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Chapter 11
Weight Loss

2. Basics of Weight Control
How may Calories are in a pound of body fat?
• 1 pound of fat = 454 grams
• 1 gram of fat = ~ 9 Calories
• 1 pound of pure fat = ~ 4,086 Calories
• Body fat contains some protein, minerals and water
• 1 pound of body fat = ~ 3,500 Calories

3. Is the caloric concept
of weight control valid?
• First Law of Thermodynamics
– Energy is neither created nor destroyed

4. Caloric Concept of Weight Control
• Caloric costs for changes in body mass
– Fat = 9 Calories per gram
– Protein = 4 Calories per gram
– Carbohydrate = 4 Calories per gram
– Water = 0 Calories per gram
• Caloric cost of weight loss may vary
• Loss of body fat, however, costs about
3,500 Calories /pound

6. Estimated Energy Requirement (EER)
• A key factor is the Physical Activity Level (PAL),
which is the TDEE divided by the BEE. The PAL is
used to determine the Physical Activity (PA)
coefficient

8. How much weight can I lose
safely per week?
• Without medical supervision
– Recommended maximal amount
• Adults: 2 pounds/week
• Growing children: 1 pound/week
– Realizable goals
• Adults: 1 pound/week
• Growing children: ½ pound/week
– Weight loss should be body fat

9. 1. Behavior Modification
• Learn new ways to deal with old problems
• For weight control, reduce or eliminate physical or
social stimuli that contribute to
– Excessive caloric intake
– Physical inactivity
• Learn to eat a leaner, healthier diet
• Learn to exercise more

10. How do I apply behavior-modification
techniques in my weight-control program?
• YOU are the most important component of your weight-
control program
• YOU must
– Face the fact that being overweight impairs your health
– Know that losing weight will improve your health
– Establish weight loss as a high priority
– Be able to tolerate some discomfort as you make changes

11. Behavior Modification
• One of the first steps is to identify your dietary and
exercise behaviors - Keep a 24-hour record

12. Diet and Exercise Behaviors
• Establish long-range
and short-range goals
– Long-range
• Lose 10-15% of body
weight over 4-6 months
– Short-range
• Lose 1-2 pounds per week
• Small behavior changes
– “ Nothing builds success
like success”
– Small Steps

13. Behavior Modification: Suggestions
• Self-discipline, self-control, and advanced planning
• Foods to eat
• Food purchasing
• Food storage
• Food preparation and serving
• Location
• Restaurant eating
• Methods of eating
• Activity
• Mental attitude

14. Self-discipline, self-control,
and advanced planning
• Establish realistic weight-loss goals
• Establish weight loss as a high priority
• Think about this priority before eating
• Take small helpings deliberately
• Plan for a modest daily caloric deficit
• Check your body weight on a regular basis

15. Foods to eat
• Use low-Calorie healthful foods for snacks
• Plan low-Calorie, high-nutrient meals
• Plan your food intake for the entire day
• Eat only foods that require no or minimal processing
• Allow yourself small amounts of foods you like, but
stay within daily caloric limits
• Know the Food Exchange system, particularly portion
size and high-fat foods and Calories per exchange

16. Food purchasing
• Do not shop when hungry
• Prepare a shopping list and do not deviate from it
• Buy only nutrient-dense foods
• Read and compare food labels
• Buy natural foods as much as possible

17. Food storage
• Keep high-Calorie foods out of sight
• Have low-Calorie snacks like carrots and radishes
readily available

18. Food preparation and serving
• Buy mainly foods that require preparation of some
type
• Do not add fats or sugar in preparation, if possible
• Prepare only small amounts. Be able to visualize one
serving size for any given food
• Do not use serving bowls on the table
• Put the food on the plate, preferably a small one

19. Location
• Eat in only one place, such as the kitchen or dining
area
• Avoid food areas such as the kitchen or snack table
at a party
• Avoid restaurants where you are most likely to buy
high-Calorie items

20. Restaurant eating
• When eating out, select the low-Calorie items
• Request your meals be prepared without fat
• Have condiments, like butter, mayonnaise, and salad
dressing served on the side; use sparingly
• Order water, not a high-Calorie beverage
• Be wary of portion sizes as most restaurant servings
contain 2-3 normal servings. Ask for a take-home
container before you eat and put half of your meal in
the box.

