hn&f 126 - exam 2

Lecture 8 and 9 – Water, Vitamins, and Minerals

I.      Water and the Body Fluids

The main role of water is to maintain an appropriate water balance to support vital functions. Intracellular fluid (inside the cells) makes up about two-thirds of the body’s water. Extracellular fluid (outside the cells) has two components—the interstitial fluid and plasma. To maintain water homeostasis, intake from liquids, foods, and metabolism must equal losses from the kidneys, skin, lungs, and feces.

II. Vitamins and Their Functions Vitamins are essential organic compounds that play crucial roles in various biochemical processes. They are categorized into water-soluble (e.g., B vitamins, vitamin C) and fat-soluble vitamins (e.g., vitamins A, D, E, K). Each vitamin has specific functions, such as supporting immune function, aiding in energy metabolism, and promoting healthy skin. In addition to their individual roles, a balanced intake of these vitamins is essential for overall health and well-being, as deficiencies can lead to various health issues.

      A.   Water Roles in the Body

1.     Carries nutrients and waste products

2.     Maintains the structure of large molecules

3.     Participates in metabolic reactions

4.     Solvent for minerals, vitamins, amino acids, glucose and others

5.     Lubricant and cushion around joints, inside the eyes, the spinal cord, and in amniotic fluid during pregnancy

6.     Regulation of body temperature

7.     Maintains blood volume

      B.   Water Balance and Recommended Intakes

1.     Water Intake

(1)   1-2 % loss of body weight – thirst, fatigue, weakness, vague discomfort, and loss of appetite

(2)   3-4 % loss of body weight – impaired physical performance, dry mouth, reduction in urine, flushed skin, impatience, and apathy

(3)   5-6 % loss of body weight – difficulty in concentrating, headache, irritability, sleepiness, impaired temperature regulation, and increased respiratory rate

(4)   7-10 % loss of body weight – dizziness, spastic muscles, loss of balance, delirium exhaustion, and collapse

c)     Water intoxication is excessive water contents in all body fluid compartments. It is rare.

2.     Water Sources

a)     Liquids 550 to 1500 mL

b)     Foods 700 to 1000 mL

c)     Metabolic Water 200 to 300 mL

3.     Water Losses

a)     Kidneys (urine) 500 to 1400 mL

b)     Skin (sweat) 450 to 900 mL

c)     Lungs (breath) 350 mL

d)     GI tract (feces) 150 mL

4.     Water Recommendations - 1.0 to 1.5 mL/kcal expended for adults

5.     Health Effects of Water

a)     Meeting fluid needs

b)     Protect the bladder, prostrate, and breast against cancer

c)     Protect against kidney stones

C.   Fluid and Electrolyte Balance

1.     Dissociation of Salt in Water          

a)     Dissociates into positive ions called cations and negative ions called anions.

b)     Ions carry electrical current so they are called electrolytes.

c)     Solutions are called electrolyte solutions.

d)     Positive and negative charges inside and outside the cell must be balanced.

2.     Electrolytes Attract Water. Oxygen is negatively charged. Hydrogen is positively charged - enables body to move fluids.

3.     Water Follows Electrolytes

a)     Sodium and chloride are primarily outside the cell.

b)     Potassium, magnesium, phosphate and sulfur are primarily inside the cell.

c)     Osmosis is the movement of water across the cell membrane toward the more concentrated solutes.        

d)     Osmotic pressure is the amount of pressure needed to prevent the movement of water across a cell membrane.

4.     Proteins Regulate Flow of Fluids and Ions

a)     Proteins attract water and regulate fluid balance.

b)     Water flows toward the more concentrated solution.

I.      The Minerals—An Overview

Major minerals are found in larger quantities in the body, while trace minerals are found in smaller quantities. Minerals are inorganic elements that retain their chemical identity. Minerals receive special handling in the body. They may bind with other substances and interact with other minerals, thus affecting absorption.

      A.   Inorganic Elements

1.     Major minerals or macrominerals retain their chemical identity.

2.     Cannot be destroyed by heat, air, acid or mixing

B.     Varied Roles

1.     Sodium, potassium and chloride function primarily in fluid balance.

2.     Calcium, phosphorus and magnesium function primarily in bone growth and health.

II.     Sodium

Sodium is one of the primary electrolytes in the body and is responsible for maintaining fluid balance. Dietary recommendations include a moderate intake of salt and sodium. Excesses may aggravate hypertension. Most of the sodium in the diet is found in table salt and processed foods. High sodium intake is associated with calcium excretion.

