Weight Management Notes

Weight Management

Factors Contributing to Weight and Body Composition

• Many choices impact weight management, influenced by factors beyond individual control.
  • Availability and affordability of healthy food options.
  • Distance to purchase fruits and vegetables.
  • Exposure to food advertisements.

Genetic Factors

• Genes influence body size and shape, fat distribution, metabolic rate, and the tendency to gain weight.
• Set-point theory: bodies maintain a stable weight range, adjusting calorie burn rate based on intake.

Fat Cells

• Some individuals have an above-average number of fat cells, increasing fat storage potential.
• Overeating can create more fat cells.
• Fat tissue sends chemical signals affecting multiple organs and systems.

Metabolism

• Metabolism: sum of processes making food energy and nutrients available to the body.
• Resting Metabolic Rate (RMR): energy required to maintain vital body functions at rest.
• Energy balance: energy intake equals energy expenditure.
• Genetics affects metabolic rate; many factors reduce metabolic rate.
• Exercise has a modest effect on RMR.
• RMR accounts for 65-70% of energy expenditure, physical activity accounts for 20-30%, and food digestion accounts for 10%.

Hormones

• Hormonal changes (puberty, pregnancy, menopause) contribute to fat accumulation in women.
• Insulin allows body cells to take up glucose; insulin problems are linked to obesity.
• Calories from carbohydrates and sugar impact insulin levels, driving increases in body fat.

Other Factors

• Gut microbiota: Trillions of microorganisms that includes bacteria, viruses and non-pathogenic fungi play a key role in digestive, metabolic, immune and neurological functions.
• Food marketing and public policy impact food choices.
• Obesogenic environments encourage overconsumption and discourage physical activity.
• Low-income neighborhoods often have only fast-food venues.
• Public policies can promote healthier choices.
• Cultural norms affect food consumption; food is integral to social gatherings.
• Individual and cultural differences affect views on body size.
• Obesity is inversely associated with socioeconomic status.
• Access to healthy foods, nutrition information, and physical activity opportunities varies.
• Many people use food as a means of coping.
• Binge eating: episodes of high consumption interrupt normal eating patterns.

Sleep Deprivation

• Sleep deprivation leads to increased hunger, more opportunities to eat, altered thermoregulation, increased fatigue, caloric intake, and reduced energy expenditure, ultimately resulting in obesity.

The Overweight and Obesity Crisis

• Over 42% of American adults have obesity.
• Over 31% of American adults and 16% of children are affected by overweight.
• Global obesity rates have tripled since 1975.
• Overweight and obesity are linked to chronic diseases and poor emotional health.
• Maximum BMI above normal is associated with increased risk of death.

Obesity Statistics (2020)

• Both sexes: 42.4%
• Males: 43.0%
• Females: 41.9%
• Non-Hispanic white males: 44.7%
• Non-Hispanic white females: 39.8%
• Non-Hispanic Black males: 41.1%
• Non-Hispanic Black females: 56.9%
• Non-Hispanic Asian males: 17.5%
• Non-Hispanic Asian females: 17.2%
• Hispanic or Latino males: 45.7%
• Hispanic or Latino females: 43.7%

Obesity and Health

• Obesity is a major controllable risk factor for heart disease.
• Increases risk of cardiovascular disease (CVD), hypertension, certain cancers, gallbladder disease, kidney disease, respiratory problems, joint diseases, skin problems, impaired immune function, and sleep disorders.
• Nearly 90% of people with type 2 diabetes are affected by overweight or obesity when diagnosed.
• A weight loss of just 5-10% can reduce the risk of weight-related health conditions and increase life expectancy.

Assessing Weight and Disease Risk

• Overweight: body weight above the recommended range for good health, often BMI between 25 and 29.9.
• Obesity: severely overweight, excessive accumulation of body fat, BMI of 30 or more.

Body Mass Index (BMI)

• BMI estimates weight status and classifies health risks.
• Calculated as weight (kg) / height (m)
• Alternative equation: $BMI = (weight \div [height \times height]) \times 703$

Waist Circumference and Fat Distribution

• BMI is combined with waist measurement to assess health risks.
• Visceral fat: fat around major organs (intra-abdominal fat).
• Subcutaneous fat: fat under the skin.

BMI, Waist Circumference, and Disease Risk

Body Image

• Body image: mental representation of our bodies
• Positive body image is important for psychological wellness and weight management.
• Poor body image can cause psychological distress.

Severe Body Image Problems

• Body dysmorphic disorder (BDD): over-concern with perceived physical flaws.
• Muscle dysmorphia: seeing oneself as small and out of shape despite being muscular.

Healthy Change and Acceptance

• Weight management is most successful in a positive and realistic atmosphere.
• The Health at Every Size (HAES) movement reframes weight loss to disease prevention.

Eating Disorders

• Eating disorder: serious disturbance in eating patterns, negative body image, concerns about weight or fat.
• About 20 million women and 10 million men in the U.S. have an eating disorder.
• Classified as mental disorders.

Types of Eating Disorders

• Disordered eating: abnormal eating habits that disrupt an individual’s life.
• Anorexia nervosa: refusal to maintain a minimally healthy weight; intense fear of gaining weight; self-starvation.
• Bulimia nervosa: recurrent episodes of binge eating and purging to prevent weight gain.
  • Purging: vomiting, laxatives, excessive exercise, restrictive dieting, enemas, diuretics, or diet pills.
• Binge eating disorder (BED): repeated episodes of eating large amounts of food in a short period; lack of control; no compensatory purging behaviors.
• Other specified feeding or eating disorders (OSFED): disorders that do not meet the full diagnostic criteria for anorexia, bulimia, or binge eating disorder.

