Weight Management: Overweight, Obesity, & Underweight

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Weight Management Overweight, Obesity,
Underweight
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Overweight

• Overweight (BMI 25-29.9) and obesity ( 30) are
  widespread health problems that are continuing to
  increase.
• Many refer to overweight and obesity as an
  epidemic.
• For good health, weight management is important.

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Overweight

• Fat Cell Development
• Fat cell numbers
• Fat cell numbers increase most rapidly in later
  childhood and early puberty.
• Fat cell numbers increase in times of positive
  energy balance.
• Hyperplastic obesity

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During growth, fat cells increase in number.
Hyper-plastic
When energy intake exceeds expenditure, fat cells
increase in size. Hypertro- phic
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
Fig. 9-2, p. 283
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Overweight

• Fat Cell Development
• Fat cell size
• Fat cell sizes increase when energy intake
  exceeds expenditure.
• Hypertrophic obesity
• The adverse effects of fat in non-adipose tissue
  are called lipotoxicity.

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Overweight

• Fat Cell Metabolism
• Lipoprotein lipase promotes fat storage.
• Gender differences
• Men are at increased risk for developing central
  obesity and women are at increased risk for lower
  body fat.

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Overweight

• Set-Point Theory
• The bodys natural regulatory centers maintain
  homeostasis at set point.
• The human body tends to maintain a certain weight.

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Causes of Obesity

• Obesity may not be as simple as food intake
  exceeding metabolic needs.
• Some factors, such as overeating and inactivity,
  are within our control.
• Genetic, hormonal and emotional factors may
  require professional intervention.

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Causes of Obesity

• Genetics
• Leptin (also called the ob protein)
• Protein that acts as a hormone to increase energy
  expenditure and decrease appetite
• Produced by fat cells under the direction of the
  ob gene
• May be deficient in obese individuals
• More research is needed.

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• I'm in shape.
• Round is a shape.

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Causes of Obesity

• Environment The gene pool of our population
  remains relatively unchanged.
• Overeating
• Present and past eating influences current body
  weight.
• Increased availability of convenient food, large
  portions, and energy-dense foods
• Physical Inactivity
• Modern technology replaces physical activities.
• Physical activity is important to allow people to
  eat enough food to get needed nutrients.

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Buy a lot of McDonalds food and get a big,
fat ass, absolutely free.
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Causes of Obesity

• Environment The gene pool of our population
  remains relatively unchanged.
• Overeating
• Present and past eating influences current body
  weight.
• Increased availability of convenient food, large
  portions, and energy-dense foods
• Physical Inactivity
• Modern technology replaces physical activities.
• Physical activity is important to allow people to
  eat enough food to get needed nutrients.

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. LAZINESS IS NOT A HANDICAP .
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Obesity Risk Factors

• Genetics
• Family history of obesity
• Psychological factors
• Social and cultural factors
• Medical Illnesses
• Medications
• Alcohol consumption
• Smoking Cessation

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Problems with Obesity

• Obesity problems depend on many factors such as
  the extent of overweight, age, health status and
  genetic makeup.
• Risk factors may differ among individuals.

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Makes a point about a topic
Lets just say you weigh too much and the less
said about your future the better

• Give a man a fish and
• he will eat for a day.
•    Teach him how to fish, and
• he will sit in a boat and
• drink beer all day.

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Problems with Obesity

• Health Risks
• Obese or overweight people with the following
  life-threatening-conditions may improve health by
  losing weight
• Heart disease
• Type 2 diabetes
• Sleep apnea

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Problems with Obesity

• Perceptions and Prejudices
• Social Consequences
• Prejudices and discrimination
• Judged on appearance rather than character
• Stereotyped as lazy and lacking self-control
• Psychological Problems
• Feelings of rejection, shame and depression are
  common.
• Ineffective treatments can lead to a sense of
  failure.

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Stepped Art
Fig. 9-4, p. 289
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Problems with Obesity

• Dangerous Interventions
• Fad Diets
• False theories
• Inadequate diets
• Can be a danger to health

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Treatment Modalities

• Diet (proper Healthy nutrition)
• Exercise
• Behavior therapy/modification/change
• Pharmacotherapy
• Surgery

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Treatment Modalities

• Diet vs proper nutrition
• Exercise
• Behavior therapy/modification/change
• Pharmacotherapy
• Surgery

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Dieting and Dollars

• Dieting? Today 40 of women, 25 of men
• Nationwide, 55 trying to maintain current
  weight.
• Approximately 45 million Americans diet each
  year.
• 80 of adult women have dieted
• 40 billion annually trying to lose weight or
  maintain weight.
• 1 to 2 billion on weight lose programs.

