3. • Overweight is defined as having a BMI 25. It is
related to an excessive body weight, not
necessarily excessive body fat. Muscle, bone,
fat, and water all contribute to body weight.
• Obesity is defined as having a BMI 30, a
condition characterized by excess
accumulation of body fat.
5. 1. Obesogenic Environment
• The dramatic rise in obesity in the U.S.
population suggesting that the root cause is
lifestyle and environment,not biology (2009)
• this imbalance is due in large part to an
increased intake in food. A decrease in
physical activity has also contributed to the
calorie imbalance.
6. • The current environment, which encourages
energy intake and discourages energy
expenditure, has been labeled obesogenic. It,
along with behavior, is believed to account for
the increased prevalence of overweight and
obesity in the world today (Corsica
and Hood, 2011).
7. Factors that contribute to an obesogenic
environment include the following:
■ An plenty of readily accessible, low-cost,
palatable, high-calorie foods in large portions
■ Increasing consumption of soft drinks and
snacks
■ A great proportion of the food budget spent
on food away from home
■ The increasing portion size of restaurant meals
8.
9. ■ A decrease in energy expenditure related to
labor-saving devices, such as remote control
devices and motorized walkways
11. ■ An increase in sedentary leisure activities,
such as watching television, playing video
games, and sitting in front of a computer. HOW?
• Television watching may promote obesity by
leaving less time for physical activity, lowering
resting metabolic rate, and/or promoting
greater meal frequency and food intake
(Chaput et al., 2011).
12. • Energy Gap: the difference between calories
consumed and calories expended.
13. Genetics
• Calorie intake and expenditure may not
completely explain the complexity of weight
regulation in obesity (Isoldi and Aronne, 2008).
Epidemiologic studies point to a genetic
susceptibility (Herrera and Lindgren, 2010).
• Genetics is involved in how likely a person is to
gain or lose weight in response to changes in
calorie intake by influencing basal metabolic rate,
where body fat is distributed, and response to
overeating (O’Neil and Nicklas, 2007).
14. • Genetics may also account for the individual
differences in weight loss that occur in
response to calorie restriction (Loos and
Rankinen, 2005) and may even account for
nutrient-specifi c food preferences (Bauer et
al., 2009). Supporting the
15. • case for a genetic basis to weight status is the
tendency of adopted children to have similar
weights to their biological parents, not their
adoptive parents (Moll, Burns, and Lauer,
1991; Stunkard et al., 1986).
16. Gene–Environment Interaction
• Clearly there is a gene–environment interaction.
Even when a genetic susceptibility exists,
exposure to an obesogenic environment is
necessary for obesity to develop (Herrera and
Lindgren, 2010).
• Likewise, in people with a genetic predisposition
to obesity, the severity of the disease is largely
determined by lifestyle and environmental
conditions (Loos and Rankinen, 2005).
18. Complications of Obesity
• Obesity significantly increases mortality and
morbidity. It is associated with a wide variety
of diabetes, hyperlipidemia, fatty liver disease,
obstructive sleep apnea, gastroesophageal
reflux disease, vertebral disk disease,
osteoarthritis, and increased risk of certain
cancers (Guh et al., 2009).
• Abdominal obesity, increases the risk of
coronary heart disease and type 2 diabetes
19. • Obesity increases the risk of complications
during and after surgery and the risk of
complications during pregnancy, labor, and
delivery.
• Overweight-obesity and physical inactivity are
estimated to be responsible for nearly 1 in 10
deaths in the United States (Danaei et
al.,2009).
20. • Obesity presents psychological and social
disadvantages. In a society that emphasizes
thinness, obesity leads to feelings of low self-
esteem, negative self-image, depression, and
hopelessness (Valtonen, Laaksonen, and
Tolmunen, 2008).
• Negative social consequences include
stereotyping; prejudice; stigmatization; social
isolation; and discrimination in social,
educational, and employment settings.
