Weight Management 1

America is getting heavier 66% of adults ages 20 to 74 years are overweight – Of this number, 32% meet criteria for obesity Center for Health Statistics reveals that 17% to 19% of children and adolescents are overweight Pg 269 Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 2

Body weight and body fat – Definitions – Body composition- measurements provide a better evaluation of overall health relative to weight Measures of weight maintenance goals – Standard height/weight tables- Table 15-2 pg 273 – Healthy weight range Individual variation-depends on gender, age, body shape, metabolic rates and genetics Necessity of body fat- insulation, cushion vital organs, temperature regulation Pg Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 3

Obesity and health – Weight extremes – Overweight and health problems- increase risk for type 2 diabetes, hypertension, heart disease, gallbladder disease, stroke Causes of obesity – Basic energy balance – Hormonal control Leptin- obesity gene (set point for fat storage) Ghrelin- appetite stimulant (secreted from the stomach) – Genetic and family factors – pg Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 4

 Individual differences and extreme practices ◦ Individual energy balance levels ◦ Extreme practices  Fad diets  Scientific inaccuracies and misinformation  Failure to address the necessity of changing long-term habits  Pg 276 Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 5

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Extreme practices, cont’d – Fasting – Specific macronutrient restrictions – Clothing and body wraps – Drugs Reduce energy intake by suppressing appetite Increase energy expenditure by stimulating basal metabolic rate Reduce the availability of nutrients to enter cells Alter lipogenesis and lipolysis Pg Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 8

Extreme practices, cont’d – Surgery Gastric restriction- creation of a small stomach-pouch designed to reduce the space for food Malabsorptive procedures (e.g., gastric bypass)- rearrange the small intestines to decrease the length and efficiency of the gut for nutrient absorption Lipectomy- removes fat deposits under the skin in places of cosmetic concern, such as the hip and thighs. Procedure can be quite painful and carries the risk of infection and disfigurement Pg 277 Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 9

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Essential characteristics Behavior modification – Basic principles – Basic strategies and actions Defining problem behavior Recording and analyzing baseline behavior Planning behavior management strategy Pg 280 Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 13

Dietary principles – Energy (kilocalories) reduced according to need- reduce kcal intake of 500 per day (total of 3500 kcal/week) to lose 1-2 pounds a week – Energy (kilocalorie) readjustment to maintain weight – Realistic goals – Nutritional adequacy – Cultural appeal – pg281 Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 14

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Basic energy balance components – Energy input: food behaviors- need to learn control of “bad” foods – Energy output: exercise behaviors- need to increase energy output to decrease weight – pg283 Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 16

Principles of a sound food plan: – Energy balance- if energy output is greater than input weight loss will occur – Nutrient balance- carbohydrates, fats, and proteins must be balanced – Distribution balance- spreading food out evenly throughout the day helps meets energy needs – Food guide-provides examples of food plans – Preventive approach- early nutritional counseling and education – Pg Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 17

Types of claims – Food cures- certain foods cure certain claims – Harmful foods- certain foods may be harmful and should be avoided – Food combinations- special food combinations restore health and reduce weight – “Natural” foods- only “natural” foods can meet body needs and prevent disease – pg287 Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 18

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 Erroneous claims  Dangers  Vulnerable groups ◦ Elderly, young persons, obese persons, athletes and coaches, entertainers  What is the answer? Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 20

 General causes ◦ Wasting disease ◦ Poor food intake ◦ Malabsorption ◦ Hormonal imbalance ◦ Energy imbalance ◦ Poor living situation Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 21

 Dietary treatment ◦ High-calorie diet ◦ High protein ◦ High carbohydrate ◦ Moderate fat ◦ Adequate sources of vitamins and minerals Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 22

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 Disordered eating ◦ Anorexia nervosa ◦ Bulimia nervosa ◦ Binge eating disorder ◦ Treatment Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 24

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Definitions- a eating disorder related to persons fear of fatness. Cycles of eating and purging Warning signs-excessive concern about weight, cycles of strict dieting and binge eating, low self esteem Treatment- skilled professional therapy which include physicians, psychologists, and dieticians Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 28

 America is getting bigger, with 66% of adults and 17% to 19% of children and adolescents being overweight.  In the traditional medical model, obesity has been viewed as an illness and a health hazard, which is true in cases of clinically severe obesity. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 29

 A sound weight loss program is based on reduced energy intake for gradual weight loss and nutrient balance to meet health standards.  The ideal plan begins with prevention, stressing the formation of positive food habits in early childhood to prevent major problems in later life. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 30

 Underlying causes of obesity include a host of various genetic and environmental factors.  America’s obsession with thinness has created extreme weight management problems such as eating disorders (e.g., anorexia nervosa, bulimia nervosa). Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 31

 Newer approaches view moderate overweight differently, however, in terms of the important aspect of fatness and leanness or body composition and propose a more person-centered positive health model Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 32