Treating Eating Disorders

• Treatment includes medical management and psychological therapy.
• Address physical issues specific to the disorder.
• Address problematic eating behaviors.
• Therapy may be individual or in a group.
• Milder patterns of disordered eating may benefit from a nutrition checkup with a registered dietitian.

Healthy Lifestyle for Managing Weight and Disease Prevention

• Healthy behavior patterns have a better chance of taking hold in early adulthood.
• Good eating habits
• Regular physical activity and exercise
• Strategies for positive thinking
• Strategies for managing emotions
• Coping strategies for the stresses and challenges in life
• Adopt healthy behaviors

Dietary Patterns and Eating Habits

Total Calories

• Find approximate daily energy intakes based on gender, age, height, weight, and activity level.
• Focus on individual energy balance.
• Adopt a level of food intake you can enjoy over the long term.

Portion Sizes

• People underestimate portion sizes by as much as 25%.
• Limiting portion sizes is critical for weight management.
• Restaurant meals today are more than 4 times larger than in the 1950s.
• Adults today are, on average, 26 lbs heavier.

Quality of Food Choices

• Energy density: number of calories per ounce or gram of food.
• Avoiding processed foods may be particularly important.

Eating Habits

• Eating small, frequent meals (every three to four hours) can help fuel healthy metabolism, maintain muscle mass, and prevent between-meal hunger that often leads to unhealthy snacking.

Examples of Foods Low in Energy Density

Physical Activity and Exercise

• Physical activity prevents weight gain, losing weight, and maintaining weight loss.
• A combination of both exercise and diet yields the best results, however.
• Physical activity is critical for avoiding weight regain.
• Diet is more effective than exercise alone for weight loss.
• Combining diet and exercise yields the best results.
• Exercise is critical for avoiding weight regain.
• Exercise increases RMR slightly.
• Moderate-intensity endurance exercise can burn a significant number of calories.
• The body tends to compensate for weight-loss by reducing RMR and increasing hunger signals.
• People who have successfully maintained weight loss over time engage in high levels of physical activity.

Thoughts, Emotions, and Coping Strategies

• Low self-esteem and negative emotions are significant problems.
• Realistic beliefs and goals, positive self-talk, and problem-solving support a healthy lifestyle.
• Appropriate coping strategies are important.
• Many people use eating as a way to cope.

Approaches to Overcoming a Weight Problem

• Focus on adopting a healthy lifestyle.
• Combine modest cuts in energy intake with exercise, and avoid very-low-calorie diets.
• Set reasonable goals.
• Don’t try to lose weight more rapidly than 0.5–2.0 lbs per week—which requires a negative energy balance of at least 250–1,000 calories per day.
• Develop a plan you can stick with.
• Maintaining weight loss is usually a bigger challenge than losing weight.

Weight-Loss Plans and Products

• Look for a plan that advocates a balanced approach to diet along with exercise and sound nutritional advice.
• Popular diets: Mediterranean style, DASH, and flexible semi-vegetarian diet.
• Low-carbohydrate, high-protein or high-fat (ketogenic) approaches are not generally recommended for long-term weight management.

Over-the-Counter Drugs and Supplements

• More than half the advertisements for weight-loss products make false representations
• Diet foods used as meal replacements do not help change eating and lifestyle behaviors.

Safety and Effectiveness of Common Over-the-Counter Weight-Loss Pills and Supplements

Weight-Loss Programs

• Commercial weight-loss programs provide group support, nutrition education, physical activity recommendations, and behavior modification advice.
• Some also make packaged foods available.
• Example: Weight Watchers
• Medically supervised clinical programs are designed to help those who are severely obese.
• They are usually located in a hospital or other medical setting.

Safe and Responsible Weight-Loss Programs

• Healthy eating plans that reduce calories but do not exclude specific foods or food groups;
• Tips on ways to increase moderate-intensity physical activity;
• Tips on healthy habits that also keep your cultural needs in mind, such as lower fat versions of your favorite foods;
• A goal of slow and steady weight-loss;
• A recommendation for medical evaluation and care if needed;
• A plan to keep the weight off after you have lost it; and
• Information on all fees and costs.
• Only 10-15% of program participants maintain their weight loss.

Weight-Loss Tips

• Eat Slowly
• Enjoy the Food You Eat
• Meal Prep
• Exercise
• Sleep
• Don’t skip meals and snack
• Stay Hydrated

Prescription Drugs

• Recommended only for people unsuccessful with nondrug options and have a BMI over 30 or additional risk factors.
• Appetite suppressants reduce hunger or increase fullness.
• Some are approved only for short-term use.
• Most experts agree they must be safe over the long term to be effective for treatment of obesity.

Surgery

• Surgical intervention—known as bariatric surgery—may be necessary as a treatment of last resort.
• Recommended for a BMI greater than 40 or a BMI greater than 35 with obesity-related illnesses.
• Modifies the gastrointestinal tract and carries numerous risks.
• Potential complications include nutritional deficiencies, fat intolerance, nausea, vomiting, and reflux.
• 10–20% of patients may require follow-up surgery.

Gaining Weight

• A program for weight gain should be gradual and include both exercise and dietary changes.
• The foundation of a successful and healthy program is a combination of strength training and diet—in most cases a high-carbohydrate, high-protein diet that also contains healthy fats.
• Energy balance is important.