• Cholesterol is a waxy fat-like substance. It is used to make Bile, the
production of Vit D, hormones and is found in every cell. Your body
produces all you need. Cholesterol in your body comes from what
your body makes PLUS what you eat.
• All foods from animals contain some cholesterol. This includes meats, such
as beef, pork, lamb, chicken, and fish. It also includes dairy products, such as
milk, cheese, and ice cream. Organ meats, such as liver, are especially high in
cholesterol.
1
Lipoproteins
• HDL/LDL/VLDL are carriers of cholesterol. “Good or bad cholesterol”
is not true. It’s all the same cholesterol, it’s just “good or bad” determining
on where it is carried (or stored) to within the body.
• The degree of lipid in a lipoprotein affects its density—the lower the
density of a lipoprotein, the more lipid it contains relative to protein. The
higher the density of a lipoprotein, the less lipid it contains relative to the
protein.
2
3
4
5
6
7
Energy Balance
CH 6
8
Measuring Energy
calorie
◦ The amount of heat necessary to raise 1 g of water 1º C
◦ 1,000 cal = 1 kcal
Too small of a unit to measure so:
1 Calorie = 1 kcal
9
Forms of Energy
Thermic effect of food is the greatest energy output:
◦ Circulation
◦ Respiration
◦ Digestion
◦ Absorption
◦ Chemical energy :
◦ Electrical energy:
◦ Mechanical energy:
◦ Thermal energy:
10
Energy Balance
Total overall energy balance depends on intake in relation to output
Energy Intake
The main source of energy for all body work is food. This is supplemented
with stored energy in the body tissue.
Sources of Stored Energy
1. CHO: Glycogen (12-48hr reserve in liver and muscles)
2. Fat: Adipose tissue
3. Pro: Muscle mass
11
The Body’s Total Energy Requirements
Depend on:
1. REE/RMR
2. Physical Activity
3. Thermic Effect of food
12
REE: Resting energy expenditure
RMR: Resting Metabolic rate
The sum of all internal working activities of the body at rest.
60% - 75% of body’s total expenditure
BEE: Basal energy expenditure
Difficult to maintain, used in clinical practice. Will be slightly
lower than REE/RMR
13
Factors That Influence RMR:
• Lean Body Mass
• Growth Periods
• Body Temperature
• Fever increases BMR by 7% by each 1ºF
• Hormonal Status
14
Ways to Measure RMR
1. Indirect Calorimetry
• Metabolic cart
• MedGem/BodyGem
2. *Mifflin-St.Jeor equation or Harris Benedict equation
3. Thyroid Function test
•
•
Measure TSH
Not expressed in kilocalorie amount but is a gauge for
normal metabolic function
15
Thyroid
• Thyroid is regulated by TSH made in the pituitary. TSH
stimulates thyroxine.
• Blood test to determine TSH levels
• Hypothyroidism:
• Does not produce enough Thyroxine
• Metabolic rate is significantly lower than normal
• Levothyroxine (synthroid)
• Hyperthyroidism:
• Produces too much Thyroxine
• Metabolic rate is significantly higher than normal
• Antithyroid medication - Tapazole
16
Physical Activity
Part of TEE
• Accounts for work or recreation
• Highly variable
• PA factor
17
Thermal Effect of Food
TEF: Activities of digestion, absorption
transport and storage of food.
• The energy expenditure is approximately
10% of the foods energy content.
Ex: 600 calorie meal would take ~60kcal to digest
18
Energy Requirements
BEE
TEF
RMR = BEE + TEF
TEE = RMR + TEF + Physical Activity
* There are 3500kcal in one pound*
19
Assignment
1. Find your BMR using the general formula (p.84)
2. Find your TEE using the Mifflin-St.Jeor equation (p.85)
3. Without changing your PA, how many calories per day would you need
to consume to lose one pound in two weeks?
4. What is your BMR if you have a fever of 102.6 F?
5. What are the two ways to lose or gain weight?
20
Energy Needs and Life Cycle
◦ Most rapid growth occurs during childhood? and adolescence?
◦ With adulthood, energy needs level off.
◦ Gradual decline as the aging process continues.
◦ There is an average decline of BMR of 1-2% per decade.
◦ A more rapid decline occurs at 40 for men and 50 for women.
