WEIGHT MANAGEMENT
Chapter 7
TEST YOUR KNOWLEDGE

About what percentage of American adults are
overweight?
a.
b.
c.
15%
35%
65%
c. About 65% of American adults are
overweight including more than 31% who are
obese. The rate of obesity among adults has
increased more than 75% since 1990
TEST YOUR KNOWLEDGE

People who are overweight get less sleep than
people who are at a healthy body weight. True or
false?
 TRUE.
It is unclear whether there is a cause and effect
relationship between lack of sleep and increased body
weight. But insufficient sleep may affect hormones,
metabolism, and appetite. Adequate sleep may also
help prevent eating in response to feelings of stress
and low energy.
TEST YOUR KNOWLEDGE

Which of the following eating disorder is most
common among Americans?
a.
b.
c.
Anorexia
Bulimia
Binge-eating disorder
c. A 2007 study reported that binge eating is more
common than either anorexia or bulimia.
Weight management



The goal for wellness is to adopt healthy
behaviors and achieve an appropriate body
composition, not to conform to rigid standards
of total body weight.
Managing body weight is not a mysterious
process. The “secret” is balancing calories
consumed with calories expended in daily
activities.
Successful weight management requires a long
term coordination of many aspects of wellness
lifestyle, including: proper nutrition, adequate
physical activity and stress management.
Health implications of overweight and
obesity


One of the major
controllable risks factors for
heart disease
Increases the risk of
cardiovascular disease,
hypertension, certain forms
of cancer, diabetes,
gallbladder disease,
respiratory problems, joint
diseases, skin problems,
impaired immune function
and sleep disorders.
Factors contributing to excess body fat

Genetic factors

Genes influence body size and shape,
body fat distribution, and metabolic rate.

Also affect the ease with which weight is
gained as a result of overeating and
where on the body extra weight is added.

The tendency to develop obesity may be inherited, but the
expression of this tendency is affected by environmental
influences.
Factors contributing to excess body fat

Physiological factors

Metabolism and energy balance








Resting metabolic rate (RMR) is the energy required to maintain vital
body functions while the body is at rest.
RMR accounts for 55 – 75% of daily energy expenditure
Energy to digest food  5 – 15 %
20 – 40% expended during physical activity
The RMR varies among individuals
Exercise has a positive effect on metabolism
An energy balance equation is the key to weight management
Hormones



Hormonal changes contribute to the amount and location of body fat.
Leptin, a hormone secreted by body fat cells is carried to the brain
and lets it know how big or small are fat stores allowing the brain to
regulate appetite and metabolic rate
Hunger is not the primary reason of overeating.
Factors contributing to excess body fat

Lifestyle factors

Eating

Many people have eating habits that
contribute to weight gain.




Eating out
Large food portions
Foods high in fat, sugar and calories and
low in nutrients
Physical activity
Most people drive to work, sit all day, relax in front of a TV, surf
the Internet, play video games rather than bicycle, practice sports
or do yard work or chores around the house
 60% of the incidence of overweight can be linked to excessive
television viewing.

Factors contributing to excess body fat

Psychological factors

Many people use food as a
means of coping with stress and
negative emotions

When eating becomes the primary
means of regulating emotions,
binge eating or other unhealthy eating patterns can develop.

Obesity is highly associated with socioeconomic status


The prevalence of obesity goes down as the income level goes up.
Obesity is also linked to cultural and family values.
Adopting a healthy lifestyle for
succesful weight management




Most weight problems are lifestyle
problems.
100 years ago diet was very different,
and people had to do much more
exercise.
Today we eat more calories, fat and
refined sugars, and fewer
carbohydrates.
We also do far less exercise


Permanent weight loss is not something you can start
and stop
Healthy behaviors should be maintained throughout
your life.
Diet and eating habits
 Physical activity and exercise
 Think positively and mange your emotions effectively
 Find ways to deal with stress and challenges in your life.

