Chapter 10 - Weight management and eating disorders

Factors contributing to obesity

Food environment (fast food more accessible), portion sizes are bigger, sleep deprivation (people who are sleep deprived have an imbalance of hormones), Fewer home cooked meals, pregnancy, emotions (we eat for different reasons, sedentary lifestyle, screen time, communities (might have barriers to physical activity), quitting smoking (sometimes replacing smoking with eating), genetics

Obesity health consequences

Causes inflammation which leads to chronic disease: Heart disease, stroke, different types of cancers, fatty liver, type 2 diabetes

Inflammation from obesity

 Enlarged fat cells produce excess hormones and hormone like messages, these hormones cause low grade inflammation in the body, contributing to development of chronic diseases

Hunger

the physiological (body) drive to find and eat food, controlled by organs, hormones, hormone like factors, nervous system

Appetite

 Psychological (mind) drive to eat, affected by external factors such as social custom, time of day, mood, memories, sight 

Ghrelin

 Increases hunger, Produced in stomach, controlled by stomach pressure and hormones, regulates hunger and satiety before and after meals, sleep deprived people have more ghrelin

Leptin

Suppressed hunger, increases calories burned, adjust food intake, maintains adequate fat stores, higher leptin levels in people that have more adipose tissue, adipose tissue produces it, tells the brain to stop hunger, increases energy expenditure to avoid excess weight gain

Satiety

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

Satiation

Sense of fullness while eating that leads to termination of a meal (getting full while eating lunch)

Station and satiety are affected by

Gastric distention (stomach expansion), Gut peptide hormones (in response to detection of nutrients in the gut)

BMI categories and calculation

BMI is a indirect measure of body fat calculated from a person's weight and height

The greater the BMI, the higher the risk of obesity-associated diseases

• Underweight < 18.5 kg/m²

• Normal weight 18.5–24.9 kg/m²

• Overweight 25–29.9 kg/m²

• Obese > 30 kg/m²

Formula to calculate: body weight in pounds/height in inches^2

Height in inches: multiply feet by 12 and then add the extra inches (5’1 - 5x12+1 = 61 inches)

Waist circumference

 Indicator of abdominal obesity, measures visceral fat

Waist circumference of more than 35 in women and more than 40 in men is an indicator of abdominal obesity 

Abdominal obesity

Apple shape, Most concerning type of obesity, has visceral fat (abdominal fat the surrounds body’s internal organs), higher risk for cardiovascular disease, type 2 diabetes, premature all cause mortality, more common in men

Pear shaped obesity

More common in women, less concerns for chronic diseases

Recommendations for wt loss

 BMI of more than 30 weight loss recommended, waist circumference bigger than 35 (women) 40 (men)

risk factors: family history of cardiovascular disease, smoking, hypertension, diabetes, physical activity level

Dietary modifications + increases physical activity are recommended to achieve and maintain healthier body weight, losing 5-10% of weight reduces risk of chronic disease and death

Body composition measurements

Skinfold measures, bodpod (measures displacement of air), hydrodensitometry (underwater weighing, measures displacement of water from your body), DEXA scan, BIA (bioelectric impedance)

Bariatric Surgeries

 Surgical approaches for weight loss, must suffer with great obesity (BMI of 40 or more OR 35 or more with additional risk, Benefits should be greater than significant risk, yields significant weight loss and reduces weight related disorders, should be an approach someone tries after trying to make proper life changes first (physical and psychological), reduces size of stomach dramatically, food intake becomes very limited, early satiety 

Intuitive Eating

 3 core components: Focus on eating for hunger, no other reasons; listening and responding to your hunger and fullness cues from the body; unconditional permission to eat what you want

Weight loss drugs  (GLP-1)

Glucagon Like peptide-1 (GLP-1) receptor agonist medications (mimic GLP-1 hormones): semaglutide (ozempic) (Wegovy) tirzempatide (mounjaro

Maximum amount of weight you should lose in a week

1-2 pounds

Disordered eating

Mild, short term changes in eating patterns, occurs 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 life- threatening conditions 

Eating disorders are more common in

Females

May be more susceptible to eating disorders because of

Genetics, Psychological reasons: Depression, anxiety disorders, substance use, some physical reasons

Eating disorders can cause _ without treatment

Heart conditions, kidney failure, death

Anorexia Nervosa

 Characteristics: extreme weight loss, distorted body image, irrational, morbid feat of obesity; seen in 1 out of every 200 adolsecent girls, may be due to tendency to blame weight gain associated with puberty on themselves; Men account for 10% of cases, athletes whose sports reiqure weight classification most at risk

Physical effect of anorexia

Low body weight (15% or more below what is expected), lower body temperature and cold intolerance, slower metabolic rate, decreased heart rate, easily fatigued, Iron deficiency, anemia, rough dry scaly cold skin, low white blood cell count, abnormal feeling of fullness or bloating, loss of hair.

More physical effect of anorexia

Appearance of lanugo (fine thin hairs that grow on chest and other areas), constipation, low potassium levels, loss of menstrual periods, changes in neurotransmitter functions, loss of teeth, muscle tears and stress fractures

Treatment of anorexia

Seeing multiple professionals (physicans, registered dieticians, psychologist, etc) Ideal setting is in a medical center, hospitalization is needed if weight falls below 75%, average time for recovery is 7 years

Nutrition therapy goal for anorexia

 stop weight loss, make metabolic weight normal, restore food habits, slow weight gain 2-3 pounds weekly, supplement with multivitamin and calcium, promote healthy attitude towards food, teach eating based on hunger and satiety cues

Bulimia nervosa

 Binge eating followed by attempts to purge excess energy with: vomiting, laxatives, diuretics, enemas, excessive exercise, turn towards food when face with problems, recognize it is a problem, 50% have severe depression 

Physical effects of Bulimia

 Demineralization of teeth, low potassium levels, swelling of salivary glands, stomach ulcers and tear in esophagus (esophagus tear can be life threatening), constipation, hands may be calloused or cut by teeth, toxic effects from ipecac syrup on heart liver kidneys 

Treatment for bulimia

Nutrition therapy: Develop regular eating habits, correct misconceptions about food, self monitor: food intake, internal sensations of hunger, environmental factors that trigger binges, thoughts and feelings accompanying binge-purge cycle, Psychological: Improve patients self acceptance, help correct all or none thinking, cope with stressful situations, accept some depression and self doubt is normal 

Binge eating disorder

 Eating large amounts of food rapidly, frequently, until feeling uncomfortably full, even when not hungry, eat alone because of embarrassment, obesity and binge eating are not linked, frequent dieting beginning in childhood may be precursor, stress depression or anxiety can trigger binge, may come from dysfunctional families

Treatment of binge eating disorder

Usually unsuccessful without professional help, nutrition therapy is the same with bulimia nervosa, Psychological: helps identify emotional needs and expressing emotion, self help groups aim to help with recovery, antidepressants may be prescribed 

OSFED (other specified feeding and eating disorders)

Subtypes of eating disorders, muscle dysmorphia, orthorexia, pregorexia