1. Chapter 11
Weight management

2. Weight Management National Institute of Health (NIH) statistics:
68.8% of American adults are overweight
35.5% of adult men and 35.8% of adult women are obese

3. Weight of Americans Aged 20 and Older, 2009–2010
GROUP
PERCENT OVERWEIGHT
PERCENT OBESE
Both sexes
68.8
35.7
All races, male
74.1
35.5
All races, female
64.5
35.8
White, male
74.0
36.2
White, female
59.5
32.2
African American, male
69.9
38.8
African American, female
82.1
58.5
Latino, male
81.7
37.0
Latino, female
75.7
41.4

4. Basic Concepts of Weight Management
Energy balance
Energy in = energy out: maintain current weight
To change weight, the balance must be tipped
Positive energy balance (consume more calories than used/burned
Negative energy balance (consume less calories than used/burned

5. Body Composition and Its Importance (1)
Fat-free mass and body fat
Fat-free mass: non-fat tissues
Body fat includes:
Essential fat
Fat stored in fat cells (adipose tissue)
Fat located in subcutaneous fat (under the skin) and around major organs (visceral fat)
Percent body fat: the proportion of the body’s total weight that is fat

6. Body Composition and Its Importance (2)
Skinfold measurement (Skinfold Caliper)
Bioelectrical impedance analysis (BIA) (Signal travels from electrodes )
Hydrostatic weighing (underwater weighing)
The Bod Pod (measures lung volume)
Scanning procedures
CT scan (Computerized tomography; X-ray)
MRI (Magnetic Resonance Imaging; radio waves)
Dual-energy X-ray absorptiometry (DEXA) (Bone density scan)
Dual-photon absorptiometry (Measures bone minerals)

7. Determining Body Mass Index (1)
Body mass index (BMI)
Measures the health risks of body weight for average people
Correlated with but does not directly measure body fat
BMI = Bodyweight in kilograms (2.20) divided by height in meters (.30=foot; inches | 12) squared OR
Weight in pounds divided by height in inches squared, multiplied by 703 (conversion factor)

8. Determining Body Mass Index (2)
Body mass index (BMI) continued
Between 18.5 and 24.9 is healthy
Greater than 25 is overweight
Greater than 30 is obese
Under 18.5 is classified as underweight
Under 17.5 is sometimes used as a diagnostic criterion for anorexia nervosa
BMI is not helpful for determining body composition because it does not distinguish between fat weight and fat-free weight

9. Determining Body Fat Distribution
Waist circumference; and waist-to-hip ratio
Apple shape: android obesity
Upper regions of the body, particularly abdomen
Negative influence on cardiovascular health
Pear shape: gynoid obesity
Fat
Storage in the hips, buttocks, and thighs

10. Factors Contributing to Excess Body Fat (1)
Genetic factors
Genetics contribute to 25–40% of an individual’s body fat, but environment is still important
“Set point” theory
Physiological factors
Metabolism
Resting metabolic rate (RMR)
Hormones
Fat cells

11. Factors Contributing to Excess Body Fat (2)
Lifestyle factors
Eating habits; physical activity
The “obesogenic” environment
Psychosocial factors
Food as a means of coping with stress and negative emotions
Obesity is strongly associated with socioeconomic status
Foods within your family and culture

12. Excess Body Fat and Wellness
Obese individuals have a mortality rate twice that of the non-obese
Life expectancy reduced by 10–20 years
Obesity is associated with a number of chronic conditions
Diabetes, heart disease, others
It is also associated with a decreased quality of life—modest weight loss results in psychological improvements

13. Diabetes Diabetes mellitus Type 1 is not related to obesity
The immune system destroys insulin-producing cells in the pancreas
Type 2 is strongly associated with excess body fat
The pancreas does not produce enough insulin, body cells have become resistant, or both
Gestational diabetes
Prediabetes

14. Heart Disease and Other Chronic Conditions
Overweight and obesity are risk factors for:
Heart disease
Hypertension (HBP)
Unhealthy levels of cholesterol and triglycerides (store fat that your body can use for energy)
Impaired heart function
Metabolic syndrome
Group of risk factors
High blood pressure, high blood sugar, unhealthy cholesterol levels, and abdominal fat

15. Adopting a Healthy Lifestyle for Successful Weight Management (1)
Diet and eating habits
Energy balance
MyPlate suggestions
Combine exercise with moderate calorie restriction
Pay attention to portion size
Replace energy-dense foods with nutrient-dense foods
Eat regular, balanced meals

