1. Weight Management: Overweight, Obesity, and Underweight
Chapter 9

2. Overweight and Obesity
Major health problem in the U.S.
Prevalence continues to increase
Defined by BMI of 25 or greater
Epidemic is worldwide

3. Fat Cell Development Energy in exceeds energy out Body fat
Stored in fat cells of adipose tissue
Body fat
Number and size of fat cells
Energy out exceeds energy in
Fat cell size decreases; no change in number

4. Fat Cell Metabolism Lipoprotein lipase (LPL) activity
Storage of triglycerides
Obese people vs. lean people
Activity in varying body regions
Enzyme activity releasing and breaking down fat
Fat oxidation is not efficient

5. Causes of Overweight & Obesity – Genetics & Epigenetics
Causative role of genetics
Genetic influences do seem to be involved
Genetics may determine predisposition to obesity
Human genome
Obesity gene
Codes for the protein leptin
Locations of leptin secretion

6. Causes of Overweight & Obesity – Genetics & Epigenetics
Genetic deficiency of leptin or genetic mutation
Leptin resistance
Roles in the body
Energy regulation
Others

7. Causes of Overweight & Obesity – Genetics & Epigenetics
Adiponectin
Secreted by adipose tissue
Inverse correlation with body fat
Benefits
Ghrelin
Promotes positive energy balance
Inverse correlation with body weight
Roles in the body beyond energy regulation

8. Causes of Overweight & Obesity – Genetics & Epigenetics
PYY
GI cells secrete in proportion to kcalories consumed
Signals satiety and decreases food intake
Ideal diet
Maintain satiating hormones
Minimize appetite stimulating hormones
Low in fat and rich in fiber

10. Causes of Overweight & Obesity – Genetics & Epigenetics
Uncoupling proteins
Proteins involved in energy metabolism
Two types of fat
White adipose tissue
Brown adipose tissue
Uncoupling proteins found in both types of fat
Influence basal metabolic rate (BMR)

11. Causes of Overweight & Obesity – Environment
Encountered daily circumstances
Interaction between environment and genetics
Overeating
Present and past eating and activity patterns influence current body weight
Availability
Serving sizes
Physical inactivity
Life requires little exertion
Inactivity contributes to weight gain and poor health
DRI for prevention of weight gain

12. Problems of Overweight and Obesity – Health Risks
Three indicators
BMI
Waist circumference
Disease risk profile
Factors taken into account
Beneficial weight loss
Health status
Motivation

13. Problems of Overweight and Obesity – Health Risks
Overweight in good health
Sometimes health is not the motivation for weight loss
Obese or overweight with risk factors
Two or more risk factors
Obese or overweight with life-threatening condition
Recommendation to lose weight

14. Problems of Overweight and Obesity – Perceptions & Prejudices
Most obese people do not successfully lose weight and maintain the loss
Social consequences
Jobs, school, and in social situations
Psychological problems

15. Problems of Overweight and Obesity – Dangerous Interventions
Intervention dangers
Diet books and weight-loss programs
Little success with weight loss maintenance
Fad diets
Weight-loss products
Herbal products
Laws for dietary supplements
Other gimmicks

16. Aggressive Treatments for Obesity – Drugs
Strategies for weight reduction depend on:
Degree of obesity
Risk of disease
Use drugs as part of long-term comprehensive weight-loss programs
Assist with modest weight loss
Drugs approved by FDA for obesity
Sibutramine
Orlistat
Phentermine and diethylpropion
Other drugs

17. Aggressive Treatments for Obesity – Surgery
Clinically severe obesity
200,000 surgeries performed each year
Reduces food capacity of stomach
Effectively limits food intake
Reduce production of ghrelin
Health-related benefits
Long-term safety and effectiveness
Liposuction

19. Weight Loss Strategies
Successful strategies
Small changes
Moderate losses
Reasonable goals
Reasonable rate of weight loss
Benefits of modest weight loss
Incorporation of healthy eating and physical activity

20. Wt Loss Strategies – Eating Plans
Be realistic about energy intake
Provide less energy than is needed
Goal: nutritional adequacy without excess
Breakfast frequency
Nutritional adequacy
Minimum of 1200 kcalories a day
Eat small portions
Eat less food at each meal; structured meal replacement plans
Feel satisfied, not stuffed
Lower energy density

21. Wt Loss Strategies – Eating Plans
Remember water
Assistance with weight management
Focus on fiber
Low in energy and high in nutrients; require effort to eat
Choose fats sensibly
Energy density and satiation
Select carbohydrates carefully
Artificial sweeteners
Watch for empty kcalories
Fat, sugar, and alcohol

22. Wt Loss Strategies – Physical Activity
Best approach to weight management
Moderate physical activity plus activities of daily life
Combination of diet and physical activity
Lose more fat
Retain more muscle
Regain less weight
Reduction of abdominal fat

23. Wt Loss Strategies – Physical Activity
kCalorie expenditure
Body weight, intensity, and duration
Greater the energy deficit, greater the fat loss
Discretionary kcalorie allowance
Metabolism
Speeds up with activity
Immediate and long-term benefits

24. Wt Loss Strategies – Physical Activity

25. Wt Loss Strategies – Physical Activity
Body composition
Fat decreases and lean body mass increases
Strength-training exercises
Appetite control
Delayed appetite
Inappropriate appetite
Psychological benefits
Self-esteem
Choosing activities
Spot reducing

26. Wt Loss Strategies – Environmental Influences
Factors surrounding eating experience and the food itself
Atmosphere
Pleasant and comfortable equals more food
Accessibility
Less effort needed to obtain food, more food eaten
Socializing
Distractions

27. Wt Loss Strategies – Environmental Influences
Presence
Sight, smell, or thought of food can prompt eating
Multiple choice
Large assortments of foods increase consumption
Package and portion sizes
Serving containers

28. Weight Loss Strategies – Behavior & Attitude
Behavior modification
Positive, matter-of-fact attitude
Become aware of behaviors
Keep record
Change behaviors

29. Weight Loss Strategies – Behavior & Attitude
Cognitive skills
Problem solving
Cognitive restructuring
Personal attitude
Understand personal relationship with food
Sound emotional health
Support groups

30. Weight Loss Strategies – Weight Maintenance
Successful weight loss
Plateau
Prevalence of successful weight loss
Difficult to determine
Weight loss
Components of successful weight loss
Changes in metabolism
Takes more to prevent weight regain than to prevent weight gain

31. Preventing Weight Gain
Preventing weight gain would benefit many people
Strategies are similar to losing weight
Start earlier

32. Public Health Programs
Possibly change environment through public health law
Stretch beyond individual

33. Underweight Affects no more than 5% of U.S. adults
Weight gain is a matter of health
Weight gain may be difficult
Demand for energy contributes to underweight
Difficult to gain weight
Learn new habits and like new foods
Underweight vs. anorexia nervosa

34. Weight-Gain Strategies
Key diet planning strategies
Energy-dense foods
Exercise