Diet and Health Guidelines for Weight
Management
Presented by
Janice Hermann, PhD, RD/LD
OCES Adult and Older Adult Nutrition Specialist
Energy Balance
Energy Balance
Excess energy whether from
 Fat
 Carbohydrate
 Protein
 Alcohol
can be converted into fat and stored in fat cells
Energy Balance
If energy in = energy out
 Maintain weight
If energy in > energy out
 Gain weight
 Stored as fat
If energy in < energy out
 Lose weight
 Body pulls on fat stores and lean tissue
Energy Balance
 3,500 kcal = 1 pound
 It only takes a small calorie imbalance to
impact weight over time
 100 kcal excess per day = 10 pound gain per year
 100 kcal deficit per day = 10 pound gain per year
“Energy In”
 Food and beverages provide the “energy in”
 The energy values of foods can be calculated
from the amounts of carbohydrate, fat and
protein, and alcohol in the foods
 1 g carbohydrate = 4 calories/g
 1 g fat = 9 calories/g
 1 g protein = 4 calories/g
 1 g alcohol = 7 calories/g
“Energy Out”
 Body expends energy in three main categories
 Basal metabolism
 60-70%
 Physical activity (most variable)
 25-30%
 Sedentary may be less than half of basal metabolism
 Extremely active may be as much as basal metabolism
 Thermic effect of food
 5-10%
Assessing Weight and Health Risk
Assessing Body Weight
 The first step in weight management is to take
a good look at current weight
 Assessing body weight can be tricky
 Body weight not a good indicator of health risk
 Body weight includes:
 Water
 Lean tissue
 Fat
Health NOT appearance - criteria for body weight
Body Fat and Health
 Body fat normally higher for females than
males
 Normal weight male 13 to 21%
 Normal weight female 23 to 31%
 Health problems typically develop when body
fat exceeds
 22% young men
25% in men over 40 yr
 32% in young women 35% in women over 40 yr
Body Mass Index (BMI)
 BMI describes relative weight for height in
regards to health
 BMI = weight(kg)/height (m)2
 For adults, a BMI of:
 BMI < 18.5 (underweight)
 BMI 18.5 to 24.9 (healthy)
 BMI 25 to 29.9 (overweight)
 BMI ≥ 30 (obese)
BMI and Health Risks
 BMI correlated with disease risk and life
expectancy
 These are correlations, not causes
 Epidemiological data show a J or U shaped
relationship between BMI and mortality
 These mortality risks decline with age
 Moderate overweight not as great of a health risk
among older adults
Health Risks Associated With
Underweight
 Health risks of underweight
 Underweight person, especially older adults, may
be unable to preserve lean tissue during a fight
against a wasting disease, such as cancer or
digestive disorder, especially if accompanied by
malnutrition
 Underweight women have higher fertility
problems
 Underweight women are at higher risk of
osteoporosis and bone fractures
Health Risks Associated With
Overweight and Obesity
 Health risks of overweight and obesity
 Diabetes
 Hypertension
 Cardiovascular disease
 Sleep apnea
 Osteoarthritis
 Certain types of cancer
 Gallbladder disease
 Respiratory problems
 Complications with pregnancy and surgery
Other Consequences Associated With
Overweight and Obesity
Perceptions and prejudices
Social consequences
Psychological consequences
Distribution of BMI’s in US Adults
BMI Limitations
 BMI doesn’t measure body composition
 A BMI in the healthy range may not be healthy
if a large percentage of weight is fat
 A BMI in the overweight range my be healthy if
a large percent of weight is muscle or bone
 Doesn’t consider ethnic and age
differences in body composition
 Certain ethnic groups have higher bone density
 Changes in body composition with age
Where Body Fat Located
 Where fat located may be more critical than
total amount of fat
 Abdominal fat (stored around the organs of the
abdomen) referred to as central obesity or upperbody fat
 Associated with increased risks of cardiovascular disease,
type 2 diabetes, and hypertension, independently of
total body fat
 Abdominal fat is most common in men and to a lesser
extent in women past menopause
 Fat around the hips and thighs referred to as
lower-body fat
 Not as associated with increased health risks
 Most common in women during reproductive years
Waist Circumference
 Waist circumference
 Practical indicator of abdominal fat
 Waist circumferences associated with central
obesity and increased health problems are:
 Women: waist circumference > 35 inches
 Men: waist circumference > 40 inches
Other Body Composition Methods
 Health care professionals commonly use BMI
and waist circumference to evaluate weight
 Easy to determine and inexpensive
 More precise measures of body composition;
more evasive, expensive and require mastery
of technique
 Fatfold measure
 Hydrodensitometry
 Bioelectrical impedance
 Air displacement plethysmography
 Dual energy X-ray absorptiometry (DEXA)
