1. © 2008 McGraw-Hill Higher Education. All rights reserved. Weight Management & Eating Disorders

2. © 2008 McGraw-Hill Higher Education. All rights reserved. 2 Introduction National Institutes of Health –66% of American adults are overweight –Including more than 32% who are obese –In 2030 it is… Estimated that the entire American adult population will be overweight or obese

3. © 2008 McGraw-Hill Higher Education. All rights reserved. 3 Prevalence of overweight and obesity among Americans (Figure 14-1)

4. © 2008 McGraw-Hill Higher Education. All rights reserved. 4 Basic Concepts Calorie – energy measurement; the body gains energy from calories when nutrients in food are broken down. 1 pound of fat = 3500 calories Metabolism – means by which your body releases the energy in food and uses it to build and repair body tissue. Basal Metabolism – amount of energy needed by the body when at rest and fasting to carry out basic life functions such as: –Breathing –Circulation –Maintaining body temperature

5. © 2008 McGraw-Hill Higher Education. All rights reserved. Basal Metabolism Basal Metabolism varies with and is determined by: – age – size – gender – physical activity – body type For example: A more muscular person will generally have an increased basal metabolism than a non-muscular person with the same weight. Basal Metabolic Rate (BMR) – the rate at which the body uses energy to support its basal metabolism. For Example: Males have a faster BMR than females due to more muscular bodies and larger bones. 5

6. © 2008 McGraw-Hill Higher Education. All rights reserved. 6 The Energy Balance Scale

7. © 2008 McGraw-Hill Higher Education. All rights reserved. 7 Energy Balance Remember energy is calories –Negative energy balance – Eating less calories than the body uses Weight LOSS will happen –Positive energy balance – Eating more calories than the body uses Weight GAIN will happen –Neutral energy balance – Eating the same amount of calories that the body uses Weight remains the same

8. © 2008 McGraw-Hill Higher Education. All rights reserved. 8 Evaluating Body Weight and Body Composition Height-Weight charts - provide only an indirect measure of body fat and health –Not a True measurement of health –Only takes into account frame size, gender and age Body Mass Index (BMI) – based on the concept that weight should be proportional to height. Can also be used in conjunction with waist circumference/waist-to-hip ratio. –Body weight in kilograms / square of height in meters –Weight in pounds X 704 / Height in inches (squared) –Does not take into account fat-free weight. Can be very inaccurate for shorter people (under 5’), muscular athletes, and older adults with little muscle mass. Waist-to-Hip Ratio - assessed by measuring waist circumference and hip circumference –Risk if total waist measurement is more than 40 inches for men and 35 inches for women

9. © 2008 McGraw-Hill Higher Education. All rights reserved. 9

10. BMI Weight Classifications Underweight – under the recommended range of good health BMI under 18.5 Healthy Weight – within the recommended range BMI between 18.5 and 24.9 Overweight –above recommended range for good health BMI over 25. Obesity – a more serious degree of overweight BMI over 30 10

11. © 2008 McGraw-Hill Higher Education. All rights reserved. 11 Assessment of BMI Measurement. Example: 5’6” tall, 150 pounds 1.Multiply weight (in pounds) by 704 150 pounds X 704 = 105,600 2.Multiply height (in inches) by height (in inches) 66 inches X 66 inches = 4,356 3.Divide the answer in step 1 by the answer in step 2 to obtain a value for BMI BMI = 105,600 / 4,356 = 24.2

12. © 2008 McGraw-Hill Higher Education. All rights reserved. Evaluating Body Weight and Body Composition Body Composition – a measure of the body components –Fat vs. Lean tissue Finds the fat percentage in the body –A True measurement of health 12

13. © 2008 McGraw-Hill Higher Education. All rights reserved. 13 Methods of Determining Percent Body Fat Hydrostatic (underwater) weighing –Most accurate Skinfold measurements –Thickness of fat under the skin Electrical Impedance Analysis –Electricity prefers lean tissue Scanning procedures –CT scan, MRI, Dual-energy X-ray

