1. Weight Management
Chapter 9

2. Overweight and Obesity
Major health problem in the United States
Growing concern worldwide
Prevalence continues to increase
Women, poor, blacks, and Mexican Americans
Children
BMI of 25 or greater
Global food system
Abundant energy-dense, processed, affordable products

3. Increasing Prevalence of Obesity Among US Adults
Figure 9-1 Increasing prevalence of obesity among U.S. adults

4. Fat Cell Development When energy in exceeds energy out:
Adipose tissue fat cells store excess
Number and size of body fat cells
Fat cell numbers increase during childhood and adolescence
Cell proliferation
When energy out exceeds energy in:
Fat cell size decreases
No change in number

5. Fat Cell Development Illustrated
Figure 9-2 Fat cell development

6. During growth, fat cells increase in number.
When energy intake exceeds expenditure, fat cells increase in size.
When fat cells have enlarged and energy intake continues
to exceed energy expenditure, fat cells increase in number
again.
With fat loss, the size of the fat cells shrinks but not the number.
Figure 9-2 Fat Cell Development
Fat cells are capable of increasing their size by 20-fold and their number by several thousand fold.
Stepped Art

7. Fat Cell Metabolism Lipoprotein lipase (LPL) activity
Storage of triglycerides
Differences between obese and lean people
Activity in varying body regions
Differences between men and women
Gender differences in enzyme activity
Releasing and breaking down fat
Fat oxidation not efficient
Set point theory

8. Genetics and Epigenetics
Causative role of genetics
Multiple genetic influences
Genetics may determine susceptibility to obesity
Genes interact with:
Diet and physical activity
Metabolic pathways
Human genome

9. Obesity Gene Gene named ob
Codes for the protein leptin
Acts as a hormone in hypothalamus
Promotes negative energy balance
Suppresses appetite
Increases energy expenditure
Leptin injections effective in reducing body weight in animals and humans
With genetic deficiency of leptin or receptor mutation

10. Mice With and Without Leptin Compared
Figure 9-3 Mice with and without leptin compared

11. Ghrelin Secreted by the stomach cells Increases appetite
Promotes positive energy balance
Inverse correlation with body weight
Psychological mindset influences ghrelin’s response to a meal
Mindset of indulgence promotes satiety
Promotes sleep

12. Uncoupling Proteins Types of body fat
White adipose tissue
Stores fat for use by other cells
Oxidation releases energy as ATP and heat
Brown adipose tissue
Releases stored energy as heat
Oxidation uncoupled from ATP formation
Differences in brown fat between obese and normal weight people

13. Brite Adipocytes Some white fat can undergo browning process
Takes on characteristics of brown fat
Resulting cells called brite adipocytes
More abundant than brown fat cells in adults
Physical activity can trigger the process

14. Environment
Obesity reflects interaction between genes and the environment
Overeating
Present and past eating and activity patterns influence current body weight
Food availability
Serving sizes
Restaurant food

15. Physical Inactivity Life requires little exertion
Modern conveniences
Inactivity contributes to weight gain and poor health
Sedentary activities and weight gain
DRI for prevention of weight gain
60 minutes of moderately intense activity daily

16. Health Risks Risk indicators Beneficial weight loss BMI
Waist circumference
Disease risk profile
Factors taken into account
Beneficial weight loss
Health status
Motivation

17. Different Conditions Overweight in good health
Sometimes health is not the motivation for weight loss
Obese or overweight with risk factors
Weight loss recommended with two or more risk factors
Obese or overweight with life-threatening condition
Weight loss recommended

18. Perceptions and Prejudices
Most obese people do not successfully lose weight and maintain the loss
Social consequences
Jobs, school, and social situations
People judged by appearance
Psychological problems
Embarrassment
Other feelings

19. The Psychology of Weight Cycling
Figure 9-4 The psychology of weight cycling

20. Stepped Art – Weight Cycling
I am fat
and unhappy.
I lose a little
weight, but then regain it (and sometimes more).
I want to be happy.
Figure 9-4 The psychology of weight cycling
If I lose weight, I will be happy.
I try too hard to reach an unrealistic goal.
Stepped Art – Weight Cycling

21. Dangerous Interventions
Diet books and weight-loss programs
Little success maintaining weight loss
Fad diets
Weight-loss products
Herbal products
Laws for dietary supplements
Other gimmicks

22. Drug Treatment for Obesity
Strategies for weight reduction depend on:
Degree of obesity
Risk of disease
Use drugs as part of long-term comprehensive weight-loss program
For people with medical risks
Assist with modest weight loss
FDA approval
Mandate: benefits must outweigh risks