Diet and eating habits

Dieting:


Involves some form of food restriction and self deprivation
Diet:
Your daily food choices.
 It is important to develop a diet
that you enjoy and that enables
you to maintain a healthy body
composition.
 For weight management you may need to pay special
attention to calories, portion sizes, energy density, fat and
carbohydrate intake and eating habits.

Total calories




The precise number of calories
needed to maintain weight will vary
from individual to individual based on
heredity, fitness status, level of
physical activity and other factors.
Crash diets are not recommended
You need to consume enough food to
meet your need for essential nutrients
It is important to adopt a level of
food intake that you can live with
over the long term.
Portion sizes




Most of us underestimate the amount of food we
eat.
Limiting portion sizes is critical for weight
management
This is the easiest method of monitoring and
managing total food intake.
When eating out, order the
smallest-sized items on the menu.
Take some home. Share it with a
friend.
Energy Density

Foods low in energy density include:
Fruits and vegetables
 Whole grain fruits.


Foods high in energy density include:
Meat
 Ice-cream
 Potato chips
 Crackers
 Low-fat cakes
 Cookies


Strategies for lowering energy density include

Eat fruit with breakfast and for dessert

Add extra vegetables to sandwiches, casseroles, stir-fry dishes,
pizza, pasta dishes and fajitas

Start meals with a bowl of broth-based soup, include a green
salad or fruit salad.

Snack on fresh fruits and vegetables rather than crackers, chips
or other energy-dense snack foods.

Limit serving sizes of energy-dense foods such as butter,
mayonnaise, cheese, chocolate, fatty meats, croissants, and snack
foods that are fried, high in added sugars or contain trans fats.
Fat calories



Avoid overeating fatty foods,
especially those high in saturated and
trans fats.
Foods high in unhealthy fats include
full-fat dairy products, fatty meats,
stick margarine, deep fried foods and
other processed foods.
Watch out for processed foods
labeled “fat-free” or “reduced-fat”
because they may be high in calories
Carbohydrates



Food rich in whole grains and fiber are lower in
calorie density, saturated fat and added sugars
and may promote feelings of satiety.
Choose a diet rich in complex carbohydrates from
whole grains, vegetables, and fruits, and be more
moderate in the consumption of starchy vegetables
like white potatoes and corn.
Watch out for high-calorie
beverages
Protein

Stay within the recommended intake of protein and
favor plant sources of protein rather than high-fat
animal products.
Eating habits

Eat small, frequent meals (4-5 meals per day)

Include breakfast and snacks on a regular schedule



Skipping meals leads to excessive hunger, feelings of deprivation and
increased vulnerability to binge eating or snacking on high-calorie, high-fat
or sugary foods.
Establish a regular pattern of eating, and
set some rules governing food choices.
Considering some foods as off limits
generally sets up a rule to be broken.
The better rule is “everything in moderation”
LAB 7,1
Calculate your approximate
daily caloric needs
Lab 7,2 optional for those who have as target weight loss or gain
Physical activity and exercise


Physical activity and exercise burn
calories and keep the metabolism
geared to using food for energy
instead of storing it as fat.
Making significant cuts in food intake
is difficult to maintain, increasing
your physical activity is a much
better strategy
Physical activity

Even a small increase in activity level can help maintain your current
weight or help you lose a moderate amount of weight.
Activity
Cal/lb/
min
Body
weight
Min
Total
Calories
Cycling (13 mph)
Dancing
Digging
Driving a car
Doing housework
Painting a house
Shoveling snow
Sitting quietly
Sleeping and resting
Standing quietly
Typing or writing
Walking briskly
0.071
0.049
0.062
0.020
0.029
0.034
0.052
0.009
0.008
0.012
0.013
0.048
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Exercise


Includes cardio-respiratory endurance exercise,
resistance training and stretching exercises.
Helps to increase the metabolic rate
Thoughts and emotions

The way you think about yourself and your world influences
and is influenced by how you feel and how you act.



