Weight Management

Ridiculous

Describe how the food supply has changed since theIndustrial Revolution

Since the industrial revolution, more foods have become processed. more and more foods have become ultra-processed, meaning they contain a single ingredient that isn’t used in a traditional kitchen. UPFs are highly processed foods derived from formulations of mostly cheap industrial sources of dietary energy and nutrients plus additives. They disguise unpalatable aspects of final products. UPFs are 55% of the calories in the US diet, and increased obesity prevalence is thought to have been caused by increased availability, convenience, palatability, and marketing of UPFs. UPS quality, quantity, and composition have changed to promote energy intake.

The difference between unprocessed, processed, and ultra-processed foods

Unprocessed: fresh, dry, or frozen veggies, fruits, grains, legumes, meat, fish, eggs, nuts, and seeds. Processing includes the removal of inedible/unwanted parts. It doesn’t add substances to the original food.

Processed foods: canned/pickled veggies, meat, fish, or fruit; artisanal bread, cheese, salted meats, wine, beer, and ciders. Processed with the addition of oil, salt, or sugar using pickling, fermenting, canning, smoking, and curing.

Ultra-processed foods: sugar-sweetened beverages, savory packaged snacks, reconstituted meat products, and pre-prepared frozen dishes. Made from a series of processes, including extraction and chemical modification, it includes very little intact from unprocessed foods.

Reasons it is so easy to overconsuemm ultra-processed foods.

They are high in salt content, calories, sugar, and fat. Can influence food reinforcement and overall intake via mechanisms distinct from the palatability or energy density of the food. Often simple carb foods with little protein are theorized to disrupt/override gut-brain signaling. Minimal satiety cues.

Role of food processing on calorie consumption, rate of eating, body weight, etc.

People who habituate slower consume more meals and are more overweight. Foods with high reinforcing value, like UPFs are also likely to be consumed in greater quantities and have higher energy density. UPFs are highly processed and derived from formulations of mostly industrial sources of dietary energy and nutrients plus additives. Foods and additives are used to imitate the sensory properties of foods or to disguise unpalatable aspects of the final product.

Barriers to eating fewer processed foods

Cost, limited time, lack of knowledge on whole foods/UPFs or cooking, eating habits, and cravings. This may be difficult to replace UPFs because they are inexpensive, have a long shelf life and are relatively safe form foodborne illnesses. They are less expensive and more convient because they are ready to eat and ready to heat.

Effects of low carb vs low fat unprocessed foods on appetite, calorie intake, body weight, etc. Which is better when following a whole-food diet? Low carb or low fat and why?

Appetite: Low Carb- tends to reduce gunger due ot increased protein and fat intake, which promote satiety. it also may help regulate hunger hormones like ghrelin and leptin. Low fat- Can still be satiating if fiber intake is high, but may not suppress hunger as effectively as low-carb

Calorie Intake: Low-Carb- Often leads to lower spontaneous calorie intake due to appetite suppression. Low Fat- May result in higher calorie intake if not carefully managed especially If meals lack sufficient protein or fiber.

Body Weight: Can lead to great initial weight loss, partly due to water loss and reduced insulin levels. Low-term effects depend on adherence and energy balance. Low-Fat - can be effective for weight loss, particularly when focused on whole, fiber-rich foods that promote fullness.

Improves insulin sensitivity in some individuals, beneficial for those with metabolic syndrome or diabetes. Low-Fat- Can improve lipid profiles if high in whole plant-based foods but may not impact insulin as strongly as low carb diets.

When low carb might be betterL if you have insulin resistance, diabetes, or metabolic syndrome, low-carb diets can improve blood sugar control and insulin sensitivity. If you struggle with hunger and cravings, low carb diets tend to reduce appetite due ti higher protein and fat intake. If you want rapid initial weight loss, low-carb diets can lead to quicker drops in weight (mostly water weight at first)

Effectiveness of exercise only interventions on body weight

Diet does the heavy lifting when it comes ot weight loss. When often considered a first-line treatment option for obesity, large amounts of exercise are required to result in a modest degree of average weight loss. PA is onoy one factor related to weight loss, and it’s not the whole picture. enhanced lipoysis and improved appetite regulation from myokines and adipokines.

Reasons exercise-only interventions are not particularly effective-what are the ecidence based reasons we discussed in class?

Compensatory Eating - Increased physical activity often leads to higher hunger levels and causes individuals to eat more and offset the calorie deficit created by exercise.

Limited caloric deficit - exercise alone does not create a significant enough energy deficit for substantial weight loss. Dietary control is needed for a meaningful impact.

Low Adherence Rates—Many people struggle to maintain consistent exercise routines, reducing the long-term effectiveness of such interventions.

Metabolic Adaptations - The body adapts to increased activity by becoming more energy-efficient, reducing the expected calorie burn over time.

Time Constraints - People often find it challenging to dedicate sufficient time to exercise, making it difficult to achieve the required levels for significant results.

Behavioral Compensation - Increased exercise may lead to reduced non-exercise physical activity (people move less outside their workouts), negating some benefits.

Psychological Factors—Some individuals may feel entitled to reward themselves with food after exercising, leading to overconsumption.

Changes in food intake and non-exercise physical activity behaviors variably compensate for energy expended during exercise. Meaning if you exercise more, it means you will eat more and increase sedentary behaviors.

Effectiveness of daily tracking, daily weighing, etc.

Daily Tracking (Food Journals, Apps, etc.): Helps with accountability and awareness of eating habits. Studies show that self-monitoring is one of the strongest predictors of successful weight loss and maintenance. Can identify patterns, triggers, and areas for imporvement. Digital tracking (apps, wearables) increases adherence compared to paper logs.