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WHO EVER INVENTED DIETS SHOULD BE TAKEN OUT AND
SHOT!
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Types of Weight Loss Diets

• Low Carbohydrate aka High Protein
• Low Fat aka High Carbohydrate
• Very Low Calorie aka Modified Fast
• Novelty Diets
• Weight Loss Programs

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Why Weight Loss Programs Do Not Work

• Negative Impact
• Temporary
• Perfect- Orientation
• Project Mentality
• Do not Address Cause

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Consequences of Dieting

• Decrease in rate of weight loss
• Loss of lean tissue with fat loss
• Decrease in metabolism, 10-40
• Decrease in Protein turnover
• Preoccupation with food
• Increase in irritability, moodiness
• Tires easier, less physical activity
• Apathy, depression

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Re-feeding after Weight Loss

• Increase in pre-dieting food intake
• Preference for high fat foods
• Regain in weight, but greater increase in BF
• Metabolism slow to return to normal
• Regain Weight quicker with each diet
• Increase in abdominal fat deposits
• Less likely to return to pre-diet physical
  activity
• Decrease in self-efficacy/esteem

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Recognizing an Unsound Diet

• Promotes Quick Weight Loss
• Limits Food Selection
• Testimonials or Famous People/Places
• Expensive Supplements or Products
• No Attempt to Permanently change eating or
• physical activity
• Critical of Scientific Community
• They know more, or something new

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Characteristics of a Sound Diet

• Nutritionally adequate yet low in calories
• Fit into current lifestyle
• Foods that are liked
• Slow rate of weight loss
• Followed for life

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Predicting Weight Loss

• Positive Affirmations
• Strong Motivation
• Supportive Environment
• Appropriate Behaviors
• Changes in Body Shape

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Predicting Weight Loss

• Positive Affirmations
• Self esteem
• Self confidence/efficacy
• Good attitude
• Positive outlook

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Predicting Weight Loss

• Strong Motivation
• Desire or want
• Belief it is possible
• Commitment to doing it
• Positive attitude
• Persistence

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Predicting Weight Loss

• Supportive Environment
• Family and friends
• Support group or organization
• Professional

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Predicting Weight Loss

• Appropriate Behaviors
• Healthy eating
• Exercise that produces goal
• Changing problem behaviors

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Predicting Weight Loss

• Changes in Body Shape
• Body Composition changes
• Circumference changes
• Looks better, Cloths fit better, etc.

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Predicting Weight Loss

• Positive Affirmations
• Strong Motivation
• Supportive Environment
• Appropriate Behaviors
• Changes in Body Shape

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• I was going to buy the book THE POWER OF
  POSITIVE THINKING and then I thought what the
  hell good would that do!

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Treatment Modalities

• Diet proper Healthy nutrition
• Exercise
• Behavior therapy/modification/change
• Pharmacotherapy
• Surgery

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I see no reason why you should not engage in
strenuous activity
Well keep looking, keep looking!

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Exercise

• In response to the question whether diet plus
  exercise is more effective than diet alone in
  causing weight loss, the conclusion of the
  consensus panel was as follows "---
• in most studies exercise does not significantly
  increase initial weight loss over and above that
  obtained with diet only. However, in almost all
  studies the diet plus exercise group lost
  somewhat more weight than the diet alone
  condition."

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THE 100 METER MOSEY
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Exercise
100
FAT
of calories expended
Carbohydrate
0
5
10
20
Time minutes
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Three more, two more, one more, okay!...Five
million leg lifts right leg first! Ready
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Exercise

• Two short sessions/day or one long session?
  

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Exercise

• Two short sessions/day or one long session?
  
• Yes!

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Exercise

• Two short sessions/day or one long session?
  
• Yes!
• Mode Walking, Daily Activity
• Frequency 5 - 7 times / week
• Duration 40-60 minutes
• 20-30 minutes X 2
• Intensity Moderately

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• My mother started walking five miles a day when
  she was 60. 
• She's 77 now and I have no idea where she is.

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Treatment Modalities

• Diet proper nutrition
• Exercise
• Behavior therapy modification/change
• Pharmacotherapy
• Surgery

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To make a long story short, what ever you are
doingSTOP IT!