21. Methods of eating
• Eat slowly. Chew your food thoroughly or drink
water between bites
• Eat with someone; conversation slows eating
• Cut food into small pieces
• Do not do anything else while eating
• Relax and enjoy the meal
• Eat only at specified times
• Eat only until pleasantly satisfied, not stuffed
• Spread your total Calories over the day; snack often

22. Activity
• Decrease the amount of time spent being sedentary
• Increase the amount of daily NEAT
• Walk more
• Use the stairs, not the elevator or escalator
• Do exercise snacks. Brisk 10-minute walk
• Get involved in physical activities with others
• Avoid sedentary night routines
• Start a regular exercise program, both aerobic and resistance
exercises
• Schedule exercise as an appointment in your daily planner

23. Mental attitude
• Recognize that you are not perfect and that lapses
will occur
• Deal positively with your lapse; put it behind you and
get back on your program
• Put reminders on the refrigerator door at home or
on your telephone at work
• Reward yourself for sticking to your plans

24. Weight maintenance
• Maintaining your new healthy body weight is the key
• Lifelong commitment to healthy diet and exercise
behaviors is needed
• Prevent a lapse from becoming a relapse
– Injury can curtail exercise
– Have alternative exercises you can do
• National Weight Control Registry
– Maintained weight loss for at least 2 years

25. 2. Dietary Modifications
• To lose weight, the key component is Calories
– One needs to consume fewer Calories than one expends

26. How can I determine the number of
Calories needed in a diet to lose weight?
• First, calculate how many Calories (C) you need daily to
maintain your current body weight
• Second, estimate how much weight you want to lose each
week.
• Example:
– 35-year old sedentary woman needs 1,820 C to maintain
current body weight at 140 pounds
– To lose 1 pound/week would require a 500 C daily deficit
– 1 pound of fat = 3,500 Calories; 3,500 ÷ 7 = 500 C
– 1,830 ― 500 = 1,330 C day diet

27. Why does a person usually lose the most
weight during the first week on a reducing diet?
• The goal is to lose body fat, not muscle
• Weight loss via dieting may come from decreased
body stores of carbohydrate and protein and resultant
body water losses, which require no Calories
– Carbohydrate stores may also bind water
– Carbohydrate losses: 300 grams
– Associated water losses: 900 grams
– Total losses: 1,200 grams (1.2 kg), or 2.6 pounds
– Water is also lost with muscle protein losses
• Loss of 1 pound occurs with < 3,500 Calorie deficit

28. Why does it become more difficult to lose weight after
several weeks or months on a diet program?
1. Body water losses decrease
– Body weight losses are now primarily from body fat, which
requires an energy deficit of 3,500 Calories
2. At your lower body weight, you need fewer daily
Calories to maintain this weight
– Example: Male who needs 18 Calories/lb to maintain weight
• 200 lbs x 18 = 3,600 Calories to maintain weight
• 180 lbs x 18 = 3,240 Calories to maintain weight
3. To maintain a set rate of weight loss, you would need
to cut more Calories from the daily diet

29. What are the major characteristics of a
sound diet for weight control?
• Hundreds of diet plans have been proposed
– Fast and easy diet plans
• No such diet
• Most diet plans focus on macronutrients
– Acceptable Macronutrient Distribution Range
(AMDR)
• Carbohydrate: 45-65% of energy intake
• Fat: 20-35% of energy intake
• Protein: 10-35% of energy intake

30. Popular Diets (Diet Books)
Diet PlanDiet Plan Average DailyAverage Daily
CaloriesCalories
%%
CarbohydratesCarbohydrates
%%
FatFat
%%
ProteinProtein
WeightWeight
watcherswatchers
1,4501,450 5656 2424 2020
AtkinsAtkins 1,5201,520 1111 6060 2929
South BeachSouth Beach 1,3401,340 3838 3939 2323
VolumetricsVolumetrics 1,5001,500 5555 2323 2222
Jenny CraigJenny Craig 1,5201,520 6262 1818 2020
ZoneZone 1,6601,660 4040 3030 3030
OrnishOrnish 1,5201,520 7777 66 1717
Adapted from Consumers Union. Rating the Diets.
Consumer Reports 70 (6):21, 2005.

31. Balanced Weight-loss Diets
• Examples of diet plans
– Various health profession organizations
• Key points of such diet plans
– Reduced in Calories yet supply all essential nutrients
– Contain a wide variety of foods that appeal to your taste
and help prevent hunger between meals; moderate in fat
– Suited to your current lifestyle and personal preferences
– Provide a slow rate of weight loss; 1-2 pounds/week
– A lifelong diet

32. Weight-loss Diet Plans
• Current research
– The Calorie content of the diet is the key factor
– Diets varying in carbohydrate, fat, or protein are
equally effective if caloric content is similar

