Chapter 12 Achieving a Healthy Weight A Wellness Way of Life Ninth Edition Robbins/Powers/Burgess © 2011 McGraw-Hill Higher Education. All rights reserved.

Chapter 12 Objectives After reading this chapter, you will be able to: Differentiate between overweight and obesity. Identify the percentages of adults over age 20 who are overweight and the percentage who are obese. Explain the purpose of the body mass index (BMI) and identify a BMI associated with health problems. List six health conditions associated with obesity. Explain how the location of fat on the body is liked to health risks and calculate waist-to-hip ratios. Identify a risky waist-to-hip ratio and a high-risk waist circumference for both men and women. Describe how each of the following factors contributes to obesity: energy balance, heredity, fat cells, set point, and metabolism. Define basal metabolic rate (BMR), and identify five factors that affect it. Distinguish a healthy weight loss program from a fad/diet program. Identify and explain the three major components of effective lifetime weight management. Explain how exercise helps in weight management. Compare and contrast the eating disorders bulimia nervosa, anorexia nervosa, binge eating disorders, and disordered eating. © 2011 McGraw-Hill Higher Education. All rights reserved.

Weight and Health 67% of American adults are overweight or obese (40% are obese). $59 billion a year is spent on weight loss. Obesity rates continue to climb. Obesity is considered by many health professionals as the most serious health threat to Americans. © 2011 McGraw-Hill Higher Education. All rights reserved.

Body Composition Fat-free mass includes muscles, bone, body fluids, and organs. Lean mass is muscle. Body fat can be either essential fat or storage fat. Essential fat is required for body functions. Storage fat is extra fat that accumulates around organs and beneath the skin for padding, insulation, and for functioning. Some storage fat is okay. © 2011 McGraw-Hill Higher Education. All rights reserved.

Overweight Versus Obese Overweight refers to a body weight in excess of a recommended range for good health. Obesity refers specifically to having an excessive accumulation of body fat. Body Mass Index (BMI): weight in pounds divided by height in inches squared multiplied by 703 (this measure is not appropriate for athletes or body builders). A BMI of 25 to 30 is considered overweight. A BMI over 30 is considered obese. © 2011 McGraw-Hill Higher Education. All rights reserved.

© 2011 McGraw-Hill Higher Education. All rights reserved. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. © 2011 McGraw-Hill Higher Education. All rights reserved.

Risks Associated with Obesity Risk factor in four of the ten leading causes of death. Heart disease, cancer, stroke, diabetes, and atherosclerosis. Aggravates liver disorders and osteoarthritis and is a factor in gallbladder disease. Complicates surgery and pregnancy. Also becoming a big problem for children. © 2011 McGraw-Hill Higher Education. All rights reserved.

Location of Fat Fat distributed primarily in the abdominal area is linked to increased risk for heart disease, hypertension, high cholesterol, type 2 diabetes, and cancer. Abdominal fat causes more fatty acids to be in the bloodstream versus lower body fats. Waist-to-hip ratio might be a better predictor of fat-related health problems. Waist-to-hip ratio is dividing the waist measurement by the hip measurement. Women should be below .8 and men below .95. Waist circumference alone can also be a predictor of risk. Men with waists over 40 inches and women with waists over 35 inches are classified as high risk, no matter what their weight. © 2011 McGraw-Hill Higher Education. All rights reserved.

Theories Energy balancing equation Fat-cell Set-point Calories eaten versus calories burned. An imbalance can create a change in weight. 3500 calories = 1 pound. Fat-cell Can increase number and size. Genetics can play a part. Can build new fat cells during growth, pregnancy, and obesity. Fat cells are indestructible. The overfat usually have more fat cells, so are more at risk for obesity due to increased fat cells. Fat produces hormones and proteins than contribute to disease. Set-point Weight regulating mechanism in the brain. May be related to number of fat cells. May be able to change set-point to lower or higher number. © 2011 McGraw-Hill Higher Education. All rights reserved.

Genetics and Metabolism Twin studies indicate there may be a genetic factor in obesity. Genetics can create a tendency for obesity, but we still have a lot of control despite our genes. Basal metabolic rate (BMR) accounts for 65-75% of the calories burned in a day for bodily functions. BMR is a result of age, gender, body size, nutritional status, musculature, activity level and genetics. BMR can be increased with exercise and muscle hypertrophy. Dietary fat doesn’t take as much energy to digest or be stored than protein or carbs. © 2011 McGraw-Hill Higher Education. All rights reserved.

Dieting Implies a way of eating that involves special foods, caloric restrictions, powders, pills, or shake – but it actually should be a balanced way of eating for a lifetime. Avoid very low calorie “diets.” They can actually slow your metabolism and cause muscle loss and increased fat. Avoid very low carb diets. Can cause ketosis which is poisonous to the body. © 2011 McGraw-Hill Higher Education. All rights reserved.

Weight Cycling Weight cycling is the repeated loss and regaining of body weight. Starvation diets (less than 800 calories a day) are detrimental and can affect BMR by decreasing muscle mass and metabolism. They also affect emotional status. Fad diets are usually detrimental to the dieter! If it seems too good to be true, it usually is! It is important to learn skills for maintaining weight loss and preventing obesity. A healthy diet is a lifetime commitment. © 2011 McGraw-Hill Higher Education. All rights reserved.

