CFB 13- Nutrition: Energy Metabolism and Weight Management

Energy intake = energy output

What is energy balance?

Brain, gut, and adipocyte hormones

What regulates appetite?

Weight gain

Energy intake > energy output

Energy imbalance: positive energy balance is

Pregnancy, lactating women, building muscle mass, fat deposition, building glycogen stores

Examples of positive energy balance

Weight loss

Energy intake < energy output

Energy imbalance: negative energy balance

Excessive exercising

Fasting

Reducing diets

Starvation

Under-nutrition

Excessive vomiting/diarrhea

Examples of negative energy balance

Depends on Total Energy Expenditure (TEE)

How much do you need to eat?

Resting energy expenditure (REE)

Thermic Effect of Food (TEE)

Physical Activity PA

Total Energy Expenditure (TEE) consists of

Amount of energy needed to sustain the body at REST for 24 hours

- Brain

- Heart

- Body temperature

- Muscle mass dependent

What is Resting Energy Expenditure

Obtain Weight in kg (divide pounds by 2.2)

REE Male = 900 + 10*(weight in kg)

REE female = 800+7*(weight in kg)

How to calculate REE

energy to run all body functions at rest

Basal Metabolic Rate

Increases energy expenditure

Increases muscle mass

Physical Activity (PA) effect on energy

Cost of digestion/absorption

What is thermic effect of food?

True

T/F: The basal metabolic rate can be changed by muscle mass

Sedentary

What physical activity level has a physical activity coefficient of 1.0-1.39?

Low active

What physical activity level has a physical activity coefficient of 1.4-1.59?

Active

What physical activity level has a physical activity coefficient of 1.6-1.89?

Very active

What physical activity level has a physical activity coefficient of 1.9-2.5?

Sedentary or low active

What activity level do most Americans fall under?

REE X activity factor

How much Kcal do you need a day? TEE aka calories needed calculated by

Resting energy expenditure (more muscle mass)

Total energy expenditure (cost of physical activity and moving the body is higher)

Athletes and very active individuals have a higher...

True

T/F: Nutrient requirement in athletes is different for water, calories, electrolytes, CHO

BMI (body mass index)

Waist circumference

Body composition measures

[Weight in pounds/(height in inches)^2] x 703

OR

(weight in KG)/((height in m)^2)

How to calculate BMI

True

T/F: oral cancer risk is associated with BMI. Low BMI poor oral cancer outcomes

Waist circumference measured at the level of the umbilicus (belly button)

How is waist circumference measured?

18.5

What is considered an underweight BMI?

Men: at least 3% body fat

Women: at least 12% body fat

What percent of body fat do men and women need to survive?

Osteoporosis, osteopenia

Infertility

Compromised immune system

Lethargy

Underweight increases the risks of:

Equal/greater than 25 = obese

Equal /greater than 30 = morbidly obese

BMI values for obese and morbidly obese

True

T/F: If one has a BMI

INCREASE in physical activity and DECREASE in calorie intake

For healthy and maintained weight loss, need both

Android "apple" & Gynoid "pear"

Two types of fat distribution patterns

Central fat body distribution = greater healthy risk

Android "apple" distribution characterized by

Lower body fat distribution = lower health risk

Gynoid "pear" distribution characterized by

Type II diabetes

Hypertension

Cardiovascular disease

Higher rates of cancer

Joint problems

Early deaths

Obesity is associated with:

Genetics

Dietary habits

Environmental

Others

Causes of obesity?

LOSE FAT, not lean tissue or water, maintain adequate vitamins and minerals

* Patient compliance is essential

* Genetic factors are not understood

Goals of Weight loss

Fewer calories than usual intake

What is a reducing diet?

- Leads to 1 lb of weight loss/ week

- 1000-1200 calories/day in Females

- 1200-1600 calories in Males

- Caloric deficit depends on sex, weight, physical activity

What is a fixed reducing diets

Low to highest risk:

LCD (low calorie diet)

VLCD (very low calorie diet)

Total fast (0 cals - NOT safe; wastes lean tissue)

Rank risk of side effects with different reducing diets from low to high medical/nutritional risks

What are very low calorie diets (VLCDs)?

Weight Watchers, Jenny Craig, LA Weight Loss

- Structured low-calorie diet

- Exercise

- Lifestyle modification

- Group support

Examples of GOOD weight loss programs?

Lower calorie, lower fat conventional foods

I.e frozen low calorie meals and liquid diet meals

What are meal replacements?

1. Portion controlled products

2. Easy to follow

3. Little thought

4. Eat with conventional foods

5. Supply needed extra fiber, fluid, nutrients

6. Anyone can buy in supermarket

Benefits of meal replacement

- Moderate obesity 25-30 BMI who wish to lose 5% body weight or maintain lower weight

- Good for people who have trouble with environmental triggers

- Busy lifestyle

Who are meal replacement options recommended for?

Balanced diet

What kind of diet is this

Low Carb diet

What kind of diet is this

Low fat diet

What kind of diet is this

High protein diet

What kind of diet is this

- fat has more cals than carbs

- low saturated fats heart healthy

- adequate protein

Low Fat diet advantages

- slow weight loss

- often not low enough in calories

- cravings

- feel hungry

- Extremes (Ornish) hard to saty on

- stimulates insulin + fatty acid synthesis

LOW FAT: disadvantages

Initial rapid weight loss

Feel full - fat inhibits gastric emptying

Easy - don't count calories

Encourages fat burning and ketogenesis

LOW CARB diet: advantages

- Ketones - acidic

- Low in fruits/veggies needed

- Gluconeogenesis will still continue

- Cravings for carbs

- Low compliance (cheating)

LOW CARB: disadvantages

Protein Sparing Modified Fast (Optifast)

- Protein based shakes

- Based on the principal that proteins can be used for energy, glucose (gluconeogenesis), and to maintain body protein levels

- 400-600 kcal/day

- Supplemented with vitamins and minerals

- Rapid, unsustainable weight loss

- Difficult to transition back to real food

High protein diet: First generation

Low calories, but not fasting levels, Real Food (e.g. Zone diet, Keto diets, protein powder diet)

What is the next generation high protein diet?