Evaluating Health Risk
 Three indicators used to evaluate health risk
relative to weight:
 Body mass index (BMI)
 BMI 25.0-29.9 = overweight
 BMI ≥ 30 obese
 Waist circumference
 Men: >102 cm (>40 in)
 Women: >88 cm (>35 in)
 Disease risk profile
 Family history, life-threatening diseases, and common
risk factors for chronic diseases
Evaluating Health Risk
Overweight in good health
 People who are overweight by BMI standards but
otherwise in good health, might not benefit from
losing weight; instead they might focus on
preventing further weight gain
Evaluating Health Risk
 Overweight/Obese with Risk Factors
 Weight loss is recommended for people who are
obese and those who are overweight (or who have
a high waist circumference) with two or more risk
factors for chronic diseases
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Hypertension
Cigarette smoking
High LDL
Low HDL
Impaired glucose tolerance
Family history of heart disease
Men ≥45 yr; women ≥55 yr
Evaluating Health Risk
 Overweight/Obese with Life Threatening
Condition
 Weight loss is also recommended for people who
are either overweight or obese and suffering from
a life-threatening condition such as cardiovascular
disease, diabetes, or sleep apnea
Fat and Fit versus Slim and Sedentary
 Cardio-respiratory fitness plays a major role in
health, independently of BMI
 Fit normal-weight people have lower health risks
than unfit normal-weight people
 Fit overweight people have lower health risks than
unfit normal-weight people
 Fitness, in and itself, offers many health
benefits
Causes of Overweight and Obesity
Causes of Overweight/Obesity
 Prevalence of overweight and obesity in the
United States continues to rise across all:
 Regions
 Genders
 Ages
 Ethnic/racial groups
 Socioeconomic groups
 Education levels
Causes Of Overweight/Obesity
 Many factors can affect food intake and
physical activity level which can lead to
weight gain:
 Genetics
 Environment
Causes of Overweight/Obesity: Genetics
 Genetics plays a true causative role in few cases
of obesity
 Example: Prader-Willi syndrome
 Even if genetics does not cause obesity, genetic
factors may influence:
 Metabolic pathways that lead to overweight/obesity
and maintain it
 Food intake
 Activity patterns
Causes of Overweight/Obesity: Genetics
 Adopted children tend to be similar in weight
to their biological parents, not to their
adoptive parents
 Identical twins are twice as likely to weight
the same as fraternal twins – even when
reared apart
 Suggest an important role for genetics in
determining a person’s susceptibility to
overweight/obesity
Causes of Overweight/Obesity: Genetics
 Genetics seem to makes some people more
or less likely to gain or lose weight when
overeating or under-eating
 Some people gain more weight than others on
comparable intakes
 Similarly, some people lose more weight than
other following comparable physical activity
routines
Causes of Overweight/Obesity: Genetics
 Although genetics has a role with
overweight/obesity
 Overweight/obesity rates have dramatically risen
over the past three decades while the gene pool
has remaining relatively unchanged
Causes of Overweight/Obesity: Environment
 Environment includes all the circumstances we
encounter daily that push us toward weight gain
 Overeating
 Remember: doesn’t mean excessive 100 kcal/day = 10 lb/yr
 Physical inactivity
 Genetics and environmental factors are not
exclusive of each other; genetics can influence
eating and activity behaviors
Causes of Overweight/Obesity: Environment
Overeating
 Energy balance must consider over time
 Family/cultural environment
 Family/cultural eating habits
 Income
 Time
 Working mothers
 Increased activities
 Emotional stress
 Override hunger, satiation, and satiety cues
 Knowledge and skills
Causes of Overweight/Obesity: Environment
Overeating
 Environment that exposes us to an abundance of
high-calorie, high-fat foods
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Readily available
Relatively inexpensive
Heavily advertise
Taste great
Large portions
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Especially restaurants
Trend towards large portions parallels prevalence of overweight
and obesity in the United States
Causes of Overweight/Obesity: Environment
Physical Inactivity
 Decrease in daily activities
 Technology replaced physical activity at home, work and
transportation
 Increase in sedentary activities
 Television, video and computer games
 Require little activity
 Replace time spent in more vigorous activities
 People tend to eat while they do sedentary activities
Causes of Overweight/Obesity: Environment
Physical Inactivity
 Other environmental issues
 Safety
 Cost
 Access places to be physically active
 Time
 Working mothers
 Increased activities
 Injury/illness
Weight Loss
