Energy Balance and Weight Management

Body Weight & Health In the United States today, 66% adults are either: Over Weight or Obese In 1960 only 13.4% adults were obese In 1990 about 23 % adults were obese And today (2010) 32% adults are obese

Obesity on The Rise

NEW YEAR RESULATION

HEALTHY BODY WEIGHT “This year I am going to loose my weight once and for all” Three (3) misconceptions Focus on weight The focus on controlling wt. Focus on a short term plan

HEALTHY BODY WEIGHT It is not your weight you need to control It is fat in proportion to lean(The Body Composition) Controlling body composition is not possible- without controlling your behavior. Sporadic bursts of activity (dietary) are not effective It is a life time commitment

What is Wrong With Having Too Much Fat?

OBESITY AS A CHRONIC DISEASE Too much body increases a person's risk of developing a host of chronic health problems, those include: High Blood pressure Heart Disease Diabetes Gallbladder Disease Arthritis Sleep Disorder (sleep apnea) Respiratory Problems Cancers of Breast, Uterus, Prostate, and Colon

What Are the Risks from Overweight? Obesity triples the risk of diabetes Even moderate weight gain increases diabetes risk The risk appears to be greater for people of European ancestry than for African Americans

OBESITY AS A CHRONIC DISEASE The Health care cost for obesity is approximately $117 billion per year. More than the health care cost incurred by: Daily smoker and Heavy drinkers 70% obese people suffer from at least one other major health problem. 300,000 people die each year from obesity related disease

WHAT IS HEALTHY WEIGHT

HEALTHY WEIGHT There is no “one cutoff” point for every one. Healthy weight is the weight that minimize health risks. Your body weight is the sum of the weight of your fat and your lean body mass. Some body fat is essential for health, but too much increases your risk for a number of chronic health problems.

HEALTHY WEIGHT How much body fat is too much depends on: Age Life style and Where fat is located

BMI Body Mass Index

BMI It is current standard for assessing healthfulness of body weight. Which determined by dividing weight (in kg) by height (in meters) square: BMI=wt. (Kg)/height (m) or BMI=wt. (lbs.)/height (In)2x705 BMI=140 lbs/(66)2in.=140/4356=0.0321x705 BMI=22.65 or 23

BMI The Healthy BMI for adults is between: 18.5 to 24.9 People with in this range have lowest health risks. BMI is not actually a measure of body fat It is recommended as a way to assess body fatness

Body Weight versus Body Fatness Body Mass Index (BMI) BMI=wt. (Kg)/height (m) or BMI=wt. (lbs.)/height (In)2x705 BMI=140 lbs/(66)2in.=140/4356=0.0321x705 BMI=22.65 or 23

BMI 18.5 or less underweight 18.5 – 24.9 normal over weight obese type I obese type II 40.0 or higher extremely obese

BODY COMPOSITION

Refer to the relative proportions of fat and lean tissue. Having more than the recommended percentage of body fat increases health risks. In general, women store more fat than men do.

BODY COMPOSITION Healthy level of body fat: For young adult female is between 21% to 32% For young adult male is between 8% to 19% With aging, lean body mass decreases and body fat increases. Some of these changes may be prevented through exercise.

BODY COMPOSITION composition can be measured using a variety of techniques, such as: 1. Skin fold thickness 2. Underwater weighing 3. Bioelectric Impedance 4. Dual Energy X-Ray Absorptiometry (DXA)

Location of Body Fat

Affects the risks associated with having too much fat. Excess Subcutaneous Fat increase health risks relatively less than the excess Visceral Fat. Visceral fat is more metabolically active than subcutaneous fat.

Location of Body Fat The location of body fat stores affects the risks associated with having too much fat Excess subcutaneous fat, which is adipose tissue located under the skin, does not increase health risk as much as does excess visceral fat, which is adipose tissue located around the organs in the abdomen

Location of Body Fat Based on the fat deposit in the body prople are dividied into two groups: “Apple” profile “Pear” profile Central Obesity Fat that collects deep within the central abdominal area of the body (visceral fat)

RICKS FROM CENTRAL OBESITY Central Obesity Visceral fat is readily released into the blood stream Fat layers lying just beneath the skin (subcutaneous fat) of the abdomen, thighs, hips, and legs release fat slower than visceral fat

RICKS FROM CENTRAL OBESITY Visceral Fat. Especially dangerous with regard to risks of: Diabetes Stroke Hypertension Coronary artery disease

Factors affecting fat distribution Smoking Moderate-to-high intake of alcohol Physical activity Menopause in women

Waist Measurement Reflects the degree of visceral fatness in proportion to body fatness. Men 40 inches(102 cm) Women 35 inches(88 cm) Anyone with the waist measurement larger than these standards may carry an increased risk of disease.