People with low self-esteem mentally compare the actual self to
an internally held picture of the “ideal self”
The more this two pictures differ, the larger the impact on selfesteem and the more likely the presence of negative emotions.
Self talk


Can either be positively motivating or self
deprecating.
Having realistic believes and goals and
engaging in positive self-talk and problem
solving is important for a healthy lifestyle.
Coping strategies







Eating
Drugs
Alcohol
Smoking
Gambling
Appropriate coping strategies help you deal with
the stresses of life.
Attempt to find new coping strategies and begin to
use food appropriately.
Approaches to overcoming a weight
problem

Doing it yourself
 Combining
modest cuts in energy
intake with exercise and avoiding
very low calorie diets
 A reasonable weight loss is 8 –
10% of body weight over 6
months
 Include strategies than can be
maintained over the long term.
Diet books






Reject books that advocate an unbalanced way of
eating
Reject books based on a “scientific breakthrough”
or that have a “secret to success”
Reject books that use gimmicks like matching
eating to blood type, rotating levels of calories,
combining foods in a special way to achieve
weight loss.
Reject books that promise quick weight loss or that
limit the selection of foods.
Accept books that advocate a balanced
approach to diet plus exercise and offer sound
nutrition advice.
Many diets cause weight loss if maintained, the
real difficulty is to find a safe and healthy
pattern of food choices and physical activity that
results in long-term maintenance of a health.
Dietary Supplements and Diet Aids.
These products typically promise a
quick and easy path to weight loss.
 More thank half of advertisements
for weight-loss products made
representations that are likely to be
false.
 There is no quick and easy way to
lose weight.
 The most effective approach is to
develop healthy diet and exercise
habits and to make them a
permanent part of your lifestyle.


Formula drinks and food bars
Canned diet drinks
 Powders used to make shakes
 Diet food bars
 Snacks

Designed to achieve weight loss by substituting for some or
all of the person’s daily food intake.
 Use of these products results in rapid short term weight loss,
but weight is typically regained because users don’t learn to
change their eating and lifestyle behaviors.


Herbal supplements
 Herbs
are considered dietary supplements and there is
little information about its effectiveness, proper dosage,
drug interaction and side effects.
 Chinese
herbal weight loss preparation
Toxic herb substituted by another compound causing kidney
damage and cancer among users

Other supplements
 Fiber:
acts as a bulking agent in the large
intestine, not the stomach, so it doesn’t‘ have a
pronounced effect on appetite.
 Some
products contain 3 or fewer grams of fiber,
which does not contribute to the recommended daily
intake.
 Conjugated
linoleic acid, carnitine, chromium,
pyruvate, calcium, B vitamins, chitosan, “fat
blockers”, “starch blockers”
 Research
has not found these products to be effective
and many have potentially adverse side effects.

Weight loss programs
 Non-commercial
weight-loss programs
Support groups
 TOPS: Take Off Pounds Sensibly
 OA: Overeaters Anonymous



Do not advocate any particular diet
Recommend seeking professional advice
OA is a 12 step program with a spiritual orientation that
promotes abstinence from compulsive overeating.

Weight – loss programs
 Commercial
weight loss programs
 Weight
watchers
 NutriSystem
 Jenny Craig
 L.A. Weight Loss
 LAIN
 Slender Quest

Provide group support, nutrition education, physical activity
recommendations and behavior modification advice. Some also
make available packaged foods.

Weight-loss programs
A
reasonable weight loss program should have the
following features:
 Safe
and balanced diet
 Physical activity and exercise strongly encouraged
 Promote slow, steady weight loss
 Offer physician evaluation and monitoring
 Plans for weight maintenance after the weight-loss phase.
 Provide information of fees and costs, including those of
supplements and prepackaged foods, as well as data on
risks and expected outcomes of participating in the
program.

Weight – loss programs
 Online
 Many
Weight-loss programs
sites offer online self assessment for diet and physical
activity habits, as well as a meal plan
 Provides an alternative to in person diet counseling and can
lead to weight loss for some people

Weight – loss programs
 Clinical
weight – loss programs
 Designed
to help those who are severely obese
 These programs typically involve a closely monitored very
low calorie diet.