Key Concepts
 Refocus attention to achieving and maintaining
good health by focusing on:
 Health, not appearance, weight management
priority
 Setting realistic goals
 Healthy eating, not “dieting”
 Regular physically active
Key Concepts
 Weight management aims at changes that
will last
 Any lasting change will be slow and gradual
 As a result, weight management is a
commitment to a healthful lifestyle and
should be viewed as an on-going process
No “Quick Fix”
 Many weight loss programs imply weight loss
is simple
 People lured into programs that promise a quick
and easy fix to a complex problem
 If weight loss were simple the success rate
would be far greater than it is
No “Quick Fix”
 Too often weight loss programs focus on
 Severely restrictive diets
 Unrealistic weight loss goals
 Inability to reach unrealistic weight loss goals
and tendency to regain weight lost sets up an
endless cycle of failure and discouragement
 Many people feel their weight loss efforts are
unsuccessful, when in actuality it may be their
weight loss goals are unrealistic
Weight-Loss Strategies
 Unreachable goals ensure failure
Weight-Loss Strategies
 Successful weight-loss strategies embrace:
 Small changes
 Moderate losses
 Reasonable goals
Weight-Loss Strategies
 A person who loses 10-20 pounds in a year by
choosing healthy nutrient-dense foods and
engaging in regular physical activity is more
likely to
 Maintain weight loss
 Gain health benefits
than if more weight is lost in less time by
radical methods
Weight Loss and Body Composition
 Quick changes in body weight are not simple
changes in fat stores
 Weight gained or lost rapidly includes:
 Some fat
 Large amount of fluid
 Some lean tissue
 Because 60% of body weight is water, retention or
loss of water dramatically affects body weight
 Even long term changes in body weight
 75% stored fat
 25% lean tissue
Weight-Loss Strategies
 Modest weight loss (5-10%), even if still
overweight, provides health benefits:
 Improves blood glucose control
 Lowers blood pressure
 Lowers LDL cholesterol
 Increased physical activity can:
 Increase HDL cholesterol
 Increase cardiovascular fitness
Weight-Loss Strategies
 Dietary Guidelines advises those who need to
lose weight to aim for a slow, steady weight
loss by:
 Decreasing calorie intake while maintaining
adequate nutrient intake and
 Increasing physical activity
Weight-Loss Strategies
 Reasonable goals
 Reasonable weight loss rate
 1 to 2 pounds per week
 Reasonable time frame
 10% of body weight over 6 months
 Example: 250 pound person
 10% loss over 6 months would be 25 pounds
 Which is about 1 pound per week
Weight-Loss Strategies
 Rapid weight loss typically results in:
 Excessive loss of lean tissue
 Including water loss
 Lower BMR
 Weight lost often regained
 May set into motion eating disorders
Weight-Loss Strategies
 Healthy eating NOT dieting
 A non-restrictive approach to eating
including a variety of foods from the USDA
Daily Food Plan food groups with a
moderate reduction in calories
 Total fat
20 to 35% of kcal
 Saturated fat less than 10% of kcal
 Cholesterol
less than 300 mg
 Carbohydrate 45 to 65% of kcal
 Protein
10% to 35% of kcal
 Fiber
14 g/1,000 kcal
Weight-Loss Strategies
 Eating plan: Healthy eating NOT dieting
 Be realistic about energy intake-Moderate calorie
reduction
 BMI 27-35: 300 to 500 calorie/day reduction
 BMI ≥ 35: 500 to 1000 calorie/day reduction
 Emphasize nutritional adequacy
 Nutritional adequacy difficult with < 1200 kcalories/day for
females and < 1600 kcalories/day for males
Weight-Loss Strategies
 Eating plans: Healthy eating NOT dieting
 Eat smaller portions
 Emphasize lower energy density foods
 Remember water
 Focus on complex carbohydrates (containing fiber)
 Reduce foods high in fat and/or simple sugars
 Watch for other empty kcalories such as beverages
 Eat slowly - satiety signal sent after a 20-minute lag
Energy Density
 Selecting grapes with their high water content
instead of raisins increases the volume and
decreases the energy intake
Energy Density
 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
Energy Density
 By selecting the low-fat version, a person can
enjoy the same amount of tuna for fewer
calories
Energy Density
Weight-Loss Strategies
 Physical activity
 People who combine healthy eating with physical
activity are more successful at losing and keeping
weight off
 People who include physical activity are also more
likely to lose body fat and keep lean muscle tissue
Weight-Loss Strategies
Physical activity
 Activity and energy expenditure
 Calories spent in activity depends on body weight,
intensity and duration
Weight-Loss Strategies
Physical activity
 Activity and metabolism
 Activity increases metabolism
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Immediately (slightly elevated for several hours after