21
Weight Management
Ch15
22
Obesity Epedemic
34.2% of adults in the US are overweight
33.8% are obese
5.7% are extreme obese
16.9% of children and adolescents between 2 and 19
yo are obese
23
Body Composition
Four body compartments that make up the total body:
1.Muscle
2. Fat
3. Water
4. Bone
24
Body Fat Methods
Body fat calipers
Hydrostatic weighing
Bioelectrical Impedance Anaylsis
Dual Energy x-ray
Air Displacement plethysmography – BOD POD
25
Obesity: 20% above a desired weight for height
Overweight: body weight is above a population’s weight for height
standard
BMI: Tool to see if your bodyweight falls in normal/overweight
category
26
BMI = Wt (kg)/Ht (m)²
OR
BMI= Wt (lb) x 703/Ht (in) ²
*ACSM “above average” 7-15% for 20-29 yo M and 14.5-22% for 20-29 yo F
27
Adult BMI Chart
28
Hamwi Method for Ideal Body Weight
Men: 106 lb for the first 5 feet then add or subtract 6 lb for
each inch above or below 5 feet.
Ex: 6’2” = 106 + 84 ± 10%
IBW = 171-209
Women: 100 lb for the first 5 feet then add or subtract 5lb for
each inch above or below 5 feet.
Ex: 5’7½” =
± 10%
IBW:
29
Considerations for Ideal Body Weight
1. Frame Size:
2. Individual Variation
3. There is a biological need for fat: survival, reproduction
◦ Minimum required for health: 5% men 12%women
30
Body weight calculations
 Body Frame Estimate: Height (cm)/wrist circumference (cm)
EX: IBW: 190# M
Wrist circumference: 22.1cm
What is his frame size?
What is his IBW with frame size considered?
Male Ratio
Small ˃10.4
Medium 10.4 – 9.6
Large ˂ 9.6
31
Obesity: A National Epidemic
32
Obesity and Health
A National Epidemic
What is to blame?
◦ Marketing?
◦ Media and social images?
◦ Lack of exercise?
◦ Obesogenic environment?
◦ Poverty?
33
Health Implications
•
•
•
•
•
HTN
Hypercholesterolemia
DM
CHD
Cancer
34
Causes of Obesity
• Input vs. Output
3500kcal = one pound
•
•
•
•
•
•
•
Physical Activity
Genetics
Hormonal
Physiological
Psychological
Environmental Factors
Family Reinforcement
35
Set Point Theory
• Researchers confirmed after wt gains or losses, the body adjusts
the metabolism to restore the original wt
• Energy expenditure ↑ after wt gain and ↓ after weight loss
• Explains why it is so difficult for an overweight person to
maintain weight losses
• It is possible for a person to change their “set-point” weight but it
takes time and effort
36
Hormonal
◦ Leptin: Released from the fat tissue to regulate satiety, food
intake and bdwt
◦ Early-Onset Obesity – Lack the leptin receptor. 3%
◦ Ghrelin – Appetite stimulate secreted from the stomach
◦ Investigations of the use of ghrelin antagonist
37
Genetic and Family Factors
Strongest factor
Potential body fat to carry
Family reinforcement
38
Physiological Factors
Fat cells
Critical period in childhood
BMR, PA, LBM
Women store more fat during pregnancy and menopause
39
Psychological Factors
Stress and comfort food
Societal pressure
40
Environmental Factors
Energy-dense food availability
Convenience foods
Portion Sizes
↓ in Food Preparation and Skill
Physical Activity
Screen Time
↓ physical requirement in household chores
41
Extreme Practices for Weight Loss
Fad diets
Fasting
Specific Macronutrient Restrictions
Drugs
◦ Fen-phen, meridian, orlistat
Surgery
◦ Gastric restriction, lipectomy
42
Sound Weight Management Program
Detect Problem Behaviors
Record and analyze food intake
Plan a behavior management strategy
Set realistic goals
Find a negative energy balance
Make it nutritionally adequate
Know the food groups!
Don’t reinvent the wheel. Use choosemyplate.gov
43
The Non-Diet Approach
Personalized
Must be motivated
Many factors considered
◦ Food
◦ Exercise
◦ Stressors
◦ Family support
Goal: 1 – 2 lbs. or 1% of BW/week
◦ It’s a marathon, not a sprint
44
Disordered Eating
Patterns of eating that may lead to a full blown eating disorder
◦ Anorexia Nervosa
◦ Bulimia Nervosa
◦ Binge Eating Disorder
◦ Orthorexia
45
Children and Weight Loss
Goal: Weight Maintenance
Physical Activity is key
Get kids involved with cooking and learning
Roles for building a healthy eater
◦ Parent: What is served and When
◦ Child: Whether to eat and how much
46