21. • Abdominal Obesity: waist circumference
exceeding 35 inches in women or 40 inches
in men.
• Metabolic Syndrome: a cluster of
interrelated symptoms, including obesity,
insulin resistance, hypertension, and
dyslipidemia, which together increase the risk
of cardiovascular disease and diabetes
23. Goals of Treatment
• weight would fall into the healthy BMI
category and would be maintained there
permanently.
• This would be gradually accomplished with a
1- to 2-pound loss every week for the first 6
months of weight loss therapy
• After 6 months, when the rate of weight loss
usually decreases, then, the focus would shift
to maintaining that weight loss.
24. • After 6 months of weight maintenance, weight
loss efforts would be repeated. The cycle
would continue until healthy weight is
achieved.
• People who have successfully lost weight have
done so by making extreme changes in their
eating and exercise habits.
25. • A modest weight loss of 5% to 10% of usual
body weight is associated with significant
improvements in blood pressure, cholesterol
and plasma lipid levels, and
26. • Compared with intense weight loss, modest weight loss
is more attainable, easier to maintain over the long
term
• Setting a modest weight loss goal and keeping that
weight off are far more realistic than striving for
thinness. Yet for some people, even modest weight loss
may be unattainable.
• A more appropriate weight management goal for
clients unable to lose weight is to prevent additional
weight gain.
27. Evaluating Motivation to Lose Weight
• Why assessing the client’s level of motivation
is crucial?
1. because weight loss is not likely to occur in
people who are not motivated or not ready
to change
2. Even worse, imposing treatment on an
unmotivated or unwilling client may prevent
subsequent attempts at weight loss when the
client may be more likely to succeed.
29. Weight management: 1. Nutrition therapy
• The first priority in obesity treatment is to
decrease calorie intake, usually by 500 to 1000
cal/day to achieve a weekly weight loss of 1 to
2 pounds (Seagle and Strain, 2009).
• This recommendation is based on the
assumption that 1 pound of fat mass is
approximately equivalent to 3500
30. • The appropriate calorie intake may be
determined by subtracting 500 to 1000 calories
from the client’s estimated total energy needs
• A more general approach is to choose a specific
calorie level based on gender. The National
Institutes of Health (NIH) recommends low-
calorie diets of 1000 to 1200 cal/day for
overweight women and 1200 to 1600 cal/day for
overweight men and heavier (165 pounds)
31. • This level of calorie restriction can promote up
to an 8% loss of body weight when followed
for 3 to 12 months (Cannon and Kumar, 2009).
• A multivitamin and mineral supplement is
recommended whenever calorie intake falls to
1200 calories or less.
32. • If 1200 calories can promote a 1 to 2 pound
loss per week, will a more drastic calorie
reduction speed the weight loss process?
• No, In reality, cutting calories too much,
particularly when protein intake is low, may
result in higher proportions of lean tissue loss,
leading to a compensatory reduction in
exercise tolerance. This makes weight loss and
eventual weight maintenance more difficult.
33. The Bottom Line.
• Low-calorie diets produce weight loss regardless of
which macronutrients they emphasize (Sacks et al.,
2009). However,
■ There is a risk of not consuming adequate amounts of
all micronutrients with either a very-low-carbohydrate
diet or a very-low-fat diet.
■ lean muscle mass is better preserved among dieters
who consume a higher protein intake and 25% to 30% of
protein may also provide greater satiety (Schoellerm and
Buchholz, 2005).
■ The “best” type of diet is individualized to the client’s
preference and health status.
34. Portion Control
• Portion control is an important strategy to
prevent weight gain as well as an integral
component of weight loss programs (Seagle and
Strain, 2009).
• Providing clients with common household
equivalents to estimate portion sizes is a useful
tool.
• While clients may not have any idea what 3 oz of
meat looks like, they can visual the size of a deck
of cards to estimate reasonable meat portions.
35.
36.
