1. Weight Management
Chapter 9

2. Healthy Body Weight National Institutes of Health
More than 67% of American adults are overweight
More than 32% of American adults are obese
Obesity has doubled since 1960
At current rates, all American adults will be overweight by 2030

3. Prevalence of Healthy Body Weight
Gender
Women
35%
Men
32%
Ethnicity
White
Latino
26%
African American
29%
Age
20–39 years
40%
40–59 years
31%
60+ years
28%
Health status
People with disabilities
People with diabetes
12%
ALL ADULTS
34%
Source: National Center for Health Statistics

4. Overweight and Obesity
Overweight = characterized by a body weight that falls above the range associated with minimum mortality; weighing 10% or more over recommended weight or having a BMI over 25
Obesity = severely overweight, with an excess of body fat; weighing 20% or more over recommended weight or having a BMI over 30

5. Health Implications of Overweight and Obesity
33% rise in type 2 diabetes
100,000+ premature deaths annually
Obesity is one of the six major controllable risk factors for heart disease
Weight loss of 5-10% in obese individuals can reduce the risk of certain diseases

6. Factors Contributing to Excess Body Fat: Genetic Factors
Genetic factors influence body size and shape, body fat distribution, and metabolic rate
Genetic contribution to obesity is estimated at 25–40%
Hereditary influences must be balanced against contribution of environmental factors
Genetics is what can happen, our choices is what does happen!!

7. PHYSICAL APPEARANCE Somatotype – Your physical appearance, body build.
We are all products of heredity and environment. What we get from our parents and what we do with what we get!
Somatotype – Your physical appearance, body build.
Endomorph – A “pear-shaped” appearance. Short legs and arms, most of body weight centered around hips and abdomen.
Mesomorph – Solid, muscular, large-boned physique. Most of body weight is away from the abdominal area. Wide shoulders, narrow hips, well-muscled.
Ectomorph – Slender bodies and a slight build. Very little body fat. Light musculature, long arms and legs. Bony in appearance, narrow chest and hips and generally linear in appearance.
Most people have some characteristics of each body type, but one will dominate.

8. Fat Cell Theory
Proponents of this theory believe that obese people have more fat cells and larger cells than the non-obese.
Total number of fat cells increase
It is believed that once we produce fat cells, they remain for life.
Any weight reduction would involve a reduction in the size of the fat cell.
Evidence seems to suggest that fat cells do reach a point where they can not get bigger, thus new cells are manufactured.

9. Physiological Factors
Metabolism – the sum of all the vital processes by which food energy and nutrients are made available to and used by the body.
Resting Metabolic Rate (RMR) – The energy required to maintain vital body functions. (heart, lungs, body) Accounts for about 55-75% of the energy used by the body.
Thermal Effect of Food (TEF) – The energy required to digest food. Accounts for additional 5-15% of daily energy expenditure.
Effect of Physical Activity – Energy expended during physical activity. Accounts for 20-40% of expended energy.
This is the component that is the most variable and the one we can do the most about.

10. Factors That Affect Metabolic Rate
RMR is higher in
Men
People with more muscle mass
People who exercise
RMR is lower in
Women
People who are sedentary
People who have lost weight

11. Energy-Balance Equation
Figure 9.1

12. Factors Contributing to Excess Body Fat: Lifestyle Factors
Eating—compared to the past, Americans now
Consume more calories
Consume more refined and simple carbohydrates
Eat out more often
People underestimate portion sizes

13. National Geographic, August 2004

14. Monster Thick Burger
1,420 calories
107 grams of fat
2 – 1/3 slabs of beef
4 strips of bacon
3 slices of cheese

15. CHEESEBURGER Today 20 Years Ago 333 calories
How many calories are in today’s cheeseburger?

16. CHEESEBURGER Today 20 Years Ago 333 calories 590 calories
Calorie Difference: 257 calories

17. Maintaining a Healthy Weight is a Balancing Act
Calories In = Calories Out
How long will you have to lift weights in order to burn the extra 257 calories?*
*Based on 130-pound person

18. Calories In = Calories Out
If you lift weights for 1 hour and 30 minutes, you will burn approximately 257 calories.*
*Based on 130-pound person

