Chapter 9 Weight Management

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Weight
Management
Chapter 9

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Overweight and Obesity
• Major health problem in the United States
• Growing concern worldwide
• Prevalence continues to increase
• Women, poor, blacks, and Mexican Americans
• Children
• BMI of 25 or greater
• Global food system
• Abundant energy-dense, processed, affordable
products

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Increasing Prevalence of
Obesity Among US Adults

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Fat Cell Development
• When energy in exceeds energy out:
• Adipose tissue fat cells store excess
• Number and size of body fat cells
• Fat cell numbers increase during childhood and
adolescence
• Cell proliferation
• When energy out exceeds energy in:
• Fat cell size decreases
• No change in number

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Fat Cell Development
Illustrated

6. Stepped Art
During
growth, fat
cells increase
in number.
When energy
intake exceeds
expenditure, fat
cells increase
in size.
When fat cells have
enlarged and energy
intake continues
to exceed energy
expenditure, fat cells
increase in number
again.
With fat loss, the
size of the fat cells
shrinks but not the
number.

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Fat Cell Metabolism
• Lipoprotein lipase (LPL) activity
• Storage of triglycerides
• Differences between obese and lean people
• Activity in varying body regions
• Differences between men and women
• Gender differences in enzyme activity
• Releasing and breaking down fat
• Fat oxidation not efficient
• Set point theory

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Genetics and Epigenetics
• Causative role of genetics
• Multiple genetic influences
• Genetics may determine susceptibility to
obesity
• Genes interact with:
• Diet and physical activity
• Metabolic pathways
• Human genome

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Obesity Gene
• Gene named ob
• Codes for the protein leptin
• Acts as a hormone in hypothalamus
• Promotes negative energy balance
• Suppresses appetite
• Increases energy expenditure
• Leptin injections effective in reducing body
weight in animals and humans
• With genetic deficiency of leptin or receptor
mutation

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Mice With and Without Leptin
Compared

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Ghrelin
• Secreted by the stomach cells
• Increases appetite
• Promotes positive energy balance
• Inverse correlation with body weight
• Psychological mindset influences ghrelin’s
response to a meal
• Mindset of indulgence promotes satiety
• Promotes sleep

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Uncoupling Proteins
• Types of body fat
• White adipose tissue
• Stores fat for use by other cells
• Oxidation releases energy as ATP and heat
• Brown adipose tissue
• Releases stored energy as heat
• Oxidation uncoupled from ATP formation
• Differences in brown fat between obese and
normal weight people

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Brite Adipocytes
• Some white fat can undergo browning
process
• Takes on characteristics of brown fat
• Resulting cells called brite adipocytes
• More abundant than brown fat cells in adults
• Physical activity can trigger the process

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Environment
• Obesity reflects interaction between genes
and the environment
• Overeating
• Present and past eating and activity patterns
influence current body weight
• Food availability
• Serving sizes
• Restaurant food

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Physical Inactivity
• Life requires little exertion
• Modern conveniences
• Inactivity contributes to weight gain and poor
health
• Sedentary activities and weight gain
• DRI for prevention of weight gain
• 60 minutes of moderately intense activity daily

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Health Risks
• Risk indicators
• BMI
• Waist circumference
• Disease risk profile
• Factors taken into account
• Beneficial weight loss
• Health status
• Motivation

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Different Conditions
• Overweight in good health
• Sometimes health is not the motivation for weight
loss
• Obese or overweight with risk factors
• Weight loss recommended with two or more risk
factors
• Obese or overweight with life-threatening
condition
• Weight loss recommended

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Perceptions and Prejudices
• Most obese people do not successfully lose
weight and maintain the loss
• Social consequences
• Jobs, school, and social situations
• People judged by appearance
• Psychological problems
• Embarrassment
• Other feelings

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The Psychology of
Weight Cycling

20. Stepped Art – Weight Cycling
I am fat
and unhappy.
I lose a little
weight, but then
regain it (and
sometimes more).
I want to
be happy.
If I lose
weight, I will
be happy.
I try too hard to
reach an
unrealistic goal.

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Dangerous Interventions
• Diet books and weight-loss programs
• Little success maintaining weight loss
• Fad diets
• Weight-loss products
• Herbal products
• Laws for dietary supplements
• Other gimmicks

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Drug Treatment for Obesity
• Strategies for weight reduction depend on:
• Degree of obesity
• Risk of disease
• Use drugs as part of long-term
comprehensive weight-loss program
• For people with medical risks
• Assist with modest weight loss
• FDA approval
• Mandate: benefits must outweigh risks