23. FDA-Approved Drugs for Weight Loss
Action
Side Effects
Orlistat (OR-leh-stat), trade names: Alli, Xenical
Inhibits pancreatic lipase activity in the GI tract, thus blocking digestion and absorption of dietary fat and limiting energy intake
Gl cramping, diarrhea, gas, frequent bowel movements, reduced absorption of fat-soluble vitamins; rare cases of liver injury
Phentermine (FEN-ter- mean), diethylpropion (DYE-eth- ill-PRO-pee-on). phendimetrazine (FEN-dye-MEH-tra-zeen)
Enhances the release of the neurotransmitter norepinephrine, which suppresses appetite
Increased blood pressure and heart rate, insomnia, nervousness, dizziness, headache
Lorcaserin hydrochloride, trade name: Belviq (BELL-veek)
Interacts with brain serotonin receptors to increase satiety and reduce food intake
Headache, dizziness, fatigue, nausea, dry mouth, and constipation; low blood glucose in people with diabetes; serotonin syndrome, including agitation, confusion, fever, loss of coordination, rapid or irregular heart rate, shivering, seizures, and unconsciousness; cannot be safely used by pregnant or lactating women or people with heart-valve problems; high doses cause hallucinations
Phentermine (an appetite suppressant) and topiramate (a seizure/migraine medication) combination, trade name: Qsymia (kyoo-sim-EE-uh)
Enhances the release of the neurotransmitter norepinephrine, which suppresses appetite, and increases the feeling of being full, making foods taste less appealing
Increased heart rate; can cause birth detects if taken in the first weeks or months of pregnancy; increased heart rate; suicidal thoughts; may worsen glaucoma and other eye problems
Table 9-1 FDA-approved drugs for weight loss
NOTE: Weight-loss drugs are most effective when taken as directed and used in combination with reduced-kcalorie diet and increased physical activity

24. Surgical Treatments for Obesity
Clinically severe obesity (BMI > 40)
More than 100,000 surgeries performed annually in the United States
Reduces food capacity of stomach
Effectively limits food intake
Gastric bypass changes hormone production
Health benefits
Long-term safety and effectiveness
Liposuction

25. Gastric Surgery Used in the Treatment of Severe Obesity
Figure 9-5 Gastric surgery used in the treatment of severe obesity

26. Weight Loss Strategies
Characteristics of successful strategies
Embrace changes
Celebrate losses
Set goals
Psychosocial support
Benefits of modest weight loss
Reasonable weight loss rate: 0.5 to 2 lb. per week
Incorporation of healthy eating and physical activity

27. Eating Patterns, Part 1 Be realistic about energy intake
Provide less energy than needed
Avoid restrictive eating
Avoid rapid weight loss
Goal: nutritional adequacy without excess
Deficit of 500 to 1000 kcalories per day
Breakfast frequency
Inversely related to obesity

28. Eating to Lose Weight Nutritional adequacy Eat small portions
Minimum 1200 kcalories per day
Eat small portions
Eat less food at each meal
Feel satisfied, not stuffed
Prepared meal plans
Slow down
Reduce energy density
Remember water

29. Energy Density
Decreasing the energy density (kcal/g) of foods allows a person to eat satisfying portions while still reducing energy intake. To lower energy density, select foods high in water or fiber and low in fat.
By selecting the water-packed tuna (on the right) instead of the oil-packed tuna (on the left), a person can enjoy the same amount for fewer kcalories.
Selecting grapes with their high water content instead of raisins increases the volume and cuts the energy intake.
Even at the same weight and similar serving sizes, the fiber-rich broccoli delivers twice the fiber for about one-third the energy.
Figure 9-6 Energy density

30. Eating Patterns, Part 2 Focus on fiber Choose fats sensibly
Low in energy and high in nutrients
Requires effort to eat
Choose fats sensibly
Energy density and satiation
Select carbohydrates carefully
Artificial sweeteners
Watch for empty kcalories
Fat, sugar, and alcohol

31. Weight-Loss Strategies
Food
Activities
To maintain weight, consume foods and drinks to meet, not exceed, kcalorie needs. To lose weight, energy out should exceed energy in by about 500 kcalories/day.
Emphasize foods with a low energy density and a high nutrient density; make legumes, whole grains, vegetables, and fruits central to your diet plan.
Eat slowly.
Drink water before you eat and while you eat; drink plenty of water throughout the day.
Track food and kcalorie intake.
Plan ahead to make better food choices.
Limit kcalorie intake from solid fats and added sugars.
Reduce portions, especially of high- kcalorie foods.
Cook and eat more meals at home, instead of eating out. When eating out, think about choosing healthy options.
Limit screen time.
Increase physical activity.
Choose moderate- or vigorous-intensity physical activities.
Avoid inactivity. Some physical activity is better than none.
Slowly build up the amount of physical activity you choose.
Table 9-3 Weight loss strategies

