1. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Weight Management Chapter 9

2. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Healthy Body Weight National Institutes of Health n More than 60% of American adults are overweight n More than 30% of American adults are obese n Obesity has doubled since 1960 n At current rates, all American adults will be overweight by 2030

3. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Prevalence of Healthy Body Weight GenderWomen35% Men32% EthnicityWhite35% Latino26% African American29% Age20–39 years40% 40–59 years31% 60+ years28% Health statusPeople with disabilities29% People with diabetes12% ALL ADULTS34% Source: National Center for Health Statistics

4. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Overweight and Obesity Overweight = characterized by a body weight that falls above the range associated with minimum mortality; weighing 10% or more over recommended weight or having a BMI over 25 Obesity = severely overweight, with an excess of body fat; weighing 20% or more over recommended weight or having a BMI over 30

5. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Health Implications of Overweight and Obesity 33% rise in type 2 diabetes 100,000+ premature deaths annually Obesity is one of the six major controllable risk factors for heart disease Weight loss of 5-10% in obese individuals can reduce the risk of certain diseases

6. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Factors Contributing to Excess Body Fat: Genetic Factors Genetic factors influence body size and shape, body fat distribution, and metabolic rate Genetic contribution to obesity is estimated at 25–40% Hereditary influences must be balanced against contribution of environmental factors

7. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Factors Contributing to Excess Body Fat: Physiological Factors Metabolism = sum of all vital processes by which food energy and nutrients are made available to and used by the body Resting metabolic rate (RMR) = energy required to maintain vital body functions; the largest component of metabolism

8. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Factors That Affect Metabolic Rate RMR is higher in n Men n People with more muscle mass n People who exercise RMR is lower in n Women n People who are sedentary n People who have lost weight

9. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Factors Contributing to Excess Body Fat: Physiological Factors Hormones play a role in the accumulation of body fat; the hormone leptin is involved in the regulation of appetite and metabolic rate Weight cycling, or yo-yo dieting

10. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Factors Contributing to Excess Body Fat: Lifestyle Factors Eating—compared to the past, Americans now n Consume more calories n Consume more refined and simple carbohydrates n Eat out more often People underestimate portion sizes

11. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Factors Contributing to Excess Body Fat: Lifestyle Factors Physical activity levels have declined; on average, Americans spend 15 minutes per day exercising 170 minutes per day watching television and movies Psychosocial factors include eating as a means of coping and cultural and family influences

12. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Activity Level and Risk of Obesity Data from Hu, F. B., et al. 2003. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. Journal of the American Medical Association 289(14): 1785–1791.

13. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Adopting a Healthy Lifestyle for Successful Weight Management Diet and eating habits Physical activity and exercise Thoughts and emotions Coping strategies

14. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Diet and Eating Habits Total calories—choose an appropriate energy intake for your activity level Portion sizes—limit portions to those recommended by My Pyramid to help keep energy intake moderate; measure portions at home and read food labels Energy (calorie) density—choose foods with a low energy density, meaning those that are relatively heavy but have few calories

15. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Diet and Eating Habits Fat calories—keep total fat intake moderate, and limit intake of saturated and trans fats Carbohydrate—emphasize whole grains, vegetables, fruits, and other high-fiber foods; limit consumption of foods high in refined carbohydrates, added sugars, and easily digestible starch Protein—meet recommended intake of 10–35% of total daily calories Eating habits—eat meals and snacks on a regular schedule

16. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Physical Activity and Exercise Physical activity—increase daily physical activity to at least 30 minutes per day; to lose weight or maintain weight loss, 60–90 or more minutes per day is recommended Exercise n Endurance exercise burns calories n Strength training builds muscle mass, which can increase metabolic rate

17. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Thoughts and Emotions How you think about yourself and your environment Realistic self-talk, beliefs, and goals can be positively motivating

18. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Coping Strategies Some people cope with stress by overeating Analyze your eating habits to determine if you are using food appropriately Develop adequate and appropriate strategies for dealing with stress

19. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Approaches to Overcoming a Weight Problem Doing it yourself Diet books Dietary supplements and diet aids Weight-loss programs Prescription drugs Surgery Psychological help

20. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Doing It Yourself Don’t try to lose more than 0.5–2 pounds per week n 3500 calories corresponds to 1 pound of body weight n A daily negative energy balance of 250–1000 calories corresponds to 0.5–2 pounds per week of weight loss Combine any cuts in calorie intake with physical activity Choose lifestyle strategies that you can maintain over the long term

21. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Diet Books Reject books that n Advocate unbalanced ways of eating n Claim to be based on a secret n Use gimmicks n Promise quick weight loss n Limit the selection of foods Accept books that advocate a balanced diet plus exercise

22. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Popular Diet Plans Any diet that cuts calories causes weight loss Low-carbohydrate diets have not been proven safe over the long-term Low-fat diets should focus on nutrient dense foods, especially whole-grains, fruits, and vegetables Diets with many restrictions have high drop-out rates People who have been successful at long-term weight loss track food intake and engage in 60 or more minutes of physical activity per day

23. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Dietary Supplements and Diet Aids Dietary supplements are subject to fewer regulations than over-the-counter medications; they have not been proven safe and effective FTC: More than half of advertisements for weight-loss products make representations that are likely to be false

24. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Weight-Loss Programs Noncommercial weight-loss programs Commercial weight-loss programs n Partnership for Healthy Weight Management Online weight-loss programs Clinical weight-loss programs

25. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Prescription Drugs Appetite suppressants include phentermine, diethylpropion, and sibutramine Orlistat is a drug that blocks fat absorption Prescription weight-loss drugs cause moderate weight loss, but all have risks and side effects Prescription weight-loss drugs are recommended only for people who have a BMI over 30 and who have been unable to lose weight with lifestyle changes

26. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Surgery Surgical intervention may be recommended for some people who have a BMI of 40 or higher or who are 100 or more pounds overweight Gastric bypass surgery modifies the gastrointestinal tract by changing the size of the stomach or how the intestine drains, thereby restricting the amount of food that can be eaten Surgery has a high rate of complications

27. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Psychological Help When concerns about body weight and shape become severe, professional help is recommended

28. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Body Image Body image = the mental representation a person holds about her or his body It consists of perceptions, images, thoughts, attitudes, and emotions Media images are linked to negative body image Different cultures have different ideas of the “ideal” body type

29. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education BMI of Miss America Pageant Winners The data shows a steady decline in winners’ BMI from a range of 20–25 in the 1920s to below 18.5, considered undernutrition by WHO and represented by the horizontal line. SOURCE: Rubinstein, S., and B. Caballero. 2000. Is Miss America an undernourished role model? Journal of American Medical Association 283(21): 1569. Used with permission from the American Medical Association.

30. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Severe Body Image Problems Poor body image can cause psychological distress Body dysmorphic disorder (BDD) n Related to obsessive-compulsive disorder n Can lead to depression, social phobia, and suicide n Treated with medication and psychotherapy Muscle dysmorphia = a disorder characterized by distorted body image; affected people inaccurately perceive themselves as small, with underdeveloped muscles

31. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Acceptance and Change Most Americans are unhappy with some aspect of their appearance Recognize the limits of change Small amounts of weight loss can significantly reduce health risks

32. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Eating Disorders Eating disorder = a serious disturbance in eating pattern or behavior, characterized by a negative body image and concerns about body weight or body fat Major types n Anorexia nervosa n Bulimia nervosa n Binge-eating disorder

33. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Eating Disorders Anorexia nervosa = an eating disorder characterized by a refusal to maintain body weight at a minimally healthy level and an intense fear of gaining weight or becoming fat n Affects 1–3 million Americans, 95% female n Distorted body image n Severe medical complications, including death

34. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Eating Disorders Bulimia nervosa = an eating disorder characterized by recurrent episodes of binge eating and purging: overeating and then using compensatory behaviors such as vomiting and excessive exercise to prevent weight gain n Begins in adolescence or young adulthood n During a binge, a person may consume 1,000 to 60,000 calories n Binge-purge cycle places tremendous stress on the body

35. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Eating Disorders Binge-eating disorder = an eating disorder characterized by binge eating and a lack of control over eating behavior in general Eating patterns: n Eating very rapidly n Eating until uncomfortably full n Eating when not hungry n Eating alone Feelings of guilt, shame, and depression

36. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Treating Eating Disorders Must address both problematic eating behaviors and the misuse of food to manage stress and emotions Averting a medical crisis Dealing with psychological aspects Stabilizing eating habits Changing behavior patterns and thoughts Possibly involving medication and/or hospitalization

37. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Creating an Individual Weight- Management Plan Assess your motivation and commitment Set reasonable goals Assess your current energy balance n To lose one pound, you must create a negative energy balance of 3500 calories To lose 1/2 pound per week requires a negative daily energy balance of 250 calories To lose 2 pounds per week requires a negative daily energy balance of 1000 calories n Energy balance is affected by food intake and energy output

38. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Energy Balance Neutral Calorie Balance Calories consumed = calories used no change in weight Positive Calorie Balance calories consumed > calories used weight gain Negative Calorie Balance calories consumed < calories used weight loss

39. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Creating an Individual Weight- Management Plan Increase your level of physical activity—exercise habits are critical for long-term success Make changes in your diet and eating habits Put your plan into action n Write daily n Get others to help n Think positively

40. Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 9 © 2007 McGraw-Hill Higher Education Weight Management Chapter 9