1. © 2012 McGraw-Hill Higher Education. All rights reserved. Chapter 14

2. © 2012 McGraw-Hill Higher Education. All rights reserved. 2 Introduction  National Institutes of Health 68% of American adults are overweight 2007-2008: 33.8% of adult men and 35.5% of adult women were obese Managing body weight ○ Balance calories in with calories expended ○ Focus on long-term goals, change in lifestyle ○ Manage nutrition, physical activity, stress control

3. © 2012 McGraw-Hill Higher Education. All rights reserved. 3 Figure 14.1 Obesity Prevalence, by Age and Sex, of American Adults, 2007-2008

4. © 2012 McGraw-Hill Higher Education. All rights reserved. 4 Basic Concepts of Weight Management  One pound of fat = 3,500 calories  Body composition Fat-free mass (or lean body mass) Body fat ○ Essential fat 3-5% of total body weight in men, 8-12% in women Amount of fat stored depends on many factors: -Gender -Age -Heredity -Metabolism -Diet -Activity level Overweight: total body weight above recommended range Obesity: a more serious degree of overweight

5. © 2012 McGraw-Hill Higher Education. All rights reserved. 5 Energy Balance  Crucial to keep a healthy ratio of fat to fat-free mass Energy (calories from food) Consumption and/or expenditure of calories Control over intake of calories Negative energy balance Positive energy balance Neutral energy balance

6. © 2012 McGraw-Hill Higher Education. All rights reserved. 6 Figure 14.2 The Energy Balance Equation

7. © 2012 McGraw-Hill Higher Education. All rights reserved. 7 Evaluating Body Weight and Body Composition  Body mass index (BMI)  Measure of body weight for classifying health risks  Weight should be proportional to height  Drawbacks of BMI  Does not distinguish between fat weight and fat-free weight

8. © 2012 McGraw-Hill Higher Education. All rights reserved. 8 Assessment of Body Weight  National Institutes of Health categories of BMI Under 18.5 is classified as underweight Between 18.5 and 24.9 is healthy (normal) Between 25 and 29.9 is overweight Between 30 and 34.9 is obese (Class I) Between 35 and 39.9 is obese (Class II) 40 or greater is extreme obesity (Class III) Under 17.5 is sometimes used as a diagnostic criterion for anorexia nervosa  BMI Measurement. Example: 5’3” tall (63 inches), 130 pounds 1. Divide your body weight in pounds by 2.2 to convert the amount to kilograms: 130 / 2.2 = 59.1 2. Multiply height (in inches) by 0.0254 to convert to meters: 63 X 0.0254 = 1.6 3. Multiply the result of step 2 by itself to get the square of the height measurement: 1.6 X 1.6 = 2.56 4. Divide the result in step 1 by the result in step 3 to determine your BMI: BMI = 59.1 / 2.56 = 23.0 Alternative equation based on pounds and inches BMI = [weight / (height x height)] x 703

9. © 2012 McGraw-Hill Higher Education. All rights reserved. 9 Figure 14.3 Body Mass Index (BMI)

10. © 2012 McGraw-Hill Higher Education. All rights reserved. 10 Body Composition Analysis  Most accurate way to evaluate body composition is to determine percent body fat  Hydrostatic (underwater) weighing and Bod Pod  Skinfold measurements Thickness of fat under the skin  Bioelectrical Impedance Analysis Electricity prefers fat-free tissue  Scanning procedures CT scan, MRI, dual-energy X-ray, dual-photon absorptiometry, infrared reactance, total body electrical conductivity

11. © 2012 McGraw-Hill Higher Education. All rights reserved. 11 Table 14.2 Percentage of Body Fat as the Criterion for Obesity

12. © 2012 McGraw-Hill Higher Education. All rights reserved. 12 Excess Body Fat and Wellness  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, death from cardiovascular disease ○ Other health factors: hypertension, cancer, impaired immune function, gallbladder and kidney disease, skin problems, impotence, sleep disorders, back pain, arthritis, complications with pregnancy, menstrual irregularities, urine leakage, increased surgical risk, psychological problems ○ Strong association : Type 2 diabetes

