Chapter 11 Weight management

Weight Management National Institute of Health (NIH) statistics: 68.8% of American adults are overweight 35.5% of adult men and 35.8% of adult women are obese

Weight of Americans Aged 20 and Older, 2009–2010 GROUP PERCENT OVERWEIGHT PERCENT OBESE Both sexes 68.8 35.7 All races, male 74.1 35.5 All races, female 64.5 35.8 White, male 74.0 36.2 White, female 59.5 32.2 African American, male 69.9 38.8 African American, female 82.1 58.5 Latino, male 81.7 37.0 Latino, female 75.7 41.4

Basic Concepts of Weight Management Energy balance Energy in = energy out: maintain current weight To change weight, the balance must be tipped Positive energy balance (consume more calories than used/burned Negative energy balance (consume less calories than used/burned

Body Composition and Its Importance (1) Fat-free mass and body fat Fat-free mass: non-fat tissues Body fat includes: Essential fat Fat stored in fat cells (adipose tissue) Fat located in subcutaneous fat (under the skin) and around major organs (visceral fat) Percent body fat: the proportion of the body’s total weight that is fat

Body Composition and Its Importance (2) Skinfold measurement (Skinfold Caliper) Bioelectrical impedance analysis (BIA) (Signal travels from electrodes ) Hydrostatic weighing (underwater weighing) The Bod Pod (measures lung volume) Scanning procedures CT scan (Computerized tomography; X-ray) MRI (Magnetic Resonance Imaging; radio waves) Dual-energy X-ray absorptiometry (DEXA) (Bone density scan) Dual-photon absorptiometry (Measures bone minerals)

Determining Body Mass Index (1) Body mass index (BMI) Measures the health risks of body weight for average people Correlated with but does not directly measure body fat BMI = Bodyweight in kilograms (2.20) divided by height in meters (.30=foot; inches | 12) squared OR Weight in pounds divided by height in inches squared, multiplied by 703 (conversion factor)

Determining Body Mass Index (2) Body mass index (BMI) continued Between 18.5 and 24.9 is healthy Greater than 25 is overweight Greater than 30 is obese Under 18.5 is classified as underweight Under 17.5 is sometimes used as a diagnostic criterion for anorexia nervosa BMI is not helpful for determining body composition because it does not distinguish between fat weight and fat-free weight

Determining Body Fat Distribution Waist circumference; and waist-to-hip ratio Apple shape: android obesity Upper regions of the body, particularly abdomen Negative influence on cardiovascular health Pear shape: gynoid obesity Fat Storage in the hips, buttocks, and thighs

Factors Contributing to Excess Body Fat (1) Genetic factors Genetics contribute to 25–40% of an individual’s body fat, but environment is still important “Set point” theory Physiological factors Metabolism Resting metabolic rate (RMR) Hormones Fat cells

Factors Contributing to Excess Body Fat (2) Lifestyle factors Eating habits; physical activity The “obesogenic” environment Psychosocial factors Food as a means of coping with stress and negative emotions Obesity is strongly associated with socioeconomic status Foods within your family and culture

Excess Body Fat and Wellness Obese individuals have a mortality rate twice that of the non-obese Life expectancy reduced by 10–20 years Obesity is associated with a number of chronic conditions Diabetes, heart disease, others It is also associated with a decreased quality of life—modest weight loss results in psychological improvements

Diabetes Diabetes mellitus Type 1 is not related to obesity The immune system destroys insulin-producing cells in the pancreas Type 2 is strongly associated with excess body fat The pancreas does not produce enough insulin, body cells have become resistant, or both Gestational diabetes Prediabetes

Heart Disease and Other Chronic Conditions Overweight and obesity are risk factors for: Heart disease Hypertension (HBP) Unhealthy levels of cholesterol and triglycerides (store fat that your body can use for energy) Impaired heart function Metabolic syndrome Group of risk factors High blood pressure, high blood sugar, unhealthy cholesterol levels, and abdominal fat

Adopting a Healthy Lifestyle for Successful Weight Management (1) Diet and eating habits Energy balance MyPlate suggestions Combine exercise with moderate calorie restriction Pay attention to portion size Replace energy-dense foods with nutrient-dense foods Eat regular, balanced meals

