Overweight

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Chapter
9
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Overweight and Obesity Defined
Health Implications of
Overweight and Obesity
Factors Contributing to Excess Body Fat
Adopting a Healthy Lifestyle for
Successful Weight Management
Physical Activity and Exercise
Thoughts and Emotions
Approaches to Overcoming a Weight Problem
Body Image
Eating Disorders
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9-2
About 69% of American adults over
the age of 20 are overweight
 Too much body fat can have negative
effect on health and well-being
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 Visceral fat: Fat located
around the major organs, also
called intra-abdominal fat
 Subcutaneous fat: Fat
located under the skin
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 Overweight: Body weight above the
recommended range for good health
 Obesity: Severely overweight,
characterized by an excessive accumulation
of body fat; may also be defined in terms
of some measure of total body weight
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9-4
SOURCE: Flegal, K. M., et al. 2012.
Prevalence of obesity and trends in the
distribution of body mass index among
U.S. adults, 1999–2010. Journal of the
American Medical Association 307(5):
491–497.
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Useful for estimating a person’s weight
status and for classifying the health risks
 BMI based on the concept that weight
should be proportional to height
 Easy to calculate and rate
 Body weight status categorized
as underweight, healthy weight, overweight,
or obese
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9-7
SOURCE: Ratings from National Heart, Lung, and Blood Institute. 1998. Clinical Guidelines on
the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence
Report. Bethesda, Md.: National Institutes of Health.
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9-8
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As overweight and obesity rates rise in
the US, prevalence of health conditions
associated with overweight rise
 82% rise in the prevalence of diagnosed
diabetes between 1995 and 2010
 Estimated that more than 112,000
premature deaths annually in the US
due to inactivity and overweight
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9-9
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Obesity is one of six
major controllable risk
factors for heart disease
 Gaining weight found
to be dangerous
 Even modest weight loss
has positive impact on health
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9-10
Genes influence body size and
shape, fat distribution, metabolic
rate, and tendency to gain weight
 Tendency to develop obesity may be
inherited, but expression of tendency
affected by environmental influences
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9-11
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Metabolism a key physiological factor in
regulation of body fat and body weight
 Hormones also play a role
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Metabolism and energy balance
 Metabolism is processes by which food energy
and nutrients are made available to and used
by the body
▪ Energy to maintain vital body functions while body
is at rest is RMR
▪ RMR about 65-70% of daily energy expenditure
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Resting metabolic rate (RMR): Energy
required (in calories) to maintain vital
body functions, including respiration, heart
rate, body temperature, and blood
pressure, while the body is at rest
 RMR dictated by many factors,
including genes and behavior
 Higher RMR means that a person
burns more calories while at rest and can
take in more calories without gaining weight
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9-13
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9-14
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Hormones
 Hormones play role in accumulation of
body fat, especially for women
 Leptin secreted by the body’s fat cells
and lets the brain know how big or
small the body’s fat stores are
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9-15
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Eating
 People underestimate
portion sizes
 Americans’ average
calorie intake
has increased by 18%
since 1983
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9-16
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Physical activity
 On average, Americans exercise
15 minutes and watch 170
minutes of TV and movies each day
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Psychosocial factors
 Binge eating: A pattern of eating in
which normal food consumption is
interrupted by episodes of high consumption
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9-17
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Total calories
 USDA suggests approximate daily energy
intakes based on gender, age, and activity
level
 The best approach for weight loss is to
increase physical activity and decrease
calorie intake
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Portion sizes
 Limiting portion sizes critical for weight
management
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9-18
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Energy (calorie) density
 Energy density: number of calories
per ounce or gram of weight in a food
 Fresh fruits and vegetables
are low in energy density
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Eating habits
 Eat small, frequent meals
 Consume majority of
calories during the day
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9-21
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Physical activity burns calories and keeps
the metabolism geared to use food for
energy rather than storing it as fat
 All physical activity helps manage weight
▪ Short bouts of activity throughout the day
can produce many of the same health
benefits as continuous physical activity
▪ People who lose weight and don’t regain it
typically burn about 2800 calories per week
through exercise
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9-22
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Exercise
 Start a regular exercise program that
includes cardiorespiratory exercise,
resistance training, and stretching
 Moderate-intensity endurance exercise
can burn a significant number of calories
 Regular physical activity makes
weight management easier
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9-23
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Low self-esteem and negative emotions
that accompany it are significant
problems
 Set realistic goals and engage in
positive self-talk and problem solving
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Coping strategies
 Many people use eating as a way to cope
