© 2010 McGraw-Hill Higher Education. All rights reserved. Chapter 11 1

© 2010 McGraw-Hill Higher Education. All rights reserved.

Chapter 11

1


Introduction

National Institutes of Health66% of American adults are overweightIncluding more than 33% of adult men and 35%

of adult women are obese.2015

○ 75% of adults will be overweight and 41% will be obese

2030○ Estimated that the entire American adult population

will be overweight or obese

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Figure 11-1 Obesity prevalence, by age and sex, of American adults

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Basic Concepts of Weight Management

1 pound of fat = 3500 calories Body Composition

Fat-free mass or Lean Body MassBody Fat

○ Subcutaneous fat 3-5% of total fat in men, 8-12% in women○ Visceral fat-(storage) –Located behind the abdominal wall

Depends on many factors:- Gender- Age- Heredity- Metabolism- Diet - Activity level

Women: <8% at risk, Average 23%, > 32% at risk Men: < 5% at risk, Average 15%, > 25% at risk

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Energy Balance

Crucial to keep a healthy ratio of fat and lean body massEnergy Consumption and/or expenditure of caloriesControl over intake of caloriesNegative energy balancePositive energy balanceNeutral energy balance

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Figure 1.2 The energy balance equation

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www.freedieting.com


Evaluating Body Weight and Body Composition Overweight – total body weight above

recommended range for good health Obesity – a more serious degree of overweight Height-Weight charts Body Mass Index (BMI)

BMI = [Weight / Height in inches (squared)] X 703

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© 2010 McGraw-Hill Higher Education. All rights reserved.8

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Body Composition Analysis Hydrostatic (underwater) weighing and

BOD PODMost accurate

Skinfold measurementsThickness of fat under the skin

Electrical Impedance AnalysisElectricity prefers lean tissue

Scanning proceduresCT scan, MRI, Dual-energy X-ray, Dual-photon

absorptiometry, Infrared reactance and total body electrical conductivity

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Body Composition Measuring Techniques


Excess Body Fat and Wellness

The Health Risks of Excess Body FatObese individuals have a mortality rate twice that

of non-obese○ Reduces life expectancy by 10-20 years○ Associated with: Unhealthy cholesterol and triglycerides,

impaired heart function, and death from cardiovascular disease

○ Other health factors: hypertension, cancer, impaired immune function, gallbladder and kidney disease, skin problems, impotence, sleep disorder back pain, arthritis

○ Strong association – Type II diabetes

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Figure 11.4 Diabetes mellitus

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© 2010 McGraw-Hill Higher Education. All rights reserved.04/19/23

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Body Fat Distribution and Health

Apple shape Android obesityUpper regions of their bodiesIncrease risk of high blood pressure, diabetes, early-

onset heart disease, stroke, and cancer

Pear shapeGynoid obesityFat storage in the hips, buttocks and thighs

Assessed by measuring waist circumferenceRisk if total waist measurement is more than 40

inches for men and 35 inches for women

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Waist-to-Hip Ratio Predicts disease risk according to “apple”

or “pear” shape

Disease Risk according to Waist-to-Hip Ratio


Body Image

Collective picture of the body as seen through the mind’s eye.PerceptionsImagesThoughtsAttitudesEmotions

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Different Body BuildsENDOMORPHY MESOMORPHY

ECTOMORPHY


Problems Associated with Very Low Levels of Body Fat Less than 8-12% for women and less than

3-5% for men. Extreme has been linked to problems with:

Reproductive Circulatory Immune system disorders

Female Athlete Triad1. Abnormal eating patterns2. Amenorrhea3. Decreased bone density

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Factors Contributing To Excess Body Fat Genetic Factors

Nutrigenomics○ Study of how nutrients and genes interact

25 to 40% of an individual’s body fat600 genes have been linked to obesity

Physiological FactorsMetabolism (RMR)HormonesFat Cells

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Lifestyle Factors Eating Physical Activity Psychosocial factors

Emotions○ Distraction from difficult feelings○ Helps regulate emotions○ Coping strategies

Socioeconomic status Family and cultures

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Adopting a Healthy Lifestyle For Successful Weight Management “Normal” body weight Diet and Eating Habits

Total Calories○ MyPyramid suggestions○ Best approach for weight loss is combining an

increase of exercise with moderate calorie restriction○ Do not go on a crash diet

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Adopting a Healthy Lifestyle For Successful Weight Management

(Continued) Portion Sizes Energy (calorie) Density Eating Habits

Processed foods“Fat-free”Stick to recommendations by:

○ Dietary Guidelines for Americans○ MyPyramid○ DASH Diet

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Physical Activity and Exercise 30 minutes or more of moderate-

intensity physical activity, everydayWalkingGardeningHouseworkWalking 1 mile in 15-20 minutes