14. © 2008 McGraw-Hill Higher Education. All rights reserved. 14 The Health Risks of Excess Body Fat Obese individuals have a mortality rate twice that of non-obese –Reduces life expectancy by 10-20 years –Associated with: Unhealthy cholesterol and triglycerides, impaired heart function, and death from cardiovascular disease –Other health factors: hypertension, cancer, impaired immune function, gallbladder and kidney disease, skin problems, impotence, sleep disorder back pain, arthritis –Strong association – Type II diabetes

15. © 2008 McGraw-Hill Higher Education. All rights reserved. 15 Body Fat Distribution and Health Apples –Fat storage in the upper regions of body –Increase risk of high blood pressure, diabetes, early-onset heart disease, stroke, and cancer Pears –Fat storage in the hips, buttocks and thighs

16. © 2008 McGraw-Hill Higher Education. All rights reserved. 16 Factors Contributing To Excess Body Fat Genetic Factors –300 genes have been linked to obesity –If one parent is obese, children have a 40% risk –If both parents are obese, children have and 80% risk of being obese –Adoptees were found to be more like those of the biological parent

17. © 2008 McGraw-Hill Higher Education. All rights reserved. 17 Factors Contributing To Excess Body Fat Physiological Factors –Metabolism –Hormonal changes at puberty, during pregnancy, and at menopause contribute to the amount and location of fat accumulation. Other hormones regulate appetite. –Fat Cells determine the amount of fat the body can store.

18. © 2008 McGraw-Hill Higher Education. All rights reserved. 18 Lifestyle Factors Contributing to Excess Body Fat Eating – the average calorie intake per day has increased by 300 calories since 1970. Physical Activity – among Americans is declining, beginning in childhood throughout adulthood. Psychosocial factors –Emotions –Coping strategies –Obesity is strongly associated with socioeconomic status.

19. © 2008 McGraw-Hill Higher Education. All rights reserved. 19 Problems Associated with Very Low Levels of Body Fat Low body fat is considered less than 8-12% for women and less than 3-5% for men. Extremely low body fat has been linked to problems with: –Reproductive cycle –Circulatory system –Immune system disorders Female Athlete Triad 1.Abnormal eating patterns 2.Amenorrhea (no menstruation) 3.Decreased bone density

20. © 2008 McGraw-Hill Higher Education. All rights reserved. Dieting in America Most commonly used methods: –Fad diets –Yo-yo dieting –Not eating * All of these are ineffective for Long-Term weight loss. 20

21. © 2008 McGraw-Hill Higher Education. All rights reserved. Why? They are nutritionally unbalanced They are not functional. –They lead to quick weight re-gain once off the diet. They are dangerous. –Large weight fluctuations can lead to Heart Disease. –Can cause dehydration. They can be habit forming. (diet pills) They can lead to a loss of muscle. 21

22. © 2008 McGraw-Hill Higher Education. All rights reserved. To Lose Weight Healthily: Eat fewer calories than the body uses. –This will cause the body to use the energy already stored as fat. –Eat healthy foods in smaller portions. –Be sure eat enough calories for your energy needs If you do not eat enough the body will begin to break down muscle tissue. This can lead to fast weight re-gain. Exercise to burn energy. * This combination is the only method that is safe for long term weight loss. 22

23. © 2008 McGraw-Hill Higher Education. All rights reserved. 23 Adopting A Healthy Lifestyle For Successful Weight Management “Normal” body weight Diet and Eating Habits –Total Calories –MyPyramid suggestions –Best approach for weight loss is combining an increase of exercise with moderate calorie restriction –Do not go on a crash diet

24. © 2008 McGraw-Hill Higher Education. All rights reserved. 24 Adopting A Healthy Lifestyle For Successful Weight Management (Continued) Portion Sizes Energy (calorie) Density Fat Calories Carbohydrates –Simple Sugars and Refined Carbohydrates Protein Eating Habits