37. Eating Frequency
• Regular, frequent meals and snacks may help
clients avoid periods of hunger, thereby
increasing the likelihood of dietary adherence.
• An individualized pattern that prevents
periods of hunger is recommended.
38. Meal Replacements
• If self-selection or portion control is difficult,
meal replacements can be an effective weight
loss and weight loss maintenance strategy
(Seagle and Strain, 2009).
• Commercial diet programs, such as Jenny
Craig and Nutrisystem, feature one to two
meals per day of vitaminand mineral-fortified,
low-calorie “meals,” this to make risk of poor
food choices is reduced.
39. Behavior Modification
1. Self-monitoring involves keeping a detailed record of the
time, amount, description,
preparation, and calorie content of all foods and beverages
consumed.
• Recording additional information, such as the client’s
emotional state, intensity of hunger, and activities at the
time of eating, may help identify “problem” behaviors.
• The primary purpose of using food records is to increase
awareness of how often and under what circumstances the
client engages in behaviors that support weight loss efforts.
40. • Self-monitoring is often considered one of the
most essential components of behavior
modification
41. 2. Goal setting: may involve specific calorie, fat gram, and
physical activity goals designed to achieve a 1- to 2-pound
weight loss per week, or it may involve specific eating
behaviors in need of improvement.
• Goals should be realistic, specific, and measurable so
that success can be achieved, thereby engendering a
sense of accomplishment and boosting motivation.
e.g: Instead of a goal to “eat better,” a goal may be to “eat
oatmeal and fruit for breakfast 5 days per week.”
42. 3. Stimulus control involves restructuring the
environment to avoid or change cues that
trigger undesirable behaviors
1. (e.g., keeping “problem” foods out of sight or
out of the house)
2. or instituting new cues to elicit positive
behaviors (e.g., putting walking shoes by
the front door as a reminder to go walking).
43. 4. Problem solving involves identifying eating
problems or high-risk situations, planning
alternative behaviors, implementing the
alternative behaviors, and evaluating the plan to
determine whether or not it reduces problem
eating behaviors.
45. 6. Promoting Dietary Adherence:
• Only one in six overweight and obese adults
report ever having maintained weight loss of
at least 10% of their body weight for 1 year
(Kraschnewski et al., 2010).
• Adding structure to a low-calorie diet may
improve adherence by limiting food choices in
meal plans and including actual grocery lists,
menus, and recipes.
46. Physical Activity
• In most studies, physical activity and improved
fitness reduce the health risks of obesity
regardless of the degree of obesity or baseline
health status (Lee, Sui, and Blair, 2009).
• With or without weight loss, increasing
activity lowers blood pressure and
triglycerides, increases HDL cholesterol, and
improves glucose
47. • Current physical activity guidelines recommend
the following (Donnelly et al., 2009):
■ Approximately 30 minutes of moderate to
vigorous physical activity (MVPA) 5 to 7 days per
week to prevent weight gain
■ 150 to 420 minutes/week of MVPA for weight loss
■ 200 to 400 minutes/week of MVPA to maintain
weight loss
48. • Physical activity and calorie restriction work
synergistically when paired together (Blackburn
et al., 2010).
• Compared to weight loss from dieting, weight
loss from exercise produces a greater percentage
of fat loss as well as a greater decrease in
abdominal and visceral fat (Ross et al., 2000).
• After weight loss, regular exercise is the primary
predictor of weight maintenance (USDHHS,
2008).
49. What type of exercises?
• Moderate-intensity aerobic activity (e.g.,
walking, cycling, swimming) is most commonly
recommended for weight loss and
maintenance.
50. Promoting Exercise Adherence
• Strategies that may promote exercise
adherence include encouraging clients to
■ Exercise at home rather than at on-site or
supervised exercise sessions.
■ Exercise in multiple short bouts (10 minutes
each), instead of one long session.
■ Adopt a more active lifestyle, such as taking
the stairs instead of the elevator or pacing while
on the phone instead of sitting down.
