3OverweightOverweight (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.
5Overweight 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
6phic During growth, fat cells increase in number. Hyper-plastic When energy intake exceeds expenditure, fat cells increase in size. Hypertro-phicWhen fat cells have enlarged and energy intake continuesto exceed energy expenditure, fat cells increase in numberagain.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 ArtFig. 9-2, p. 283
7Overweight Fat Cell Development Hypertrophic obesity Fat cell size Fat cell sizes increase when energy intake exceeds expenditure.Hypertrophic obesityThe adverse effects of fat in non-adipose tissue are called lipotoxicity.
8Overweight Fat Cell Metabolism Lipoprotein lipase promotes fat storage.Gender differencesMen are at increased risk for developing central obesity and women are at increased risk for lower body fat.
9Overweight Set-Point Theory The body’s natural regulatory centers maintain homeostasis at set point.The human body tends to maintain a certain weight.
10Causes of ObesityObesity 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.
11Causes of Obesity Genetics Leptin (also called the ob protein) Protein that acts as a hormone to increase energy expenditure and decrease appetiteProduced by fat cells under the direction of the ob geneMay be deficient in obese individualsMore research is needed.
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15Causes of ObesityEnvironment – The gene pool of our population remains relatively unchanged.OvereatingPresent and past eating influences current body weight.Increased availability of convenient food, large portions, and energy-dense foodsPhysical InactivityModern technology replaces physical activities.Physical activity is important to allow people to eat enough food to get needed nutrients.
16Buy a lot of McDonald’sfood and get a big, fatass, absolutely free.
18Causes of ObesityEnvironment – The gene pool of our population remains relatively unchanged.OvereatingPresent and past eating influences current body weight.Increased availability of convenient food, large portions, and energy-dense foodsPhysical InactivityModern technology replaces physical activities.Physical activity is important to allow people to eat enough food to get needed nutrients.
21Obesity: Risk Factors Genetics Family history of obesity Psychological factorsSocial and cultural factorsMedical IllnessesMedicationsAlcohol consumptionSmoking Cessation
22Problems with ObesityObesity problems depend on many factors such as the extent of overweight, age, health status and genetic makeup.Risk factors may differ among individuals.
23Makes a point about a topic Let’s just say you weightoo much and the less said about your future the betterGive a man a fish andhe will eat for a day. Teach him how to fish, andhe will sit in a boat anddrink beer all day.
24Problems with Obesity Health Risks Obese or overweight people with the following life-threatening-conditions may improve health by losing weight:Heart diseaseType 2 diabetesSleep apnea
25Problems with Obesity Perceptions and Prejudices Social Consequences Prejudices and discriminationJudged on appearance rather than characterStereotyped as lazy and lacking self-controlPsychological ProblemsFeelings of rejection, shame and depression are common.Ineffective treatments can lead to a sense of failure.
26weight, but then regain it (and sometimes more). I want to be happy. I am fatand unhappy.I lose a littleweight, 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 ArtFig. 9-4, p. 289
27Problems with Obesity Dangerous Interventions Fad Diets False theories Inadequate dietsCan be a danger to health
29Diet vs proper nutrition Treatment ModalitiesDiet vs proper nutritionExerciseBehavior therapy/modification/changePharmacotherapySurgery
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.
31WHO EVER INVENTED DIETS R 114'14Et4,T ssout-co 13E AC-XGF-P INVO STIRR 114'14Et4,T ssout-co 13E AC-XGF-P INVO STIRR 114'14Et4,T ssout-co 13E AC-XGF-P INVO STIRWHO EVER INVENTED DIETSSHOULD BE TAKEN OUTAND SHOT!