Dailt Weighing: Helps maintain self-awareness and detect trends early. Research suggests that frequent self-weighing is linked ot better weight maintenance.

Potential Downside: some individuals may experience anxiety or stress from daily weighing, making it important to focus on trends rather than day-to-day flucuations.

How predictable is acute vs. chronic weight loss?

Short term (acute) is relatively preditable

Long-term (chronic) people respond very differently to over and unfeeding; less predictable.

What is the typical pattern of weight loss and regain?

Obesity interventions typically result in rapid early weight loss followed by a weight platau and profressive regain

based on the chart

• more than half of the lost weight was regained within two years

• By year 5 more then 80% of lost weight was regained.

How are non-obese and reduced obese bodies throught to differ?

• non-obese bodies have a healthier districution of fat (more around the hips and tighs in women) and a lower visceral fat & higher lean muscle mass.

• Reduced obese bodies may still carry fat around the abdominal region due to previously being obese but lost a significant amount of weight, with higher visceral fat.

Which tissue is more metabolically active?

Muscle: more metabolically active; burns more calories at rest due to more energy needed for repair. Increases RMR and improves insulin sensitivity

Fat: less metabolically active; stores energy and byrns fewer calories at rest. Excess fat, especially visceral fat can lower insulin sensitivity and contirbute to metabolic issues.

Can adding resistance training to a wieght loss routine prevent resting metabolic rate from dropping? What happened to the RMR of those who participated in the BIggest Loser competition (at end of show and 6 years later)

Yes, and at the end of the show RMR decreased by 789 calories/day at end of study

6 years later, RMR did not change, participants with the greatest weight loss at the end of the competition experienced the greatest slowing of RMR at the time.

How much weight did competitiors lose on average throughout the show?

57.6kg (126.72lbs)

What is metabolic adaptation?

The body’s repsonse to weight loss (for survival)

The reduction of energy expenditure at rest and with exercise likely occurs with weight loss

May be greater during times of negative energy balance

Reflects magnitude of weight loss in short and long term

Does NOT necessarily predict weight regain

What tool has been created by Kevin Hall’s group that may help folks understand their calorie needs before, during, and after intentional weight loss?

This tool allows someone to put in their goal weight and the timeframe they want to reach it. The model will tell them how many calories they need to cut from their diet and change their physical activity to reach their goal. It also provides this plan to maintain the goal weight over time.

In the biggest loser studies, what was the best predictor of long-term weight loss?

Metabolic adaptaion may be a reflection of the magnitude of weight loss

Describe the changes in appetite that follow weight loss

Appetite changes likely play a more important role than slowing metabolism in explaining the weight loss plateau

What is the compensatory theory?

When a person loses weight the body fights back , with physiological adaptations that try to bring bodyweight back to its original state.

How many kcal/day has it been proposed that RMR drops and appetite increases per kilogram of weight lost? Be able to complete a calculation relate dto this like we did in class…

DEC: 20-30 kcal/day calorie expenditure

INC - 100 kcal/day in appetite above baseline level prior to weight loss

Calculation:

Travis recently lost 22 lbs. How much would you predict his RMR to drop in calories/day, and how much would you predict his appetite to increase in calories/day?

A: 22/2.2 = 10 kg

B: RMR —> 10lbs x 20-30 = 200-300 drop in RMR

C: Calorie drive —> 10lbs x 100 = 1000 calories increase in appetite

Effect of diet composition on appetite

May be able to suppress heightened appetite during weight maintenance phase by consumption of food products high in fiber and/or protein

• Associated with improved maintenance of weight loss

Spendthrift vs thifty phenotypes

Spendthift: characterized by small decrease in energy expent=diture in response to underfeeding —> big increase in energy expenditure with overfeeding

• Associated with improved maintenance of weight loss

Thrifty Phenotype: characterized by greater decrease in energy expenditure with fasting —> prone to less weight loss during underfeeding but greater weight gain with overfeeding

• Metabolically efficient —> prone to less weight loss but greater weight gain

Strategies to support weight management and realistic expectations around weight management through lifestyle interventions

• Use weight management-specific counseling/strategies: Weight loss-specific behaviors associated with long-term success are helpful for patients to build insight into long-term management, anticipate struggles, prepare contingency plans, moderate behavioral fatigue, and put into perspective the lapses and relapses of any long-term engagement (frequent self-monitoring, self-weighing, reduced calorie intake, small and more frequent meals, etc.).

• Strengthen satisfaction with outcomes:

• Relapse prevention training: Anticipating and managing high-risk situations to minimize relapses, helpful for patients to minimize relapses and stay on track and avoid giving up (engaging in mindful activities such as a grocery list)

• Cognitive restructuring:

• Developing cognitive flexibility: Developing a realistic nonrestrictive mindset and not changing everything at once, helps with long-term maintenance creates more realistic plans, and eliminates hard expectations and the ultimate failure of the expectations. (instead of zero carbs just cut out added sugars, eating a light dessert but not restricting yourself the next day by feeling guilty that you ate it.)

• Appeal to patients’ deeper motivations:

• Manage expectations— patients and providers: A SMART goal is specific, measurable, achievable, relevant, and time-bound, focusing on realistic and attainable outcomes. It helps ensure goals are manageable and motivating, preventing disappointment from unrealistic expectations. For example, (a goal to lose 5%of body weight in 6 months through diet and exercise.)

• Escalate treatment as needed: