Chapter 9: Weight Control

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Chapter 9 Weight Control
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• Incidence of Obesity in U. S.
• 60 of adults are overweight
• 35 of adults are obese
• One out of five adolescents/children are
  overweight
• 280,000 deaths each year are due to obesity
  related factors, therefore preventable
• NHLBI Obesity Education Initiative, 1998
• Mokad, JAMA, 1999
• Obesity has been linked to increased morbidity
  and mortality
• High Blood Pressure
• Lipidemia
• CVD
• Diabetes
• Stroke
• Must et al, 1999

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Malnutrition

• Any state in which a person is not adequately
  nourished to maintain good health. Can be over
  nourished or undernourished.
• Obesity is the 1 malnutrition problem in the U.S.

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Energy Balance

• State in which energy intake, in the form of
  food and /or alcohol, matches the energy
  expended, primarily through basal metabolism and
  physical activity

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Positive Energy Balance

• Energy intake gt energy expended
• Results in weight gain

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Negative Energy Balance

• Energy intake lt energy expended
• Results in weight loss

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Brain as a Regulator of Weight

• Hypothalamus
• Links endocrine system and autonomic NS
• Regulates temperature, water balance, food intake
  (satiety) and hormone balance!

Hormones that affect weight or food intake
include Cortisol- increases with stress
causing increase in fat storage Serotonin
low levels occur with those suffering from
depression. Overeating can occur
Insulin high levels cause increase in fat
storage
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Macronutrients and Fat Storage

• Most fat is stored directly into adipose tissue
• Body has unlimited ability to store fat (as fat)
• CHO needed to burn fat
• Most CHO is used as a energy source
• Excessive CHO (i.e. sugar) will be synthesized
  into fat (for storage)

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Essential Body Fat vs Stored

• Essential
• Males
• 5 of TBW
• Females
• 8-12 of TBW
• Stored
• ????????????????????????????????

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Ideal Body Fat

• Males
• 10-18
• Females
• 18-22

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Fat Cells

• Born with a certain number
• Hyperplasia
• Easier to increase the number during
• Gestation/Utero
• Infancy
• Adolescence
• Hypertrophy
• Increase size of fat cells at all other times
• Lose weight/gain weight fill/empty fat cells
• Fat cells LIKE to be filled with fat, they will
  work to accomplish this!

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Protein and Fat Storage

• Protein is primarily used for tissue synthesis
• Excess protein is stored as fat
• Some protein could be used for energy source in
  absence of adequate CHO and kcals but this leads
  to less LBM
• This leads to decrease in BMR

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Basal Metabolism

• The minimum energy expended to keep a resting,
  awake body alive
• 60-70 of the total energy needs
• Includes energy needed for maintaining a
  heartbeat, respiration, body temperature
• Amount of energy needed varies between
  individuals
• More muscle mass means higher BMR
• Minimum caloric intake 1200 kcals?

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Calculating BMR Actual Weight in Kg X .9Female
_____ kcals/hr Kg X 1 Male
_____ kcals/hr _____kcals/hr X 24 hr
________BMR needs/day Another Way Body weight
() X 10kcals _____ kcals needed
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Influences on Basal Metabolism

• Body surface area (weight, height)
• Gender
• Body temperature
• Thyroid hormone
• Nervous system activity
• Age
• Kcal intake
• Use of caffeine and tobacco

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Thermic Effect of Food (TEF)

• Energy used to digest, absorb, and metabolize
  food nutrients
• 5-10 above the total energy consumed
• TEF is higher for CHO (high FIBER and protein
  than fat
• Less energy is used to transfer dietary fat into
  adipose stores (very easy for the body to do!)

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Estimating Energy Needs Based On Activity Level

• Sedentary wt in kg x 30 kcal/kg
• Moderate activity wt in kg x 35 kcal/kg
• Heavy activity wt in kg x 40 kcal/kg
• Subtract 100 kcal for every 10 years over 30

• Example 150 pound (68 kg), 40 yr. old,
  moderately active person
• (68 kg x 35 kcal/kg) - 100 kcal 2300 kcal per
  day

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Body Mass Index

• Weight-for-height standard
• Most closely related to body fat content
• BMI gt 25 is at greater risk for obesity
• related disorders

Body Weight (kg) OR Weight
(pounds) x 703.1 Height2 (meters)
Height2 (inches)
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Same HeightSame WeightSame BMI?
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Obesity

• Excessive amount of body fat
• Women gt 30 body fat
• Men gt 25 body fat
• Increase risk for health problems
• Are usually overweight ???

Measure percentage of BF in relation to FFM
several ways
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Estimation of Body Fat

• Underwater weighing (Fig. 9-5)
• Most accurate
• Fat is less dense than lean tissue
• Fat floats

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Ways to Estimate Body Fat

• Skinfold thickness
• Bod Pod
• DEXA scan
• Tanita Scale
• Bioelectrical impedance
• Measures the resistance of electrical flow
• Fat is resistant to electrical flow

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Distribution of Body Fat

• Upper-body (android) obesity--Apple shape
• Associated with more heart disease, HTN, Type II
  Diabetes
• Fat goes directly to the liver
• Fat affects livers ability to clear insulin and
  lipoprotein and insulin CVD, Fat storage
• Encouraged by testosterone and excessive alcohol
  intake
• Defined as waist to hip ratio of gt1.0 in men and
  gt0.8 in women

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Lower-Body (Gynecoid) Obesity-- Pear Shape

• Encouraged by estrogen and progesterone
• Less health risk than upper-body obesity

Women usually become apple shaped AFTER
menopause Less estrogen means decrease in
protective effect on heart and fat
becomes distributed in trunk/upper torso
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Onset of Obesity

