ENERGY BALANCE, WEIGHT
CONTROL AND EATING
DISORDERS
PART 2 OF 2
CHAPTER 10
LEARNING OUTCOMES
• Describe the different methods to measure
body composition.
• Describe the programs available to treat
overweight and obesity.
• Discuss the characteristics of fad diets.
• Be able to evaluate whether weight loss
programs are safe and likely to result in longterm weight loss.
2
LEARNING OUTCOMES
• Describe the treatments that are available
for more severe obesity.
• Describe the causes of, effects of, typical
persons affected by, and treatment for
anorexia nervosa, bulimia nervosa, and
binge-eating disorder
• Explain methods for reducing the
development of eating disorders, including
the use of early warning signs to identify
early cases.
3
TREATMENT PYRAMID
Surgery
BMI
Pharmacotherapy
Lifestyle Modification
Diet
Physical Activity
DO DIETS WORK AT WEIGHT LOSS?
DIET
WEIGHT
COST
LOSS
Weight
5% in 6
$167
Watchers months
VLCD
15-20% in 6 $1700-2100
months
Internetbased
1% in 6
months
$65 (per 3
months)
The average weight loss for high quality, state of the art
weight loss diets is 10% in 6 months.
Tsai and Wadden. Ann Intern Med 2005.
5
FAD DIETS
• Encourage rapid weight loss
• Lean tissue and water loss occur
• Does not encourage behavior change
• Weight loss is usually regained
• Low carbohydrate diets
• Novelty diets
• Quick fad diets
6
TREATMENT OF OVERWEIGHT AND
OBESITY
• 3 Key Components to Sound Weight
Loss
• Control of energy intake
• Fewer kilocalories
• Low energy density diet
• Physical activity
• Control of behavior problems
• Behavior modification techniques
7
CONTROL OF PROBLEM BEHAVIORS:
CHAIN BREAKING
8
CONTROL OF PROBLEM BEHAVIORS:
STIMULUS CONTROL
• What about your environment may
be driving you to eat more or make
poor choices?
• Where?
• What?
• Why?
9
CONTROL OF PROBLEM BEHAVIORS:
COGNITIVE RESTRUCTURING
• Changing ones frame of mind about
eating
• Making “excuses” or justifying unhealthy
habits
• Being very negative or hard on yourself
10
CONTROL OF PROBLEM BEHAVIORS:
SELF MONITORING
• Tracking food intake, physical activity,
and body weight
• Tracking emotions related to eating
11
WILL THEY KEEP THE WEIGHT OFF?
DIET
LONG TERM
WT LOSS
LONG TERM
ATTRITION
RATE%
Weight
Watchers
3.2% at 2 y
27% at 2 yr
VLCD
7.3% at 3.4 yr 42% at 3.4 yr
Internet
1.1% at 1 yr
34% at 1 yr
Tsai and Wadden. Ann Intern Med 2005.
12
WHY IS IT SO HARD TO MAINTAIN
WEIGHT LOSS?
IS IT EVEN POSSIBLE?
13
WEIGHT MAINTENANCE
• When you restrict calories for weight loss your
body responds by reducing energy expenditure
lower than one would expect for the new weight
and body composition.
• Restricting calories also alters expression of
hormones which increase hunger.
• EXERCISE can help prevent the above things
from happening
14
SUCCESSFUL WEIGHT MANAGEMENT: LESSONS
FROM THE NATIONAL WEIGHT CONTROL REGISTRY
•Registry members have lost an average
of 66 pounds and kept it off for 5.5 years
– 90% exercise, on average, about 1 hour per
day.
– 62% watch less than 10 hours of TV per week.
– 78% eat breakfast every day.
– 75% weigh them self at least once a week.
CASE STUDY: RK AND THE FRESHMAN 40
• 19 yo female
• 65 inches, 180 lbs, BMI 30
• Wt history: weighed 140 (BMI 23.3) in HS. Also
played soccer and ran track.
• Lifestyle: Stopped playing sports, lives in dorm, busy
schedule.
• Goal: 120 lbs
16
STEP 1: SET REALISTIC GOALS
– Substitute healthy weight for ideal or
“dream” weight
– Loss of 10% of body weight (18 lbs or 162#)
– 1-2 pounds per week (will take 9-18 weeks)
– Long term goal should be weight
maintenance
17
ASSESS EXPECTATIONS: WEIGHT GOALS
•
•
•
•
•
•
•
•
Dream Weight
A weight you would choose if you could weigh whatever
Happy Weight
A weight that is not as ideal but would be happy to
achieve
Acceptable Weight
A weight you would not be particularly happy with, could
accept
Disappointed Weight
Less than current weight, but could not view as
successful in any way
18
WEIGHT EXPECTATIONS
Defined Weights
% Reduction
Dream
38%
Happy
31%
Acceptable
25%
Disappointed
17%
After 48 weeks of treatment, 47% of patients did not
achieve even a disappointed weight.