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FDA-Approved Drugs for
Weight Loss
Drug Action Side Effects
Orlistat (OR-leh-stat), trade names:
Alli,
Xenical
Inhibits pancreatic lipase activity in the GI
tract, thus blocking digestion and absorption
of dietary fat and limiting energy intake
Gl cramping, diarrhea, gas, frequent bowel movements,
reduced absorption of fat-soluble vitamins; rare cases of
liver injury
Phentermine (FEN-ter-
mean), diethylpropion (DYE-eth-
ill-PRO-pee-on). phendimetrazine
(FEN-dye-MEH-tra-zeen)
Enhances the release of the neurotransmitter
norepinephrine, which suppresses appetite
Increased blood pressure and heart rate, insomnia,
nervousness, dizziness, headache
Lorcaserin hydrochloride, trade
name: Belviq (BELL-veek)
Interacts with brain serotonin receptors to
increase satiety and reduce food intake
Headache, dizziness, fatigue, nausea, dry mouth, and
constipation; low blood glucose in people with diabetes;
serotonin syndrome, including agitation, confusion, fever,
loss of coordination, rapid or irregular heart rate,
shivering, seizures, and unconsciousness; cannot be safely
used by pregnant or lactating women or people with
heart-valve problems; high doses cause hallucinations
Phentermine (an appetite
suppressant) and topiramate (a
seizure/migraine medication)
combination, trade name: Qsymia
(kyoo-sim-EE-uh)
Enhances the release of the neurotransmitter
norepinephrine, which suppresses appetite,
and increases the feeling of being full, making
foods taste less appealing
Increased heart rate; can cause birth detects if taken in
the first weeks or months of pregnancy; increased heart
rate; suicidal thoughts; may worsen glaucoma and other
eye problems
NOTE: Weight-loss drugs are most effective when taken as directed and used in combination with reduced-kcalorie diet and increased physical activity

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Surgical Treatments
for Obesity
• Clinically severe obesity (BMI > 40)
• More than 100,000 surgeries performed annually
in the United States
• Reduces food capacity of stomach
• Effectively limits food intake
• Gastric bypass changes hormone production
• Health benefits
• Long-term safety and effectiveness
• Liposuction

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Gastric Surgery Used in the
Treatment of Severe Obesity

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Weight Loss Strategies
• Characteristics of successful strategies
• Embrace changes
• Celebrate losses
• Set goals
• Psychosocial support
• Benefits of modest weight loss
• Reasonable weight loss rate: 0.5 to 2 lb. per week
• Incorporation of healthy eating and physical
activity

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Eating Patterns, Part 1
• Be realistic about energy intake
• Provide less energy than needed
• Avoid restrictive eating
• Avoid rapid weight loss
• Goal: nutritional adequacy without excess
• Deficit of 500 to 1000 kcalories per day
• Breakfast frequency
• Inversely related to obesity

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Eating to Lose Weight
• Nutritional adequacy
• Minimum 1200 kcalories per day
• Eat small portions
• Eat less food at each meal
• Feel satisfied, not stuffed
• Prepared meal plans
• Slow down
• Reduce energy density
• Remember water

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Energy Density
Decreasing the energy density (kcal/g) of foods allows a person to eat satisfying portions while still reducing energy intake. To
lower energy density, select foods high in water or fiber and low in fat.
Selectinggrapeswith theirhigh
watercontentinsteadof raisins
increasesthevolumeandcuts
the energyintake.
Even at the same weight
and similar serving sizes,
the fiber-rich broccoli
delivers twice the fiber for
about one-third the energy.
By selecting the water-
packed tuna (on the right)
instead of the oil-packed
tuna (on the left), a person
can enjoy the same amount
for fewer kcalories.

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Eating Patterns, Part 2
• Focus on fiber
• Low in energy and high in nutrients
• Requires effort to eat
• Choose fats sensibly
• Energy density and satiation
• Select carbohydrates carefully
• Artificial sweeteners
• Watch for empty kcalories
• Fat, sugar, and alcohol

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Weight-Loss Strategies
Food Activities
 To maintain weight, consume foods and drinks to meet, not
exceed, kcalorie needs. To lose weight, energy out should
exceed energy in by about 500 kcalories/day.
 Emphasize foods with a low energy density and a high
nutrient density; make legumes, whole grains, vegetables,
and fruits central to your diet plan.
 Eat slowly.
 Drink water before you eat and while you eat; drink plenty
of water throughout the day.
 Track food and kcalorie intake.
 Plan ahead to make better food choices.
 Limit kcalorie intake from solid fats and added sugars.
 Reduce portions, especially of high- kcalorie foods.
 Cook and eat more meals at home, instead of eating out.
When eating out, think about choosing healthy options.
 Limit screen time.
 Increase physical activity.
 Choose moderate- or vigorous-intensity physical
activities.
 Avoid inactivity. Some physical activity is better than
none.
 Slowly build up the amount of physical activity you
choose.