III.   Potassium

Potassium is another electrolyte associated with fluid balance. It is associated with hypertension. Low potassium intakes increase blood pressure. High potassium intakes prevent and correct hypertension.

IV.   Calcium

Most of calcium is found in the bones. The blood calcium has many functions. These are kept in balance with a system of hormones and Vitamin D. Blood calcium remains in balance at the expense of bone calcium and the risk of developing osteoporosis in later years. Mineralization – process whereby minerals crystallize on the collagen matrix of a growing bone, hardening of the bone. Peak bone mass is the bone’s fullest potential in size and density developed in the first three decades of life. Calcium from dairy foods has better results than calcium from supplements. Bones get robbed of calcium before blood concentrations get low. Absorption rate for adults is 25% of calcium consumed.

A.  Calcium Sources    

1.     Calcium in Milk Products

2.     Calcium in Other Foods

a)     Tofu, corn tortillas, some nuts and seeds

b)     Mustard and turnip greens, broccoli, bok choy, kale, parsley, and watercress

c)     Legumes

d)     Oysters and sardines with bones

e)     Mineral waters, calcium-fortified orange juice, fruit and vegetable juices, high-calcium milk

f)      Calcium-fortified cereal

      D.   Calcium Deficiency and Toxicity

1.     Osteoporosis is the disease where the bones become porous and fragile due to mineral losses.

2.     No obvious symptoms of mineral loss in bones. It is silent.

3.     Deficiency symptom is stunted growth in children

4.     Toxicity symptoms include constipation, increased risk of urinary stone formation, kidney dysfunction, and interference with the absorption of other minerals

V.    Phosphorus

Most of the phosphorus is found in the bones and teeth. It is also important in energy metabolism, as part of phospholipids, and as part of genetic materials.

VI.   Highlight: Osteoporosis and Calcium

Osteoporosis is one of the most prevalent diseases of aging. Strategies to reduce risks involve dietary calcium.   

A.    Gender and Hormones

1.     Men at lower risk than women

2.     Hormonal changes

3.     Soy offers some protection

4.     Rapid bone loss in non-menstruating women

B.     Genetics and Ethnicity

1.     Genes may play a role

2.     Environment also – diet and calcium

3.     Physical activity, body weight, alcohol, and smoking have a role

C.    Physical Activity and Body Weight

1.     Muscle strength and bone strength go together

2.     Heavy body weights and weight gains place a stress on bones and promote bone density

D.    Smoking and Alcohol

1.     Smokers

a)     Less dense bones

b)     Decreased calcium absorption

c)     Increased bone resorption

2.     Alcohol abuse

a)     Enhances fluid excretion thus increased calcium losses

b)     Upsets hormonal balance for healthy bones

c)     Slows bone formation

d)     Stimulates bone breakdown

e)     Increases risks of falling

      G.   Dietary Calcium is the key to prevention

      H.  A Perspective on Supplements - calcium rich foods are best

I.     Closing Thoughts - Age, gender and genetics are beyond control. There are effective strategies for prevention that include adequate calcium and Vitamin D intake, physical activity, moderation of alcohol, abstaining from cigarettes, and supplementation if needed.

I.      The Vitamins - An Overview

Vitamins differ from carbohydrate, fat and protein in structure, function and food contents. Vitamins are similar to the energy-yielding nutrients in that they are vital to life, organic and available from foods.

      A.   Bioavailability is the rate and extent that a nutrient is absorbed and used.

1.     Water-soluble vitamins are absorbed directly into the blood and travel freely.

2.     Fat-soluble vitamins are absorbed first into the lymph, then the blood. Many require protein carriers.

      B.   Precursors, also known as provitamins, are consumed in an inactive form and become active vitamins in the body.

      C.   The organic nature of vitamins means they can be destroyed in cooking and storage. There are methods used to minimize nutrient losses.