25. © 2008 McGraw-Hill Higher Education. All rights reserved. 25 Physical Activity and Exercise Accumulate 60 minutes or more of moderate- intensity physical activity, every day for normal weight individuals –Walking –Gardening –Housework –Walking 1 mile in 15-20 minutes 60 minutes per day to avoid slow weight gain in adulthood 60-90 minutes per day to lose weight or to prevent weight regain after losing weight

26. © 2008 McGraw-Hill Higher Education. All rights reserved. To Gain Weight Healthily 1 pound of muscle tissue = approximately 700-800 calories No hormone, vitamin, drug or protein supplement will increase muscle mass A high intake of protein is not necessary since excess protein is broken down for energy or stored as fat How to Gain Weight Healthily: –Eat a well-balanced diet with an excess of 500-1000 calories per day –Weight training is essential to stimulate the growth of muscle tissue 26

27. © 2008 McGraw-Hill Higher Education. All rights reserved. 27 Body Image Collective picture of the body as seen through the mind’s eye. –Perceptions –Images –Thoughts –Attitudes –Emotions Body image issues must be dealt with when dealing with obesity issues and eating disorders.

28. © 2008 McGraw-Hill Higher Education. All rights reserved. 28 Eating Disorders Any person who has an Eating Disorder has problems with body weight and weight control 0.5-2.0% of Americans suffer from anorexia and bulimia –Over 1 Million Americans develop anorexia or bulimia each year - 90% are female. –10% of college-aged women have an eating disorder Binge eating may affect 2-5% of all adults and 8% of those who are obese –60% of binge-eating problems are female

29. © 2008 McGraw-Hill Higher Education. All rights reserved. 29 Factors in Developing an Eating Disorder One central feature – a dissatisfaction with body image and body weight Heredity –Over 50% of the risk Home environment –Hostile environment? –Lack of cohesion with members –Rigid or overprotective parents –“Perfectionist”

30. © 2008 McGraw-Hill Higher Education. All rights reserved. 30 Anorexia Nervosa Failure to eat enough food to maintain a reasonable body weight Can be life-threatening Characteristics of Anorexia: Fear of gaining weight Distorted self-image Compulsive behaviors and rituals Excessive dieting “Self-starvation” Excessive exercise Layering of clothing Anti-social behavior Depression

31. © 2008 McGraw-Hill Higher Education. All rights reserved. Health Risks of Anorexia Stop menstruation Intolerant of cold temperatures Low blood pressure and heart rate Dry skin Hands and feet may swell and take on a blue tinge Depression and suicide 31

32. © 2008 McGraw-Hill Higher Education. All rights reserved. Anorexia Medical Complications Disorders of the: –Cardiovascular system –Gastrointestinal system –Endocrine system –Skeletal system 32

33. © 2008 McGraw-Hill Higher Education. All rights reserved. 33 Bulimia Nervosa Recurring episodes of “Binge eating followed by Purging” –Self-induced vomiting or laxative use Begins in adolescence or young adulthood –Increasingly younger (11-12 years) and older (40-60 years) ages Can be Life-threatening

34. © 2008 McGraw-Hill Higher Education. All rights reserved. Characteristics of Bulimia Rapidly consumes food, then purges Done in secret –Foraging and hoarding food After a binge - feels ashamed, disgusted and physically and emotional drained Constant preoccupation of food control Weight fluctuations due to alternative gorging and fasting Low self-esteem “Perfectionist” 34

35. © 2008 McGraw-Hill Higher Education. All rights reserved. Health Risks of Bulimia Erodes tooth enamel and gum disease Deficient calorie intake Swollen glands “Chipmunk Cheeks” Liver and kidney damage Cardiac arrhythmia Chronic hoarseness Esophageal tearing Rupture of the stomach Menstrual problems Increased depression 35

36. © 2008 McGraw-Hill Higher Education. All rights reserved. 36 Binge Eating Similar to Bulimia except no Purging behavior. –Eating patterns - very rapid, eating until uncomfortably full. –Often eat as a way of coping. –Likely to be obese. –High rates of depression and anxiety

37. © 2008 McGraw-Hill Higher Education. All rights reserved. 37 Treating Eating Disorders Address both eating disorder, misuse of food and manage emotions –Anorexia Nervosa –Bulimia Nervosa –Binge-Eating

38. © 2008 McGraw-Hill Higher Education. All rights reserved. 38 Correct Weight The “right” weight for any individual should be the result of a healthy lifestyle.