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Physical Activity
• Best approach to weight management
• Moderate physical activity plus activities of daily
life
• Combination of diet and physical activity
• Lose more fat
• Retain more muscle
• Regain less weight
• Reduction of abdominal fat

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Activity Energy Expenditure
• kCalorie expenditure
• Influenced by body weight, intensity, and duration
• Greater the energy deficit, greater the fat loss
• Discretionary kcalorie allowance
• Metabolism
• Speeds up with activity
• Immediate and long-term benefits

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Influence of Physical Activity
on Discretionary kCalories

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Physical Benefits of Activity
• Body composition
• Fat decreases and lean body mass increases
• Strength-training exercises
• Abdominal fat
• Appetite control
• Delayed appetite
• Inappropriate appetite

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Psychological Benefits of
Activity
• Self-esteem
• Choosing activities
• Ones you enjoy and are willing to do regularly
• Moderate intensity
• 2000 kcalories per week
• Energy-expending daily activities
• Spot reducing

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Environmental Influences
• Factors surrounding eating experience and
the food itself
• Changes can influence amount a person eats
• Atmosphere
• Pleasant and comfortable equals more food
• Accessibility
• Less effort needed to obtain food, more food
eaten

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Environmental Factors While
Eating
• Socializing
• Duration of meal
• Visual cues
• Distraction
• Distractions
• Initiating eating
• Interfering with internal controls
• Extending duration of eating

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Other Environmental Factors
That Influence Eating
• Multiple choices
• Large assortments of foods increase consumption
• Package and portion sizes
• Serving containers

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Behavior and Attitude
• Behavior modification
• Positive, matter-of-fact attitude
• Become aware of behaviors
• Keep record
• Change behaviors
• Set small, time-specific goals
• Practice
• Reward

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Cognitive Skills
• Problem solving
• Cognitive restructuring
• Replace negative thoughts
• Personal attitude
• Understand personal relationship with food
• Sound emotional health
• Support groups

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Successful Weight Loss
• Weight loss
• Maintained for at least a year
• Prevalence of successful weight loss
• Difficult to determine
• Components of successful weight loss
• Vigorous exercise regimens
• Careful eating patterns
• Frequent self-monitoring

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Maintaining Weight Loss
• Hormonal and metabolic changes
• Persist over time
• Takes more effort to prevent weight regain
than to prevent weight gain

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Prevention
• Preventing weight gain
• Easier than losing weight
• Strategies similar to losing weight
• Start earlier
• Form beneficial habits
• Food choices
• Activity

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Community Programs
• Reversing obesity epidemic in the United
States
• Challenging
• May require community action to promote healthy
lifestyle choices
• Efforts go beyond individuals
• Social networks
• Community institutions
• Government policies

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National Strategies to Prevent
Obesity
• Provide a variety of opportunities to help make physical activity an integral and
routine
part of life.
• Create environments that ensure healthy foods and beverages are visible,
attractive, and
easy-to-obtain.
• Encourage media messages that promote physically active lifestyles and
nutritionally
healthy diets.
• Support health care providers in offering information on weight management and
employers in offering wellness programs.
• Make schools centers for health and wellness.
SOURCE: Accelerating Progress in Obesity Prevention: Solving the Weight of the
Nation, (Washington. DC: Institute of
Medicine of the National Academies). 2012.

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Underweight
• Affects fewer than two percent of U.S. adults
• Weight gain a matter of health
• Individual matter
• Weight gain may be difficult
• Physical conditioning combined with high energy
intakes

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Problems of Underweight
• Diverse causes
• High demand for energy may contribute
• Physical activity
• Growth and development
• Difficult to gain weight
• Adaptive thermogenesis
• Learn new habits and like new foods
• Difference between underweight and anorexia
nervosa

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Weight-Gain Strategies
• Key diet planning strategies
• Adequacy and balance
• Energy-dense foods
• Regular meals daily
• Large portions
• Extra snacks
• Juice and milk
• Liquid supplements for illness
• Exercise to build muscles

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The Latest and
Greatest Weight-
Loss Diet – Again
Highlight 9

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Fad Diets
• Outrageous claims
• No requirements to prove the claims
• Do not have to undertake credible research
• Often distorted research
• Anyone can publish anything
• Numerous fad diet plans

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Fad Diets’ Appeal
• Market for weight-loss products is huge
• Estimated $33 billion yearly in United States
• Greatest appeal
• Tend to ignore sound dietary recommendations
• Sophisticated and often erroneous
explanations
• Tend to work for short time
• Fail to produce long-lasting results

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Don’t Count kCalories
• Claim to disregard kcalories
• Designed to have low energy intake
• Tend to lack variety
• Monotonous
• Often recommend dietary supplement
• Follow a plan
• Most fad diets cannot support optimal health
over time

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The Real Deal
• Fad diet “magical powers”
• Tipping the energy balance equation to greater
energy expenditure
• Weight loss
• Long-term lifestyle changes
• Healthy plan
• Flexibility and variety