Weight Management

Energy Balance Equation Balance: energy intake = energy expenditure energy intake > energy expenditure = weight gain energy intake < energy expenditure = weight loss

Control of Food Intake Control Center is the hypothalamus hunger center satiety center

Resting Energy Expenditure metabolic requirements necessary to live, resting anything above is additional energy requirements

Most Effective For Weight Loss Caloric Restriction Most regain weight Exercise is less effective

Most Effective for Maintenance of Weight Loss Physical Activity began during caloric restriction

Caloric Restriction most common treatment of excess weight composition of diet is also important

Very Low Calorie Diets can be dangerous many people have died of cardiac arrest associated with serious cardiac arrhythmias loss of hair loss of lean body mass

thinning of skin coldness in the extremities gallbladder stones gout elevated cholesterol

Dehydration diuretics impermeable clothing weight loss is due to dehydration, not fat loss usually re-hydrate after the loss

Medical Procedures Prolonged fasting Bariatric bypass Lipectomy (liposection)

Drugs to control weight appetite suppressants thermogenic drugs Drugs Xenical (fat absorption in the gut) Meridia (brain chemistry) 7-10# more than if diet alone

Behavior Modification Focus on elimination of the behavior that is associated with poor eating and exercise habits 30% of participants maintain weight loss after one year and continue to lose

Exercise Single session of exercise will result in little fat loss Regular exercise training will lead to adaptations that increase utilization of fat

Exercise adaptations Begin to utilize fats earlier in the exercise bout Utilize more fats Females utilize fats more efficiently than males

Fat Metabolism and Gender Females are more efficient at storing fat Females store more fat Females may store more from a similar meal as fat than a male would

Fat Metabolism Adipocytes process and store lipids Produce a variety of hormones Lipoatrophy: reduced or absent fat deposits Insulin resistance Type II Diabetes

Leptin Hormone produced by adipose tissue Not just obesity, metabolic regulation of virtually all metabolic systems Mediator of energy balance Glucose and other substrates increase ATP production and stimulate leptin secretion Deplete energy stores inhibits leptin secretion

Leptin Con’t Starvation promotes increased energy intake decreased expenditure Increased lipogenesis Normal maturation Adequate stores for reproduction Increased nitric oxide (NO) Homeostasis of BP

What is the best intensity? What works for you will not burn more fat at low intensity (in total) than if you exercise at high or moderately high intensity 1 mile = ~100 kcal Whether you walk the mile or run the mile

Reasonable changes Should be small Should become part of your lifestyle 21 days to make a habit

Weight Loss Strategies Meal Planning Physical Activity Behavior Therapy Lifestyle Therapy Pharmacotherapy Weight Reduction Surgery Weight Maintenance Plan

Weight Maintenance is more important that a “diet” or weight loss Better long-term outcomes and long-term health