19. FRENCH FRIES 20 Years Ago Today 210 Calories 2.4 ounces
How many calories are in
today’s portion of fries?

20. Calorie Difference: 400 Calories
FRENCH FRIES
20 Years Ago
Today
210 Calories
2.4 ounces
610 Calories
6.9 ounces
Calorie Difference: 400 Calories

21. Maintaining a Healthy Weight is a Balancing Act
Calories In = Calories Out
How long will you have to walk leisurely in order to burn those extra 400 calories?*
*Based on 160-pound person

22. Calories In = Calories Out
If you walk leisurely for 1 hour and 10 minutes you will burn approximately 400 calories.*
*Based on 160-pound person

23. Diet and Eating Habits 1 pound = 3500 calories
If calorie intake = calorie output, weight remains the same.
For weight loss, goal should be to lose
pounds/week

24. Successful Weight Loss
A successful, long-term weight control program involves three elements.
Diet – the number of calories consumed should be reduced, along with the fat content of the diet. Watch portion sizes. Choose complex carbohydrates – fruits, vegetables and whole grains (Nutrient –dense foods) Or those foods which have a lower energy (calorie) density. An apple vs a pie of apple pie.
Exercise – Goal is to expend calories/day with exercise.
Behavior Modification
Self-monitoring – Keep a food log, recording amounts and circumstances of eating.
Food triggers – Identify those factors which trigger eating. Boredom, anxiety, stress, exhaustion.
Develop techniques to control eating. Positive self-talk. Goals. Stay busy. Plan meals. Control social bingeing.
Reinforce results with rewards.

25. Physical Activity and Exercise
Physical activity—increase daily physical activity to at least 30 minutes per day; to lose weight or maintain weight loss, 60–90 or more minutes per day is recommended
Exercise
Endurance exercise burns calories
Strength training builds muscle mass, which can increase metabolic rate

26. National Geographic, August 2004

27. Diet and Eating Habits
Fat calories—keep total fat intake moderate, and limit intake of saturated and trans fats
Carbohydrate—emphasize whole grains, vegetables, fruits, and other high-fiber foods; limit consumption of foods high in refined carbohydrates, added sugars, and easily digestible starch
Protein—meet recommended intake of 10–35% of total daily calories
Eating habits—eat meals and snacks on a regular schedule

28. Doing It Yourself
Physical activity is a critical component of healthy weight management
Source: Ryan McVay/Getty Images (courtesy of McGraw-Hill Higher Education)

30. Approaches to Overcoming a Weight Problem
Doing it yourself
Diet books
Dietary supplements and diet aids
Weight-loss programs
Prescription drugs
Surgery
Psychological help

31. Diet Books Reject books that
Advocate unbalanced ways of eating
Claim to be based on a secret
Use gimmicks
Promise quick weight loss
Limit the selection of foods
Accept books that advocate a balanced diet plus exercise

32. Popular Diet Plans Any diet that cuts calories causes weight loss
Low-carbohydrate diets have not been proven safe over the long-term
Low-fat diets should focus on nutrient dense foods, especially whole-grains, fruits, and vegetables
Diets with many restrictions have high drop-out rates
People who have been successful at long-term weight loss track food intake and engage in 60 or more minutes of physical activity per day

33. Dietary Supplements and Diet Aids
Dietary supplements are subject to fewer regulations than over-the-counter medications; they have not been proven safe and effective
FTC: More than half of advertisements for weight-loss products make representations that are likely to be false

34. Surgery
Surgical intervention may be recommended for some people who have a BMI of 40 or higher or who are 100 or more pounds overweight
Gastric bypass surgery modifies the gastrointestinal tract by changing the size of the stomach or how the intestine drains, thereby restricting the amount of food that can be eaten
Surgery has a high rate of complications

35. Surgery Adjustable gastric banding Roux-en-Y gastric bypass
Adjustable gastric banding: In this procedure, a hollow band made of silicone rubber is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the rest of the stomach. The band is then inflated with a salt solution through a tube that connects the band to an access port placed under the skin. It can be tightened or loosened over time to change the size of the passage by increasing or decreasing the amount of salt solution
Roux-en-Y gastric bypass (RGB). This operation is the most common and successful combined procedure in the United States. First, the surgeon creates a small stomach pouch to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine). This reduces the amount of calories and nutrients the body absorbs.
Weight-Control Information Network Gastrointestinal Surgery for Severe Obesity. NIH Publication No
Adjustable gastric banding Roux-en-Y gastric bypass
Source: National Institutes of Health

