2. • Normal Weight:(desirable,healthy,ideal) is a weight
which is appropriate for the maintenance of good
health for a particular individual at a particular time.
• Over Weight is a weight 10-20% above average
i.e;ideal body weight. or BMI > 25.
• Obesity is an excess body fat with weight 20% above
average. or BMI >30 .
• Under Weight is weight 10-15% below average. or
BMI < 18.5.
3.
4. • Body Mass Index :BMI is an index of weight
in relation to height, calculated mathematically
by dividing weight in kilograms by the square
of the height in meters.
• E.g.; wt in kg
ht in meters 2
5.
6. Ideal Body Weight:
“ideal” wt based on height:
Men :106 lbs for the first 5 feet of height and
6 lbs for each additional inch.
Example: height is 5feet 8 inches
The ideal body wt would be about 154lbs
Women :100 lbs for the first 5 feet of height
and 5 lbs for each additional inch.
Example: height is 5feet 4 inches
The ideal body weight would be 120 lbs
7. Waist to Hip Ratio : can give an indication of
risk.
waist measurement (cm)
hip measurement (cm)
A ratio greater than 1.0 in men &
0.8 in women
Indicates risk for certain diseases.
8. • CAUSES OF OBESITY IN PAKISTAN
• In Pakistan obesity level among rural areas is found to be 9% in
males and 14% in women,while in urban ares the obesity level is
found to be 22% in males and 37% in females.The higher obesity
level in urban area is due to their changing lifestyle,high fat and
CHO rich food and lack of exercise.(nov 5 2011 study)
• Increased intake of energy dense food that are
high in fats,salts and sugars but less in
vitamins,minerals and other micronutrients.
• Decrease activity due to the increasingly
sedentary nature of many forms of work.
• Changing modes of transportation
• Increasing urbanization.
9. ETIOLOGiC FACTORS
Calorie/Energy imbalance: more calories than
burned.
1 lb fat =3500 calories.
Eating 500 calories extra per day for 7 days will
produce a wt gain of 1 pound.(500 x 7 = 3500)
Eating 1000 calories extra per day for 7 days will
produce a wt gain of 2 pound.(1000 x 7 = 7000)
11. • ENERGY NUTRIENT VALUES:
The energy nutrients are
carbohydrates(CHO),Fats,and Proteins.
A food calorie value is determined by its content
of CHO,Fats and Proteins.
1gm CHO--------------4 Kcal
1gm Prot---------------4Kcal
1gm Fats---------------9Kcal
1gm alcohol-----------7 Kcal
12. • Energy Balance:
• If energy intake exactly equal expenditure ,a person
is in energy balance or energy equilibrium state and
his/her weight remains stable.
13. • Positive energy balance: If energy intake exceeds
expenditure it is called Positive energy balance. An
increase in body energy content means either an
increase in lean body mass (growth) or an increase in
body fat deposition or both.
14. • Negative Energy Balance: energy output exceeds
intake. Individuals in negative energy balance lose
energy and this is reflected in their weight loss.
Expenditure is
Greater than
Consumption.
15. Body frame profile:
(apple (intra-abdominal/truncal obesity) verses
pear shaped hips and thighs)
•
Carrying more weight around hips and having a narrower waist puts a person at
A lower risk of developing diabetes, heart disease, and other complications of metabolic
Syndrome.
16. Presence of central obesity (intra-abdominal fat)
leads to an increase in the development of obesity
because excess fat is converted to LDL(low
density lipoprotein{bad cholesterol}) in the
liver.
17. Etiologic Factors(cont)
• Consumption of caloric density foods
Calorie dense food:also called energy dense food,contains high levels
of calories per serving.Some of these foods contain “empty
calories” in that they provide energy from calories without other
significant nutritional value.
E.g; cakes,cookies,candies,cola drinks,some fast foods.
Nutrient dense food: contains high levels of nutrients,such as
proteins,CHO,fats,vitamins and minerals.
E .g; fresh fruits and vegetables,lean meats are nutrient dense
also.Many cereals like bread oats are aso nutrient dense because
hey have been ENRICHED WITH ADDED VITAMINS AND MINERALS.
