2. Causes of Obesity Genetics: Influences eating behavior
Impacts body composition
Affects risk of obesity
Two to three times higher with family history of obesity
Interrelated with environment factors

3. Causes of Obesity (cont’d.)
Research involving proteins
Lipoprotein lipase (LPL) enzyme: higher level of activity in fat cells of obese people
Obesity (ob) gene: codes for the protein leptin
What is the role of leptin, and what is leptin resistance?
Ghrelin: stimulates appetite and promotes efficient energy storage

4. Causes of Obesity (cont’d.)
Fat cells in obese people compared to healthy-weight people
Higher number
Larger fat cells
What happens to the number and size of fat cells with weight loss?
Set-point theory
Body weight: physiologically regulated

5. Figure 7-1 Fat Cell Development
Fat cells are capable of increasing their size by 20-fold and their number by several thousandfold.

6. Causes of Obesity (cont’d.)
Environment
Readily available high-kcalorie foods
Large serving sizes
Energy dense foods
Psychological stimuli
What is the difference between hunger and appetite?
Food behavior: linked to emotional needs

7. Causes of Obesity (cont’d.)
Physical inactivity
Sedentary screen time
Technology
Physical activity displaced at home, at work, at school, and in transportation
Obstacles to physical activity and healthy foods
Aspects of the built environment
What are food deserts?

8. Causes of Obesity (cont’d.)
National Academies’ Institute of Medicine
National goals to counter obesity and improve the nation’s health
Make physical activity an integral and routine part of American life
Make healthy foods and beverages available
Advertise and market what matters for a healthy life
Activate employers and health-care professionals
Strengthen schools as the heart of health

9. Obesity Treatment: Who Should Lose?
Factors
Extent of overweight, age, health, genetics, etc.
Must weigh the benefits and risks of weight loss

10. Inappropriate Obesity Treatments
Over-the-counter (OTC) weight-loss products
Weight loss pills, powders, and other dietary supplements
Other gimmicks
Steam and sauna baths
Brushes, sponges, wraps, creams, and messages

11. Aggressive Treatments of Obesity
Obesity drugs
Beneficial with modest weight loss
As part of a long-term, comprehensive weight-loss program
Must consider risks of long-term use
FDA-approved drugs for weight loss (Table 7-1)

12. Aggressive Treatments of Obesity (cont’d.)
Surgery
Most effective treatment for clinically severe obesity (morbid obesity)
Types of procedures
Gastric bypass
Gastric banding
Laparoscopic weight-loss surgery
Significant, long-term weight loss; shortens recovery; and less invasive than open surgery

13. Reasonable Strategies for Weight Loss
Must integrate
Healthy eating patterns, physical activities, supportive environments, and psychosocial support
Successful strategies
Embrace small changes, moderate losses, and reasonable goals

14. Reasonable Strategies for Weight Loss (cont’d.)
Dietary Guidelines for Americans for weight loss
Consume fewer kcalories from foods and beverages
Increase physical activity
Reduce time spent in sedentary behaviors

15. Reasonable Strategies for Weight Loss (cont’d.)
Reasonable goals to reduce weight to lower disease risk
Reduce body weight by about 10 percent over half a year’s time
Maintain a lower body weight over the long term
At a minimum, prevent further weight gain

16. Reasonable Strategies for Weight Loss (cont’d.)
A healthful eating plan
Energy intake
Provides less energy than the person needs to maintain present body weight
Not too restrictive
Eating pattern for safely losing weight
Men: 1600 kcalories per day
Women: 1200 kcalories per day

17. Table 7-2 Daily Amounts from Each Food Group for 1200- to 1600-kCalorie Diets

18. Reasonable Strategies for Weight Loss (cont’d.)
A healthful eating plan
Breakfast is important
Frequency is inversely associated with obesity
Results in higher overall diet quality and lower daily energy density
Maintain nutritional adequacy
Consume a minimum of 1200 kcal per day

19. Reasonable Strategies for Weight Loss (cont’d.)
A healthful eating plan
Food selections
Fresh fruits and vegetables; low-fat milk products or substitutes; legumes; small amounts of lean meats, seafood, poultry, or meat alternatives; nuts; whole grains; and enough unsaturated oils to support health
Dietary supplement
Vitamins and minerals at or below 100 percent of the Daily Values

20. Reasonable Strategies for Weight Loss (cont’d.)
A healthful eating plan
Small portions
Foods with lower energy density
Fruits, vegetables, and broth-based soups
Limited intakes of added sugars and alcohol
Small, frequent meals
Adequate water

21. Figure 7-2 Energy Density
Selecting grapes with their high water content instead of raisins increases the volume and cuts the energy intake in half.
Even at the same weight and similar serving sizes, the fiber-rich broccoli delivers twice the fiber of the potatoes for about one-fourth the energy.
By selecting the water-packed tuna (on the right) instead of the oil-packed tuna, a person can enjoy the same amount for fewer kcalories.
Decreasing the energy density (kcal/g) of foods allows a person to eat satisfying portions while still reducing energy intake. To lower energy density, select foods high in water or fiber and low in fat.

22. Reasonable Strategies for Weight Loss (cont’d.)
Physical activity
Combined with energy restriction
More likely to lose more fat, retain more muscle, and regain less weight than diet alone
Physical Activity Guidelines for Americans, 2008 (Table 1-5 – Chapter 1)
Benefits
Reduces abdominal obesity, improves blood pressure, insulin resistance, etc.

23. Table 7-3 Physical Activity Strategies for Weight Management

24. Reasonable Strategies for Weight Loss (cont’d.)
Physical activity
Directly increases energy output
Energy spent on various activities (Table 6-2 – Chapter 6)
BMR
Elevated following physical activity
Rises as more lean tissue is added
Appetite control

25. Reasonable Strategies for Weight Loss (cont’d.)
Physical activity
Psychological benefits
Curbs emotional eating
Reduces stress
Improves self-esteem
What kind of physical activity is best for health?

26. Reasonable Strategies for Weight Loss (cont’d.)
Behavior and attitude
Behavior modification
Manipulating antecedents, the behavior itself, and consequences
Behavior awareness: keep a diary
Technology tools for tracking daily food and physical activity
Applications for smart phones
Social media sites

27. Figure 7-3 Food and Activity Diary
The entries in a food and activity diary should include the times and places of meals and snacks, the types and amounts of foods eaten, and a description of the individual’s feelings when eating. The diary should also record physical activities: the kind, the intensity level, the duration, and the person’s feelings about them.

28. Reasonable Strategies for Weight Loss (cont’d.)
Behavior and attitude
Focus on desired behaviors and eliminating unwanted behaviors
Set small time-specific goals
“How To” apply behavior modification to manage body fatness
Cognitive skills: “positive self-talk”

29. Reasonable Strategies for Weight Loss (cont’d.)
Behavior and attitude
Identify stressors
Learn to practice problem-solving skills
Weight maintenance
Long-term success behaviors
Believe in ability to control weight (self-efficacy), eat breakfast, stay physically active, monitor weight once per week, maintain lower-kcalorie eating patterns, etc.

30. Table 7-4 Weight-Loss Strategies

31. Strategies for Weight Gain
Underweight
Affects about two percent of U.S. adults
Physical activity
Focus on resistance training with increased energy intake
Energy-dense foods
Choose high-kcalorie items from each food group

32. Strategies for Weight Gain (cont’d.)
Consume at least three healthy meals daily
Large portions at each meal
Have extra snacks between meals
Increase kcalories with beverages
Juice and milk

33. Table 7-5 Weight-Gain Strategies