13. © 2012 McGraw-Hill Higher Education. All rights reserved. 13 Figure 14.4 Diabetes Mellitus

14. © 2012 McGraw-Hill Higher Education. All rights reserved. 14 Body Fat Distribution and Health  Apple shape Android obesity Upper regions of their bodies Increase risk of high blood pressure, diabetes, early- onset heart disease, stroke, cancer  Pear shape Gynoid obesity Fat storage in the hips, buttocks and thighs  Assessed by measuring waist circumference Risk for men: waist measurement over 40 inches Risk for women: waist measurement over 35 inches

15. © 2012 McGraw-Hill Higher Education. All rights reserved. 15 Body Image  Collective picture of the body as seen through the mind’s eye Perceptions Images Thoughts Attitudes Emotions

16. © 2012 McGraw-Hill Higher Education. All rights reserved. 16 Problems Associated with Very Low Levels of Body Fat  Less than 8-12% for women and less than 3-5% for men  Extreme leanness linked to problems Reproductive Circulatory Immune system disorders  Female Athlete Triad 1. Abnormal eating patterns 2. Amenorrhea 3. Decreased bone density

17. © 2012 McGraw-Hill Higher Education. All rights reserved. 17 What Is the Right Weight for You?  General guides BMI Percent body fat Waist circumference measurement  Let your lifestyle be your guide 1. Eat moderate amounts 2. Get plenty of exercise 3. Think positively 4. Learn to deal with stress

18. © 2012 McGraw-Hill Higher Education. All rights reserved. 18 Factors Contributing to Excess Body Fat  Genetic factors Nutrigenomics ○ Study of how nutrients and genes interact Genetics 25-40% of an individual’s body fat 600 genes have been linked to obesity  Physiological Factors Resting metabolic rate (RMR) Hormones Fat cells

19. © 2012 McGraw-Hill Higher Education. All rights reserved. 19 Lifestyle Factors  Eating  Physical Activity  Psychosocial factors Emotions ○ Distraction from difficult feelings ○ Helps regulate emotions ○ Coping strategies  Socioeconomic status  Family and cultures

20. © 2012 McGraw-Hill Higher Education. All rights reserved. 20 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

21. © 2012 McGraw-Hill Higher Education. All rights reserved. 21 Adopting a Healthy Lifestyle for Successful Weight Management (continued)  Portion sizes  Energy (calorie) density  Eating habits Eat small, frequent meals Don’t skip meals Consume most calories in daytime

22. © 2012 McGraw-Hill Higher Education. All rights reserved. 22 Physical Activity and Exercise  30 minutes or more of moderate-intensity physical activity every day Walking Gardening Housework Walking 1 mile in 15-20 minutes

23. © 2012 McGraw-Hill Higher Education. All rights reserved. 23 Thinking and Emotions  What do you think of yourself?  Self-esteem  Negative emotions  “Ideal self”  Beliefs and attitudes you hold

24. © 2012 McGraw-Hill Higher Education. All rights reserved. 24 Coping Strategies  Adequate and appropriate strategies  Don’t use food as a way to cope with stress Good communication Adequate exercise Positive thinking and emotions Effective coping strategies and behavior patterns

25. © 2012 McGraw-Hill Higher Education. All rights reserved. 25 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 ○ Accept books that advocate a balanced approach Diet supplements and diet aids ○ Formula drinks and food bars ○ Herbal supplements ○ Other supplements

26. © 2012 McGraw-Hill Higher Education. All rights reserved. 26 Weight-Loss Programs  Noncommercial TOPS (Take Off Pounds Sensibly) OA (Overeaters Anonymous) ○ 12-step program with spiritual orientation  Commercial  Online  Clinical