39. © 2008 McGraw-Hill Higher Education. All rights reserved. Nutrition Unit Test Eating Disorders definitions Nutrition Basics –Super Six definitions –Calories, Fiber definitions –Nutrition Label identification –My Plate food categories Weight Management –BMI, Body Composition, BMR definitions –Energy Balances (negative, positive, neutral) 39

40. © 2008 McGraw-Hill Higher Education. All rights reserved. Weight Management Chapter 14

41. © 2008 McGraw-Hill Higher Education. All rights reserved. Body Composition –Lean Body Mass –Body Fat Essential fat - 3-5% of total fat in men, 8-12% in women Nonessential fat-(storage) – Located just below the skin –Depends on many factors: »Gender »Age »Heredity »Metabolism »Diet activity level 41

42. © 2008 McGraw-Hill Higher Education. All rights reserved. 42 Weight Cycling YO-YO effect of dieting Some feel that it may be harmful to both overall health and to efforts at weight lost. Studies have not yet conclusively shown weight cycling be harmful.

43. © 2008 McGraw-Hill Higher Education. All rights reserved. 43 Approaches to Overcoming A Weight Problem Doing it yourself –0.5-2.0 pounds per week –Initial weight loss from fluids. –Very low calorie diets need to be avoided. –Diet Books: Reject books with gimmicks or rotating levels of calories. –Diet Supplements and Diet Aids Formula drinks and food bars Herbal Dietary supplements

44. © 2008 McGraw-Hill Higher Education. All rights reserved. 44 Weight-Loss Programs Noncommercial Self-help groups –TOPS, and OA Commercial Online Clinical

45. © 2008 McGraw-Hill Higher Education. All rights reserved. 45 Overcoming a Weight Problem Legitimate programs provide; –Nutritional Education Emphasis on exercise and change in lifestyle Individual and Group counseling Self-Help groups Registered dietitians Physician monitored program

46. © 2008 McGraw-Hill Higher Education. All rights reserved. 46 Prescription Drug Appetite Suppressants Produce a 5-15% weight reduction by controlling appetite. Once drugs are stopped most return to original heavy weight. Good option for very obese who need help getting started - permanent life style change.

47. © 2008 McGraw-Hill Higher Education. All rights reserved. 47 Surgery Severely obese - BMI of 40 or higher or are 100 pounds or more over recommended weight. –Roux-en-Y-gastric bypass –Vertical banded gastroplasty (VBG) –Liposuction Weight loss from surgery generally ranges between 40% and 70% of total body weight over a years time.

48. © 2008 McGraw-Hill Higher Education. All rights reserved. 48 Psychological Help Body Image –Severe body image problems Body dysmorphic disorder (BDD) –Knowing when the limits to healthy change have been reached. –Knowing the unrealistic cultural ideal. Acceptance and change –Can-do attitude

49. © 2008 McGraw-Hill Higher Education. All rights reserved. 49 Thinking and Emotions What do you think of yourself? Self-esteem Negative emotions Ideal self Beliefs and attitudes you hold

50. © 2008 McGraw-Hill Higher Education. All rights reserved. 50 Coping Strategies Adequate and appropriate strategies Healthy lifestyles and proper stress management techniques will naturally and easily result in a reasonable body weight –Good nutrition –Good communication –Adequate exercise –Positive thinking and emotions –Effective coping strategies and behavior patterns