nutrition: energy balance chap 10

obesity

america’s #1 health crisis; complex disease influenced by genetics, environment, and behavior

factors contributing to development of obesity

food environment, large portion sizes, fewer home cooked meals, sleep deprivation, pregnancy, emotions, sedentary lifestyle, televisoin, communities, perscription drugs, smoking, genes

energy balance equilibrium

calories=calories out

positive energy balance

calories in > calories out

negative energy balance

calories in < calories out

obesity, low grade inflammation, and chronic disease

enlarged fat cells produce excess hormones and hormone like messengers; hormones cause low grade inflammation contributing to development of chronic disease

hunger

physiological drive to find and eat food; controlled by internal mechanisms such as organs, hormones, hormones like factors, nervous system

appetite

psychological drive to eat; affected by external factors such as social custom, time of day, mood, memories, sight

2 factors effect fullness

satiety and satiation; effected by gastric distention(stomach expansion) and gut peptide hormones(in response to detection of nutrients in the gut)

satiety

the effect a meal has on our interest in food after and between meals and when we feel hungry again

satiation

sense of fullness while eating that leads to termination of a meal

short term biology of hunger

controlled by hormone (ghrelin - increases hunger); controlled by stomach pressure; regulates hunger and satiety before and after meals

long term biology of hunger

controlled by hormones (leptin - suppresses hunger); adjusts food intake and energy expenditure; maintains adaquate fat stores

ghrelin

hunger hormone; produced in stomach; secretion is inhibited by carbs, proteins, then dietary fat(least effective)

leptin

produced in adipose cells; acts on the brain; inhibits hunger; increases energy expenditure to avoid excess weight gain

body mass index

indirect measure of body fat calculated from a persons weight and height

underweight BMI

<18.5 kg/m²

normal BMI

18.5-24.9 kg/m²

over weight BMI

25-29.9 kg/m²

Obese BMI

>30 kg/m²

calculating BMI

(body weight(lb)/height²(in²))x703

waist circumference

indicator of abdominal obesity(>35 in in women, >40 in in men); visceral fat(abdominal fat that surrounds bodies internal organs; health risk of: CVD, type 2 diabetes, and premature all cause mortality)

weight loss recommendations

BMI of 30.0 or greater; large waist circumference; overwight and have two or more risk factors(CVD or family history of it, smoking, hypertension, diabetes, physical inactivity, age>45 men and >50 women)

weight loss

dietary modifications and increased physical activity are recommended; losing 5% to 10% of weight reduce risk by 50%

surgical approach to weight loss

extreme obesity(BMI >40 or >35 with additional risk factors); benefit should be greater than risk; reduce stomach capacity, limit food intake, and increase satiety; laparoscopic sleeve, gastric bypass, gastric banding

GLP-1

glucagon like peptide 1; natural hormone released by the gut after eating; helps the body release insulin to control blood sugar, slows stomach emptying, signals the brain that youre full reducing hunger

GLP-1 medications

mimic the action of a natural gut hormone; help manage type 2 diabetes and/or support chronic weight management

intuitive eating

evidence based, non-dieting approach to health, focus on physiological hunger and fullness; based on eating for hunger, listening and responding to hunger and fullness cues from the body, unconditional permission to eat what you want

professional help for weight control

treatment of underweight; health risks associated with BMI under 18.5; extra 500 cals may be required in the form of energy dense foods; reduce physical activity

disordered eating

mild, short-term changes in eating patterns; occur in response to: stressful event, illness, desire to modify diet; may lead to changes in body weight and nutritional problems; rarely requires professional attention

eating disorder

more severe distortions of eating process; can develop into life-threatening conditions; anorexia nervose, bulimia nervosa, binge-eating disorder

prevalence and susceptibility of eating disorders

6-10 times more common in females(3-5% in NA wil develop); may be more susceptible because of genetics, psychological reasons(depression, substance abuse, anxiety disorders), physical reasons

anorexia nervosa

extreme weight loss, distorted body image, irrational morbid fear of obesity; may be due to tendency to blame weight gain associated with puberty on themselves; athletes whose sports require weight classification most at risk

bulimia nervosa

binge-eating followed by attempts to purge excess energy(vomiting, laxatives, diuretics, enemas, excessive exercise); turn towards food when faced with problems, recognize their behavior as abnormal, 50% have major depression

binge-purge cycle

hunger leads to anxiety, eat then feel guilty, binge then feel numb, purge then feel redemption, diet then control; gradually will distance themselves from others

physical effects of bulimia nervosa

demineralization of teeth, low potassium, swelling of salivary glands, stomach ulcers and tears in esophagus, constipation, hands may be calloused or cut by teeth, toxic effect from ipecac syrup on heart, liver, kidneys

treatment of bulimia nervosa

nutrition therapy; develop regular eating habits, correct misconceptions about food, self monitor: food intake, internal sensations of hunger, environmental factors that trigger bingers, thoughts and feeling accompanying binge-purge cycle

binge-eating disorder

eating large amounts of food(frequently, rapidly, until feeling uncomfortably full, even when not hungry); alone because of embarrassment; not linked to obesity; frequent dieting; stress, depression, or anxiety can trigger; may come from dysfunctional families

treatment of binge-eating disorder

professional help, nutrition therapy like bulimia nervosa, psycholocial therapy for emotional needs, self-help groups, antidepressants

other specified feeding and eating disorders

OSFED are subtypes; diagnosis is not used if not all criteria is met, other related: muscle dysmorphia, orthorexia, pregorexia

ARFIP

eating disorder where a person avoids certain foods or eats too little to meet nutritional needs; sensory sensitivity, fear, and low interest; effects are nutrient deficiency, weight loss, difficulty meeting energy and nutritional needs

physical effects of anorexia nervosa

low body weight, low body temp and cold tolerance, slow metabolic rate, decreased HR easy faatigue, iron deficiency anemia, rough dry scaly cold skin, low WBC count, abnormal feeling of fullness or bloating, loss of hair

treatment of anorexia nervosa

physicians, registered dieticians, psychologists; hospitalization needed if weight falls below 75%; average time is 7 years; nutrition therapy