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

3. Overweight and Obesity  Major health problem in the U.S.  66% of Adults  33% of Children  Growing concern worldwide  Prevalence especially high among women, poor, blacks, and Hispanics  BMI of 25 or greater  Epidemic is worldwide  Not merely among industrialized countries

4. Overweight and Obesity BMI > 25

5. 1993: Most states had prevalence rates less than 15 percent, with a couple reporting rates less than 10 percent; no state had prevalence rates greater than or equal to 20 percent. <10% 10%–14% 15%–19% Key: No Data 20%–24% 25%–29% ≥ 30% BMI > 25

6. <10% 10%–14% 15%–19% Key: 20%–24% 25%–29% ≥ 30% No Data 1998: Most states had prevalence rates less than 20 percent, with none reporting rates less than 10 percent; seven states had prevalence rates greater than or equal to 20 percent. BMI > 25

7. <10% 10%–14% 15%–19% Key: 20%–24% 25%–29% ≥ 30% No Data 2003: More than half the states had prevalence rates greater than 20 percent, with four states reporting prevalence rates greater than or equal to 25 percent. BMI > 25

8. <10% 10%–14% 15%–19% Key: 20%–24% 25%–29% ≥ 30% No Data 2008: Only one state had prevalence rates less than 20 percent; more than half the states had prevalence rates greater than 25 percent, with six states reporting prevalence rates greater than or equal to 30 percent. BMI > 25

9. Fat Cell Development  Energy in exceeds energy out  Body fat stored in cells of adipose tissue  Number and size of fat cells  Late childhood/early puberty fat cell numbers increase  Fat deposited in organs- inflammation, insulin resistance  Energy out exceeds energy in  Fat cell size decreases; no change in number

10. Energy in > Energy out

11. During growth, fat cells increase in number. When energy intake exceeds expenditure, fat cells increase in size. When fat cells have enlarged and energy intake continues to exceed energy expenditure, fat cells increase in number again. With fat loss, the size of the fat cells shrinks but not the number. Stepped Art Fat Cell Development

12. Fat Cell Metabolism  Lipoprotein lipase (LPL) stores triglycerides  LPL activity in obese > than lean people  Men- abdomen  Women- breasts, hips, thighs  Hormone-sensitive lipase (HSL) releases and breaks down triglycerides  Weight regain: After wt. loss, LPL production increases. Fat oxidation is less efficient than fat storage.

13. Causes of Overweight & Obesity – Genetics & Epigenetics  Causative role of genetics  Genetic influences do seem to be involved  Genetics may determine predisposition to obesity  Genes interact with:  Diet and physical activity  Satiety and energy balance  Human genome

14. Causes of Overweight & Obesity – Genetics & Epigenetics  Obesity gene  Codes for the protein leptin  Acts as a hormone in hypothalamus  Promotes negative energy balance  Suppresses appetite  Increases energy expenditure  Locations of leptin secretion

15. With leptin treatment, this mouse lost a significant amount of weight but still weighs almost one and a half times as much as a normal mouse. Without leptin, this mouse weighs almost three times as much as a normal mouse.

16. Causes of Overweight & Obesity – Genetics & Epigenetics  Obesity gene that codes for leptin- protein that suppresses appetite  Genetic deficiency of leptin or genetic mutation- rare in obese people  Leptin resistance  Leptin rises with BMI, declines with dieting  Roles in the body  Energy regulation  Immune system, RBC’s, female fat reserves

17. Causes of Overweight & Obesity – Genetics & Epigenetics  Adiponectin  Secreted by adipose tissue  Inverse correlation with body fat  Inhibits insulin resistance, inflammation, CHD  Ghrelin  Acts in hypothalamus, secreted by stomach  Promotes positive energy balance  Inverse correlation with body weight

18. 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-leptin, PYY, CCK  Minimize appetite stimulating hormone ghrelin  Low in fat and rich in fiber

19. Proteins Regulating Appetite and Energy Proteins Regulating Appetite and Energy

20. 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)

21. 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  Restaurant food

22. 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 (on the left), a person can enjoy the same amount for fewer kcalories.

