetic. How well we store fat may also be genetic. Different enzymes may be genetically more or less able to store fat. White body fat energy Brown body fat heat

http://www. ecanadanow http://www.ecanadanow.com/news/health/activating-brown-fat-may-help-adults-lose-weight-naturally-20090410.html

Causes of Obesity Overeating Physical inactivity What else?

The Psychology of Weight Cycling

Dangerous Interventions Over-the-counter drugs Benzocaine Phenylpropanolamine Fad Diets Already covered.

Diet Drugs Meridia Xenical Enhances satiety (reduces food intake) May increase blood pressure, heart rate, headaches, and dry mouth Xenical Partially blocks fat absorption May cause oily stools, especially if high fat foods are eaten Reduces absorption of fat-soluble vitamins

Weight Loss Drugs Drug Dose Action Adverse Effects Sibutramine 5, 10, 15 mg Norepinephrine, Increase in heart (Meridia) 10 mg po qd dopamine, and rate and blood pressure. o start, may be serotonin reuptake increased to 15 mg or inhibitor. decreased to 5 mg. Orlistat 120 mg Inhibits pancreatic Decrease in lipase, decreases absorption (Xenical) 120 mg po tid fat absorption. of fat-soluble before meals. vitamins; soft stools and anal leakage. The drugs used to promote weight loss have been anorexiants or appetite suppressants. Two new drugs are sibutramine (Meridia) and orlistat (Xenical). Sibutramine and orlistat are FDA-approved drugs for weight loss. Very few trials longer than 6 months have actually been done with any of these new drugs. These drugs are associated with adverse health effects, including an increase in heart rate and blood pressure for sibutramine and, for orlistat, a decreased absorption of fat-soluble vitamins. Ephedrine, caffeine, and fluoxetine have also been tested for weight loss but are not approved for use in the treatment of obesity. Mazindol, phentermine, benzphetamine, and phendimetrazine are approved for only short-term use for the treatment of obesity. Herbal preparations are not recommended as part of a weight loss program. These preparations have unpredictable amounts of active ingredients and unpredictable and potentially harmful effects. CORE SET VI

http://online.wsj.com/article/SB125348639093926227.html

Dangerous Interventions Herbal products and dietary supplements St. John’s wort Serotonin

Aggressive Treatments Of Obesity Clinically severe obesity Drugs Sibutramine: appetite suppressent Orlistat: inhibits pancreatic lipase

Surgical Procedures

Weight-Loss Strategies Reasonable goals vs. expectations

Weight-Loss Strategies Eating plans Be realistic about energy intake Emphasize nutritional adequacy Eat small portions Lower energy density Remember water Focus on complex carbohydrates Choose fats sensibly Watch for empty kcalories

Weight-Loss Strategies

Weight-Loss Strategies Physical activity Activity and energy expenditure Activity and metabolism Activity and body composition Activity and appetite control Activity and psychological benefits Choosing activities Spot reducing

Weight-Loss Strategies Behavior and attitude Behavior modification Become aware of behaviors Change behaviors Personal attitude Support groups

Weight-Loss Strategies

What Should the Government Do? Public health programs

Weight-Loss Strategies

Enemies of Weight Management? The remote-controlled remote control. Can Johnny come outside and eat? Decreased walking and stairs Desk jobs