33. Is it a good idea to count Calories when
attempting to lose body weight?
• Counting Calories may be helpful during early stages
of a diet
• Learning the Food Exchange System and using Food
Labels helps you learn the caloric contents and
serving sizes of various foods, which can help in the
selection of low-Calorie, nutrient dense foods
• Keep track of foods rich in fat and sugar

34. What is the Food Exchange System?

35. How can I determine the number of
Calories I eat daily?
• Carry a notebook with you and a reminder, such as a
rubber band on your finger
• Record your daily food intake, and physical activity, in
detail, as soon as possible
• Record food intake over a 3-7 day period of time
which represents your normal dietary habits
• Use the Food Exchange System or Nutrition Facts on
food labels to record serving size and Calories
• Use measuring devices, such as a measured cup
• Learn to estimate portion sizes

36. Determining Caloric Intake
• Eating out
– Fast-food restaurants
• Nutrition fact sheets
• See Appendix F
– Other restaurants
• Use PDA or cell phone
• Email calories@dietdetective.com
• Receive response with Calorie, fat, and carbohydrate
content

37. Determining Caloric Intake
• Enter food record into MyPyramid dietary
analysis program
• You may keep a record of your caloric
(energy) intake over the course of a year

38. What are some general guidelines I can use in the
selection and preparation of foods to promote weight
loss or maintain a healthy body weight?
• Consumer Reports study of 32,000 dieters who lost
weight and kept it off
– The National Weight Control Registry
• No specific plan but used sensible strategies
– Cut portion sizes
– Eat fewer Calories from fat and sugar
– Eat healthier carbohydrates, fats, and proteins

39. Guidelines for Weight Control and Healthy Eating
1. Decrease caloric intake -- eat more nutrient-dense
foods and fewer energy-dense foods
2. Eat foods that make you feel full
3. Restrict portion sizes
4. Eat less fat
5. Eat fewer and smaller amounts of refined sugar
6. Reduce the intake of both fat and sugar
7. Eat more low-fat dairy products

40. Guidelines for Weight Control and Healthy Eating
8. Eat more low-fat meat and meat substitutes
9. Eat more whole, unprocessed carbohydrates
10. Eat more fruits
11. Eat more veggies
12. Consume fewer high-Calorie fat exchanges
13. Reduce liquid Calories
14. Limit intake of alcohol
15. Limit salt intake

41. Guidelines for Weight Control and Healthy Eating
16. Eat slowly
17. Nibble, don’t gorge
18. Eat breakfast
19. Learn to cook
20. Learn low-Calorie foods

42. Guidelines for Weight Control and Healthy Eating
1. Eat more nutrient-dense foods and fewer energy-
dense foods

43. Guidelines for Weight Control and Healthy Eating
2. Eat foods that make you feel full
Volumetrics: High-volume, low-Calorie foods
Soups
Salads
Vegetables
Whole grains

44. Guidelines for Weight Control and Healthy Eating
3. Restrict portion sizes
Evolution of Coca-Cola
8-ounce bottle
12-ounce bottle
20-ounce bottle
64-ounce fountain serving
Evolution of fast-food hamburgers
Single 4-ounce patty
Double burger
Triple burger

45. Guidelines for Weight Control and Healthy Eating
4. Eat less fat
Proposed rationale:
• Rich in Calories
• Appetizing and does not rapidly suppress the appetite
• Has a lower TEF or higher metabolic efficiency
• May be stored preferentially in the abdominal area

46. Guidelines for Weight Control and Healthy Eating
5. Eat fewer and smaller amounts of refined sugar
• Reduce intake of sugar-sweetened beverages
• Use sugar substitutes

47. Guidelines for Weight Control and Healthy Eating
6. Reduce the intake of both fat and sugar
• May constitute 50% of daily energy intake

48. Guidelines for Weight Control and Healthy Eating
7. Eat more low-fat dairy products
• Rich in protein, vitamins and minerals, especially calcium

49. Guidelines for Weight Control and Healthy Eating
8. Eat more low-fat meat and meat substitutes
• Very lean meat exchange
• Fish, chicken breast, beef eye of round, flank steak
• 35 Calories, 1 gram of fat
• High in protein
• Low in fat
• Low in Calories
• Rich in minerals (iron and zinc)

50. Guidelines for Weight Control and Healthy Eating
9. Eat more whole, unprocessed carbohydrates
• High volume food
• Rich in fiber
• Select 100% whole wheat or whole grain

51. Guidelines for Weight Control and Healthy
Eating
10. Eat more fruits
• Select fresh fruits
• Select canned or frozen fruits in own juices
• Avoid fruits in heavy sugar syrups
• Limit intake of dried fruits (high in Calories)
• Limit intake of fruit juices (high in Calories)