24. Causes of Overweight & Obesity – Environment  Physical inactivity  Life requires little exertion  Modern technology  Inactivity contributes to weight gain and poor health  Sedentary activities and weight gain  DRI for prevention of weight gain  60 minutes of moderate activity every day

26. 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

27. Problems of Overweight and Obesity – Health Risks  Overweight but in good health  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

28. 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  Embarrassment  Other feelings

29. Fig. 9-6, p. 285

30. Problems of Overweight and Obesity – Weight Cycling

31. Problems of Overweight and Obesity – Popular Interventions  Diet books and weight-loss programs  Limited success with weight loss maintenance  Fad diets- cabbage soup, shakes only  Weight-loss products  Meal replacements  Herbal products  No regulations for dietary supplements  Liposuction

32. OTC

33. Drug Treatments for Obesity  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  Four drugs approved by FDA for obesity

34. Drug Treatments for Obesity  Sibutramine  Suppresses appetite  Side effects- dry mouth, rapid heart rate, etc  Warning from FDA  Orlistat  Inhibits pancreatic lipase activity in GI tract  Blocks dietary fat digestion and absorption  Side effects- gas, frequent BM’s, decreased absorption of fat-sol. vitamins

35. Drug Treatments for Obesity  Phentermine and diethylpropion  Enhance release of neurotransmitter norepinephrine  Mood high, appetite low  Side effects- hyperactivity, insomnia  Off-label use, “Stacking”  Sudafed (pseudoephedrine)  Claritin  Benadryl

36. Diet Pills for sale online  http://www.webmd.com/diet/guide/herbal- remedies http://www.webmd.com/diet/guide/herbal- remedies  http://www.thedietadvisors.com/adipozin.ht ml http://www.thedietadvisors.com/adipozin.ht ml  http://www.weightlossdietpills.com/?gclid=C JSlwpaCs6cCFQcBbAodkThW_w http://www.weightlossdietpills.com/?gclid=C JSlwpaCs6cCFQcBbAodkThW_w

37. How Appetite Suppressants Cause Weight Loss  They are STIMULANTS (caffeine, ephedra, phentermine, chemicals that act like cocaine)  Appetite suppressants promote weight loss by tricking the body into believing that it is not hungry or that stomach is full.  They decrease appetite by increasing serotonin or catecholamine -- two brain chemicals that affect mood and appetite.

38. Prescription Weight Loss Drugs/Surgery Indications  An option for the following individuals:  People with a body mass index(BMI) of 30 and above with no obesity-related conditions.  A person with a BMI of 27 and above with obesity-related conditions, such as diabetes or high blood pressure.  http://www.webmd.com/diet/weight-loss- surgery/news/20110217/fda-oks-lap-band- surgery-for-more-patients http://www.webmd.com/diet/weight-loss- surgery/news/20110217/fda-oks-lap-band- surgery-for-more-patients

39. Surgical Treatments for Obesity  http://www.lapband.com/en/home/ http://www.lapband.com/en/home/  http://www.webmd.com/diet/weight-loss- surgery/news/20110217/fda-oks-lap-band- surgery-for-more-patients http://www.webmd.com/diet/weight-loss- surgery/news/20110217/fda-oks-lap-band- surgery-for-more-patients  Clinically severe obesity  200,000 surgeries performed each year  Reduces food capacity of stomach  Reduce production of ghrelin  Health-related benefits  Long-term safety and effectiveness

40. Surgical Treatments for Obesity

41. Esophagus Surgical staples Small stomach pouch Stomach Esophagus Duodenum Gastric band Jejunum StomachPort Large intestine In gastric bypass, the surgeon constructs a small stomach pouch and creates an outlet directly to the small intestine, bypassing most of the stomach, the entire duodenum, and some of the jejunum. (Dark areas highlight the flow of food through the GI tract; pale areas indicate bypassed sections.) In gastric banding, the surgeon uses a gastric band to reduce the opening from the esophagus to the stomach. The size of the opening can be adjusted by inflating or deflating the band by way of a port placed in the abdomen just beneath the skin. Small stomach pouch

42. Weight Loss Strategies  Successful strategies  Find individual rate of change  Moderate losses  Reasonable short-term / long-term goal weight  Reasonable rate of weight loss  Benefits of modest weight loss  Incorporate healthy eating and exercise

43. Weight Loss Strategies

44. Weight Loss Strategies – Eating Plans  Be realistic about energy intake  Must provide less energy than is needed  Avoid restrictive eating  Avoid rapid weight loss  Goal: nutritional adequacy without excess  Deficit of 500 to 1000 kcalories per day  Breakfast frequency  Inversely related to obesity

45. Weight Loss Strategies Eating Plans  Nutritional adequacy minimum ~1200 kcal/d  Eat small portions  Eat less food at each meal  Feel satisfied, not stuffed  Structured meal replacement plans  Lower energy density  Mind control http://www.webmd.com/diet/default.htm http://www.webmd.com/diet/default.htm

46. Weight Loss Strategies – Eating Plans

47.  Remember water  Assistance with weight management  Focus on fiber  Low in energy and high in nutrients  Require effort to eat  Speed of food consumption  Choose fats sensibly  Energy density and satiation