16. Adopting a Healthy Lifestyle for Successful Weight Management (2)
Physical activity and exercise
Burns calories
Positive effects on metabolism
Increased muscle mass
Improves cardiovascular (heart) and respiratory (Nasal cavity, nose, pharynx, larynx, trachea, bronchii and lungs) health
Enhances mood, sleep, self-esteem, and one’s sense of accomplishment

17. Adopting a Healthy Lifestyle for Successful Weight Management (3)
Thinking and emotions
Weight problems are associated with low self-esteem and negative emotions
The “ideal self”
Self-talk can be self-deprecating or positively motivating
Coping strategies
Develop appropriate coping strategies to deal with the stresses of life

18. Approaches to Overcoming a Weight Problem (1)
Doing it yourself
Loss of 0.5–2.0 pounds per week recommended
Initial weight loss is from fluids
Very low calorie diets should be avoided
Diet supplements and diet aids
Formula drinks and food bars, herbal supplements, and others: claims are often false

19. Approaches to Overcoming a Weight Problem (2)
Weight loss programs
Noncommercial: TOPS (Take Off Pounds Sensibly); OA (Overeaters Anonymous)
Commercial: Weight Watchers
Commitment and a plan for maintenance are important
Online
Clinical: medically supervised

20. Approaches to Overcoming a Weight Problem (3)
Prescription drugs
Appetite suppressants
All have potential side effects
Work best in conjunction with behavior modification
Once drugs are stopped, most individuals return to their original heavy weight
A good option for the very obese who need help getting started

21. Approaches to Overcoming a Weight Problem (4)
Surgery
Severe obesity is a medical condition
Often complicated by other health problems
Bariatric surgery
Modifies gastrointestinal tract
Key to weight-loss surgery success
Adequate follow-up
Continued motivation

22. Problems Associated with Very Low Levels of Body Fat
Low levels of body fat are a threat to wellness
Female athlete triad:
Abnormal eating patterns (and excessive exercising)
Amenorrhea (absence of menstruation)
Decreased bone density

23. Body Image
The collective picture of the body as seen through the mind’s eye
Perceptions, images, thoughts, attitudes, and emotions
Severe body image problems:
Body dysmorphic disorder (BDD)
Constant preoccupation with body imperfections
Related to obsessive-compulsive disorder
Muscle dysmorphia

24. Eating Disorders
Psychological disorders, characterized by severe disturbances in body image, eating patterns, and eating-related behaviors
Types:
Anorexia (self-starvation and excessive weight loss)
Bulimia (binging —or excessive overeating—followed by purging)
Binge-eating disorder

25. Anorexia Nervosa (1)
Failure to eat enough food to maintain a reasonable body weight
Characteristics:
Fear of gaining weight or becoming fat
Distorted self-image
Compulsive behaviors and rituals
Excessive exercise

26. Anorexia Nervosa (2) Health risks of anorexia nervosa: Amenorrhea
Cold intolerance
Low blood pressure and heart rate
Dry skin, and swelling of the hands and feet
Depression and suicide
Medical complications
Disorders of the cardiovascular, gastrointestinal, endocrine (glands of an organism that secrete hormones) and skeletal systems

27. Bulimia Nervosa (1)
Recurring episodes of binge eating followed by purging
Characteristics:
Rapid consumption of food, followed by purging
Eating in secret
After a binge, feeling ashamed, disgusted, and physically and emotional drained

28. Bulimia Nervosa (2) Health risks of bulimia nervosa:
Eroded tooth enamel
Deficient calorie intake
Liver and kidney damage
Cardiac arrhythmia
Chronic hoarseness
Esophageal tearing
Rupture of the stomach
Menstrual problems
Depression

29. Binge-Eating Disorder
Uncontrollable eating followed by feelings of guilt and shame about weight gain
Characterized by very rapid eating, eating until uncomfortably full, eating when not hungry, and preferring to eat alone
Often, eating is a way of coping
Likely to be obese
High rates of depression and anxiety

30. Borderline Disordered Eating
Symptoms of an eating disorder, but the individual does not meet the full diagnostic criteria
Excessive dieting
Occasional binging and purging
Inability to control eating

31. Treating Eating Disorders
Must address eating behaviors and misuse of food to manage stress and emotions
Psychotherapy and medical management
Anorexia nervosa: averting a medical crisis
Adequate body weight; psychological aspects
Bulimia nervosa and binge-eating disorder: stabilizing the eating patterns
Identifying and changing the patterns of thinking
Improving coping skills

32. What Is the Right Weight for You?
Acceptance and change
Focus on living a healthy lifestyle not on the scale
Know when the limits to healthy change have been reached