19
STEP 2: ASSESS DIET
Time Food
8am: Large coffee w/skim milk
and splenda & protein bar
1pm: Tuna salad wrap
3pm: Diet coke and bag of Baked Lays
7pm: 3 cups pasta with red sauce
10pm: 1 slice pizza
Kcal
(220)
(700)
(200)
(650)
(300)
2070
20
STEP 3: DETERMINE ENERGY NEEDS
• Estimated calorie needs for RK: 1913 Calories/day
• Cut 500 calories/day to cut 3500 calories/week = 1
pound loss/week
• New calorie goal: 1413 (*not less than 1200
calories/week)
21
STEP 4: MAKE NEW PLAN- CAN USE FOOD
GUIDE WEBSITE HTTP://WWW.CHOOSEMYPLATE.GOV/
Food group
Amount
Tips
Grains
5 oz
3 oz whole grain
Vegetables
2.0 cups
VARIETY
Fruit
1.5 cups
VARIETY
Dairy
3 cups
Low fat
Protein
4 oz
Lean
Oils
3 tsp
Monounsaturated
Discretionary
100 calories
Limit empty
calories
22
STEP 4: MAKE NEW PLAN
Time Food
8am: Small latte w/skim milk
& high fiber bar and banana
1pm: Tuna SW on whole wheat
w/lite mayo w/ cup of veg soup
3pm: Water and yogurt
7pm: 1 cup ww pasta, 2 cup veg, 2 oz chix
10pm: Sundae from McD
Kcal
(180)
(400)
(130)
(400)
(330)
144023
FAST FORWARD 20 YEARS…
• Every January RK tried a new fad diet that
produced a 10 lb loss followed quickly by a 15 lb
gain.
• She now weighs 280 lbs (BMI 46.6) and has type 2
diabetes. She needs knee replacement surgery but
because of other health conditions her Dr. tells her
to lose weight first.
24
Treatment Pyramid
Surgery
BMI
Pharmacotherapy
Lifestyle Modification
Diet
Physical Activity
25
DRUG TREATMENT
• Subutramine or Meridia
• Reduces hunger by changing some of the signals
in the brain (hypothalamus)
• Phentermine
• Also reduces hunger by changing some of the
signals in the brain (hypothalamus) and raises basal
metabolic rate
• Orlistat, Zenical, or Alli
• Blocks fat absorption by inhibiting lipoprotein lipase
• Other
• Anti depressant and anti seizure medications that
reduce hunger
26
INDICATIONS FOR WEIGHT LOSS
SURGERY
1. BMI > 35 in association with major medical
complications of obesity
OR
BMI > 40
2. Failure of other approaches to long-term weight loss
ROUX EN Y GASTRIC BYPASS
•Small stomach
pouch
•Alteration of food
pathway
•Causes decreased
hunger, increased
fullness
•Average weight loss
is 30% of initial
weight
28
ADJUSTABLE GASTRIC BANDING
•Small stomach pouch
•Requires regular
adjustments and
greater dietary
monitoring
•Average weight loss is
20% of initial weight
•No change in food
pathway
29
EATING DISORDERS
Anorexia Nervosa
• Denial of appetite +
poor body image
Bulimia Nervosa
• Binge followed by
purge
30
Who?
31
32
33
EATING DISORDERS OTHERWISE NOT
SPECIFIED (EDOS)
• Broad category to include partial symptoms
of anorexia or bulimia
• Examples:
• Meets all criteria for anorexia nervosa but
continues to menstruate OR whose weight is in
normal range
• Meets all criteria for bulimia nervosa but binges
less than twice/week OR does not binge OR spits
out food
34
EATING DISORDERS: TREATMENT
AN
• Nutrition
• Gradual weight gain
• Help choose healthy food
• Psychological
• Body image
• Coping skills (control)
BN
• Nutrition
• Emphasis on regular meal
patterns
• Self monitor
• Psychological
• Coping skills
• All or nothing thinking
35
EATING DISORDERS: PREVENTION
• Recognizing what’s normal and what is
a red flag
• Treating any physical and emotional
problems early
• Setting up children for positive body
image, tolerance for all body types
36
ALMOST EVERYONE IN MARY’S
FAMILY IS OVERWEIGHT OR OBESE.
SHE IS WORRIED ABOUT THIS AS
WELL.
SHOULD SHE BE?
IS THERE ANYTHING SHE CAN DO TO
AVOID EXCESS WEIGHT GAIN?
37
ED DOES HIS PROJECT FOR HUMAN
NUTRITION. HIS WEIGHT IS STABLE,
BUT ACCORDING TO THE DIETARY
ANALYSIS HE IS CONSUMING MUCH
LESS THAN HE SHOULD BE.
WHY MIGHT THIS HAPPEN?
SHOULD HE INCREASE HIS
CALORIES?
38