Energy Balance and Weight Control

Chapter 10
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What is healthy weight & why is it important to maintain weight?

A healthy weight is considered a body weight that does not increase risk of developing weight related health problems Overweight and obesity are conditions characterized by excessive body fat. 2/3 of American adults were either overweight or obese.
The prevalence of excess body fat among children is also increasing.

Health Problems Associated With Obesity

Hypertension Heart disease Gallbladder disease Type 2 diabetes Osteoarthritis Some cancers Sleep apnea

Body Composition
Two major components:
Fat-free mass Fat Body water, mineral-rich tissues, and proteinrich tissues Total body fat Adipose tissue Essential fat in cell membranes, certain bones, and nervous tissue

How Much Body Fat Is Too Much?

Using BMI to Classify Body Weight

What is BMI? BMI?
Numerical value of relationship between body weight and risk of certain chronic health problems

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Simple formula: formula Weight (lbs)

Height (in)2 X 703

Adult Weight Status Categories (BMI)

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Subcutaneous Fat Distribution

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Body Fat Distribution

Distribution of excess body fat is more closely associated with obesity-related diseases than the percentage of total body fat.
Heart disease, type 2 diabetes, hypertension

Underwater Weighing
Compares weight on land to weight when completely submerged in a tank of water Problems: Problems
inconvenient, expensive, and impractical

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Dual-Energy X-Ray Absorptiometry (DXA)

Uses multiple lowenergy X-rays to scan the body Provides detailed picture of internal structures Problems: Problems
Very expensive and not widely available outside of clinical settings

Bioelectrical Impedance
Measures conduction of a weak electrical current through the body Problem: Problem
Method can be reliable if body hydration status is normal.
Scientific data about the accuracy of bioelectrical impedance devices for home use are lacking.

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Skinfold Thickness
Skinfold thickness is measured at multiple body sites by trained person. Benefits: Benefits
Relatively easy and inexpensive to perform

Air Displacement Using a BodPod

Expensive Accurate

Problems: Problems
May underestimate total body fat on overfat people

Lower Body Fat Distribution

Lower body fat or pear shape adds stress to hip and knee joints, but carries lower risk of chronic diseases such as type 2 diabetes. Insert figure 10.7

Upper Body Fat Distribution

Excess upper body fat or apple shape poses higher risk of serious health problems. May result in the release of fatty acids that negatively affect the liver May be source of inflammation

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Measuring Waist Circumference

Waist circumference is a quick and easy way to determine obesity-related risk. Desirable circumferences: circumferences Men < 40 in. Women < 35 in.

Energy for Living

What is Energy?
The capacity to perform work

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Forms of energy in living things:

Heat, mechanical, chemical, and electrical

Amount of energy is constant

Energy can be stored, released, moved, or transformed from one form of energy to another.

Energy Balance

Energy Output
Energy output or expenditure: energy cells use to carry out activities Basal and resting metabolism (BMR) Physical activity Thermic effect of food (TEF) Nonexercise activity thermogenesis (NEAT)

Basal Metabolism (BMR)

Metabolism The amount of energy the body expends to meet its basic physiological needs.
Basal metabolism
Minimal number of calories the body uses for vital physiological activities after fasting and resting for 12 hours

Factors that Influence Metabolic Rate

Factors that influence metabolic rate include:
Body composition (lean body mass) Age Gender Body surface area Genes/ethnicity Calorie intake Stress Stimulant drugs/caffeine Environmental factors

Calculating Metabolic Energy Needs

Energy for Physical Activity

Physical activity increases energy needs above basal energy needs. Caloric expenditure is dependent on: Type of activity Duration Intensity Weight of the person

Rule of Thumb Formulas

For men: 1.0 kcal/kg/hr For women: 0.9 kcal/kg/hr

Putting It All Together

To estimate daily energy needs, add together energy (kcal) used for:

Factors that Contribute to Obesity

Physiological aspects (hunger vs satiety) Environmental influences (activity & calorie intake) Socioeconomic status Psychological conditions (disordered eating)

Basal Metabolism Physical Activity Thermic Effect of Food (TEF) Nonexercise Activity Thermogenesis (NEAT)

Four Key Factors of Successful Long-Term Weight Management

1. Motivation/support 2. Calorie reduction 3. Regular physical activity 4. Behavior modification

Calorie Reduction
Loss of 1 lb body fat requires a negative energy state of 3500 kcal To lose 1 lb in 7 days:
Consume 500 kcal less per day Expend 500 kcal more per day Or combine eating less and exercising more to result in a deficit of 3500 kcal

Ideal dietary pattern: reduced intake of foods and pattern: beverages that contain high amounts of added sugars, fats, and/or alcohol

Losing Weight The Healthy Way

Reduce calories/portion control Reduce fast food/snacking Consume more fruits & vegetable Replace refined carbohydrates with complex-high fiber carbohydrates Do not skip meals Drink plenty of water Exercise

Characteristics of A Typical Fad Weight Loss Diet

Offers a quick fix with rapid weight loss Limits food selections to a few food groups Requires buying a book or various gimmicks, such as supplements, patches, or creams Uses outlandish and unscientific claims Relies on testimonials of famous people Does not emphasize the need to change eating habits and physical activity patterns

Roux-en-Y Gastric Bypass

Bariatric Surgical Procedures
Bariatric surgery is effective method of treating extreme obesity. Surgery reduces size of stomach, limiting the amount of food that can be eaten. After weight loss, patients often achieve normal blood pressure, glucose, and triglyceride levels Complications include: intestinal blockage and bleeding, ulcer or blood clot formation. Death due to complications results in 1% of patients.