.
18. • High calorie density food
If a food is of high energy density, then a little of it
provides a lot of energy(calories).e.g high fat foods.
19. • Low calorie density food :Foods with high water and
fiber will have lower calorie density.
• Grapes have fewer calorie density than raisins in a
given volume.
20. • Nutrient Density Of Foods: refers to the concentration
of nutrients in a food compared with the foods calorie
content.
• If the food is high in calories and low in nutrients, the
nutrient density of a food is low.
• If the food is low in calories and high in nutrients, the
nutrient density of food is high e.g;cantaloupe (melon)
low in calories high in vitamin C.
• Empty Calories means that food contain calories and
almost no nutrients e.g. sugar, cola drink.
22. Health Consequences of Obesity
• Coronary heart disease.
• Type 2 diabetes.
• Cancers (endometrial, breast, and colon)
• Hypertension (high blood pressure)
• Dyslipidemia (for example, high total
cholesterol or high levels of triglycerides)
• Stroke.
• Liver and Gallbladder disease.
• Sleep apnea and respiratory problems.
23. Goals of weight management
• A more appropriate goal is a modest weight loss of
5-10% of initial body weight or drop of 1 or 2 BMI
units (approx 10-15 lbs below current wt).
• Compared with dramatic wt loss, modest wt loss is
more attainable, easier to maintain over a long
time.
• A more appropriate wt mgt goal for clients unable
to lose wt is to prevent additional wt gain.
24. Strategies for Weight Loss and Management
• Nutritional therapy
• Increased physical activity
• Behavior therapy
• Surgery
• Combination of these options..
25. • Nutritional Therapy
• :Decrease calories IN and Increase calories
OUT: is the most effective way of achieving
weight loss and maintaining a desired weight.
For overwt clients a BMI of 27-35 a decrease of
300-500-calories /d will lead to ½ -1 lb
loss/week.
For clients with BMI of >35 a calorie deficit of
500-1000/d will result in 1-2 lb wt loss/week.
26. How Should the Diet be Modified?
Balanced diet
Low in fat and simple sugars
High in complex CHO and fiber
Moderate protein
Calorie deficit of 500 calories / day.
Avoidance of junk food ,use skim milk, avoid red
meats.
27. The Diet Therapy is effective when weight loss has
been maintained for a period of at least 2 yrs.
Weight control requires a lifestyle commitment
with education, activity and family support.
28. • FAD DIETS
• However a fad diet is simply a weight loss diet
that becomes very popular (often quickly) and
then may fall out of favor (sometimes just as
quickly).
• EXAMPLE OF SOME POPULAR FAD DIETS
• 3-day diet
• Cabbage soup die
• Grape fruit diet
• Atkins diet
• South beach diet
29. • Fad diets can cause health problems
Because they often cut out key foods, fad diets may cause
the following symptoms:
• Dehydration
• Weakness and fatigue
• Nausea and headaches
• Constipation
• Inadequate vitamin and mineral intake.
• Fad diets that severely restrict food groups or nutrients
may also mean that a person miss out on the
protective health effects that a balanced eating plan
provides
30. • .THE ANSWER IS A BALANCED EATING PLAN.
• Eat plenty of vegetables, legumes and fruits.
• Include a variety of cereals (including breads, rice, pasta and noodles),
preferably wholegrain.
• Include lean meat, fish, poultry or alternatives.
• Include milk, yoghurts, cheeses or alternatives.
• Drink plenty of water.
• Limit saturated fat and moderate total fat intake.
• Choose reduced fat varieties of foods where possible.
• Choose foods low in salt.
• Limit alcohol intake, if you choose to drink.
• Consume only moderate amounts of sugars, and food and drinks
containing added sugars. In particular, limit sugar-sweetened beverages.
• IT'S CALLED A BALANCED EATING PLAN AND IT'S NOTHING
NEW. COMBINED WITH MODERATE PHYSICAL ACTIVITY, IT
WILL CHANGE LIFE.