 Analyze eating habits with fresh eyes
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9-24
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Doing it yourself
 Focus on adopting a healthy lifestyle
 Combine modest cuts in energy intake with
exercise, and avoid very-low-calorie diets
 Negative energy balance of 250 to 1,000
calories per day will produce weight loss
 Maintaining weight loss can be a
bigger challenge than losing weight
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9-25
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Use books that advocate a balanced
approach to diet plus exercise and
nutritional advice
 Reject any book that:
▪ Advocates an unbalanced diet
▪ Claims to have a “secret” or “scientific
breakthrough”
▪ Uses gimmicks
▪ Promises fast weight loss
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9-26
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Many diets cause weight
loss if maintained
 Difficulty is finding a safe
and healthy pattern of food
choices and physical activity
that result in long-term
maintenance of body weight
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9-27
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FTC: More than half of advertisements
for weight loss products make
representations that are likely to be false
 Hidden and undisclosed ingredients are
becoming problems in weight loss products
▪ Formula drinks and food bars
▪ Herbal supplements
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9-28
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Other supplements
 Dietary fiber acts as a bulking agent in
the large intestine, not the stomach, so it
doesn’t have a pronounced effect on appetite
 Popular dietary supplements include
conjugated linoleic acid, carnitine,
chromium, pyruvate, calcium,
B vitamins, chitosan, and a number of
products labeled “fat absorbers,”
“fat blockers,” or “starch blockers”
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9-30
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Noncommercial weight-loss programs
 Take Off Pounds Sensibly (TOPS)
and Overeaters Anonymous (OA)
 These programs provide group support
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Commercial weight-loss programs
 Typically provide group support, nutrition
education, physical activity
recommendations, and behavior modification
advice
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9-31
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A responsible and safe weight-loss
program should have the following:
 Be safe and balanced
 Promote slow, steady weight loss
 Offer physician evaluation/monitoring
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Clinical weight-loss programs
 Usually in hospital or other medical setting
 The cost of a clinical program is usually high,
but insurance often covers part of the fee
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
Appetite suppressants reduce feelings of
hunger or increase feelings of fullness
 Most appetite suppressants approved only for
short-term use
▪ Sibutramine and orlistat (Xenical)
approved for longer-term use
▪ There are side effects
 The latest federal guidelines advise trying
lifestyle modifications for at least 6 months
before trying drug therapy
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9-33
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About 6% of Americans are severely
obese, meaning they have a BMI of 40 or
higher
 Bariatric surgery may be recommended
for patients with a BMI greater than 40 or
greater than 35 with obesity-related illnesses
▪ Roux-en-Y gastric bypass
▪ Vertical banded gastroplasty (VGB/Lap-Band)
 Liposuction involves the removal of small
amounts of fat from specific locations
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If concerns about body weight and
shape develop into eating disorder,
professional help is recommended
 Therapists should have experience
in weight management, body
image issues, eating disorders,
addictions, and abuse issues
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9-35
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Body image: Mental representation
a person holds about her or his
body consisting of perceptions,
images, thoughts, attitudes,
and emotions about the body
 Severe body image problems
▪ Body Dysmorphic Disorder (BDD)
▪ Body image may bear little resemblance to fact
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9-36
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Acceptance and change
 Weight management needs to take place
in a positive and realistic atmosphere
 Hazards of excessive dieting and
over concern about body weight need
to be countered by change in attitude
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9-37
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Eating disorder: Serious disturbance in
eating patterns or eating-related
behavior characterized by a negative
body image and concerns about body
weight
 Eating disorders affect more than ten million
American females and one million males
 A growing number of people, especially
adolescent girls and young women,
experience eating disorders
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9-38
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Anorexia nervosa:
Eating disorder characterized by
refusal to maintain body weight at a
minimally healthy level and intense
fear of gaining weight or becoming
fat; self-starvation
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9-39
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Bulimia nervosa: Eating disorder
characterized by recurrent episodes
of binge eating and purging
to prevent weight gain
 Purging: The use of vomiting, laxatives,
excessive exercise, restrictive dieting,
enemas, diuretics, or diet pills to compensate
for food that has been eaten and that the
person fears will produce weight gain
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9-40
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Binge-eating disorder: An eating
disorder characterized by binge
eating and a lack of control
over eating behavior in general
 Affects 2% of American adults
 Characterized by uncontrollable eating
without any compensatory purging behaviors
 Binge eaters are almost always obese
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9-41
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Borderline Disordered Eating
 Some symptoms of eating
disorders but do not meet full
diagnostic criteria for eating disorder

Treating eating disorders
 Must address problematic eating behaviors
and misuse of food to manage emotions
 Milder patterns may benefit from nutrition
checkup with a registered dietitian
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9-42
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