27. © 2012 McGraw-Hill Higher Education. All rights reserved. 27 Weight-Loss Programs  Prescription drugs Appetite suppressants control appetite All have potential side effects Once drugs are stopped, most return to original heavy weight Good option for very obese who need help getting started - permanent life style change Two drugs approved for longer-term use: Sibutramine Orlistat (Xenical)

28. © 2012 McGraw-Hill Higher Education. All rights reserved. 28 Surgery  Severely obese – 5.7% of adult Americans is “morbidly” obese NIH recommends gastric bypass for individuals with a BMI of 40 or higher Roux-en-Y gastric bypass Vertical banded gastroplasty (VBG) Lap-Band – variation of VGB ○ Adjustable band Liposuction

29. © 2012 McGraw-Hill Higher Education. All rights reserved. 29 Body Image  Severe body image problems ○ Body dysmorphic disorder (BDD) Affects about 2% of Americans Usually before age 18 ○ Muscle dysmorphia Acceptance and change Know when the limits to healthy change have been reached Know the unrealistic cultural ideal

30. © 2012 McGraw-Hill Higher Education. All rights reserved. 30 Eating Disorders  Problems with body weight and weight control  Characterized by severe disturbances in body image, eating patterns, and eating- related behaviors  Disordered eating affects an estimated 10 million American females and 1 million males

31. © 2012 McGraw-Hill Higher Education. All rights reserved. 31 Eating Disorders  Central feature – dissatisfaction with body image and body weight created by distorted thinking  Heredity Over 50% of the risk  Turning points in life Coping with stress

32. © 2012 McGraw-Hill Higher Education. All rights reserved. 32 Eating Disorders  Anorexia Nervosa - failure to eat enough food  Affects 3 million people – 95% are female Typically develops between the ages of 12 and 18  Characteristics Fear of gaining weight Distorted self-image Compulsive behaviors and rituals Excessive exercise  Health risks of anorexia nervosa Stop menstruation Intolerant of cold Low blood pressure and heart rate Dry skin Hands and feet may swell and take on a blue tinge Depression and suicide  Medical complications Disorders of the cardiovascular, gastrointestinal, endocrine, and skeletal systems

33. © 2012 McGraw-Hill Higher Education. All rights reserved. 33 Eating Disorders  Bulimia Nervosa  Bulimia Nervosa - recurring episodes of binge eating followed by purging  Begins in adolescence or young adulthood Increasingly younger (11-12 years) and older (40-60 years) ages  Characteristics Rapidly consumes food, then purges Done in secret After a binge, feels ashamed, disgusted, and drained both physically and emotionally  Health risks Erodes tooth enamel Deficient calorie intake Liver and kidney damage Cardiac arrhythmia Chronic hoarseness Esophageal tearing Rupture of the stomach Menstrual problems Increased depression

34. © 2012 McGraw-Hill Higher Education. All rights reserved. 34 Eating Disorders  Binge-eating disorder (BED) - similar to bulimia, except no purging behavior Affects about 2% of American adults Uncontrollable eating, usually followed by guilt and shame Often eat as a way of coping Likely to be obese High rates of depression and anxiety

35. © 2012 McGraw-Hill Higher Education. All rights reserved. 35 Borderline Disordered Eating  Eating habits and body image run along a continuum from healthy to seriously disordered Some have symptoms of disorder Do not meet full diagnostic criteria for disorder Behaviors Danger signs Seek help

36. © 2012 McGraw-Hill Higher Education. All rights reserved. 36 Treating Eating Disorders  Combination of psychotherapy and medical management  Address eating disorder, misuse of food, and managing emotions Anorexia nervosa ○ Avert a medical crisis Adequate body weight ○ Psychological aspects Bulimia nervosa ○ Stabilize the eating patterns ○ Identify and change thinking patterns ○ Improve coping skills ○ Drug treatment: Binge-eating ○ Similar treatment protocol as bulimia nervosa

37. © 2012 McGraw-Hill Higher Education. All rights reserved. Chapter 14