AMERICA’S ENERGY IMBALANCE

Over the past 40 years, changes in environmental and social factors have affected : What we eat How much we eat, and How much exercise we get. We are eating more and burning fewer calories than we did 40 years ago. Food is plentiful and continuously available, and little activity is required in our daily lives

AMERICA’S ENERGY IMBALANCE In America today: supermarkets fast-food restaurants, and convenience marts make: palatable, affordable food readily available Advertisements entice us with : tasty inexpensive foods, and

AMERICA’S ENERGY IMBALANCE convenience stores food courts, and vending machines tempt us with the sights and smells of : fatty sweet and high-calorie snacks The accessibility of tempting treats stimulates appetite

AMERICA’S ENERGY IMBALANCE Appetite –Psychological phenomena Hunger – Physiological Phenomena In addition to having more enticing choices available to us, we consume more calories today because portion sizes have increased. The more food that is put in front of people, the more they eat. People tend to eat in units, such as one cookie, one sandwich, or one bag of chips, regardless of the size of the unit

Calories and obesity

AMERICA’S ENERGY IMBALANCE LESS PHYSICAL ACTIVITY

ENERGY BALANCE

The Body’s Energy Balance Daily energy balance Change in energy stores = energy in - energy out Each 3500 Cal. in excess of expenditure we store approx. 1lb of fat 3500 Cal= 1lb Fat

ENERGY BALANCE Energy Intake: The amount of energy you consume depends on what and how much you eat and drink. The carbohydrate fat protein, and alcohol consumed in food and drink all contribute energy: 4, 9, 4, and 7 Calories/gram, respectively

ENERGY BALANCE Energy Expenditure: The total amount of energy used by the body each day is called total energy expenditure. It includes the energy needed : to maintain basic body functions needed to fuel physical activity and process food.

The Body’s Energy Balance Energy In and Energy Out The energy in foods and beverages contribute to the “energy in” side of the energy balance equation The “energy out” side of the equation requires knowing about a person’s lifestyle and metabolism

How Many Calories Do I Need Each Day? Energy output Basal metabolism Sum total of energy expended on all of the involuntary activities needed to sustain life Excludes digestion Voluntary activities (exercise & non exercise activity thermogenesis-NEAT) Thermic effect of food (TEF) 5%-10% of a meal’s energy is expended in stepped-up metabolism in the 5+ hours after a meal

Can I Speed Up My Metabolism To Promote Fat Loss? - Cannot increase BMR in short time - Can increase voluntary activity Food such as grapefruit or vinegar cannot increase BMR__ Only increases temporary energy expenditure as thermic effect or Heat increment. Over the long term, increasing voluntary activities will increase BMR Lean tissue has a higher BMR then fat tissue

Factors That Affect The BMR - Age - Height - Growth - Body Composition - Fever - Stress - Environmental Temperature - Fasting/ Starvation - Malnutrition - Thyroxin

The Basics of Weight Gain & Weight Loss Excess energy is stored as fat in adipocytes, which make up adipose tissue. Store energy is used when energy intake is reduced.

Storing and Retrieving Energy

Estimated Energy Requirement (EER)

Estimated Energy Requirement (EER) The current recommendation for energy intake in the United States is the estimated energy requirement. The number of calories needed for a healthy individual to maintain his or her weight. It is calculated using equations that take into account : gender age height weight activity level, and life stage, --- all of which affect calorie needs.

EER. Boys 9-18yr EER=88.5-(61.9xAge in yrs)+PA[26.7xWeight in kg) +(903xHeight in m)]+25 Girls 9-18 EER= (30.8xAge in yrs)+PA[10xWeight in kg) +(934xHeight in m)]+25

The Mystery of Obesity Why do some people get fat? Why do some stay thin? is weight controlled by hereditary metabolic factors or by environment influences is it a matter of eating behaviors if so, what directs these behavior internal controls or person’s free will

The Mystery of Obesity Many factors, some of them conflicting correlate with obesity. Cause of obesity is difficult to determine Researchers are interested in: why people eat and what they eat why some people over eat Eating behavior seems to be regulated be a series of signals that fall into two functional categories “Go” mechanisms “stop” mechanisms

“Go” Signals – Hunger & Appetite Hunger- the physiological need to eat, experienced as a drive for obtaining food: An unpleasant sensation that demand relief. Hunger is physiological and ask “is there anything to eat?” Appetite is psychology and ask “what do I feel like eating” appetite intensify hunger but a person can experience appetite without hunger

“Go” Signals – Hunger & Appetite Hunger Sensation that signals a need for food Occurs roughly 4-6 hours after eating After the food has left the stomach and much of the nutrient mixture has been absorbed Triggered by a contracting empty stomach, an empty small intestine, the stomach hormone ghrelin produced between meals, and chemical and nervous signals in the brain Another hormone, peptide PYY, causes a reduction in appetite