1.     Refrigerate fruits and vegetables.

2.     Store cut fruits and vegetables in airtight wrappers or closed containers and refrigerate.

3.     Use a microwave, steam, or simmer in small amounts of water. Save cooking water for other uses.

4.     Avoid high temperatures and long cooking times.

      D.   Solubility and Storage

1.     Water-soluble vitamins (B Vitamins and Vitamin C)

a)     Circulate freely

b)     Excreted in urine

2.     Fat-soluble vitamins (Vitamins A, D, K and E)

a)     Stored in cells associated with fat

b)     Less readily excreted

      E.   Toxicity     

1.     Water-soluble vitamins can reach toxic levels with supplement use.

2.     Fat-soluble vitamins are likely to reach toxic levels with supplement use.

II.     The B Vitamins are very active in the body. Several of the B Vitamins form part of the coenzymes that assist enzymes in the release of energy. Other B Vitamins participate in metabolism and cell multiplication. There are deficiencies, toxicities and food sources that are unique for each vitamin

The B Vitamins are interdependent. The presence of one may affect the absorption, metabolism and excretion of another. A deficiency of one may affect the functioning or deficiency of another. A variety of foods from each food group will provide an adequate supply of all the B Vitamins.

A.    B Vitamin Roles     

1.     Coenzymes involved directly or indirectly with energy metabolism

2.     Facilitate energy-releasing reactions

3.     Build new cells to deliver oxygen and nutrients for energy reactions

B.     B Vitamin toxicities can occur with supplements.

C.    B Vitamin Food Sources

1.     Cereal and bread group provides thiamin, riboflavin, niacin and folate.

2.     Fruits and vegetables provide folate.

3.     Meat group provides thiamin, niacin, Vitamin B₆ and Vitamin B₁₂.

4.     Milk group provides riboflavin and Vitamin B₁₂.

III.   Vitamin C (antiscorbutic factor is the original name for Vitamin C). Vitamin C differs from the B Vitamins in that it serves as a cofactor to facilitate the action of an enzyme. It also serves as an antioxidant.

      A.   Vitamin C Roles:

1.     Antioxidant

a)     Defends against free radicals

b)     Protects tissues from oxidative stress

2.     Stress - Vitamin C needs increase during body stress, i.e. infections, burns, extremely high or low temperatures, heavy metal intakes, certain medications, and smoking

3.     Cure for the Common Cold

4.     Disease prevention is still being researched.

      C.   Vitamin C Deficiency

1.     Deficiency disease is called scurvy

2.     Deficiency Symptoms

a)     Anemia – small cell type

b)     Atherosclerotic plaques and pinpoint hemorrhages

c)     Bone fragility and joint pain

d)     Poor wound healing and frequent infections

e)     Bleeding gums and loosened teeth

f)      Muscle degeneration and pain, hysteria, and depression

g)     Rough skin and blotchy bruises

      D.   Vitamin C Toxicity

1.     Toxicity Symptoms

a)     Nausea, abdominal cramps, diarrhea, headache, fatigue and insomnia

b)     Hot flashes and rashes

c)     Interference with medical tests creating a false positive or a false negative

d)     Aggravation of gout symptoms, urinary tract infections, and kidney stones

      E.   Vitamin C Food Sources    

1.     Citrus fruits, cantaloupe, strawberries, papayas and mangoes

2.     Cabbage-type vegetables, dark green vegetables like green peppers and broccoli, lettuce, tomatoes and potatoes

F.     Other Information

1.     Also called ascorbic acid

2.     Easily destroyed by heat and oxygen

IV.   Highlight: Vitamin and Mineral Supplements. Many people take dietary supplements for dietary and health insurance. Some take multinutrient pills daily. Others take large doses of single nutrients. A valid nutrition assessment by professionals determines the need for supplements. Self-prescribed supplementation is not advised. There are many arguments for and against supplements.

V.    Vitamin A and Beta-Carotene. Vitamin A has functional roles in vision, and growth. Vitamin A deficiency is a major health problem in the world. Toxicity is often associated with supplemental abuse. Plant foods provide carotenoids, some of which have Vitamin A activity.