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Behavior therapy

• Behavior modificationTo lose weight and keep it
  off, you need to make changes in your lifestyle.
  But there's more to changing your lifestyle than
  choosing different foods and putting more
  activity into your day. It also involves changing
  your approach to eating and activity, which means
  changing how you think, feel and act.

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Behavior therapy

• A behavior modification program can help make
  lifestyle changes
• Behavior modification programs may include
  examining current habits to find out what factors
  or situations may have contributed to excess
  weight.
• Exploring current eating and exercise habits
  gives a place to start when changing behaviors.

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Behavior therapy

• First identify those that are a problem
• Choose those that you are willing to change
• Take responsible for your behavior
• Have a plan to make better choices
• Remember the benefit
• Focus on the positive

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Behavior therapy

• Have a plan. People do NOT plan to fail, they
  simply fail to plan!
• Work out a strategy that will gradually change
  habits and attitudes.
• Consider how often and how long to exercise.
• Determine a realistic eating plan that includes
  plenty of water, fruits and vegetables.
• Write it down and choose a start date.

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Behavior therapy

• Set realistic goals.
• Weight-loss goals can be process goals, such as
  exercising regularly, or outcome goals, such as
  losing 20 pounds in four months.
• Make sure process goals are realistic, specific
  and measurable. For example, you'll walk for 30
  minutes a day, five days a week.
• For outcome goals, aim to lose weight at a safe
  pace of 0.5 or 2 pounds a week. Losing weight
  more rapidly means losing water weight or muscle
  tissue, rather than fat.

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Behavior therapy

• Avoid food triggers. (Cues)
• Distract from the desire to eat with something
  positive, such as calling a friend, taking a
  walk, reading a book (not a recipe book).
• Practice saying No to unhealthy foods and big
  portions.
• Eat when actually hungry not when the clock
  says it's time to eat.

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This is my relaxation tape its the sound of
ocean waves crashing onto the shore, snatching
my teachers body off his beach chair and
carrying him out to sea.

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Treatments of Obesity

• Individuals with clinically severe obesity and
  major medical problems may benefit from drugs or
  bariatric surgery.
• But changing and improving eating and exercise
  habits offer the greatest benefit.

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Treatment Modalities

• Diet proper nutrition
• Exercise
• Behavior therapy modification/change
• Pharmacotherapy
• Surgery

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Problems with Obesity

• Dangerous Interventions
• Weight-Loss Products
• Ephedrine-containing products inhibit serotonin
  and suppress the appetite. Supplements containing
  Ephedra have been banned by the FDA due to
  potential health risks.
• Herbal laxatives do not prevent absorption.
• Current laws do not require safety tests and
  effectiveness tests for these products.

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To help you lose weight, take one aspirin every
day. Take it for a jog, then take it to the
gym, then take it for a bike ride

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Treatments of Obesity

• Drugs
• Sibutramine suppresses the appetite and is most
  effective when used with a reduced kcalorie diet
  and increased physical activity. There are many
  side effects.
• Orlistat blocks fat digestion and absorption.
  There are many side effects including anal
  leakage.

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Treatment Modalities

• Diet proper nutrition
• Exercise
• Behavior therapy modification/change
• Pharmacotherapy
• Surgery

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Treatments of Obesity

• Surgery
• Surgery is an option for those who have tried
  weight loss programs and failed, have a BMI 35,
  and are having health problems due to their
  weight.
• Gastric surgery has short-term and long-term
  problems and requires compliance with dietary
  instructions.
• Liposuction is a popular procedure that is
  primarily cosmetic but poses risk.

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Predicting Weight Loss

• Positive Affirmations
• Strong Motivation
• Supportive Environment
• Appropriate Behaviors
• Changes in Body Shape

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Weight-Loss Strategies

• A life-long eating plan for good health, which
  includes nutritionally adequate eating,
  reasonable expectations, regular physical
  activity, and permanent lifestyle changes, is
  best for achieving permanent weight loss.
• Weight loss of 0.5-2 pounds per week or 10 of
  body weight in six months is safe.

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Weight-Loss Strategies

• Eating Plans
• Be Realistic about Energy Intake
• 300-500 kcalories/day reduction for BMI between
  27 and 35
• 500-1000 kcalories/day reduction for BMI 35
• Dietary Guidelines should be followed.
• Diet should be nutritionally adequate while
  avoiding excessive consumption.
• Smaller portions are recommended to feel
  satisfied, not stuffed.