32Types of Weight Loss Diets Low Carbohydrate aka High ProteinLow Fat aka High CarbohydrateVery Low Calorie aka Modified FastNovelty DietsWeight Loss Programs
34Why Weight Loss Programs Do Not Work Negative ImpactTemporaryPerfect- OrientationProject MentalityDo not Address Cause
35Consequences of Dieting Decrease in rate of weight lossLoss of lean tissue with fat lossDecrease in metabolism, 10-40%Decrease in Protein turnoverPreoccupation with foodIncrease in irritability, moodinessTires easier, less physical activityApathy, depression
36Re-feeding after Weight Loss Increase in pre-dieting food intakePreference for high fat foodsRegain in weight, but greater increase in % BFMetabolism slow to return to normalRegain Weight quicker with each dietIncrease in abdominal fat depositsLess likely to return to pre-diet physical activityDecrease in self-efficacy/esteem
37Recognizing an Unsound Diet Promotes Quick Weight LossLimits Food SelectionTestimonials or Famous People/PlacesExpensive Supplements or ProductsNo Attempt to Permanently change eating orphysical activityCritical of Scientific Community‘They know more, or something new
38Characteristics of a Sound Diet Nutritionally adequate yet low in caloriesFit into current lifestyleFoods that are likedSlow rate of weight lossFollowed for life
50why you should not engage in I see no reasonwhy you should not engage instrenuous activityWell keeplooking,keep looking!
51ExerciseIn 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."
60To make a long story short, what ever you are doing…STOP IT!
61Behavior therapyBehavior 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.
62Behavior therapyA behavior modification program can help make lifestyle changesBehavior 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.
63Behavior therapy First identify those that are a problem Choose those that you are willing to changeTake responsible for your behaviorHave a plan to make better choicesRemember the benefitFocus on the positive
64Behavior therapyHave 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.
66Behavior 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.
67Behavior 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 ontothe shore, snatching my teacher’s body off hisbeach chair and carrying him out to sea.”
70Treatments of ObesityIndividuals 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.
72Problems 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…”
74Treatments 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.
76Treatments 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.
78Predicting Weight Loss Positive AffirmationsStrong MotivationSupportive EnvironmentAppropriate BehaviorsChanges in Body Shape
79Weight-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.
81Weight-Loss Strategies Eating PlansBe Realistic about Energy Intakekcalories/day reduction for BMI between 27 and 35kcalories/day reduction for BMI ≥ 35Dietary Guidelines should be followed.Diet should be nutritionally adequate while avoiding excessive consumption.Smaller portions are recommended to feel satisfied, not stuffed.
82Weight-Loss Strategies Eating PlansEat 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.
83Meal Planning Plan meals throughout the day Eat a variety o Foods (at each meal)Center Meals around the carbohydrate foodsMinimize the addition of FAT all the time and sugar at any one timeDon’t worry about protein
84Plan Meals thru the DayThink about what you are going to eat instead of eating by habit or impulse!Eat more earlier when more activeEat less later when less activei.e. a little often vs. a lot at onceThe later you eat, the lighter you eat
85Eat a Variety of Foods (at Each Meal) Provides more nutritionEach member of the family can choose what they want at that timeControls eating one food in excessExposes a person to different foodsMakes a better meal
86Center 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!
88Minimize FATS and SUGAR Fats are fatteningFats can lead to other health problems‘Minimize’ fat intake, don’t eliminate itSugar in large amounts is a problemSugar is an enjoyable taste and may displace foods with more nutrition and be concentratedFat and Sugar mix well with each other: the real problem
89Don’t worry about PROTEINS Important for growth (height) and developmentNeeded 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)
90Weight-Loss Strategies Physical ActivityAn 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.
91Weight-Loss Strategies Physical ActivityChoosing ActivitiesChoose 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 ReducingRegular aerobic exercise and weight loss will help trouble spots.Strength training can improve muscle tone.Stretching can help flexibility.
92Weight-Loss Strategies Behavior and AttitudeBehavior 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.
93Weight-Loss Strategies Weight MaintenanceSuccessful 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
94Weight-Loss Strategies PreventionEat 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.
95UnderweightIncidences of underweight and associated health problems are less prevalent than overweight and obesity problems.
96Underweight 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.
97Underweight 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.