Weight Management: Overweight, Obesity, & Underweight

Overweight Overweight (BMI 25-29.9) 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.

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

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

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.

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.

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

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.

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.

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“I'm in shape”. “Round is a shape”.

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.

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

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.

. LAZINESS IS NOT A HANDICAP 20

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

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.

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.

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

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.

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

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

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

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

“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.

WHO EVER INVENTED DIETS w@io R 114'14Et4,T ssout-co 13E AC-XGF-P INVO -STIR 0 0 w@io R 114'14Et4,T ssout-co 13E AC-XGF-P INVO -STIR 0 0 w@io R 114'14Et4,T ssout-co 13E AC-XGF-P INVO -STIR 0 0 WHO EVER INVENTED DIETS SHOULD BE TAKEN OUT AND SHOT!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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."

THE 100 METER MOSEY

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

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

Exercise Two short sessions/day or one long session?

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

Exercise Two short sessions/day or one long session? Yes! Mode: Walking, Daily Activity Frequency: 5 - 7 times / week Duration: 40-60 minutes 20-30 minutes X 2 Intensity: Moderately

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

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

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

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.

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.

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

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.

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.

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.

“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.”

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.

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

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.

“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…”

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.

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

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.

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

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 0.5-2 pounds per week or 10% of body weight in six months is safe.

Weight-Loss Strategies Eating Plans Be Realistic about Energy Intake 300-500 kcalories/day reduction for BMI between 27 and 35 500-1000 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.

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.

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

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

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

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!

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

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)‏

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.

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.

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.

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

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.

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

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.

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.