Weight Management:
Overweight, Obesity,
and Underweight
Chapter 9
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
Overweight and Obesity
BMI > 25
BMI > 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
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥ 30%
BMI > 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
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥ 30%
BMI > 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
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥ 30%
BMI > 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:
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥ 30%
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
Energy in > Energy out
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
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.
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
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
Without leptin, this mouse weighs
almost three times as much as a
normal mouse.
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.
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
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
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
Proteins Regulating Appetite and Energy
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)
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
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 waterpacked tuna (on the
right) instead of the oilpacked tuna (on the
left), a person can
enjoy the same amount
for fewer kcalories.
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
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
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
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
Fig. 9-6, p. 285
Problems of Overweight and Obesity –
Weight Cycling
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
OTC
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
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
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
Diet Pills for sale online
 http://www.webmd.com/diet/guide/herbalremedies
 http://www.thedietadvisors.com/adipozin.ht
ml
 http://www.weightlossdietpills.com/?gclid=C
JSlwpaCs6cCFQcBbAodkThW_w
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.
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-losssurgery/news/20110217/fda-oks-lap-bandsurgery-for-more-patients
Surgical Treatments for Obesity
 http://www.lapband.com/en/home/
 http://www.webmd.com/diet/weight-losssurgery/news/20110217/fda-oks-lap-bandsurgery-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
Surgical Treatments for Obesity
Esophagus
Surgical
staples
Small stomach
pouch
Esophagus
Stomach
Small stomach
pouch
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.
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
Weight Loss Strategies
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
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
Weight Loss Strategies –
Eating Plans
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
Food Choices Slideshow
 http://www.webmd.com/diet/slideshow-fatfighting-foods
Weight Loss Strategies –
Eating Plans
 Volumetrics
 Select carbohydrates carefully
 Artificial sweeteners
 Impact on energy intake
 Watch for empty/hidden kcalories
 Fat, sugar, and alcohol
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
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
Weight Loss Strategies –
Physical Activity
Energy allowance
to maintain weight
2500
kCalories
2000
Discretionary
kcalorie allowance
1500
1000
Energy intake to
meet nutrient needs
500
0
Sedentary person
Active person
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
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
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
Weight Loss Strategies –
Environmental Influences
 Socializing
 Duration of meal
 Visual cues
 Distraction
 Distractions
 Initiating eating
 Interfering with internal controls
 Extending duration of eating
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
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
Eating not for Hunger
 See Emotional Eating Handouts
 Internet full of tips
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
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
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
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.
Public Health Programs
 Possibly change food environment through
public health law
 Stretch beyond individual
 Social networks
 Community institutions
 Government policies
Public Health Programs
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
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
Weight-Gain Strategies
 Key diet planning strategies
 Adequacy and balance
 Energy-dense foods
 Regular meals daily
 Large portions
 Extra snacks
 Juice and milk
 Exercise
Highlight 9
The Latest and Greatest WeightLoss Diet – Again
Fad Diets
 Outrageous claims
 No requirements to prove the claims
 Do not have to support with credible
research
 Distorted research
 Numerous fad diet plans
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
“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
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