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Chapter 9 Weight Management

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1 Chapter 9 Weight Management

2 What Is Obesity? A life-long, progressive, life-threatening, costly, genetically-related, multi-factorial disease of excess fat storage with multiple co-morbidities

3 Obesity is multifactorial:
Genetic Metabolic Biochemical Psychological Environmental Obesity is a very complex disease that is not necessarily caused by overeating and a lack of activity and willpower.

4 Risk factors that cannot be changed
Genetics A child born to two obese parents has a 70-80% chance of becoming obese A child with one obese parent has a 30% chance of becoming obese A child born to normal-weight parents has a 14% Genetics may influence the number of fat cells in the body, how much and where fat is stored, and resting metabolic rate.

5 Genetics In 1994, researchers discovered that mutations in a gene – termed the obesity (ob) gene – prevented the production of leptin, a protein that promotes satiety, reduces appetite, and speeds up metabolism to maintain a normal level of body fat. A second mutation (db) affects the leptin receptor in the hypothalamus resulting in resistance to high leptin levels.

6 Genetics Another genetic influence may effect levels of the enzyme, lipoprotein lipase. This enzyme promotes fat storage. Obese people have high LPL activity and are especially efficient at storing fat.

7 Causes of Obesity Without leptin the mouse weighs almost as much
as a normal mouse. With leptin treatment the mouse lost a significant amount of weight. Copyright 2005 Wadsworth Group, a division of Thomson Learning

8 Fat Cell Development – the number of fat cells
increases more rapidly in obese children during late childhood and early puberty; fat cells may expand or shrink in size, but not their number which is why people with extra fat cells may tend to regain lost weight rapidly; the goal is to prevent fat cell numbers from increasing during the growing years

9 Fat Cell Development Copyright 2005 Wadsworth Group, a division of Thomson Learning

10 Risk factors that cannot change
Metabolic Metabolism is the process that extracts and utilizes energy from food, including resting metabolic rate and thermogenesis Whether or not obese people have an abnormally slow metabolism is controversial! Set Point Theory – the body may have a mechanism for keeping weight at a predetermined level of body fat. The level of body fat is controlled by the adipostat in the hypothalamus. Actions perceived as voluntary, such as eating and physical activity, may be subtly controlled by our adipostat which maintains the set point by adjusting appetite, physical activity, and RMR to conserve or expend energy

11 Risk factors that cannot be changed
Biochemical Hormonal Abnormalities - endocrine diseases, such as hypothyroidism, polycystic ovary syndrome, tumors of the pituitary or adrenal glands, insufficient production of sex hormones, insulin-producing tumors of the pancreas are uncommon and rarely a primary cause of obesity, but need to be ruled out.

12 Risk factors that can be changed
Dietary Intake The “input” side of the energy equation Although a reduction in calorie intake is essential for weight loss, to point to overeating as the cause of obesity is overly simplistic.

13 Risk factors that can be changed
Physical Activity The “output” side of the energy equation Regular exercise burns calories, builds lean muscle mass, and raises resting metabolic rate too much T.V., computer & car time = too little energy expenditure

14 Risk factors that can be changed
Psychological Learned behaviors – psychological stimuli, such as boredom, stress, depression, loneliness, may trigger inappropriate eating What purpose does eating/food serve? Hunger is physiological, appetite is psychological - an important distinction to identify reasons for eating other than hunger

15 Risk factors that can be changed
Environment Our environment – which includes three-car households, the movement of jobs from farms and mines to offices, TVs & computers in every home, 670-calorie Cinnabons, and supermarkets the size of small cities – makes it too easy to eat more and exercise less.

16 “Genetics loads the gun—the environment pulls the trigger
“Genetics loads the gun—the environment pulls the trigger.” George Bray, Courtesy of Ethicon Endo-Surgery, Inc.

17 Measure of Weight Status
Height/weight tables do not take into account body composition and are not based on scientific calculations of ideal weight but are derived from ht., wt., mortality data from life insurance company Weight-for-height – depends on gender & frame size; easy to do but doesn’t always reflect body fatness If 10% below median weight = underweight If 10-20% above standard = overweight If >20% above standard = obese

18 Measure of Weight Status
Obesity is diagnosed by Body Mass Index (BMI) and waist circumference. BMI is a measurement of weight as it relates to height (determined by dividing weight in kilograms by the square of height in meters) and correlates strongly with the amount of body fat and disease risk. BMI = overweight BMI = Obesity BMI >40 = Clinically Severe Obesity

19 Quick Estimation of DBW
“Rule of 5’s and 6’s” Men: ’0” Add 6 lbs. Per inch Women: ’0” Add 5 lbs. Per inch +10% for large frame - 10% for small frame

20 Do You Know Your Own BMI? Weight (lbs) Height 5'4" 5'2" 5'0" 5'10"
5'8" 5'6" 6'0" 6'2" 120 130 150 160 170 180 190 200 210 220 230 240 250 140 260 270 280 290 300 6'4"

21 Determining BMI using a table is relatively easy but is still only an indirect measure of body fat.
It does not take gender or frame size into consideration; at any given BMI women will have more body fat than men.

