1. Weight Management: Overweight, Obesity, & Underweight

3. Overweight
Overweight (BMI ) and obesity (≥ 30) are widespread health problems that are continuing to increase.
Many refer to overweight and obesity as an epidemic.
For good health, weight management is important.

5. Overweight Fat Cell Development Hyperplastic obesity Fat cell numbers
Fat cell numbers increase most rapidly in later childhood and early puberty.
Fat cell numbers increase in times of positive energy balance.
Hyperplastic obesity

6. phic During growth, fat cells increase in number. Hyper-plastic
When energy intake exceeds expenditure, fat cells increase in size. Hypertro-
phic
When fat cells have enlarged and energy intake continues
to exceed energy expenditure, fat cells increase in number
again.
With fat loss, the size of the fat cells shrinks but not the number.
Figure 9.2: Fat Cell Development.
Fat cells are capable of increasing their size by 20-fold and their number by several thousandfold.
Stepped Art
Fig. 9-2, p. 283

7. Overweight Fat Cell Development Hypertrophic obesity Fat cell size
Fat cell sizes increase when energy intake exceeds expenditure.
Hypertrophic obesity
The adverse effects of fat in non-adipose tissue are called lipotoxicity.

8. Overweight Fat Cell Metabolism
Lipoprotein lipase promotes fat storage.
Gender differences
Men are at increased risk for developing central obesity and women are at increased risk for lower body fat.

9. Overweight Set-Point Theory
The body’s natural regulatory centers maintain homeostasis at set point.
The human body tends to maintain a certain weight.

10. Causes of Obesity
Obesity may not be as simple as food intake exceeding metabolic needs.
Some factors, such as overeating and inactivity, are within our control.
Genetic, hormonal and emotional factors may require professional intervention.

11. Causes of Obesity Genetics Leptin (also called the ob protein)
Protein that acts as a hormone to increase energy expenditure and decrease appetite
Produced by fat cells under the direction of the ob gene
May be deficient in obese individuals
More research is needed.

12. w@io R 114'14Et4,T ssout-co 13E AC-XGF-P INVO -STIR 0 0

14. “I'm in shape”.
“Round is a shape”.

15. Causes of Obesity
Environment – The gene pool of our population remains relatively unchanged.
Overeating
Present and past eating influences current body weight.
Increased availability of convenient food, large portions, and energy-dense foods
Physical Inactivity
Modern technology replaces physical activities.
Physical activity is important to allow people to eat enough food to get needed nutrients.

16. Buy a lot of McDonald’s
food and get a big, fat
ass, absolutely free.

18. Causes of Obesity
Environment – The gene pool of our population remains relatively unchanged.
Overeating
Present and past eating influences current body weight.
Increased availability of convenient food, large portions, and energy-dense foods
Physical Inactivity
Modern technology replaces physical activities.
Physical activity is important to allow people to eat enough food to get needed nutrients.

20. . LAZINESS IS NOT A HANDICAP20

21. Obesity: Risk Factors Genetics Family history of obesity
Psychological factors
Social and cultural factors
Medical Illnesses
Medications
Alcohol consumption
Smoking Cessation

22. Problems with Obesity
Obesity problems depend on many factors such as the extent of overweight, age, health status and genetic makeup.
Risk factors may differ among individuals.

23. Makes a point about a topic
Let’s just say you weigh
too much and the less said about your future the better
Give a man a fish and
he will eat for a day.
   Teach him how to fish, and
he will sit in a boat and
drink beer all day.

24. Problems with Obesity Health Risks
Obese or overweight people with the following life-threatening-conditions may improve health by losing weight:
Heart disease
Type 2 diabetes
Sleep apnea

25. Problems with Obesity Perceptions and Prejudices Social Consequences
Prejudices and discrimination
Judged on appearance rather than character
Stereotyped as lazy and lacking self-control
Psychological Problems
Feelings of rejection, shame and depression are common.
Ineffective treatments can lead to a sense of failure.

