1. Chapter 11
Weight management

2. 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

3. Figure 11-1 Obesity prevalence, by age and sex, of American adults3
Figure Obesity prevalence, by age and sex, of American adults
Figure 11.1 Prevalence of overweight and obesity among American adults age 20-74

4. 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

5. 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

6. Figure 1.2 The energy balance equation

7. 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

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

9. 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

10. Body Composition Measuring Techniques

11. 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 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

12. Figure 11.4 Diabetes mellitus

13. 4/21/2017

14. 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

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

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

17. Different Body Builds
ENDOMORPHY
MESOMORPHY
ECTOMORPHY

18. 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

19. 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

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

21. 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

22. 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

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

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

25. 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

26. Approaches to Overcoming a Weight Problem
Doing it yourself
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

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

28. 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.

29. 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.

30. 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 Gastrointestinal Surgery for Severe Obesity. NIH Publication No
Adjustable gastric banding Roux-en-Y gastric bypass
Source: National Institutes of Health

31. 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

32. 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.

33. 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

34. 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

35. 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

36. 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.

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

38. Weight Management
Chapter 11