52. Guidelines for Weight Control and Healthy Eating
11. Eat more vegetables
• High volume foods
• Low in Calories
• Rich in vitamins, minerals, fiber, phytonutrients
• Many vegetables are listed as Free Food
Exchanges
• Fewer than 20 Calories per serving

53. Guidelines for Weight Control and Healthy Eating
12. Consume fewer high-Calorie fat exchanges
• Reduce intake
• Butter
• Margarine
• Cooking oils
• Salad dressing
• Mayonnaise
• Most are pure fat
• Use fat-free or low-fat versions

54. Guidelines for Weight Control and Healthy Eating
13. Reduce liquid Calories
• Beverages other than milk and fruit juice should have no
Calories
• Sweetened sodas and drinks may be associated with weight
gain and obesity
• Some specialty coffees contain as many Calories as
McDonald’s Big Mac
• Starbucks Choclaty Chip Frappuccino Blended Crème > 500 Calories

55. Guidelines for Weight Control and Healthy Eating
14. Limit your intake of alcohol
– A gram contains 7 Calories, comparable to fat
– Calories in alcohol do not replace Calories in a
meal, so total caloric intake is increased
– Selecting low-alcohol beer and wine may help
save Calories
• 64 Calories versus 150 Calories
• Decreased carbohydrate and alcohol

56. Guidelines for Weight Control and Healthy Eating
15. Limit salt intake
• Salt may increase appetite
• Salt may increase thirst for sugar-sweetened beverages
• Use herbs, spices and other nonsalt seasonings

57. Guidelines for Weight Control and Healthy Eating
16. Eat slowly
• Eating slowly may help curb your appetite
• Eat a low-Calorie soup or salad as an appetizer
• May help curb the appetite for the main course

58. Guidelines for Weight Control and Healthy Eating
17. Nibble, don’t gorge
• Eat 5-6 smaller snacks and meals during the day
• May help curb the appetite
• Use low-Calorie, nutrient-dense foods
• 100-Calorie snacks
• An apple
• A hard-boiled egg
• A dozen almonds
• 3 Hershey’s kisses
• 3 cups of air-popped, fat free popcorn

59. Guidelines for Weight Control and Healthy Eating
18. Eat breakfast
• A hearty breakfast may help curb appetite
through the morning hours
• A high-protein breakfast may be helpful
• Egg substitutes
• Whole wheat bagels with salmon
• Whole grain cereals with skim milk and fruit

60. Guidelines for Weight Control and Healthy Eating
19. Learn to cook
• Select healthy foods
• Cook and serve small portions
• Ease of cooking
• Microwaves
• Electric grills

61. Guidelines for Weight Control and Healthy Eating
20. Learn low-Calorie foods
• Learn to substitute low-Calorie foods for those
high in Calories
• Know the Food Exchange System
• Practice what you learn
• Gradual transition in small steps
• Whole milk → low-fat milk → skim milk

62. Are very-low-Calorie diets (VLCD) effective and
desirable as a means to lose body weight?
• VLCD are modified fasts (< 800 Calories/day)
• May be used under medical supervision
• Not recommended for typical individual who wants
to lose 10-20 pounds

63. Is it harmful to overeat occasionally?
• Occasional overeating is not harmful
to dieting, as long as it does not
become a habit
• Try to avoid high-fat meals if prone to cardiovascular
disease
• Rapid weight gain from overeating may occur, but is
not body fat
– Water retention with carbohydrate stores
– Water retention with excess sodium
• Getting back on your weight loss plan will return
body weight to normal

64. 3. Exercise Modifications
Increase any of the FITT Principles
• Frequency
• Intensity
• Time
• Type

65. Comprehensive Weight-Control Programs
• Comprehensive program
– Behavior modification
– Diet
– Exercise
• Most important feature
– Maintenance of stable healthy body weight
• Lifelong commitment

66. What is more effective for weight control
—dieting or exercise?
• Dieting alone may be an effective means to lose
excess body fat
– Increasing protein content may help maintain muscle
– Some indicate dieting alone to maintain weight is designed
to fail in the long run
• Exercise alone may also be an effective means to
lose body fat
– Dietary energy intake needs to remain constant

67. Dieting and Exercise for Weight Control
• Combination of dieting and exercise is the most
effective approach to weight control
– A proper diet can control energy intake
– A proper aerobic and resistance exercise program provides
multiple benefits
• Expends caloric energy
• Prevent decrease in lean body mass
• Maintain resting energy expenditure (REE)
• Exercise may improve dietary compliance

68. Weight Control
• The Bottom Line
Eat less, move more