1. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.1 Chapter 15 Weight Management

2. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.2 Lesson 15.1 Chapter 15

3. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.3 Key Concepts Underlying causes of obesity include a host of various genetic, environmental, and psychological factors. Realistic weight management focuses on individual needs and health promotion, including meal pattern planning and regular physical activity.

4. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.4 Key Concepts, cont’d America’s obsession with thinness carries social, physiologic, and biologic costs.

5. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.5 Introduction America is getting heavier 66% of adults ages 20 to 74 years are overweight –Of this number, 32% meet criteria for obesity Center for Health Statistics reveals that 17% to 19% of children and adolescents are overweight

6. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.6 Overweight and obesity, by age: United States, 1960-2004

7. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.7 Obesity and Weight Control Body weight and body fat –Definitions –Body composition Measures of weight maintenance goals –Standard height/weight tables –Healthy weight range Individual variation Necessity of body fat

8. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.8 Obesity and Weight Control, cont’d Obesity and health –Weight extremes –Overweight and health problems Causes of obesity –Basic energy balance –Hormonal control Leptin Ghrelin –Genetic and family factors

9. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.9 Obesity and Weight Control, cont’d Genetic and family factors

10. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.10 Obesity and Weight Control, cont’d Individual differences and extreme practices –Individual energy balance levels –Extreme practices Fad diets –Scientific inaccuracies and misinformation –Failure to address the necessity of changing long-term habits

11. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.11 Obesity and Weight Control, cont’d Extreme practices, cont’d –Fasting –Specific macronutrient restrictions –Clothing and body wraps –Drugs Reduce energy intake by suppressing appetite Increase energy expenditure by stimulating basal metabolic rate Reduce the availability of nutrients to enter cells Alter lipogenesis and lipolysis

12. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.12 Obesity and Weight Control, cont’d Extreme practices, cont’d –Surgery Gastric restriction Malabsorptive procedures (e.g., gastric bypass) Lipectomy

13. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.13 Surgery

14. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.14 Surgery, cont’d

15. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.15 Surgery, cont’d

16. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.16 Sound Weight Management Program Essential characteristics Behavior modification –Basic principles –Basic strategies and actions Defining problem behavior Recording and analyzing baseline behavior Planning behavior management strategy

17. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.17 Sound Weight Management Program, cont’d Dietary principles –Energy (kilocalories) reduced according to need –Energy (kilocalorie) readjustment to maintain weight –Realistic goals –Nutritional adequacy –Cultural appeal

18. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.18 Lesson 15.2 Chapter 15

19. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.19 Key Concepts Short-term food patterns, or fads, often stem from food misinformation that appeals to some human psychological need but does not necessarily meet physiologic requirements.

20. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.20 Key Concepts, cont’d Realistic weight management focuses on individual needs and health promotion, including meal pattern planning and regular physical activity. America’s obsession with thinness carries social, physiologic, and biologic costs.

21. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.21 Sound Weight Management Program Basic energy balance components –Energy input: food behaviors –Energy output: exercise behaviors

22. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.22 Sound Weight Management Program, cont’d Principles of a sound food plan: – Energy balance – Nutrient balance – Distribution balance – Food guide – Preventive approach

23. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.23 Food Misinformation and Fads Types of claims –Food cures –Harmful foods –Food combinations –“Natural” foods

24. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.24 Food Misinformation and Fads, cont’d Erroneous claims Dangers Vulnerable groups –Elderly, young persons, obese persons, athletes and coaches, entertainers What is the answer?

25. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.25 Underweight General causes – Wasting disease – Poor food intake – Malabsorption – Hormonal imbalance – Energy imbalance – Poor living situation

26. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.26 Underweight, cont’d Dietary treatment –High-calorie diet –High protein –High carbohydrate –Moderate fat –Adequate sources of vitamins and minerals

27. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.27 Underweight, cont’d Disordered eating –Anorexia nervosa –Bulimia nervosa –Binge eating disorder –Treatment

28. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.28 Anorexia

29. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.29 Anorexia

30. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.30 Bulimia Nervosa and Binge Eating Disorder Definitions Warning signs Treatment

31. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.31 Summary America is getting bigger, with 66% of adults and 17% to 19% of children and adolescents being overweight. In the traditional medical model, obesity has been viewed as an illness and a health hazard, which is true in cases of clinically severe obesity.

32. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.32 Summary, cont’d A sound weight loss program is based on reduced energy intake for gradual weight loss and nutrient balance to meet health standards. The ideal plan begins with prevention, stressing the formation of positive food habits in early childhood to prevent major problems in later life.

33. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.33 Summary, cont’d Underlying causes of obesity include a host of various genetic and environmental factors. America’s obsession with thinness has created extreme weight management problems such as eating disorders (e.g., anorexia nervosa, bulimia nervosa).

34. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.34 Summary, cont’d Newer approaches view moderate overweight differently, however, in terms of the important aspect of fatness and leanness or body composition and propose a more person-centered positive health model