- Normal food

- Higher protein, Lower fat than Adkins-like diets

- Protein can be used to make ATP, glucose, and muscle

- Better compliance than other diets

High protein diet: next generation advantages

- Not appropriate for people with any kind of liver or kidney disease

- Still must control portion size

- Low in fiber, vitamins A, B6, E, K, thiamin, folate.

- Mineral deficiency - Calcium, Magnesium, Iron, Potassium

High protein diet: next generation disadvantages

- Unlimited protein and animal products

- Eat the way our ancestors did

- Tied to cross fit

- Low carb - Non-starchy vegetables

- Minimal fruit

- Low in: Fiber, Calcium, Vitamin K

What is Paleo diet?

- High fat diet, encourages ketogenesis

- Ketones are burned less efficiently than fatty acids

- Long term risks outweigh weight loss benefits

Keto diet

Weight loss (often rapid)

Reduced body fat

Increased HDL

Easy to follow

Keto diet: pros

Limited diet

Long term consequences (kidneys, ketoacidosis, nutrient deficiencies, heart disease, cancer, diabetes, alzheimers)

Keto diet: cons

Both high and low percentages of carbohydrate diets were associated with increased mortality

- Minimal risk observed at 50-55% carbohydrate intake

What does this study show about carb intake?

- Fasting has been tied to longevity in animals

- Lots of intermittent fasting techniques (16 hours - every day, 24 hour fast one to two days a week)

- Unclear how long one needs to fast to see beneficial adaptations

- Benefits:

- - Heart health

- - Reduce blood pressure

- - Regulate blood sugars/ insulin

- - Reduce risk of neurodegenerative disease

- - Remove toxins

must be done the right way to work

What is intermittent fasting?

Meridia (sibutramine)

Xenical

Oxempic

Phentermine

FDA approved weight loss medications

- Appetite suppressant

- Withdrawn from market due to blood pressure concerns in 2010

What does Meridia (sibutramine) do?

- Inhibits pancreatic lipase (fat breakdown) & fat absorption

- Limits absorption of fat soluble vitamins

What does xenical do?

Induces satiety (fullness)

What does Ozempic do?

appetite suppressant

What does phentermine do?

1. Gastric & Pancreatic Lipase inhibitor - Orlistat, Xenical, & OTC Alli

2. Must be taken with low fat meals (

What are Orlistat/Xrnivsl/Alli steps to use?

- Anti-obesity drugs

- INCREASE satiety and fullness, DECREASE snacking

- Mechanism - keep food in the stomach longer

- Work on 1 GLP-1 receptors.

- Ideal for obese patients.

- Only one piece of the puzzle.

Side effects:

Nausea

Constipation

Slow Gl, Gl shut down.

Loss of muscle mass

How do GLP-1 meds (Semaglotide/Ozempic) work?

Increase

How do GLP-1 meds change insulin secretion, resistance, and sensitivity?

Decrease

How do GLP-1 meds change gastric emptying?

Increase satiety, insulin selectivity, neuroprotection, cognition

How do GLP-1 meds change brain function?

Only for the severely obese after trying other ways to lose weight

- BMI > 35 with comorbidites

- Or BMI > 40

- Must be at least 100 lbs over ideal body weight

When is bariatric surgery used?

- Roux-en-Y Gastric Bypass

- LAP-BAND

- Vertical Sleeve Gastrectomy

What are the three types of bariatric surgery?

Up to 49%

In Bariatric patients, what is the postoperative deficiency of vitamin B (thiamine)?

25-80%

In Bariatric patients, what is the postoperative deficiency of Vitamin D?

30% up (up to 45% after 2 yars)

In Bariatric patients, what is the postoperative deficiency of iron?

21-33%

In Bariatric patients, what is the postoperative deficiency of zinc?

- Provide BMI charts & healthy weight ranges.

- Screen patients for obesity and nutrition concerns

- Discuss HEALTHY goals of weight loss

- Refer pts to qualified health professionals (dietitians, exercise physiologists, MDs)

- Consult a Registered Dietitian (RD)

How can a dentist help?

True

T/F: no two patients are the same

False, NOT ALWAYS

T/F: weight loss and weight maintanence are ALWAYS the same diet

True

T/F: In order to achieve weight loss, you must burn more calories than you eat

False, MUSCLE burns more cals than fat. More muscle = higher metabolic rate

T/FL fat burns more calories than muscle, the more fat you have the higher your metabolic rate

True

T/F: generally, reduce simple carbohydrates, eat more veggies, less refined grains/starch and fruits in moderation

True

T/F: generally, reduce/eliminate processed foods i.e high in sodium

- Start slowly adding calories

- Add a few calories to each meal (spread it out)

- Stay away from added sugars and processed foods

- Focus on adding more protein, fruits/veggies/ "healthy fats"

- Choose calorie dense foods such as: dried fruits, avocado, adding dairy to soups

What are the healthy ways to gain weight?

Nuts, legumes, pb, whole grain, fish, chicken/turkey breast

Ways to maintain/increase protein

Increased periodontal disease

How does Type II diabetes impact oral health?

True

T/F: Poor diets impact bone health and oral bone tissue