Healthy Weight Loss Should use real, regular food. Should allow a slow weight loss of 1-2 pounds per week. Should encourage the reduction of fat and sugar in the diet. Should encourage safe and personalized exercise. Should not promise a quick fix or easy answer. Should teach lifelong skills that allow for some flexibility in eating and exercise patterns. Should make social eating and eating out possible. Should allow for basic caloric needs – never under 1200(women)/1500(men) calories per day. Should not be too costly. Should teach techniques to maintain positive behavior. © 2011 McGraw-Hill Higher Education. All rights reserved.

Lifetime Weight Management Strategies Food management Balanced diet (low in fat and sugar, high in fruits, veggies, whole grains, moderate low-fat proteins) with appropriate amount of calories. Recognize portion distortion. Avoid mindless eating. Emotional management Delay, distract, distance. Avoid eating primarily for emotional needs (stress, bored, lonely, angry, habit). Observe your eating patterns – when, why, with who, how you feel. Exercise management Exercise is the key to maintaining weight loss. It burns calories. It prevents loss of lean muscle mass. It decreases abdominal fat. It is a natural appetite suppressor. It may lower your set point. It helps maintain weight loss. It improves self-esteem. © 2011 McGraw-Hill Higher Education. All rights reserved.

Culture and Weight In the past, fat was a sign of beauty and success. Over time, culture changed (for numerous reasons) and by the 60s, thin was in. Media and society have shifted the expectation for what is “attractive” and promote the idea that thin is desirable. Most women don’t (and maybe cannot) meet the expectation of very thin. The average woman in America is 144 pounds and wears a size 12-14. This problem affects men as well as women. Most women have a distorted body image. The problem is increasing among men also. © 2011 McGraw-Hill Higher Education. All rights reserved.

Eating Disorders Desire to be thin has become an obsession for many and can begin early in life. Thinness is associated with popularity and attractiveness. Estimated that 2/3 of teenage girls have dysfunctional eating behavior. Fear of fat gain, obsessive dieting, and a distorted body image can lead to eating disorders. An eating disorder is a disturbance in eating behavior that jeopardizes a person’s physical or psycho-social health. Estimated that 8 to 10 million Americans struggle with eating disorders. © 2011 McGraw-Hill Higher Education. All rights reserved.

Eating Disorders Some general causes are: social pressure for thin and lean body family with overly high expectations perfectionist personality genetic propensity to be overweight pressure from others to lose weight appearance-obsessed friends low self-esteem Bulimia, Anorexia, Binge Eating © 2011 McGraw-Hill Higher Education. All rights reserved.

Bulimia Nervosa Recurrent binge eating large quantities of food. Feeling of lack of control over eating during binges. Self-induced purging: vomiting, using laxatives and/or diuretics, fasting, or excessive exercise. Two binge episodes a week for at least 3 months. Self-evaluation unduly influenced by body shape and weight. Bingeing and purging are not accompanied by anorexia nervosa. Treatment goal is to get bulimics to cope with stress and body image insecurities through less destructive ways and to feel more comfortable with who they are. © 2011 McGraw-Hill Higher Education. All rights reserved.

Anorexia Nervosa Found primarily in early and middle adolescent females. May lead to physical deterioration to the point of hospitalization or death. Rigid dieting. Excessive exercise and energy. Criteria include: Refusal to maintain body weight at or above a minimal normal level for age and height (15% below normal). Intense fear of weight gain or becoming fat despite being significantly underweight. Distorted body image. Amenorrhea for at least 3 consecutive cycles. Treatment involves medical, psychological, and nutritional help. Denial is the major obstacle to treatment. Entire family should be involved. © 2011 McGraw-Hill Higher Education. All rights reserved.

Binge Eating Disorder Sometimes called compulsive overeating. The most common eating disorder. Eating an amount of food much larger than most people would eat in a similar period and accompanied by a sense of lack of control or a feeling that one can’t stop eating. Criteria include: Eating much more rapidly than normal. Eating until uncomfortably full. Eating large amounts of food when not hungry. Eating alone because of embarrassment about how much is eaten. Feeling disgusted with oneself, depressed, or guilty about eating. The binge eating occurs, on average, at least 2 days a week for 6 months. Treatment Goal is to normalized eating – to refuse overeating. Help in adopting a plan of healthy eating and moderation without rigid rules. Help coping with underlying emotions – anxiety, loneliness, depression, shame, inferiority, and fear of criticism. Finally, to accept their bodies. © 2011 McGraw-Hill Higher Education. All rights reserved.

What Can Be Done Prevention – helping people understand the concept of health/wellness and healthy body image. Encouraging self-acceptance and esteem. Professional counseling or support groups are available. May need medical attention. Support, love, and encouragement. May have to be persistent to get some help. © 2011 McGraw-Hill Higher Education. All rights reserved.

Rx for Action Keep a food journal to see what, how much, and why you are eating. Take a favorite recipe and investigate ways to make it less caloric and more nutritious. Resign from the “clean plate club.” Even if it feels somewhat uncomfortable, leave a small amount of food on your plate. Do some form of exercise that burns a minimum of 300 calories. Make a rule. No TV or Internet until you’ve exercised for 30 minutes. © 2011 McGraw-Hill Higher Education. All rights reserved.

What Do You Think? What are your thoughts on weight and body image in America? What is your BMI? Are you in a risk category? What are the health conditions associated with obesity? What are healthy weight loss or weight maintenance strategies? Do you engage in any of them? Do you know anyone that has an eating disorder? How could they get help? © 2011 McGraw-Hill Higher Education. All rights reserved.

Questions? © 2011 McGraw-Hill Higher Education. All rights reserved.