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Weight-Loss Strategies

• Eating Plans
• Eat foods of lower energy density, that are high
  in fiber, high in water and low in fat.
• Water is important to increase fullness and
  reduce hunger.
• Complex carbohydrates offer abundant vitamins,
  minerals and fiber with little fat.
• Choose fats sensibly and reduce the quantity of
  fat.
• Watch empty kcalories from sugar and alcohol.

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Meal Planning

• Plan meals throughout the day
• Eat a variety o Foods (at each meal)
• Center Meals around the carbohydrate foods
• Minimize the addition of FAT all the time and
  sugar at any one time
• Dont worry about protein

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Plan Meals thru the Day

• Think about what you are going to eat instead of
  eating by habit or impulse!
• Eat more earlier when more active
• Eat less later when less active
• i.e. a little often vs. a lot at once
• The later you eat, the lighter you eat

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Eat a Variety of Foods(at Each Meal)?

• Provides more nutrition
• Each member of the family can choose what they
  want at that time
• Controls eating one food in excess
• Exposes a person to different foods
• Makes a better meal

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Center Meals around the Carbohydrate Foods

• Answers the question
• What am I supposed to eat?
• Provides the best source of energy.
• Provides a lot of most nutrients, (including
  fiber)?
• Low in fat, and has the good type and contains
  no cholesterol.
• Most have protein, certainly enough.
• Are not fattening--fats are!

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Minimize FATS and SUGAR

• Fats are fattening
• Fats can lead to other health problems
• Minimize fat intake, dont eliminate it
• Sugar in large amounts is a problem
• Sugar is an enjoyable taste and may displace
  foods with more nutrition and be concentrated
• Fat and Sugar mix well with each other the real
  problem

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Dont worry about PROTEINS

• Important for growth (height) and development
• Needed in smaller amount than most people think
  (.8 grams/kilogram BW)?
• Can be gotten from a variety of carbohydrate
  foods as well as the protein foods (meat, dairy)?
• Use as a part of the meal, not as the meal (eat
  lean, less and last)?

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Weight-Loss Strategies

• Physical Activity
• An individuals body weight as well as intensity
  and duration of activity influence energy
  expenditure.
• Physical activity increases the amount of
  discretionary kcalories that can be consumed.
• Metabolic rates can rise with daily vigorous
  activity.
• Activity can decrease body fat and increase lean
  body mass.
• Exercise may help to curb appetite.
• Activity can reduce stress and improve
  self-esteem.

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Weight-Loss Strategies

• Physical Activity
• Choosing Activities
• Choose activities that you enjoy and are willing
  to do regularly.
• Low to moderate intensity for long duration is
  recommended.
• Daily routines can incorporate energy activities.
• Spot Reducing
• Regular aerobic exercise and weight loss will
  help trouble spots.
• Strength training can improve muscle tone.
• Stretching can help flexibility.

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Weight-Loss Strategies

• Behavior and Attitude
• Behavior modification requires time and effort.
• Awareness of behavior is the first key.
• Changing behaviors one at a time works best.
• Do not grocery shop when hungry.
• Eat slowly.
• Exercise while watching television.
• Personal attitudes toward food and eating must be
  understood.
• Support groups may be helpful for some people.

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Weight-Loss Strategies

• Weight Maintenance
• Successful weight-loss maintenance programs use
  different criteria so they are difficult to
  compare.
• Vigorous exercise and careful eating plans are
  key.
• Frequent self-monitoring is recommended. Weekly
  weight, food diary, exercise journal,
  circumference measurements

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Weight-Loss Strategies

• Prevention
• Eat regular meals and limit snacking.
• Drink water in place of high-kcalorie beverages.
• Select sensible portion sizes and limit daily
  energy intake to energy expended.
• Limit sedentary activities and be physically
  active.

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Underweight

• Incidences of underweight and associated health
  problems are less prevalent than overweight and
  obesity problems.

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Underweight

• Problems of Underweight
• Causes are diverse.
• Energy demands may be great and foods are needed
  to support growth and physical activities.
• Eating disorders are severe cases.

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Underweight

• Weight-Gain Strategies
• Energy-dense foods can be included but choose fat
  wisely to avoid the associated cardiac risks.
• Regular meals each day must become a priority.
• Use large portions and expect to feel full.
• Consume extra snacks between meals.
• Juice and milk are easy ways to increase
  kcalories.
• Exercising to build muscles will support
  increases in muscle mass.