“Stop” signals- satiation and satiety Satiety After meal feeling of satiety continues to suppress hunger Satiation inform the body when to stop eating Satiety allows the body to stay stopped for a while some food sustain feelings of satiety longer than other foods high in fiber and protein sustain satiety longer than those high in fat white or sugar – (some caloric food)

“Stop” signals- satiation and satiety Satiation The perception of fullness that builds throughout a meal Eventually reaching the degree of fullness and satisfaction that halts eating Stomach stretching to accommodate a meal triggers receptors in the stomach to send signals to the brain that tell it that the stomach is full The brain also detects nutrients in the blood

“Stop” signals- satiation and satiety Satiety The perception of fullness that lingers after a meal Suppresses hunger

Why Did I Eat That? Hunger strongly stimulates eating behavior Satiation and satiety exert weaker control over food intake and can be ignored

“Stop” signals- satiation and satiety Brian receives messages from several sources that enough food has been eaten- satiation This condition originates when stomach starches to accommodate meal nutrients from the meal enter in small intestine- stimulate receptor nerves and release hormones & neurotransmitters blood nutrients Hypothalamus get information about the nature and size of meal - & satiation occurs.

“Stop” signals- satiation and satiety Leptin: A Satiety Hormone Leptin An appetite-suppressing hormone Produced by adipose tissue Travels to the brain Directly linked to appetite and body fatness Some production by the stomach Where it may contribute to satiety

“Stop” signals- satiation and satiety More on leptin… Gain of body fatness stimulates leptin production Reducing food consumption; resulting in fat loss Loss of body fat reduces leptin secretion Increasing appetite

Causes of obesity is divided into two groups 1) In- side-the- body causes a. Genetic and weight gain b. Energy wasting protein c. Leptin 2) Out- side- the- body causes a. external cues to overeating b. food availability c. physical inactivity

Inside-the-Body Causes of Obesity Genetic makeup influences the body’s tendency to consume or store too much energy pr burn too little If our parent is obese- 60% chance the child will be obese If both parents are obese- 90% chance the child will be obese Genetics play a very important role but lifestyle help to determine whether inborn tendency in expressed.

Inside-the-Body Causes of Obesity If some group of people are given 1000cal for 100 days- some gain 30lbs others only 10lbs some may lose wt. faster than others- SET POINT THEORY this phenomenon is part of the set- point theory- the theory that the body tends to maintain a certain wt. by means of its own internal controls.

Inside-the-Body Causes of Obesity 1b Energy wasting protein Enzymes that expand energy in heat production or thermogenesis but produce no other useful work in process. researchers have discovered one gene seems to influence BMR and oppose the development of obesity children who posses a variety and the gene- over weight

Inside-the-Body Causes of Obesity C. Leptin- directly linked to both appetite and body fatness An appetite- suppressing hormone produced in the fat cells that conveys about body fatness to the brain & stimulate muscles to increase energy expenditure. Increase adipose tissue- increase Leptin- decrease appetite Decrease adipose tissue- decrease Leptin- increase appetite Small % of obese people fail to produce Leptin- When injected- no effect

Outside – the – body causes of obesity Food Price, Availability, and Advertising High-calorie fast foods are relatively inexpensive, widely available, heavily advertised, and (to some people) delicious Occasional indulgence in high-calorie foods does not mean the eater will become obese Moderation and common sense are the keys

Outside – the – body causes of obesity Physical Inactivity Some people are obese not because of how much they eat, but because they move too little Diet histories of obese people often report energy intakes similar to, or even less then, those of others It is the lack of physical activity that results in an energy surplus

Outside – the – body causes of obesity Such inactivity is a recent phenomenon 100 years ago, 30% of the energy used in farm and factory work came from human muscle power: today only 1% does The same trend follows elsewhere It takes active muscle movement to achieve energy balance

Calories and obesity Today’s Meal - calories total= calories intake= 925 Difference x52 wk/year= calories 3500 cal= 1 lbs fat / 3500 = 16 lbs body fat in one year by eating only once a week many little daily decisions such as this adds up over time.

How the Body Loses and Gains Weight Low-carbohydrate, high-protein diets bring about large initial weight losses This large initial weight loss is primarily the water and glycogen losses that occur when carbohydrate is lacking This kind of weight loss rapidly reverses when a person begins eating normally Loss of appetite accompanies any low-calorie diet

How the Body Loses and Gains Weight Alcohol: used for fuel or converted to body fat and stored Alcohol slows down the body’s use of fat for fuel by as much as ≈ 33%, causing more fat to be stored Primarily as visceral fat

Achieving and Maintaining a Healthy Body Weight Motivation Is your goal health or to achieve a socially defined idea of attractiveness? Goals Unreasonable vs. realistic goals Keeping record Planning a lifestyle for wt loss and maintenance – you are going on “diet”

Achieving and Maintaining a Healthy Body Weight Weight loss takes time and patience Even modest weight loss, even for a person still overweight, can improve health

What Diet Strategies Are Best for Weight Loss?