22 Obesity and Mortality Risk
2.5 2.0 Mortality Ratio 1.5 1.0 Very Low Very High Moderate Low Moderate High 20 25 30 35 40 BMI Gray DS. Med Clin North Am. 1989;73(1):1–13.

23 Body Fat Distribution Central Obesity - independent risk factor for obesity-related diseases Waist circumference reflect body fat distribution; fat accumulation around the abdomen (central obesity) has higher disease risk, especially diabetes and high blood pressure. Waist measurements of 35” or greater (women) and 40” or greater (men) are independent risk factors for obesity-related diseases.

24 Body Fat Distribution “Apple shape”
1. Occurs more in men, postmenopausal women, smokers, “heavy drinkers”, & sedentary individuals 2. Waist-to-hip ratio – assesses risk waist (inches) hips (inches) High risk if: Men = > Women= >.8 “Pear shape” has lower disease risk

25 Copyright 2005 Wadsworth Group, a division of Thomson Learning

26 Body Composition Assessing body composition – determine body fat by:
1. Fat-fold tests 2. Bioelectrical impedance 3. Underwater (hydrostatic) weighing What should % body fat be? 1. Normal for men: 10-22% Absolute minimum: ~5% Health problems if >25% 2. Normal for women: 18-32% Absolute minimum: 15% Health problems if >35%

27 Obesity Is a Big Problem!
Major public health problem – about to surpass smoking as the #1 leading cause of preventable death in this country! Affects 25% of industrialized world American statistics: 55% (34 million) adults are overweight (BMI > 25) or obese (BMI > 30), 5% severely obese 25% of children are overweight 7-8% of health care expenditures (>300 billion/year) 300,000 deaths annually

28 Obesity Trends* Among U.S. Adults BRFSS, 1985
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) No Data <10% %–14%

29 Obesity Trends* Among U.S. Adults BRFSS, 1987
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) No Data <10% %–14%

30 Obesity Trends* Among U.S. Adults BRFSS, 1989
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) No Data <10% %–14%

31 Obesity Trends* Among U.S. Adults BRFSS, 1991
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) No Data <10% %– %–19%

32 Obesity Trends* Among U.S. Adults BRFSS, 1993
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) No Data <10% %–14% %–19%

33 Obesity Trends* Among U.S. Adults BRFSS, 1995
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) No Data <10% %–14% %–19%

34 Obesity Trends* Among U.S. Adults BRFSS, 1997
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) No Data <10% %–14% %–19% ≥20%

35 Obesity Trends* Among U.S. Adults BRFSS, 1999
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) No Data <10% %–14% %–19% ≥20%

36 Obesity Trends* Among U.S. Adults BRFSS, 2001
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) No Data <10% %–14% %–19% %–24% ≥25%

37 Obesity Trends* Among U.S. Adults BRFSS, 2002
(*BMI 30, or ~ 30 lbs overweight for 5’4” person) (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) No Data <10% %–14% %–19% %–24% ≥25% Source: Behavioral Risk Factor Surveillance System, CDC

38 Americans spend millions of dollars every year on antiobesity products in a desperate quest for that “magic potion”. The recidivism rate for weight loss is unacceptably high – partially due to this “quick-fix “ mentality & treatment failure. Many fad diets, over-the-counter drugs, herbal products, and dietary supplements are “gimmicks” and potentially dangerous interventions.

39 Why Treat Obesity? Obesity CANNOT be cured –
Improvement in multiple comorbidities Decrease in mortality and morbidity Improvement in quality of life Obesity CANNOT be cured – it CAN be treated and controlled

40 Obesity Related Co-Morbidities
Hyperlipidemia Cardiac disease Respiratory disease Sleep apnea Arthritis Depression Stress Incontinence Menstrual irregularity Hypertension Diabetes Some cancers

41 Non-Medical Co-Morbidities
Physical – public seating limitations & personal hygiene Economic – employment & education discrimination Psychological – low self-esteem & depression Social – harassment & prejudice

42 The Psychology of Weight Cycling
Copyright 2005 Wadsworth Group, a division of Thomson Learning

43 Weight-Loss Strategies
Reasonable goals vs. expectations Copyright 2005 Wadsworth Group, a division of Thomson Learning


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