Chapter 11 Weight management

Introduction National Institutes of Health 66% of American adults are overweight Including more than 33% of adult men and 35% of adult women are obese. 2015 75% of adults will be overweight and 41% will be obese 2030 Estimated that the entire American adult population will be overweight or obese

Figure 11-1 Obesity prevalence, by age and sex, of American adults 3 Figure 11-1 Obesity prevalence, by age and sex, of American adults Figure 11.1 Prevalence of overweight and obesity among American adults age 20-74

Basic Concepts of Weight Management 1 pound of fat = 3500 calories Body Composition Fat-free mass or Lean Body Mass Body Fat Subcutaneous fat 3-5% of total fat in men, 8-12% in women Visceral fat-(storage) –Located behind the abdominal wall Depends on many factors: Gender Age Heredity Metabolism Diet Activity level Women: <8% at risk, Average 23%, > 32% at risk Men: < 5% at risk, Average 15%, > 25% at risk

Energy Balance Crucial to keep a healthy ratio of fat and lean body mass Energy Consumption and/or expenditure of calories Control over intake of calories Negative energy balance Positive energy balance Neutral energy balance

Figure 1.2 The energy balance equation www.freedieting.com

Evaluating Body Weight and Body Composition Overweight – total body weight above recommended range for good health Obesity – a more serious degree of overweight Height-Weight charts Body Mass Index (BMI) BMI = [Weight / Height in inches (squared)] X 703

Figure 11.3 Body Mass Index (BMI) 8 Figure 11.3 Body Mass Index (BMI)

Body Composition Analysis Hydrostatic (underwater) weighing and BOD POD Most accurate Skinfold measurements Thickness of fat under the skin Electrical Impedance Analysis Electricity prefers lean tissue Scanning procedures CT scan, MRI, Dual-energy X-ray, Dual-photon absorptiometry, Infrared reactance and total body electrical conductivity

Body Composition Measuring Techniques

Excess Body Fat and Wellness The Health Risks of Excess Body Fat Obese individuals have a mortality rate twice that of non-obese Reduces life expectancy by 10-20 years Associated with: Unhealthy cholesterol and triglycerides, impaired heart function, and death from cardiovascular disease Other health factors: hypertension, cancer, impaired immune function, gallbladder and kidney disease, skin problems, impotence, sleep disorder back pain, arthritis Strong association – Type II diabetes

Figure 11.4 Diabetes mellitus

4/21/2017

Body Fat Distribution and Health Apple shape Android obesity Upper regions of their bodies Increase risk of high blood pressure, diabetes, early-onset heart disease, stroke, and cancer Pear shape Gynoid obesity Fat storage in the hips, buttocks and thighs Assessed by measuring waist circumference Risk if total waist measurement is more than 40 inches for men and 35 inches for women

Waist-to-Hip Ratio Predicts disease risk according to “apple” or “pear” shape Disease Risk according to Waist-to-Hip Ratio

Body Image Collective picture of the body as seen through the mind’s eye. Perceptions Images Thoughts Attitudes Emotions

Different Body Builds ENDOMORPHY MESOMORPHY ECTOMORPHY

Problems Associated with Very Low Levels of Body Fat Less than 8-12% for women and less than 3-5% for men. Extreme has been linked to problems with: Reproductive Circulatory Immune system disorders Female Athlete Triad Abnormal eating patterns Amenorrhea Decreased bone density

Factors Contributing To Excess Body Fat Genetic Factors Nutrigenomics Study of how nutrients and genes interact 25 to 40% of an individual’s body fat 600 genes have been linked to obesity Physiological Factors Metabolism (RMR) Hormones Fat Cells

Lifestyle Factors Eating Physical Activity Psychosocial factors Emotions Distraction from difficult feelings Helps regulate emotions Coping strategies Socioeconomic status Family and cultures

Adopting a Healthy Lifestyle For Successful Weight Management “Normal” body weight Diet and Eating Habits Total Calories MyPyramid suggestions Best approach for weight loss is combining an increase of exercise with moderate calorie restriction Do not go on a crash diet

Adopting a Healthy Lifestyle For Successful Weight Management (Continued) Portion Sizes Energy (calorie) Density Eating Habits Processed foods “Fat-free” Stick to recommendations by: Dietary Guidelines for Americans MyPyramid DASH Diet

Physical Activity and Exercise 30 minutes or more of moderate-intensity physical activity, everyday Walking Gardening Housework Walking 1 mile in 15-20 minutes

Thinking and Emotions What do you think of yourself? Self-esteem Negative emotions “Ideal self” Beliefs and attitudes you hold

Coping Strategies Adequate and appropriate strategies Healthy lifestyles and proper stress management techniques will naturally and easily result in a reasonable body weight Good nutrition Good communication Adequate exercise Positive thinking and emotions Effective coping strategies and behavior patterns