26. weight, but then regain it (and sometimes more). I want to be happy.
I am fat
and unhappy.
I lose a little
weight, but then regain it (and sometimes more).
I want to be happy.
Figure 9.4: The Psychology of Weight Cycling.
If I lose weight, I will be happy.
I try too hard to reach an unrealistic goal.
Stepped Art
Fig. 9-4, p. 289

27. Problems with Obesity Dangerous Interventions Fad Diets False theories
Inadequate diets
Can be a danger to health

28. Treatment Modalities Diet – (proper “Healthy” nutrition) Exercise
Behavior therapy/modification/change
Pharmacotherapy
Surgery

29. Diet vs proper nutrition
Treatment Modalities
Diet vs proper nutrition
Exercise
Behavior therapy/modification/change
Pharmacotherapy
Surgery

30. “Dieting” and Dollars Dieting? Today ~40% of women, ~25% of men
Nationwide, 55% trying to maintain current weight.
Approximately 45 million Americans diet each year.
80% of adult women have dieted
$40 billion annually trying to lose weight or maintain weight.
~1 to 2 billion on weight lose programs.

31. WHO EVER INVENTED DIETS
R 114'14Et4,T ssout-co 13E AC-XGF-P INVO STIR
R 114'14Et4,T ssout-co 13E AC-XGF-P INVO STIR
R 114'14Et4,T ssout-co 13E AC-XGF-P INVO STIR
WHO EVER INVENTED DIETS
SHOULD BE TAKEN OUT
AND SHOT!

32. Types of Weight Loss Diets
Low Carbohydrate aka High Protein
Low Fat aka High Carbohydrate
Very Low Calorie aka Modified Fast
Novelty Diets
Weight Loss Programs

34. Why Weight Loss Programs Do Not Work
Negative Impact
Temporary
Perfect- Orientation
Project Mentality
Do not Address Cause

35. Consequences of Dieting
Decrease in rate of weight loss
Loss of lean tissue with fat loss
Decrease in metabolism, 10-40%
Decrease in Protein turnover
Preoccupation with food
Increase in irritability, moodiness
Tires easier, less physical activity
Apathy, depression

36. Re-feeding after Weight Loss
Increase in pre-dieting food intake
Preference for high fat foods
Regain in weight, but greater increase in % BF
Metabolism slow to return to normal
Regain Weight quicker with each diet
Increase in abdominal fat deposits
Less likely to return to pre-diet physical activity
Decrease in self-efficacy/esteem

37. Recognizing an Unsound Diet
Promotes Quick Weight Loss
Limits Food Selection
Testimonials or Famous People/Places
Expensive Supplements or Products
No Attempt to Permanently change eating or
physical activity
Critical of Scientific Community‘
They know more, or something new

38. Characteristics of a Sound Diet
Nutritionally adequate yet low in calories
Fit into current lifestyle
Foods that are liked
Slow rate of weight loss
Followed for life

40. Predicting Weight Loss
Positive Affirmations
Strong Motivation
Supportive Environment
Appropriate Behaviors
Changes in Body Shape 40

41. Predicting Weight Loss
Positive Affirmations
Self esteem
Self confidence/efficacy
Good attitude
Positive outlook 41

42. Predicting Weight Loss
Strong Motivation
Desire or want
Belief it is possible
Commitment to doing it
Positive attitude
Persistence 42

43. Predicting Weight Loss
Supportive Environment
Family and friends
Support group or organization
Professional 43

44. Predicting Weight Loss
Appropriate Behaviors
Healthy eating
Exercise that produces goal
Changing problem behaviors 44

45. Predicting Weight Loss
Changes in Body Shape
Body Composition changes
Circumference changes
“Looks better”, Cloths fit better, etc. 45

46. Predicting Weight Loss
Positive Affirmations
Strong Motivation
Supportive Environment
Appropriate Behaviors
Changes in Body Shape 46

47. “ I was going to buy the book “THE POWER OF POSITIVE THINKING” and then I thought what the hell good would that do!”

49. Exercise Treatment Modalities Diet – proper “Healthy” nutrition
Behavior therapy/modification/change
Pharmacotherapy
Surgery

50. why you should not engage in
I see no reason
why you should not engage in
strenuous activity
Well keep
looking,
keep looking!

51. Exercise
In response to the question whether diet plus exercise is more effective than diet alone in causing weight loss, the conclusion of the consensus panel was as follows "---
“in most studies exercise does not significantly increase initial weight loss over and above that obtained with diet only. However, in almost all studies the diet plus exercise group lost somewhat more weight than the diet alone condition."

