HTHSCI 3BB3 - F2023 - 12A - Weight Management and Eating Disorders

Converting excess macronutrients for storage is a multistep process that

- requires energy itself
- Storing dietary fat as energy is the most energy efficient
- 2-3% of the energy from fat is used to store it

Energy Storage: Proteiin

Used to synthesize proteins
2. Excess is converted into glucose (gluconeogenesis) and used for energy or stored as glycogen

Energy Storage: Carbs

Used to maintain blood glucose levels and stored as glycogen
2. Excess is used for energy

Energy Storage: Fats

Used for energy
2. Excess is stored as fat

positive energy balance

the state in which energy intake is greater than energy expended, generally resulting in weight gain

negative energy balance

the state in which energy intake is less than energy expended, resulting in weight loss

EER

Basal Metabolic Rate (BMR, REE)
+Activity Level (Exercise and Non-exercise)
+ Thermic Effect of Food (TEF)

What affects BMR

Age and Gender
Height and Weight
Life Stage (Pregnancy, Lactation, Infancy,
Childhood and Adolescence)
Hormones (i.e. Thyroid Hormone)
Stress, Fever, Illness
Genetics
Drugs and other compounds (e.g. caffeine)
Starvation and Fasting

Energy Intake: external cues

Time
• Food Availability
• Food Quality
• Social Norms and Influences

Energy Intake: internal cues

Hunger and Satiety
• Emotions(e.g.Stress,Boredom)

which hormone increases food intake

ghrelin

which hormones decrease food intake

Vagal stimulation
Leptin - adipose tissue (fat cells)
GLP-1- distal small intestine
CCK - duodenum
Insulin - pancreas

1 kg of adipose tissue stores approximately

7,700 kcal of Energy
• 1 lb = 3,500 kcal of Energy

A 68-year-old is in the hospital with a chronic illness and is overweight (BMI= 29). This client refuses to eat vegetables and continues to ask for food to be delivered. Which of the following might this client be experiencing?
a) Undernutrition
b) Overnutrition
c) Both over and under nutrition
d) Protein-calorie malnutrition

Both over and under nutrition

Role of obesity in diabetes

Adipose tissue release adipokines
Anti-inflammatory and Insulin-sensitizing Adiponectin
Pro-inflammatory and increases insulin-resistance: Resistin, TNF-alpha

Role of obesity in CV disease

High levels of VLDL affect normal metabolism of lipoproteins
Transfer of cholesterol and triglycerides between lipoproteins
Production of small dense - LDL which can infiltrate vascular tissue and become oxidized, starting a plaque

A client asks if their weight is considered a health risk. Based on BMI, the client is 10 lbs overweight. Which response would be appropriate?
a) "Yes, this weight puts you at risk for developing heart disease"
b) "No, 10 pounds are nothing to be concerned about"
c) "Yes,andyoushoulddiettolosethose10poundsassoonas possible"
d) "Let's measure your waist size and look at your blood work before figuring that out"

"Let's measure your waist size and look at your blood work before figuring that out"

BMI calculation

weight (kg) / height (m^2)

BMI is less effective at the individual level because:

Doesn't factor in lean muscle mass vs. adipose
tissue
Location of adipose tissue is an important consideration
Ignores metabolic markers of disease risk and mental health

what serves as an indicator of energy stores

Leptin is a critical regulator of energy intake and expenditure
Adipose cells have an average lifespan of ~9.5 years

body going into energy saver mode:
(what factors make it easier to regain a positive energy balance, allowing adipose cells to refill)

BMR decreases (conserve energy)
Activity decreases (conserve energy)
Leptin decrease --> increased hunger (increase food intake)

Weight loss - longter

Long-term behavior modification is the goal
Substitutions as opposed to eliminations
Protein to increase satiety
Water as a drink of choice
Nutrient dense as opposed to energy dense foods
Reduced processed foods

Weight loss programs

Low Calorie
• Prepared Meals/Drinks
• Low Fat•
Low. Carbohydrate
- Intermittent Fasting
• Gluten-Free

Weight Loss Pharmacotherpy

Orlistat - pancreatic lipase inhibitor
Liraglutide and Semaglutide - GLP-1 agonists
Naltrexone and bupropion - hunger suppression

bariatric surgery

Gastric Banding (top)
Gastric Bypass (bottom)
Sleeve Gastroectomy

bariatric surgery outcomes

Permanent changes to GI physiology
Requires life long changes in diet and lifestyle to accommodate changes in absorption
Good outcomes

A client who is undernourished is seen in the clinic with an infected foot wound. This client is at continued risk for which of the following?
a) Elevated iron levels
b) Ongoing infections
c) Hypertension
d) Development of type 2 diabetes

Ongoing infections

Causes of Eating Disorders

Societal pressures, psychological factors combine to develop a distorted body image
Genetics can play a factor
• Personality, body type
All these factors coalesce, often during adolescence
Control can be desired which can manifest in control of food intake and weight

Anorexia Nervosa

Persistent restriction of energy intake that leads to significant low
body weight
Intense fear of gaining weight or becoming fat
Disturbed body image
Subtypes: Restricting Type, Binge-eating/Purging Type

Bulimia Nervosa

Repeated binging episodes with a feeling of lack of control overeating
Repeated compensation after binging of vomiting, misuse of laxatives, or excessive exercise to prevent weight gain
One episode of binging and compensatory behavior per week
Disturbed Body Image
Does not occur exclusively during episodes of anorexia nervosa

Binge-eating Disorder

Most common eating disorder• Binge eating without compensatory behaviors
• Characterized by eating more than needed and intense feelsing of guilt and shame

A client who is 25 lbs underweight has noted new bruising and "bleeding marks" under the skin. This client might be experiencing...
a) Vitamin D deficiency
b) Vitamin B12 deficiency
c) Vitamin C deficiency
d) Protein deficiency

Vitamin C deficiency