48. Food Choices Slideshow  http://www.webmd.com/diet/slideshow-fat- fighting-foods http://www.webmd.com/diet/slideshow-fat- fighting-foods

50. Weight Loss Strategies – Eating Plans  Volumetrics  Select carbohydrates carefully  Artificial sweeteners  Impact on energy intake  Watch for empty/hidden kcalories  Fat, sugar, and alcohol

51. Weight Loss Strategies Physical Activity  Necessary for 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

52. Weight Loss Strategies Physical Activity  kCalorie expenditure  Body weight, intensity, and duration  Greater the energy deficit, greater the fat loss  Discretionary kcalorie allowance (reward)  Metabolism  Speeds up with activity  Immediate and long-term benefits

53. Weight Loss Strategies – Physical Activity

54. Energy allowance to maintain weight Discretionary kcalorie allowance Energy intake to meet nutrient needs Sedentary personActive person kCalories 2500 2000 1500 1000 500 0

55. Weight Loss Strategies Physical Activity  Body composition  Fat decreases, esp. abdominal fat  Lean body mass increases  Strength-training exercises  Appetite control  Delayed appetite from released stored fuel  Exercise curbs appetite from boredom, anxiety, depression

56. Weight Loss Strategies Physical Activity  Psychological benefits  Self-esteem  Choosing activities  Ones you enjoy & are willing to do regularly  Convenience  Energy-expending daily activities  Spot reducing vs. strength training

57. Weight 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

58. Weight Loss Strategies – Environmental Influences  Socializing  Duration of meal  Visual cues  Distraction  Distractions  Initiating eating  Interfering with internal controls  Extending duration of eating

59. Weight 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

62. Weight Loss Strategies – Behavior & Attitude  Behavior modification  Positive, matter-of-fact attitude  Become aware of behaviors  Keep record  Change behaviors  Set small, specific goals  Practice, make new habits  Reward

63. Eating not for Hunger  See Emotional Eating Handouts  Internet full of tips

64. Weight Loss Strategies – Behavior & Attitude  Cognitive skills  Problem solving  Cognitive restructuring  Replace negative thoughts  Personal attitude  Understand personal relationship with food  Sound emotional health  Support groups- WW, TOPS, OA

65. Weight Loss Strategies – Weight Maintenance  Successful weight loss  Plateau  Appropriate goal at this point  Prevalence of successful weight loss  Difficult to determine  Weight loss  Without formal program  Maintained for at least a year

66. Weight Loss Strategies – Weight Maintenance  Components of successful weight loss  Vigorous exercise regimens  Careful eating patterns  Frequent self-monitoring  Changes in metabolism  Takes more to prevent weight regain than to prevent weight gain

67. Preventing Weight Gain/Regain  Strategies are similar to losing weight  Read labels  Watch portion size  Change your grocery list  Eat out less  Ask yourself, “Am I hungry?”  Exercise daily: Walk/bike more. Drive less. Plant a garden.

68. Public Health Programs  Possibly change food environment through public health law  Stretch beyond individual  Social networks  Community institutions  Government policies

69. Public Health Programs

70. Underweight  Affects no more than 5% of U.S. adults  Weight gain is a matter of health  Individual matter  Weight gain may be difficult  Physical conditioning combined with high energy intakes

71. Problems of Underweight  Demand for energy contributes to underweight  Physical activity  Growth and development  Difficult to gain weight  Adaptive thermogenesis  Learn new habits and like new foods  Underweight vs. anorexia nervosa

72. Weight-Gain Strategies  Key diet planning strategies  Adequacy and balance  Energy-dense foods  Regular meals daily  Large portions  Extra snacks  Juice and milk  Exercise

73. Highlight 9 The Latest and Greatest Weight- Loss Diet – Again

74. Fad Diets  Outrageous claims  No requirements to prove the claims  Do not have to support with credible research  Distorted research  Numerous fad diet plans

76. Fad Diets’ Appeal  Market for weight-loss products is huge  Greatest appeal  Tend to ignore dietary recommendations  Sophisticated and often erroneous explanations  Too much rat data  Tend to work for short time  Fail to produce long-lasting results

77. “Don’t Count Calories?!”  Claim to disregard kcalories  Designed to have low energy intake  Tend to lack variety  Monotonous  Often recommend dietary supplement  Follow a plan  Most fad diets cannot support optimal health over time

78. Dieting vs. Living Healthy  Fad diet “magical powers”  Tipping the energy balance equation to greater energy expenditure  Weight loss  Long-term lifestyle changes  Healthy plan  Flexibility and variety