intense and prolonged activity)
Long term (Increasing lean tissue – muscle has a higher
metabolic rate)
 Activity and body composition
 Increases lean tissue, decreases body fat
 NOTE: Muscle weighs twice as much as fat - may have
more gradual weight loss, but will be more fat loss and
less muscle
Weight-Loss Strategies
Physical activity
 Activity and appetite control
 During activity body releases stored energy to support
physical activity, also suppresses digestion
 Physical activity can help reduce appetite related to
boredom, anxiety or depression
 Activity and psychological benefits
 Health benefits
 Lowers risks for type 2 diabetes, cardiovascular disease,
hypertension, colon cancer
Weight-Loss Strategies
Physical activity
 Choosing activities
 Activities they enjoy and are willing to do regularly
 Spot reducing
 Muscles do not "own" the fat that surrounds them
 Fat cells from all over the body release fat in response
to the demand for physical activity
 Physical activity can firm and strengthen muscles in a
particular area
Weight-Loss Strategies
 How Much Physical activity
 Activity of low-to-moderate intensity that
expends at least 2,000 calories per week is
especially helpful for weight management
 Dietary Guidelines physical activity
recommendations:
 For substantial health benefits
 150 minutes of moderate-intensity per week or
 75 minutes of vigorous-intensity per week
 For additional health benefits
 300 minutes of moderate-intensity per week or
 150 minutes of vigorous-intensity per week
Weight-Loss Strategies
 Physical activity doesn’t have to be at one
time
 Try two to three 10-minute bouts rather than one
continuous 30 minutes
 If you haven’t been physically active build up
time gradually
Before You Begin
 A health care provider should be consulted
before becoming more physically active,
especially if
 Chronic health problem such as heart disease,
hypertension, diabetes, osteoporosis, or obesity
 Arthritis or joint problems
 High risk for heart disease
 Over age 40 for men or 50 for women
Hitting A Plateau
 People often lose much of their weight within
6 months and reach a plateau
 Hitting a plateau is normal
 Body requires fewer calories to function as weight
decreases
 This slow down can be disappointing, but is
an opportunity for the body to adjust to its
new weight
Hitting A Plateau
 Attempting to lose additional weight at this
point can result in failure, instead focus on
maintaining the weight loss
 After successfully maintaining an initial
weight loss for 6 months gradually increasing
the amount of physical activity may help a
continued weight loss
Prescription Medications
 The FDA has approved several prescription
medications for appetite control
 Prescription medications are not "Magic
Pills," they are used in combination with
moderate calorie restriction and increased
physical activity
Prescription Medication
 Weight loss medications are serious medicine
for serious obesity
 They should only be used under medical
supervision
 They are only recommended for people with
serious weight problems, not for people who want
to lose a few pounds
Weight-Loss Strategies
 Behavior and attitude
 Behavior modification
 Become aware of behaviors
 Change behaviors
 Personal attitude
 Support groups
Weight Gain
Weight Gain
 For some people weight management may
translate into weight gain
 Although being underweight is a less
prevalent problem than being overweight, for
some people the struggle to gain weight is
just as difficult as weight loss is for others
Weight Gain
 Healthy weight gain is accomplished through
a combination of:
 Increased calories
 Increased physical activity to build muscle mass
 Weight gain can occur with increased
calories and no physical activity, but it will
be mostly fat, which is detrimental to health
just as being underweight
Weight-Gain Strategies
 The foundation of a healthy diet, even for
weight gain, follows the USDA Daily Food Plan
 Increase calories
 Healthy eating for weight gain focuses on eating
foods that provide many calories in a small volume
 Energy intake should exceed output (including
increased needs for physical activity by about 500
calories per daily
 Expect weight gain to take time (1 pound per
month would be reasonable)
Weight-Gain Strategies
 To gain weight, increase calorie intake by:
 Eating regular meals
 Taking larger portions
 Selecting calorie dense foods
 Consuming extra snacks and beverages
Weight-Gain Strategies
Physical Activity
 Healthy physical activity for weight gain focuses on
strengthening activities to build muscle mass
 Muscle tissue weighs nearly twice as much as fat
tissue
 Remember energy intake should exceed output
(including increased needs for physical activity)
by about 500 calories per daily