36. Body Image
Dissatisfaction with weight and shape is common in people with eating disorders
Source: BananaStock/PunchStock (courtesy of McGraw-Hill Higher Education)

37. Body Image
Body image = the mental representation a person holds about her or his body
It consists of perceptions, images, thoughts, attitudes, and emotions
Media images are linked to negative body image
Different cultures have different ideas of the “ideal” body type

38. BMI of Miss America Pageant Winners
The data shows a steady decline in winners’ BMI from a range of 20–25 in the 1920s to below 18.5, considered undernutrition by WHO and represented by the horizontal line.
SOURCE: Rubinstein, S., and B. Caballero Is Miss America an undernourished role model? Journal of American Medical Association 283(21): Used with permission from the American Medical Association.

39. Acceptance and Change
Most Americans are unhappy with some aspect of their appearance
Recognize the limits of change
Small amounts of weight loss can significantly reduce health risks

40. Eating Disorders
Society has created tremendous pressure for individuals to be thin.
More than two-thirds of women between the ages of 12 and 23 have felt dissatisfied with their body image and feel pressure to conform to the “ideal” body size and shape.
Weight reduction, often takes over thoughts and energies. Some feel weight loss makes them more attractive, accepted and successful.
The pursuit of thinness can result in serious and sometimes life-threatening eating disorders.

41. Eating Disorders
Anorexia Nervosa – Condition is marked by suppression of appetite and intentional caloric deprivation or self-starvation.
May have intense fear of becoming overweight and weight loss does not detensify that fear.
There is a psychological distortion of body image, as the anorexic sees him/herself as fat, even if extremely underweight.
Weight loss is pursued through extreme limitation of calories, fasting, strenuous exercise, use of laxatives and diuretics and sometimes self-induced vomiting.
Disorder sometimes begins at the onset of puberty.
Problems include CV problems, gastrointestinal problems, body can use organs for protein due to lack of fat, amenorrhea (suppression of menstrual cycle), anemia, calcium loss, brittle bones, swollen joints and light-headedness. Eventually heart failure can occur.

42. Eating Disorders
Bulimia Nervosa – This is known as the binge-purge syndrome.
It is marked by high amounts of food/calorie consumption (1,000-60,000 calories), followed by self-induced vomiting and/or use of laxatives and diuretics.
Compulsive exercise also may be a characteristic of bulimia.
Bulimia differs from anorexia in that the individual may maintain a normal body weight due to the binges experienced. This allows the bulimic to hide the problem, making it more difficult to identify.
Eating disorders are mental disorders and must be treated as such.
Causes and contributing factors are complex and professional help is necessary.

43. Eating Disorders
Binge-Eating Disorders – Individuals typically experience episodes of out of control eating.
Common characteristics include:
Eating much more rapidly than normal
Eating until uncomfortably full
Eating large quantities of food even when not hungry
Eating alone to hide the quantity of food being ingested
Feeling disgusted, depressed, or guilty after overeating
They do not purge their bodies after eating, thus different from bulimia.

44. Who Is At Risk? Estimated 1 in every 100 teenage girls are anorexic
Anorexia usually occurs in adolescent women (90% of all reported cases)
Estimated 1 in every 5 college-bound females is bulimic
College campuses have a higher incidence of people with eating disorders
Upper middle class women who are extremely self-critical are also more likely to become anorexic
Activities such as dance and dance team, gymnastics, figure skating, track and cheerleading tend to have higher incidences of eating disorders
Wrestlers and body builders are also at risk due to unsafe practices to “make weight” before competition.

45. TREATMENT Be supportive. Provide information about eating disorders.
Be a good listener.
Encourage professional help. Person may need counseling, medical treatment or hospitalization.
Be prepared for denial resistance and even hostility.
Realize that the person’s responsibility is his/hers, not yours.
Eating Disorders Therapy/Programs
ISU Counseling Center
ISU Health Services
ISU Nutrition Mission
Anorexia Nervosa and Related Eating Disorders, Inc. –