It’s Your Diet, So You’d Better Plan It No particular food must be included or excluded from the diet Adopt a healthy eating plan Fruits, veg. and whole grains Crunchy, wholesome, unprocessed or lightly processed food- bulk satiety Limit, do not eliminate, lean meat and other low fat protein sources Pay close attention to portion sizes

What Diet Strategies Are Best for Weight Loss? *Reduce fat without reducing total calories does not produce wt. lose* If you drink alcoholic beverages, cut down or eliminate More meals- small size Mild hunger not appetite is prompting you to eat Eat regularly and before becoming very hungry No particular food plan is magical No particular food must be either included or excluded instead adapt a healthy eating plan for life So it must be consist of foods you like, that re readily available and affordable

What Diet Strategies Are Best for Weight Loss? Choosing Realistic Calorie Intakes Energy intakes lower than about 800 calories (very-low- calorie diets [VLCD]) are unsuccessful at achieving lasting weight loss, lack necessary nutrients, and may promote eating disorders

What Diet Strategies Are Best for Weight Loss? Balancing Carbohydrates, Fats, and Protein Choose fats sensibly Avoid saturated and trans fats Include enough of the health-supporting fats to provide satiety but not so much as to oversupply calories Protein Choose lean meats or other low-fat protein sources Limit these foods but don’t eliminate them

What Diet Strategies Are Best for Weight Loss? Critical Importance: Portion Sizes The enemy is the large portions served by restaurants and sold in packages Train yourself to use a measuring cup to learn to judge portion sizes Fat grams add up quickly and contribute more calories than do grams of carbohydrate or protein

What Diet Strategies Are Best for Weight Loss? Critical Importance: Portion Sizes Eating large portions of reduced-calorie foods is self- defeating Read labels and compare calories per serving Meal Spacing Breakfast Physical Activity

What Diet Strategies Are Best for Weight Loss? Consider Milk and Milk Products Several studies have found that higher calcium intake, especially from low-fat milk and milk products, correlates with lower body fatness Evidence suggests that calcium in milk may stimulate hormonal action that speeds up the breakdown of stored fat

Drugs and Surgery to Treat Obesity BMI≥30 and those with elevated disease risk may benefit from prescription medication, along with diet, exercise, and behavior therapy, to lose weight

Drugs and Surgery to Treat Obesity Extreme obesity (BMI≥40; BMI≥35 with coexisting disease); a.k.a. morbid obesity Health permitting, surgery may be an option Surgical reduction of stomach size Surgery is not a cure for obesity Some do not lose the expected pounds Some who initially lose weight gain it back through the course of time

Drugs and Surgery to Treat Obesity

Copyright 2010, John Wiley & Sons, Inc. Gastric Bypass and Banding

Drugs and Surgery to Treat Obesity Lipectomy (liposuction) Cosmetic procedure If fat is gained back after surgery, as it often is, a lumpy, dimpled layer can be formed There can be serious complications, including death, as a result of the surgery

Drugs and Surgery to Treat Obesity Herbal Products For many, their effectiveness and safety have not been proved “Natural” does not mean safe Belladonna, hemlock, and sassafras all contain toxins Marketed as “dietary supplements” and thus escape FDA scrutiny

Drugs and Surgery to Treat Obesity Other Gimmicks Steam baths and saunas do not melt off fat May dehydrate you and result in water loss Brushes, sponges, wraps, creams, and massages intended to move, burn, or break up “cellulite” are useless for fat loss

Drugs and Surgery to Treat Obesity FDA has sent letters warning supplement distributors to stop claiming that their products: Block starch, fat, sugar absorption Neutralize starch, fat, or sugar in a meal Promote weight loss with no effort

Once I’ve Changed My Weight, How Can I Stay Changed? A reason why gimmicks fail is that they fail to produce lasting changes Disappointment, frustration, and self-condemnation are common in dieters who have returned to their original weight or even gained weight

Once I’ve Changed My Weight, How Can I Stay Changed? A key to weight maintenance is accepting it as a lifelong endeavor Prepare the mind for making permanent changes More physically active than the average person Monitor fat grams, calorie intake, and body weight

Eating Disorders ≈5 million people in the U.S. suffer from eating disorders Mainly females Anorexia nervosa Bulimia nervosa Many more suffer from binge eating disorder

Eating Disorders ≈85% of eating disorders start during adolescents Markers of disordered eating - including restrained eating, binge eating, purging, fear of fatness, distorted body image - are common