Chapter 14

Chapter Fourteen

Weight Management

2010 McGraw-Hill Higher Education. All rights reserved.

Introduction

National Institutes of Health

66% of American adults are overweight
Including more than 33% of adult men and 35%

of adult women are obese. 2015

75% of adults will be overweight and 41% will be

obese
2030 Estimated that the entire American adult population will be overweight or obese
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Figure 14-1 Prevalence of overweight and obesity among American adults age 20-74

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Basic Concepts of Weight Management

1 pound of fat = 3500 calories Body Composition

Fat-free mass or Lean Body Mass Body Fat Subcutaneous fat 3-5% of total fat in men, 8-12% in women Visceral fat-(storage) Located behind the abdominal wall
Depends on many factors:

Gender Age Heredity Metabolism Diet Activity level

Women: <8% at risk, Average 23%, > 32% at risk Men: < 5% at risk, Average 15%, > 25% at risk
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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

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Figure 14-2 The energy balance equation

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Evaluating Body Weight and Body Composition

Overweight total body weight above recommended range for good health Obesity a more serious degree of overweight Height-Weight charts Body Mass Index (BMI)
BMI = [Weight / Height in inches (squared)] X 703

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Assessment of Body Weight

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 Under 17.5 is sometimes used as a diagnostic criterion for anorexia nervosa

BMI Measurement. Example: 53 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 63 X 0.0254 = 1.6

2. Multiply height (in inches) by 0.0254 to convert to meters

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 value for BMI

BMI = 59.1 / 2.56 = 23.0

Alternative equation based on pounds and inches BMI = [weight / (height X height)] X 703
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9 Chapter Fourteen Weight Management

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Body Composition Analysis

Hydrostatic (underwater) weighing and BOD POD

Most accurate

Skinfold measurements
Thickness of fat under the skin

Electrical Impedance Analysis

Electricity prefers lean tissue

Scanning procedures
CT scan, MRI, Dual-energy X-ray, Dual-photon

absorptiometry, Infrared reactance and total body electrical conductivity

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Table 14-1 Percent Body Fat Classification

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Excess Body Fat and Wellness

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

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Figure 14.4 Diabetes mellitus

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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, and cancer

Pear shape
Gynoid obesity 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

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Body Image

Collective picture of the body as seen through the minds eye.

Perceptions Images

Thoughts
Attitudes Emotions

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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. 2. 3.

Abnormal eating patterns Amenorrhea Decreased bone density

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Factors Contributing To Excess Body Fat

Genetic Factors
Nutrigenomics Study of how nutrients and genes interact
25 to 40% of an individuals body fat

600 genes have been linked to obesity

Physiological Factors
Metabolism (RMR)

Hormones
Fat Cells
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Lifestyle Factors
Eating Physical Activity Psychosocial factors

Emotions Distraction from difficult feelings Helps regulate emotions Coping strategies

Socioeconomic status Family and cultures

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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

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Adopting A Healthy Lifestyle For Successful Weight Management (Continued)

Portion Sizes Energy (calorie) Density Eating Habits

Processed foods
Fat-free Stick to recommendations by: Dietary Guidelines for Americans MyPyramid DASH Diet
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Physical Activity and Exercise

30 minutes or more of moderateintensity physical activity, everyday

Walking Gardening

Housework
Walking 1 mile in 15-20 minutes

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Thinking and Emotions

What do you think of yourself? Self-esteem Negative emotions Ideal self Beliefs and attitudes you hold

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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
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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
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Weight-Loss Programs

Noncommercial
TOPS (Take Off Pounds Sensibly)
OA (Overeaters Anonymous) 12-step program with spiritual orientation

Commercial Online Clinical

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Weight-Loss Programs

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.

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Surgery

Severely obese
One in 50 adult Americans has morbid obesity NIH recommends gastric bypass for individuals with a

BMI of 40 or higher or are 100 pounds or more over recommended weight. Roux-en-Y-gastric bypass Vertical banded gastroplasty (VBG) Lap-Band variation of VGB Adjustable band Liposuction

Weight loss from surgery generally ranges between 40% and 70% of total body weight over a years time.
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Chapter Fourteen

Psychological Help

Body Image
Severe body image problems Body dysmorphic disorder (BDD)
Affects about 2% of Americans Usually before age 18

Muscle dysmorphia

Knowing when the limits to healthy change have

been reached. Knowing the unrealistic cultural ideal.

Acceptance and change

Knowing what is a healthy lifestyle change
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Chapter Fourteen

Weight Management

2010 McGraw-Hill Higher Education. All rights reserved.

Eating Disorders
Problems with body weight and weight control. Characterized by severe disturbances in body image, eating patterns, and eatingrelated behaviors. Disordered eating affects an estimated 10 million American females and 1 million males.

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Eating Disorders
Once central feature a dissatisfaction with body image and body weight created by distorted thinking. Heredity

Over 50% of the risk

Turning points in life

Coping with stresses in ones life

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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 gaining weight. Distorted self-image. Compulsive behaviors and rituals. Excessive exercise 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 skeletal systems

Health Risks of Anorexia Nervosa

Medical complications
Disorders of the cardiovascular, gastrointestinal, endocrine, and

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Eating Disorders

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 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
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Chapter Fourteen

Weight Management

2010 McGraw-Hill Higher Education. All rights reserved.

Eating Disorders

Binge-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

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Treating Eating Disorders

Combination of psychotherapy and medical management Address both eating disorder, misuse of food and manage emotions

Anorexia Nervosa
Averting a medical crisis Adequate body weight Psychological aspects

Bulimia Nervosa

Stabilizing the eating patterns Identify and changing the patterns of thinking Improve coping skills 2006, JAMA study found:
Topiramate (anti-seizure drug) helped with Bulimia Nervosa

Binge-Eating
Similar treatment protocol as Bulimia Nervosa

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Chapter 14

2010 McGraw-Hill Higher Education. All rights reserved.