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Thinking and Emotions

What do you think of yourself? Self-esteem Negative emotions “Ideal self” Beliefs and attitudes you hold

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Coping Strategies Adequate and appropriate strategies Healthy lifestyles and proper stress

management techniques will naturally and easily result in a reasonable body weightGood nutritionGood communicationAdequate exercisePositive thinking and emotionsEffective coping strategies and behavior

patterns

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Approaches to Overcoming a Weight Problem

Doing it yourself○ 0.5-2.0 pounds per week○ Initial weight loss from fluids○ Very low calorie diets need to be avoided

Diet Books:○ Reject books with gimmicks or rotating levels of calories.○ Accept books that advocate a balanced approach.

Diet Supplements and Diet Aids○ Formula drinks and food bars○ Herbal supplements○ Other supplements

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Weight-Loss Programs

NoncommercialTOPS (Take Off Pounds Sensibly)OA (Overeaters Anonymous)

○ 12-step program with spiritual orientation

Commercial Online Clinical

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Weight-Loss Programs Prescription Drug

Appetite SuppressantsProduce a 5-15% weight reduction by

controlling appetite.Once drugs are stopped most return to

original heavy weight.Good option for very obese who need help

getting started - permanent life style change.

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Surgery Severely obese –

One in 50 adult Americans has “morbid obesity”NIH recommends gastric bypass for individuals with a

BMI of 40 or higher or are 100 pounds or more over recommended weight.

Roux-en-Y-gastric bypassVertical banded gastroplasty (VBG)Lap-Band – variation of VGB

○ Adjustable bandLiposuction

Weight loss from surgery generally ranges between 40% and 70% of total body weight over a years time.

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http://www.chakpak.com/video/liposuction-surgery-video/363314

http://www.videojug.com/interview/roux-en-y-gastric-bypass-2

© 2010 McGraw-Hill Higher Education. All rights reserved.© 2010 McGraw-Hill Higher Education. All rights reserved.

Surgery

Adjustable gastric banding Roux-en-Y gastric bypassSource: National Institutes of Health


Body ImageSevere body image problems

○ Body dysmorphic disorder (BDD)Affects about 2% of AmericansUsually before age 18

○ Muscle dysmorphiaKnowing when the limits to healthy change have

been reached.Knowing the unrealistic cultural ideal.Acceptance and change

○ Knowing what is a healthy lifestyle change

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Eating Disorders Problems with body weight and weight

control. Characterized by severe disturbances in

body image, eating patterns, and eating-related behaviors.

Disordered eating affects an estimated 10 million American females and 1 million males.

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Eating Disorders Anorexia NervosaAnorexia Nervosa - Failure to eat enough food… Affects 3 million people – 95% are female

Typically develops between the ages of 12 and 18 Characteristics

Fear gaining weight. Distorted self-image. Compulsive behaviors and rituals. Excessive exercise

Health Risks of Anorexia Nervosa Stop menstruation Intolerant of cold Low blood pressure and heart rate Dry skin Hands and feet may swell and take on a blue tinge Depression and suicide

Medical complications Disorders of the cardiovascular, gastrointestinal, endocrine, and

skeletal systems

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Eating Disorders Bulimia NervosaBulimia Nervosa - recurring episodes of binge eating followed

by purging. Begins in adolescence or young adulthood

Increasingly younger (11-12 years) and older (40-60 years) ages. Characteristics:

Rapidly consumes food, then purges. Done in secret. After a binge - feels ashamed, disgusted and physically and emotional

drained. Health Risks:

Erodes tooth enamel Deficient calorie intake Liver and kidney damage Cardiac arrhythmia Chronic hoarseness Esophageal tearing Rupture of the stomach Menstrual problems Increased depression

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Eating Disorders

Binge-EatingBinge-Eating - Similar to Bulimia except no Purging behavior.Eating patterns - very rapid, eating until

uncomfortably full.Often eat as a way of coping.Likely to be obese.High rates of depression and anxiety

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Treating Eating Disorders

Combination of psychotherapy and medical management Address both eating disorder, misuse of food and manage

emotions Anorexia Nervosa

○ Averting a medical crisis Adequate body weight

○ Psychological aspects Bulimia Nervosa

○ Stabilizing the eating patterns○ Identify and changing the patterns of thinking○ Improve coping skills○ 2006, JAMA study found:

Topiramate (anti-seizure drug) helped with Bulimia Nervosa Binge-Eating

○ Similar treatment protocol as Bulimia Nervosa

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© 2010 McGraw-Hill Higher Education. All rights reserved.© 2010 McGraw-Hill Higher Education. All rights reserved.

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Chapter 11

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© 2010 McGraw-Hill Higher Education. All rights reserved. Chapter 11 1