32. Physical Activity Best approach to weight management
Moderate physical activity plus activities of daily life
Combination of diet and physical activity
Lose more fat
Retain more muscle
Regain less weight
Reduction of abdominal fat

33. Activity Energy Expenditure
kCalorie expenditure
Influenced by body weight, intensity, and duration
Greater the energy deficit, greater the fat loss
Discretionary kcalorie allowance
Metabolism
Speeds up with activity
Immediate and long-term benefits

34. Influence of Physical Activity on Discretionary kCalories
Figure 9-7 Influence of physical activity on discretionary kcalories

35. Physical Benefits of Activity
Body composition
Fat decreases and lean body mass increases
Strength-training exercises
Abdominal fat
Appetite control
Delayed appetite
Inappropriate appetite

36. Psychological Benefits of Activity
Self-esteem
Choosing activities
Ones you enjoy and are willing to do regularly
Moderate intensity
2000 kcalories per week
Energy-expending daily activities
Spot reducing

37. Environmental Influences
Factors surrounding eating experience and the food itself
Changes can influence amount a person eats
Atmosphere
Pleasant and comfortable equals more food
Accessibility
Less effort needed to obtain food, more food eaten

38. Environmental Factors While Eating
Socializing
Duration of meal
Visual cues
Distraction
Distractions
Initiating eating
Interfering with internal controls
Extending duration of eating

39. Other Environmental Factors That Influence Eating
Multiple choices
Large assortments of foods increase consumption
Package and portion sizes
Serving containers

40. Behavior and Attitude Behavior modification Become aware of behaviors
Positive, matter-of-fact attitude
Become aware of behaviors
Keep record
Change behaviors
Set small, time-specific goals
Practice
Reward

41. Cognitive Skills Problem solving Cognitive restructuring
Replace negative thoughts
Personal attitude
Understand personal relationship with food
Sound emotional health
Support groups

42. Successful Weight Loss
Maintained for at least a year
Prevalence of successful weight loss
Difficult to determine
Components of successful weight loss
Vigorous exercise regimens
Careful eating patterns
Frequent self-monitoring

43. Maintaining Weight Loss
Hormonal and metabolic changes
Persist over time
Takes more effort to prevent weight regain than to prevent weight gain

44. Prevention Preventing weight gain Form beneficial habits
Easier than losing weight
Strategies similar to losing weight
Start earlier
Form beneficial habits
Food choices
Activity

45. Community Programs Reversing obesity epidemic in the United States
Challenging
May require community action to promote healthy lifestyle choices
Efforts go beyond individuals
Social networks
Community institutions
Government policies

46. National Strategies to Prevent Obesity
• Provide a variety of opportunities to help make physical activity an integral and routine part of life. • Create environments that ensure healthy foods and beverages are visible, attractive, and easy-to-obtain. • Encourage media messages that promote physically active lifestyles and nutritionally healthy diets. • Support health care providers in offering information on weight management and employers in offering wellness programs. • Make schools centers for health and wellness. SOURCE: Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation, (Washington. DC: Institute of Medicine of the National Academies)
Table 9-4 National strategies to prevent obesity

47. Underweight Affects fewer than two percent of U.S. adults
Weight gain a matter of health
Individual matter
Weight gain may be difficult
Physical conditioning combined with high energy intakes

48. Problems of Underweight
Diverse causes
High demand for energy may contribute
Physical activity
Growth and development
Difficult to gain weight
Adaptive thermogenesis
Learn new habits and like new foods
Difference between underweight and anorexia nervosa

49. Weight-Gain Strategies
Key diet planning strategies
Adequacy and balance
Energy-dense foods
Regular meals daily
Large portions
Extra snacks
Juice and milk
Liquid supplements for illness
Exercise to build muscles

50. The Latest and Greatest Weight-Loss Diet – Again
Highlight 9

51. Fad Diets Outrageous claims Numerous fad diet plans
No requirements to prove the claims
Do not have to undertake credible research
Often distorted research
Anyone can publish anything
Numerous fad diet plans

52. Fad Diets’ Appeal Market for weight-loss products is huge
Estimated $33 billion yearly in United States
Greatest appeal
Tend to ignore sound dietary recommendations
Sophisticated and often erroneous explanations
Tend to work for short time
Fail to produce long-lasting results

53. Don’t Count kCalories Claim to disregard kcalories Follow a plan
Designed to have low energy intake
Tend to lack variety
Monotonous
Often recommend dietary supplement
Follow a plan
Most fad diets cannot support optimal health over time

54. The Real Deal Fad diet “magical powers” Weight loss
Tipping the energy balance equation to greater energy expenditure
Weight loss
Long-term lifestyle changes
Healthy plan
Flexibility and variety