31. Increasing Physical Activity
• It promotes wt loss and preserve or increase lean body
mass.
• Increase metabolic rate
• Reduces abdominal fat
• Increase activity with or without wt loss lowers blood
pressure and triglycerides, increase HDL(good
cholesterol) and improve glucose tolerance.
32. Recommendations for Increasing Activity:
A variety of aerobic activities are available but walking is the
most appropriate physical activity for obese clients.
An initial goal may be to walk 30 min/d for 3 days a week,
building to 45 min/d of more intense walking for at least 5
d/week.
“The best exercise is the one that uses the maximum
number of large muscles.”
33. • Behavior Therapy
• Changing your eating and physical activity habits can be difficult at first.
But once you've started, it's easy to sustain. Here are a few tips to help
ease the transition: Combine an active lifestyle with healthy eating.
• Make small, achievable, lifelong changes to your lifestyle and eating
habits.
• Fill up on low-calorie nutritious foods.
• Keep portions moderate in size.
• Eat until you have had enough – not until you are full.
• Do your best to avoid eating when you are not hungry.
• Recognize that on some days you might be hungrier than on other days.
• Eat slowly and enjoy your food.
• Eat regular meals including breakfast, lunch and dinner.
• Reduce the amount of 'extra' or 'sometimes' foods that you eat.
• Examples of 'sometimes' foods include biscuits, cakes, desserts, pastries,
soft drinks and high fat snack items such as crisps, pies, pasties, sausage
rolls, other takeaway foods, and chocolate.
34. Medication
Medications used to treat obesity are indicated
for clients who are not able to lose 1lb per
week after 6 months of lifestyle changes.
Side effects include:
dry mouth,anorexia,insomnia,constipation,and
increased diastolic blood pressure.
Medications is contraindicated for clients with
cardiac history, renal or liver dysfunction
,hypertension, pregnancy or who are lactating.
35. Surgery
GASTRIC STAPLING: a surgical procedure on
the stomach to induce weight loss by reducing
the size of the stomach; also known as
GASTROPLASTY.
36. • GASTRIC BYPASS: a surgical procedure that
routes food around the stomach.
• Complications of gastric bypass and
gastroplasty:
Nausea,vomitting,bloating,heartburn,staple
disruption,obstruction,dumping syndrome.
37.
38. UNDERWEIGHT
An underweight person has a BMI of < 18.5 with
subsequent ill effects on health.
Causes: inadequate consumption of nutrients
because of depression,anorexia nervosa,some
disease or infection,poverty.It can also be
caused by excessive activity,wasting of certain
tissues,poor absorption of nutrients.
39. DANGERS :
It may lower ones resistance to infection and if
carry to extreme can cause death.
It can cause complications in pregnancy and
various nutritional deficiencies.
40. • TREATMENT
• Under weight client is treated by a high calorie diet or by a high
calorie diet combined with phsycological counselling if the
condition is pshycological in origin.
• restore weight to a reasonable level on BMI,height frame and energy
requirements.
• Increase the intake of calories
• Increase the intake of high density food.
• Incorporate physical activity to maintain muscle tone, and gain
strength.
• Drink fluids and include them as a source of energy
• e.g;milk shakes, juices.
• Supplemental feeding may be required vie the enteral or parenteral
route to meet dietary goals.
41. • For underweight clients
• Gain weight in a healthy manner
Add healthy choices(EG adding nuts cheese as
side dishes)
Go nutrient dense(avoide eating lot of empty
calories and junk food)
Snack away(eg;enjoy snack that contain plenty of
protein and healthy carbohydrates)
Eat mini meals(eat small meals throughout day)
Bulk up(weight lifting and yoga can help in
gaining weight by building muscle)
42. • SAMPLE BREAKFAST MENU for reducing
weight
Normal (calories) Reduced(calories)
• Fruit juice –120 Fresh Fruit—60
• Fried Egg—120 Boiled egg—75
• 2 Bread slices—160 1 Bread slice—80
1 cup whole milk—150 1cup skimmed milk90
Total calories 595 309
Difference =290 calories
