Weight Management: Overweight, Obesity, and Underweight

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Weight Management Overweight, Obesity, and
Underweight

• Chapter 9

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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

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Overweight and Obesity
BMI gt 25
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BMI gt 25
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.
Key
No Data
2024 2529 30
lt10 1014 1519
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BMI gt 25
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.
Key
No Data
2024 2529 30
lt10 1014 1519
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BMI gt 25
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.
Key
No Data
2024 2529 30
lt10 1014 1519
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BMI gt 25
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.
Key
2024 2529 30
No Data
lt10 1014 1519
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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

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Energy in gt Energy out
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Fat Cell Development
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
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Fat Cell Metabolism

• Lipoprotein lipase (LPL) stores triglycerides
• LPL activity in obese gt 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.

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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

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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

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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.
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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, RBCs, female fat reserves

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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

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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

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Proteins Regulating Appetite and Energy
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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)

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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

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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.
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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

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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

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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

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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

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Fig. 9-6, p. 285
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Problems of Overweight and Obesity Weight
Cycling
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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

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OTC
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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

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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 BMs, decreased
  absorption of fat-sol. vitamins

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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

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Diet Pills for sale online

• http//www.webmd.com/diet/guide/herbal-remedies
• http//www.thedietadvisors.com/adipozin.html
• http//www.weightlossdietpills.com/?gclidCJSlwpaC
  s6cCFQcBbAodkThW_w

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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.

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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-patien
  ts

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Surgical Treatments for Obesity

• http//www.lapband.com/en/home/
• http//www.webmd.com/diet/weight-loss-surgery/news
  /20110217/fda-oks-lap-band-surgery-for-more-patien
  ts
• 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

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Surgical Treatments for Obesity
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Esophagus
Surgical staples

Small stomach pouch
Esophagus
Small stomach pouch
Stomach
Duodenum
Gastric band
Jejunum
Stomach
Port
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.
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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

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Weight Loss Strategies
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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

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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.ht
  m

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Weight Loss Strategies Eating Plans
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Weight Loss Strategies Eating Plans

• 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

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Food Choices Slideshow

• http//www.webmd.com/diet/slideshow-fat-fighting-f
  oods

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Weight Loss Strategies Eating Plans

• Volumetrics
• Select carbohydrates carefully
• Artificial sweeteners
• Impact on energy intake
• Watch for empty/hidden kcalories
• Fat, sugar, and alcohol

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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

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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

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Weight Loss Strategies Physical Activity
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Energy allowance to maintain weight
2500 2000 1500 1000 500 0
Discretionary kcalorie allowance
kCalories
Energy intake to meet nutrient needs
Sedentary person
Active person
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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

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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

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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

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Weight Loss Strategies Environmental Influences

• Socializing
• Duration of meal
• Visual cues
• Distraction
• Distractions
• Initiating eating
• Interfering with internal controls
• Extending duration of eating

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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

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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

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Eating not for Hunger

• See Emotional Eating Handouts
• Internet full of tips

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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

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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

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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

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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.

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Public Health Programs

• Possibly change food environment through public
  health law
• Stretch beyond individual
• Social networks
• Community institutions
• Government policies

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Public Health Programs
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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

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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

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Weight-Gain Strategies

• Key diet planning strategies
• Adequacy and balance
• Energy-dense foods
• Regular meals daily
• Large portions
• Extra snacks
• Juice and milk
• Exercise

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Highlight 9

• The Latest and Greatest Weight-Loss Diet Again

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Fad Diets

• Outrageous claims
• No requirements to prove the claims
• Do not have to support with credible research
• Distorted research
• Numerous fad diet plans

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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

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Dont 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

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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