Adopting a Healthy Lifestyle for Successful Weight Management (2) Physical activity and exercise Burns calories Positive effects on metabolism Increased muscle mass Improves cardiovascular (heart) and respiratory (Nasal cavity, nose, pharynx, larynx, trachea, bronchii and lungs) health Enhances mood, sleep, self-esteem, and one’s sense of accomplishment

Adopting a Healthy Lifestyle for Successful Weight Management (3) Thinking and emotions Weight problems are associated with low self-esteem and negative emotions The “ideal self” Self-talk can be self-deprecating or positively motivating Coping strategies Develop appropriate coping strategies to deal with the stresses of life

Approaches to Overcoming a Weight Problem (1) Doing it yourself Loss of 0.5–2.0 pounds per week recommended Initial weight loss is from fluids Very low calorie diets should be avoided Diet supplements and diet aids Formula drinks and food bars, herbal supplements, and others: claims are often false

Approaches to Overcoming a Weight Problem (2) Weight loss programs Noncommercial: TOPS (Take Off Pounds Sensibly); OA (Overeaters Anonymous) Commercial: Weight Watchers Commitment and a plan for maintenance are important Online Clinical: medically supervised

Approaches to Overcoming a Weight Problem (3) Prescription drugs Appetite suppressants All have potential side effects Work best in conjunction with behavior modification Once drugs are stopped, most individuals return to their original heavy weight A good option for the very obese who need help getting started

Approaches to Overcoming a Weight Problem (4) Surgery Severe obesity is a medical condition Often complicated by other health problems Bariatric surgery Modifies gastrointestinal tract Key to weight-loss surgery success Adequate follow-up Continued motivation

Problems Associated with Very Low Levels of Body Fat Low levels of body fat are a threat to wellness Female athlete triad: Abnormal eating patterns (and excessive exercising) Amenorrhea (absence of menstruation) Decreased bone density

Body Image The collective picture of the body as seen through the mind’s eye Perceptions, images, thoughts, attitudes, and emotions Severe body image problems: Body dysmorphic disorder (BDD) Constant preoccupation with body imperfections Related to obsessive-compulsive disorder Muscle dysmorphia

Eating Disorders Psychological disorders, characterized by severe disturbances in body image, eating patterns, and eating-related behaviors Types: Anorexia (self-starvation and excessive weight loss) Bulimia (binging —or excessive overeating—followed by purging) Binge-eating disorder

Anorexia Nervosa (1) Failure to eat enough food to maintain a reasonable body weight Characteristics: Fear of gaining weight or becoming fat Distorted self-image Compulsive behaviors and rituals Excessive exercise

Anorexia Nervosa (2) Health risks of anorexia nervosa: Amenorrhea Cold intolerance Low blood pressure and heart rate Dry skin, and swelling of the hands and feet Depression and suicide Medical complications Disorders of the cardiovascular, gastrointestinal, endocrine (glands of an organism that secrete hormones) and skeletal systems

Bulimia Nervosa (1) Recurring episodes of binge eating followed by purging Characteristics: Rapid consumption of food, followed by purging Eating in secret After a binge, feeling ashamed, disgusted, and physically and emotional drained

Bulimia Nervosa (2) Health risks of bulimia nervosa: Eroded tooth enamel Deficient calorie intake Liver and kidney damage Cardiac arrhythmia Chronic hoarseness Esophageal tearing Rupture of the stomach Menstrual problems Depression

Binge-Eating Disorder Uncontrollable eating followed by feelings of guilt and shame about weight gain Characterized by very rapid eating, eating until uncomfortably full, eating when not hungry, and preferring to eat alone Often, eating is a way of coping Likely to be obese High rates of depression and anxiety

Borderline Disordered Eating Symptoms of an eating disorder, but the individual does not meet the full diagnostic criteria Excessive dieting Occasional binging and purging Inability to control eating

Treating Eating Disorders Must address eating behaviors and misuse of food to manage stress and emotions Psychotherapy and medical management Anorexia nervosa: averting a medical crisis Adequate body weight; psychological aspects Bulimia nervosa and binge-eating disorder: stabilizing the eating patterns Identifying and changing the patterns of thinking Improving coping skills

What Is the Right Weight for You? Acceptance and change Focus on living a healthy lifestyle not on the scale Know when the limits to healthy change have been reached