Prescription drugs



Appetite suppressants usually work by increasing levels of
catecholamine or serotonin, two brain chemicals that affect mood and
appetite.
Other drugs work lowering the calorie consumption by blocking fat
absorption in the intestines. They might also reduce the absorption of fat
soluble vitamins and antioxidants.
Potential side effects include









Sleepiness
Nervousness
Euphoria
Increased blood pressure and heart rate
Headaches
Constipation or diarrhea
Dry mouth
Insomnia.
Should only be used for short term periods

Surgery

Gastric bypass surgery



Severe obesity is a serious medical condition often
complicated by other health problems such as
diabetes, sleep disorders, heart disease and
arthritis.
Gastric bypass surgery may be recommended for
people with a BMI greater than 40
Gastric bypass surgery modifies the
gastrointestinal tract by changing either the size of
the stomach or the way the intestine drains.



Roux en Y gastric bypass
Vertical banded gastroplasty
Liposuction


Involves the removal of small amounts of fat from
specific locations
It is not a method for treating obesity.

Psychological help
 When
concern about body
weight and shape have
developed into an eating
disorder, professional help
is recommended.
Body Image

The perceptions, images, thoughts,
attitudes and emotions as seen through
the minds eye.

Body image problems

Those who have a negative body image
are more likely to diet restrictively, eat
compulsively or develop some other form of
disordered eating.

BDD: Body Dimorphic Disorder
Sufferers are overly concerned with physical appearance
 Spend hours everyday thinking concerned with physical
appearance
 Often focus on what they perceive to be slight “flaws” of
the face or head
 Can lead to depression, social phobia and suicide


Muscle dismorphia
 Disorder
experienced by some
bodybuilders in which they see
themselves as small and out of shape
despite being very muscular
 Let bodybuilding interfere with their
work and relationships
 May use steroids and other potentially
dangerous drugs

Eating disorders

Characterized by severe disturbances in
eating patterns and eating related
behavior
Anorexia nervosa
 Bulimia nervosa
 Binge-eating disorder


One feature in common:
Dissatisfaction with body image and body
weight
 Created by distorted thinking, including
perfectionist beliefs, unreasonable demands
for self control and excessive self criticism.


Anorexia nervosa
A person with anorexia does not eat enough food
to maintain a reasonable body weight.
 Typically develops between 12 and 18 years.
 People with anorexia have an intense fear of
gaining weight or becoming fat
 Many engage in compulsive behaviors or rituals
that help them keep from eating
 Commonly use vigorous and prolonged physical
activity to reduce body weight
 Are typically introverted, emotionally reserved
and socially insecure.
 Women with anorexia often stop mestruating


Bulimia nervosa
Implies binge eating followed by purging
 During a binge, a bulimic person may consume anywhere from
1000 to 60.000 calories within few hours, followed by an attempt
to get rid of the food by purging, usually vomiting or using
laxatives or diuretics.
 Health effects include tooth decay, esophageal damage and
chronic hoarseness, menstruation irregularities, depression, liver
and kidney damage and cardiac arrhythmia.

 Binge-eating
 Involves
disorder
uncontrollable eating
without any compensatory purging
behaviors.
 Eating more rapidly than normal
 Eating until uncomfortably full
 Eating when not hungry
 Preferring to eat alone.
 Compulsive overeaters rarely eat
because of hunger. Instead they use
food to cope with stress, conflict
and other difficult emotions or to
provide solace or entertainment.

Acceptance and change

There are limits to the changes that can be made to body weight
and body shape, both of which are influenced by heredity

The hazards of excessive dieting and over-concern about body
weight need to be countered by a change in attitude.
Creating an individual weight
management plan

Assess your motivation and commitment




Set reasonable goals
Assess your current energy balance


Its usually best to exercise more rather than eat less.
Make changes in your diet and eating habits


Create a negative energy balance
Increase your level of physical activity


Think about the reasons you want to lose weight
Your reasons should be self focused.
Make small changes in your diet that you can maintain for a lifetime.
Put your plan into action



Write a journal
Get other’s help
Think positively
Lab 7.3
Checking for body image
problems and eating disorders