• Juvenile
• Increase in the number of adipose cells
• Adipose cells have long life span and need to
  store fat
• Makes it difficult to loose the fat (weight loss)
  More likely to remain overweight
• Adult-onset obesity
• Fewer (number of) adipose cells
• These adipose cells are larger (stores excess
  amount of fat)
• If weight gain continues, the number of adipose
  cells can increase

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Causes of Overweight

• Family history
• Environment
• Educational or socioeconomic level
• Metabolism
• Hormone problems (?) 3

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Nurture Debate

• Environmental factors influence weight
• What is available in stores, house etc.
• Learned eating habits
• What your parents taught you
• Activity factor (or lack of)
• Poverty and obesity
• Female obesity is rooted in childhood obesity
• Male obesity appears after age 30

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Facts

• A child with no obese parents has a 10 chance of
  becoming obese
• A child with 1 obese parent has a 40 chance
• A child with 2 obese parents has a 80 chance

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Nature Vs. Nurture?

• Those at risk for obesity could face a
• lifelong struggle with weight
• Gene does not control destiny You make choices!
  With the right tools and mindset, you can make
  the best choices and take control of your
  health/destiny
• Education, increased physical activity, moderate
  intake can promote healthy weight

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Treatment of Obesity

• Obesity is now a chronic disease
• Treatment requires long-term lifestyle changes
• Dieters are misdirected
• More concerned about weight loss than healthy
  lifestyle. Want the QUICK FIX
• Unrealistic weight expectations

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Dieters grasp at a tiny little life
preserver Instead of getting in the
boat and rowing to safety!
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Weight Cycling (Yo-Yo Dieting)

• Weigh 140 25 yr old who is 25 BF
• Diets and loses 10
• 10 pounds made of 5 water
• 3 fat
• 2 LBM

Now weight is 130 Goal achieved, Diet OVER!
Goes back to regulareating pattern and gains
10 Back 5 fat and 5 water. Weight is again
140 but missing 2 LBM so BF is 26.5 As time
goes on . . .
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Weight Cycling (Yo-Yo Dieting)

• Typically weight loss is not maintained
• Weight lost consists of fat and lean tissue
• Weight gained after weight loss is primarily
  adipose tissue
• Weight gained is usually more than weight lost
  (not 10 back but 12!)
• Associated with upper body fat deposition

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Lifestyle Vs. Weight Loss

• Prevention of obesity is easier than curing
• Balance energy in (take) with energy out (put)
• Focus on improving food habits
• Focus on increase physical activities

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What It Takes To Lose A Pound

• Body fat contains 3500 kcal per pound
• Must have an energy deficit of 2700-3500 kcal to
  lose a pound per week

Cut out 250 kcals (16-20oz soda) per day for a
week and lose 1,750 kcals or a HALF a pound. Is
this pleasing to us?????
NO!!!!
WHY????
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Do The Math
To lose one pound, you must create a deficit of
3500 kcal So to lose a pound in 1 week (7 days),
try cutting back on your kcal intake and increase
physical activity so that you create a deficit of
400-500 kcal per day - 500 kcal x 7 days
- 3500 kcal 1 pound of weight loss day
week in 1 week
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Simple Guidelines for Weight Loss Require
That You Focus On Three Areas -Quality
-Quantity -Frequency
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Quality

• Less Fat
• Less Sugar
• Less Fast Food
• Less Processed Food
• More Fruits
• More Veggies
• More Fiber

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Quantity

• Watch Portion Size
• Kcals In vs Kcals Out
• Consume Right Amount of Kcals to Meet BMR and
  Activity Level needs
• Know your Numbers
• What you need
• What is in your food

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Frequency

• How Often DO you consume foods that are not very
  healthy?
• Every Day?
• Several TIMES a day?
• Once a Week?
• Once a Month?

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Sound Weight Loss Program

• Rate of Loss 1 to 2 per week
• Safe
• Maintainable Long Term
• Behavior Modification
• Promotes Overall Health by Meeting Nutrient Needs
• EXERCISE is included

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What To Eat To Loose Weight?

• Food Guide Pyramid
• Regular meal pattern
• Lower the fat (meat and baked goods)
• Increase the FIBER
• Lower the empty kcals - sugar
• Consider Healthy Eating vs. Dieting

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Weight Maintenance

• Prevent relapse
• Occasional lapse is fine, but take charge
  immediately
• Continue to practice newly learned behavior
• Requires motivation, movement, and monitoring
• Have social support
• Encouragement from friends/ family/ professionals

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Why Diets Fail

• Negative feelings
• Out-of-control situations
• Reverting to old habits
• No PLAN
• No monitoring
• No education
• No behavioral changes
• No EXERCISE!

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To DO IT

• Education
• Plan
• Monitor
• Accountability
• Healthy Eating CONSISTENTLY
• Exercise REGULARLY
• Self Efficacy - ????

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Gastroplasty - Stomach Stapling

• Common non-reversible surgical procedure for
  treating severe obesity
• Reduces the stomach size (from 4 cups) to shot
  glass size (2 oz)
• Overeating will result in rapid vomiting
• Smaller stomach promotes satiety earlier
• 75 will lose 50 of excess body weight
• Dangerous and Costly way to lose weight

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Ideal Body Weight?

• Females
• 100 for first 5 ft then 5 for each inch over 5
  ft
• so, 5 5 should weigh 125
• Males
• 106 for first 5ft then 6 for each inch over 5
  ft.
• so, 5 11 should weigh 172

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Calculating LBM

• Person who is 20 BF, 20 of total weight is fat
  weight so, how much LEAN does a person have who
  is 130 and is 20 BF?
• 130 X .2 26 of fat
• 130 - 26 104 Lean

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Calculating BF

• TBW 125
• FW 25
• What is body fat
• (25/125)10020

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