52. THE 100 METER MOSEY

53. Exercise FAT Time minutes % of calories expended Carbohydrate 5 10 20
100%
FAT
% of calories expended
Carbohydrate 5 10 20
Time minutes

54. Three more, two more, one more, okay
Three more, two more, one more, okay!...Five million leg lifts right leg first! Ready

55. Exercise
Two short sessions/day or one long session?

56. Exercise
Two short sessions/day or one long session?
Yes!

57. Exercise Two short sessions/day or one long session? Yes!
Mode: Walking, Daily Activity
Frequency: times / week
Duration: minutes
20-30 minutes X 2
Intensity: Moderately

58. “My mother started walking five miles a day when she was 60”. 
“She's 77 now and I have no idea where she is”.

59. Behavior therapy modification/change
Treatment Modalities
Diet – proper nutrition
Exercise
Behavior therapy modification/change
Pharmacotherapy
Surgery

60. To make a long story short, what ever you are doing…STOP IT!

61. Behavior therapy
Behavior modification To lose weight and keep it off, you need to make changes in your lifestyle. But there's more to changing your lifestyle than choosing different foods and putting more activity into your day. It also involves changing your approach to eating and activity, which means changing how you think, feel and act.

62. Behavior therapy
A behavior modification program can help make lifestyle changes
Behavior modification programs may include examining current habits to find out what factors or situations may have contributed to excess weight.
Exploring current eating and exercise habits gives a place to start when changing behaviors.

63. Behavior therapy First identify those that are a problem
Choose those that you are willing to change
Take responsible for your behavior
Have a plan to make better choices
Remember the benefit
Focus on the positive

64. Behavior therapy
Have a plan. People do NOT plan to fail, they simply fail to plan!
Work out a strategy that will gradually change habits and attitudes.
Consider how often and how long to exercise.
Determine a realistic eating plan that includes plenty of water, fruits and vegetables.
Write it down and choose a start date.

66. Behavior therapy Set realistic goals.
Weight-loss goals can be process goals, such as exercising regularly, or outcome goals, such as losing 20 pounds in four months.
Make sure process goals are realistic, specific and measurable. For example, you'll walk for 30 minutes a day, five days a week.
For outcome goals, aim to lose weight at a safe pace of 0.5 or 2 pounds a week. Losing weight more rapidly means losing water weight or muscle tissue, rather than fat.

67. Behavior therapy Avoid food triggers. (Cues)
Distract from the desire to eat with something positive, such as calling a friend, taking a walk, reading a book (not a recipe book).
Practice saying ”No” to unhealthy foods and big portions.
Eat when actually hungry — not when the clock says it's time to eat.

68. “This is my relaxation tape–
it’s the sound of ocean waves crashing onto
the shore, snatching my teacher’s body off his
beach chair and carrying him out to sea.”

70. Treatments of Obesity
Individuals with clinically severe obesity and major medical problems may benefit from drugs or bariatric surgery.
But changing and improving eating and exercise habits offer the greatest benefit.

71. Treatment Modalities Pharmacotherapy Diet – proper nutrition Exercise
Behavior therapy modification/change
Pharmacotherapy
Surgery

72. Problems with Obesity Dangerous Interventions Weight-Loss Products
Ephedrine-containing products inhibit serotonin and suppress the appetite. Supplements containing Ephedra have been banned by the FDA due to potential health risks.
Herbal laxatives do not prevent absorption.
Current laws do not require safety tests and effectiveness tests for these products.

73. “To help you lose weight, take one aspirin
every day. Take it for a jog, then take it to the gym,
then take it for a bike ride…”

74. Treatments of Obesity Drugs
Sibutramine suppresses the appetite and is most effective when used with a reduced kcalorie diet and increased physical activity. There are many side effects.
Orlistat blocks fat digestion and absorption. There are many side effects including anal leakage.

75. Surgery Treatment Modalities Diet – proper nutrition Exercise
Behavior therapy modification/change
Pharmacotherapy
Surgery

76. Treatments of Obesity Surgery
Surgery is an option for those who have tried weight loss programs and failed, have a BMI ≥ 35, and are having health problems due to their weight.
Gastric surgery has short-term and long-term problems and requires compliance with dietary instructions.
Liposuction is a popular procedure that is primarily cosmetic but poses risk.

78. Predicting Weight Loss
Positive Affirmations
Strong Motivation
Supportive Environment
Appropriate Behaviors
Changes in Body Shape

79. Weight-Loss Strategies
A life-long eating plan for good health, which includes nutritionally adequate eating, reasonable expectations, regular physical activity, and permanent lifestyle changes, is best for achieving permanent weight loss.
Weight loss of pounds per week or 10% of body weight in six months is safe.