Approaches to Overcoming a Weight Problem Doing it yourself 0.5-2.0 pounds per week Initial weight loss from fluids Very low calorie diets need to be avoided Diet Books: Reject books with gimmicks or rotating levels of calories. Accept books that advocate a balanced approach. Diet Supplements and Diet Aids Formula drinks and food bars Herbal supplements Other supplements

Weight-Loss Programs Noncommercial Commercial Online Clinical TOPS (Take Off Pounds Sensibly) OA (Overeaters Anonymous) 12-step program with spiritual orientation Commercial Online Clinical

Weight-Loss Programs Prescription Drug Appetite Suppressants Produce a 5-15% weight reduction by controlling appetite. Once drugs are stopped most return to original heavy weight. Good option for very obese who need help getting started - permanent life style change.

Surgery Severely obese – One in 50 adult Americans has “morbid obesity” NIH recommends gastric bypass for individuals with a BMI of 40 or higher or are 100 pounds or more over recommended weight. Roux-en-Y-gastric bypass Vertical banded gastroplasty (VBG) Lap-Band – variation of VGB Adjustable band Liposuction Weight loss from surgery generally ranges between 40% and 70% of total body weight over a years time. http://www.chakpak.com/video/liposuction-surgery-video/363314 http://www.videojug.com/interview/roux-en-y-gastric-bypass-2

Surgery Adjustable gastric banding Roux-en-Y gastric bypass Adjustable gastric banding: In this procedure, a hollow band made of silicone rubber is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the rest of the stomach. The band is then inflated with a salt solution through a tube that connects the band to an access port placed under the skin. It can be tightened or loosened over time to change the size of the passage by increasing or decreasing the amount of salt solution Roux-en-Y gastric bypass (RGB). This operation is the most common and successful combined procedure in the United States. First, the surgeon creates a small stomach pouch to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine). This reduces the amount of calories and nutrients the body absorbs. Weight-Control Information Network. 2004. Gastrointestinal Surgery for Severe Obesity. NIH Publication No. 04-4006 Adjustable gastric banding Roux-en-Y gastric bypass Source: National Institutes of Health

Body Image Severe body image problems Body dysmorphic disorder (BDD) Affects about 2% of Americans Usually before age 18 Muscle dysmorphia Knowing when the limits to healthy change have been reached. Knowing the unrealistic cultural ideal. Acceptance and change Knowing what is a healthy lifestyle change

Eating Disorders Problems with body weight and weight control. Characterized by severe disturbances in body image, eating patterns, and eating-related behaviors. Disordered eating affects an estimated 10 million American females and 1 million males.

Eating Disorders Anorexia Nervosa - Failure to eat enough food… Affects 3 million people – 95% are female Typically develops between the ages of 12 and 18 Characteristics Fear gaining weight. Distorted self-image. Compulsive behaviors and rituals. Excessive exercise Health Risks of Anorexia Nervosa Stop menstruation Intolerant of cold Low blood pressure and heart rate Dry skin Hands and feet may swell and take on a blue tinge Depression and suicide Medical complications Disorders of the cardiovascular, gastrointestinal, endocrine, and skeletal systems

Eating Disorders Bulimia Nervosa - recurring episodes of binge eating followed by purging. Begins in adolescence or young adulthood Increasingly younger (11-12 years) and older (40-60 years) ages. Characteristics: Rapidly consumes food, then purges. Done in secret. After a binge - feels ashamed, disgusted and physically and emotional drained. Health Risks: Erodes tooth enamel Deficient calorie intake Liver and kidney damage Cardiac arrhythmia Chronic hoarseness Esophageal tearing Rupture of the stomach Menstrual problems Increased depression

Eating Disorders Binge-Eating - Similar to Bulimia except no Purging behavior. Eating patterns - very rapid, eating until uncomfortably full. Often eat as a way of coping. Likely to be obese. High rates of depression and anxiety

Treating Eating Disorders Combination of psychotherapy and medical management Address both eating disorder, misuse of food and manage emotions Anorexia Nervosa Averting a medical crisis Adequate body weight Psychological aspects Bulimia Nervosa Stabilizing the eating patterns Identify and changing the patterns of thinking Improve coping skills 2006, JAMA study found: Topiramate (anti-seizure drug) helped with Bulimia Nervosa Binge-Eating Similar treatment protocol as Bulimia Nervosa Bulimia – begin with stabilizing eating patterns, then changing the patterns of thinking that led to the disorder Treatment combines medical management and psychological treatment, individually or on a group basis. Sometimes treatment may involve the entire family. Hospitalization may be required in the most severe cases.

Connect Assignment Chapter 11 Connect Assignment Due Tuesday, March 16th

Weight Management Chapter 11