Procedure reduces stomach capacity to ~ 1.5 oz Small intestine is cut with lower end attached to the newly formed stomach pouch

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Gastric Bypass with Stapling

Some patients have a more drastic gastric bypass procedure.

Adjustable Gastric Banding

A small stomach pouch is created with an adjustable band instead of fixed surgical staples. Tightness of the band determines the size of the stomach.

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What Is Liposuction?
Surgical method of suctioning the excess fat out of the body
cosmetic procedure to improve body contours

Gaining Weight
Factors contributing to underweight: underweight
Genetics, lifestyle practices, chronic diseases, psychological disturbances, cancer, TB, or AIDS

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Not considered a treatment for obesity

To gain weight: weight

Add high-calorie healthy foods, such as low-fat cheeses, olives, avocados, seeds, nuts, or granola, to diet.

Anorexia Nervosa
Definition
Severe psychological disturbance characterized by self-imposed starvation selfresulting in malnutrition and low body weight

Anorexia Nervosa (continued)

Common Features: Maintain BMI of 17.5 or less Have distorted body images Are obsessed with losing weight in spite of thinness Avoid fattening foods foods Engage in one or more of the following: Self-induced vomiting/ Abuse laxatives Self Excessive exercise/Use of appetite suppressants Display signs of hormonal imbalances Are depressed or anxious/withdrawn

Prevalence ~90% of cases are females

Affects 1 in 200 women

Anorexia Nervosa
Common Features Include:
Extremely restrictive eating practices Self-starvation Intense fear of weight gain Amenorrhea: no menstrual periods for at least 3 months Unhealthful body image May binge-purge at times (but mainly starvation)

Bulimia Nervosa
Definition
Eating disorder characterized by cyclic episodes of bingeing and calorie-restrictive caloriedieting People typically binge on cakes, cookies, ice cream, and other high-fat, high-carbohydrate highhighfoods.

Prevalence
Affects 2 to 5% of U.S. population More common in females

Bulimia Nervosa
(continued)
Common Features Include:
Scrapes or scars on knuckles Blood chemistry abnormalities, particularly low potassium levels Swollen salivary glands Tears or bleeding of the esophagus Tooth erosion (from vomiting)

Bulimia Nervosa
Common Features:
Recurrent episodes of binge eating Recurrent inappropriate behavior to compensate for binge eating (vomiting, laxatives, diuretics, fasting, exercise) Binge eating occurs on average at least twice a week for three months Eating in secret Negative body image/depression

Bulimia Nervosa (continued)

Treatment A team approach similar to that used with anorexia nervosa May require use of medication Prognosis Recovery is dependent upon medical management/therapy/motivation

Binge-Eating Disorder Night Eating Syndrome

Both characterized by food binges NOT followed by purging More common in overfat people Binge-Eating Disorder Binge ~1 to 2% of Americans suffer from binge-eating binge During binge, person eats large amounts of energy-dense energyfoods, such as ice cream, chips, and cookies, in secret. Night Eating Syndrome Person is not hungry during the morning, but wakes up and eats during the night.

Disordered Eating
Disordered eating is comprised of a variety of unhealthful behaviors including
Binge-eating disorder Chronic overeating Chronic dieting

Female Athlete Triad

Female Athlete Triad

Characterized by disordered eating, lack of menstrual periods, and osteoporosis Common in appearance-based competitive appearancesports, such as gymnastics, swimming, and distance running Seen in 15 to 60% of female athletes Treatment goal: improving the patients nutritional patient state to reverse the signs and symptoms

Treatment for Eating Disorders

Many different treatment plans are used depending on the needs of the patient. Treatment plans may include:
Nutritional rehabilitation Psychosocial interventions Medications

Treatment for Eating Disorders

Treatment for anorexia should
Restore healthy weight Treat complications Encourage healthful behaviors Correct dysfunctional feelings toward the eating disorder Enlist the help of family and friends

Treatments for Eating Disorders

Bulimia treatments should
Identify and modify the events that trigger binging and purging behaviors Monitor and alter thought patterns related to food and body image Include family and friends to support the patient

Preventing Eating Disorders

Prevention of eating disorders requires
Reducing weight-related criticism of children and young adults Identifying unrealistic body images in the media Participation in physical activity and sports Modeling a healthy diet by parents