81. Weight-Loss Strategies
Eating Plans
Be Realistic about Energy Intake
kcalories/day reduction for BMI between 27 and 35
kcalories/day reduction for BMI ≥ 35
Dietary Guidelines should be followed.
Diet should be nutritionally adequate while avoiding excessive consumption.
Smaller portions are recommended to feel satisfied, not stuffed.

82. Weight-Loss Strategies
Eating Plans
Eat foods of lower energy density, that are high in fiber, high in water and low in fat.
Water is important to increase fullness and reduce hunger.
Complex carbohydrates offer abundant vitamins, minerals and fiber with little fat.
Choose fats sensibly and reduce the quantity of fat.
Watch empty kcalories from sugar and alcohol.

83. Meal Planning Plan meals throughout the day
Eat a variety o Foods (at each meal)
Center Meals around the carbohydrate foods
Minimize the addition of FAT all the time and sugar at any one time
Don’t worry about protein

84. Plan Meals thru the Day
Think about what you are going to eat instead of eating by habit or impulse!
Eat more earlier when more active
Eat less later when less active
i.e. a little often vs. a lot at once
The later you eat, the lighter you eat

85. Eat a Variety of Foods (at Each Meal)‏
Provides more nutrition
Each member of the family can choose what they want at that time
Controls eating one food in excess
Exposes a person to different foods
Makes a better meal

86. Center Meals around the Carbohydrate Foods
Answers the question
“What am I supposed to eat”?
Provides the best source of energy.
Provides a lot of most nutrients, (including fiber)‏
Low in fat, and has the ‘good’ type and contains no cholesterol.
Most have protein, certainly enough.
Are not fattening--fats are!

88. Minimize FATS and SUGAR
Fats are fattening
Fats can lead to other health problems
‘Minimize’ fat intake, don’t eliminate it
Sugar in large amounts is a problem
Sugar is an enjoyable taste and may displace foods with more nutrition and be concentrated
Fat and Sugar mix well with each other: the real problem

89. Don’t worry about PROTEINS
Important for growth (height) and development
Needed in smaller amount than most people think (.8 grams/kilogram BW)‏
Can be gotten from a variety of carbohydrate foods as well as the protein foods (meat, dairy)‏
Use as a part of the meal, not as the meal (eat lean, less and last)‏

90. Weight-Loss Strategies
Physical Activity
An individual’s body weight as well as intensity and duration of activity influence energy expenditure.
Physical activity increases the amount of discretionary kcalories that can be consumed.
Metabolic rates can rise with daily vigorous activity.
Activity can decrease body fat and increase lean body mass.
Exercise may help to curb appetite.
Activity can reduce stress and improve self-esteem.

91. Weight-Loss Strategies
Physical Activity
Choosing Activities
Choose activities that you enjoy and are willing to do regularly.
Low to moderate intensity for long duration is recommended.
Daily routines can incorporate energy activities.
Spot Reducing
Regular aerobic exercise and weight loss will help trouble spots.
Strength training can improve muscle tone.
Stretching can help flexibility.

92. Weight-Loss Strategies
Behavior and Attitude
Behavior modification requires time and effort.
Awareness of behavior is the first key.
Changing behaviors one at a time works best.
Do not grocery shop when hungry.
Eat slowly.
Exercise while watching television.
Personal attitudes toward food and eating must be understood.
Support groups may be helpful for some people.

93. Weight-Loss Strategies
Weight Maintenance
Successful weight-loss maintenance programs use different criteria so they are difficult to compare.
Vigorous exercise and careful eating plans are key.
Frequent self-monitoring is recommended. Weekly weight, food diary, exercise journal, circumference measurements

94. Weight-Loss Strategies
Prevention
Eat regular meals and limit snacking.
Drink water in place of high-kcalorie beverages.
Select sensible portion sizes and limit daily energy intake to energy expended.
Limit sedentary activities and be physically active.

95. Underweight
Incidences of underweight and associated health problems are less prevalent than overweight and obesity problems.

96. Underweight Problems of Underweight Causes are diverse.
Energy demands may be great and foods are needed to support growth and physical activities.
Eating disorders are severe cases.

97. Underweight Weight-Gain Strategies
Energy-dense foods can be included but choose fat wisely to avoid the associated cardiac risks.
Regular meals each day must become a priority.
Use large portions and expect to feel full.
Consume extra snacks between meals.
Juice and milk are easy ways to increase kcalories.
Exercising to build muscles will support increases in muscle mass.