2. Figure 6-5 (continued fasting).

4. Energy Balance and Weight Management ENERGY IN  Regulation of food intake:  Hunger  Satiation and satiety  Appetite

5. ENERGY OUT  Energy expenditure at rest:  BMR - basal metabolic rate: rate of energy expended at rest (kcal/hr or kcal/day), also called RMR (resting metabolic rate).  Factors that affect BMR (page 257)

7. ENERGY OUT  Energy expenditure for physical activity:  Depends on the activity duration, type, and intensity (page 255)  Also affected by body size and fitness level

8. ENERGY OUT  NEAT is the energy associated with unintentional activities like fidgeting, maintenance of posture, or spontaneous muscle contraction

9. ENERGY OUT  Energy expenditure to process food:  Thermic effect of food (TEF) – the energy used to digest, absorb, and metabolize energy-yielding food  TEF is lower for fat than for carbohydrate and protein  TEF peaks one hour after eating, and normally dissipates within 5 hours  Accounts for ~10% of total energy expenditure

10. Components of Energy Expenditure  Physical Activity = 30-50%  TEF = 10%  BMR = 50-65%

11. MEASUREMENT of ENERGY EXPENDITURE  Estimating energy expenditure:  EER – an equation used to estimate REE based on age, weight, height, and sex  Page 257

12. BODY COMPOSITION  Assessing body weight:  weight tables  body mass index (BMI) = weight (kg) weight (kg) height (m 2 ) height (m 2 )

13. BODY COMPOSITION  As the BMI table shows, healthy weight falls between a BMI of approximately 18.5 and 24.9.

14. BODY FAT DISTRIBUTION  gynoid obesity (pear-shaped figure), more common in women  android obesity (apple-shaped figure), more common in men increases risk of heart disease and diabetes mellitus (Type II) increases risk of heart disease and diabetes mellitus (Type II)

15. “apple” “pear” “apple” “pear”

17. WHAT CAUSES OBESITY? Current Thinking  Hereditary and genetic factors  Sociocultural influences  Age and lifestyle  Sex  Race and ethnicity  Socioeconomic status  Employment  Psychological factors

18. ENERGY IMBALANCE: Overweight and Obesity  Health risks (page 265)  Prevalence of overweight and obesity – it is a worldwide public health problem. We are now seeing an obesity epidemic in children as well as adults.

22. OBESITY in our CHILDREN  National Center for Health Statistics suggests nearly 25% of children are overweight or obese  There are now about 5 million obese children in the United States – up by 50% since 1991

24. OBESITY in our CHILDREN A 1999 Survey of Seattle High Schools showed that:  9% of males and 6% of females were overweight

25. HEALTH CONSEQUENCES  Overweight children and adolescents are more likely to become overweight or obese adults  Type 2 diabetes, high blood lipids, hypertension, early maturation and orthopedic problems also occur with increased frequency in overweight youth

26. ECONOMIC CONSEQUENCES  In 2000, the total cost of obesity was estimated to be $117 billion  Most of the cost associated with obesity is due to type 2 diabetes, coronary heart disease, and hypertension

27. WEIGHT MANAGEMENT What Works?????  Unfortunately, there is no magic pill, no perfect diet. The simple fact is, if you consume more calories than you burn, you will gain weight  A slow weight loss (1-2 pounds per week) is the best way  To lose 1 pound of fat, you must burn an extra 3500 calories (in one week that = 500 calories per day)

28. WEIGHT MANAGEMENT  Important Components: Diet composition Diet composition Physical activity Physical activity Behavioral change Behavioral change Balancing acceptance and change Balancing acceptance and change Support! Support!

29. DIET COMPOSITION  A Healthful Eating Plan Involves: Realistic energy intake Realistic energy intake Nutritional adequacy Nutritional adequacy Small portions, small frequent meals Small portions, small frequent meals Reduced simple sugar and alcohol intake Reduced simple sugar and alcohol intake Adequate water Adequate water

30. PHYSICAL ACTIVITY  Contributions to weight loss and maintenance: Direct increases in energy output (muscles and cardiovascular system) Indirect energy output (elevated BMR) Appetite control Psychological benefits  Note: Spot reducing is not possible.

31. BEHAVIORAL CHANGE  Behavior modification: the changing of behavior by the manipulation of antecedents (cues or environmental factors that trigger behavior), the behavior itself, and consequences (the penalties or rewards attached to behavior). Figure 7-7 Food and Activity Diary

32. SUPPORT Family Family Friends Friends Weight Loss Support Groups Weight Loss Support Groups

33. WEIGHT MANAGEMENT  Adjuncts to treatment Drugs Drugs Self-help activities Self-help activities Commercial programs Commercial programs Professional private counselors Professional private counselors Surgery: gastric bypass, gastric banding Surgery: gastric bypass, gastric banding

37. Why is abdominal fat bad?  http://www.health.harvard.edu/newsweek/ Abdominal-fat-and-what-to-do-about-it.htm