1. © 2008 McGraw-Hill Higher Education. All rights reserved. Weight Management Chapter 11

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 –2030 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 11-1)

4. © 2008 McGraw-Hill Higher Education. All rights reserved. 4 Basic Concepts 1 pound of fat = 3500 calories 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 –Women: 32% at risk –Men: 25% at risk

5. © 2008 McGraw-Hill Higher Education. All rights reserved. 5 Energy Balance Crucial to keep a healthy ratio of fat and lean body mass –Energy –Consumption and/or expenditure of calories –Control over intake of calories –Negative energy balance –Positive energy balance –Neutral energy balance

6. © 2008 McGraw-Hill Higher Education. All rights reserved. 6

7. 7 Evaluating Body Weight and Body Composition Percent body fat and distribution of body fat = weather a change on body composition would improve health. Overweight –above recommended range for good health Obesity – a more serious degree of overweight Height-Weight charts Body Mass Index (BMI) –Weight in pounds X 703 / Height in inches (squared) Body Composition

8. © 2008 McGraw-Hill Higher Education. All rights reserved. 8 Body Mass Index (BMI) National Institutes of Health –Under 18.5 is classified underweight –Between 18.5 and 24.9 is healthy –Greater than 25 is overweight –Greater than 30 is obese Measurement. Example: 5’6” tall, 150 pounds 1.Multiply weight (in pounds) by 704 –150 X 704 =105,600 2.Multiply height (in inches) by height (in inches) –66 X 66 = 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

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

10. 10 Body Composition Analysis Hydrostatic (underwater) weighing –Most accurate Skinfold measurements –Thickness of fat under the skin Electrical Impedance Analysis –Electricity prefers lean tissue

11. © 2008 McGraw-Hill Higher Education. All rights reserved. 11 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

12. © 2008 McGraw-Hill Higher Education. All rights reserved. 12 Body Fat Distribution and Health Apples –Upper regions of their bodies –Increase risk of high blood pressure, diabetes, early-onset heart disease, stroke, and cancer Pears –Fat storage in the hips, buttocks and thighs Assessed by measuring waist circumference –Risk if total waist measurement is more than 40 inches for men and 35 inches for women

13. © 2008 McGraw-Hill Higher Education. All rights reserved. 13 Body Image Collective picture of the body as seen through the mind’s eye. –Perceptions –Images –Thoughts –Attitudes –Emotions

14. © 2008 McGraw-Hill Higher Education. All rights reserved. 14 Problems Associated with Very Low Levels of Body Fat Less than 8-12% for women and less than 3-5% for men. Extreme has been linked to problems with: –Reproductive –Circulatory –Immune system disorders Female Athlete Triad 1.Abnormal eating patterns 2.Amenorrhea 3.Decreased bone density

15. © 2008 McGraw-Hill Higher Education. All rights reserved. 15 Factors Contributing To Excess Body Fat Genetic Factors –25 to 40% of an individual’s body fat –300 genes have been linked to obesity Physiological Factors –Metabolism (RMR) –Hormones –Fat Cells –Carbohydrate Craving

16. © 2008 McGraw-Hill Higher Education. All rights reserved. 16 Lifestyle Factors Eating Physical Activity Psychosocial factors –Emotions –Coping strategies

17. © 2008 McGraw-Hill Higher Education. All rights reserved. 17 Adopting A Healthy Lifestyle For Successful Weight Management 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

18. © 2008 McGraw-Hill Higher Education. All rights reserved. 18 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

19. © 2008 McGraw-Hill Higher Education. All rights reserved. 19 Physical Activity and Exercise 30 minutes or more of moderate- intensity physical activity, everyday –Walking –Gardening –Housework –Walking 1 mile in 15-20 minutes

20. © 2008 McGraw-Hill Higher Education. All rights reserved. 20 Thinking and Emotions What do you think of yourself? Self-esteem Negative emotions Ideal self Beliefs and attitudes you hold

21. © 2008 McGraw-Hill Higher Education. All rights reserved. 21 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

22. © 2008 McGraw-Hill Higher Education. All rights reserved. 22 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

23. © 2008 McGraw-Hill Higher Education. All rights reserved. 23 Weight-Loss Programs Noncommercial –TOPS, and OA Commercial Online Clinical

24. © 2008 McGraw-Hill Higher Education. All rights reserved. 24 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.

25. © 2008 McGraw-Hill Higher Education. All rights reserved. 25 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.

26. © 2008 McGraw-Hill Higher Education. All rights reserved. 26 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

27. © 2008 McGraw-Hill Higher Education. All rights reserved. 27 Eating Disorders Problems with body weight and weight control. 0.5-2.0% of Americans suffer from anorexia and have bulimia 10% of college-aged women Binge eating disorder may affect 2-5%of all adults and 8% of those who are obese Over 1 Million Americans develop anorexia or bulimia each year - 90% are female. 60% of binge-eating are female

28. © 2008 McGraw-Hill Higher Education. All rights reserved. 28 Eating Disorders Anorexia NervosaAnorexia Nervosa - Failure to eat enough food to maintain a reasonable body weight. Affects 3 million people – 95% are female –Characteristics Fear 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

29. © 2008 McGraw-Hill Higher Education. All rights reserved. 29 Eating Disorders Bulimia NervosaBulimia 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 physically and emotional drained. 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

30. © 2008 McGraw-Hill Higher Education. All rights reserved. 30 Eating Disorders Binge-EatingBinge-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

31. © 2008 McGraw-Hill Higher Education. All rights reserved. 31 Treating Eating Disorders Address both eating disorder, misuse of food and manage emotions –Anorexia Nervosa –Bulimia Nervosa –Binge-Eating Today’s Challenge

32. © 2008 McGraw-Hill Higher Education. All rights reserved. Weight Management Chapter 11