VI.   Vitamin D is not an essential nutrient. The body can make Vitamin D with help from sunshine.                A.      Roles in the body - bone growth

1.     Vitamin D in Foods

a)     Fortified milk, butter, and margarine

b)     Cereals

c)     Chocolate mixes

d)     Veal, beef, egg yolks, liver, fatty fish and their oils

2.     Vitamin D from the Sun      

a)     Synthesized in the body from cholesterol

b)     Can be obtained from tanning beds depending on type of UV radiation

VII. Vitamin E as an antioxidant

1.     Stops the chain reaction of free radicals

2.     Protects the oxidation of LDLs

3.     Protection of polyunsaturated fatty acids and Vitamin A

4.     Other claims about Vitamin E are myths.     

VIII.    Vitamin K is unique in that half of human needs are met through the action of intestinal bacteria. Vitamin K is essential in blood clotting. Vitamin K deficiency can cause uncontrolled bleeding. Food sources include leafy green vegetables, cabbage-type vegetables and liver.

IX.   The Fat-Soluble Vitamins – In Summary

The function of fat-soluble vitamins depends on the presence of other fat-soluble vitamins. There are many interactions of fat-soluble vitamins with minerals. It is important to eat a wide variety of foods every day.

X.     Highlight: Antioxidant Nutrients in Disease Prevention. Oxidants are compounds in the body that oxidize other compounds. Antioxidants have a role in preventing oxidation, and thus assist in the prevention of chronic disease. Researchers and medical experts are still clarifying the roles of these nutrients in relationship to health and disease.

      A.   Free Radicals and Disease

1.     Produced by normal body processes and environmental factors such as ultraviolet light, air pollution and tobacco smoke.

2.     Free radicals are highly unstable and often damaging.

3.     Antioxidants stabilize free radicals and protect against oxidative stress.

4.     Cognitive performance, aging, cancer, arthritis, cataracts and heart disease may be protected with antioxidants.

B.   Defending against Cancer

1.     Antioxidants may protect DNA

2.     Fruits and vegetables have Vitamin C and Vitamin A

Study Questions with Answers

1.          List the roles of water in the body.

Water carries nutrients and waste products throughout the body; helps to form the structure of macromolecules; actively participates in chemical reactions; fills the cells and the spaces between them; serves as the solvent for minerals, vitamins, amino acids, glucose, and many other small molecules; acts as lubricant around joints; serves as shock absorber inside the eyes, spinal cord, and in pregnancy, the amniotic sac; aids in the body's temperature regulation.

2.          List the sources of water intake and routes of water excretion.

Sources of intake:  liquids, foods, metabolic water. Routes of excretion:  kidneys, skin, lungs, feces. 

3.          How does the body use electrolytes to regulate fluid balance?

The body uses electrolytes to control the movement of water inside cells and between cells.

4.          What do the terms major and trace mean when describing the minerals in the body?

Major minerals are needed in the largest amounts in the body; trace minerals are needed in small amounts in the body. Both are equally important.

5.          List calcium's roles in the body. How does the body keep blood calcium constant regardless of intake? 

Bone structure, cell membrane integrity, transport of ions, muscle action, nerve impulses, regulates blood vessel wall muscle tone, helps regulate blood pressure, aids blood clotting, acts as cofactor for enzymes. When levels fall, intestinal absorption increases, bone withdrawal increases, and kidney excretion diminishes; these processes are regulated by a system of hormones and vitamin D.

9.          Name significant food sources of calcium. What are the consequences of inadequate intakes?

Calcium is found predominantly in milk and milk products. Inadequate intakes limit the bones’ ability to achieve optimal mass and density and increase risk of osteoporosis and associated fractures.

10.        How do the vitamins differ from the energy nutrients?

They differ in structure, function, and food contents.

11.        Describe some general differences between fat-soluble and water-soluble vitamins.

Water-soluble vitamins are:  carried in the blood, excreted in the urine, needed in frequent, small doses, unlikely to reach toxic levels in the body. Fat-soluble vitamins are:  absorbed into the lymph and carried in the blood by protein carriers, stored in body fat, needed in periodic doses, and more likely to be toxic when consumed in excess of needs.

12.        List the fat-soluble vitamins. What characteristics do they have in common? How do they differ from the water-soluble vitamins?  

Vitamins A, D, E, and K. Found in the fat and oily parts of foods; stored primarily in the liver and adipose tissue. Fat-soluble vitamins are stored longer; therefore, daily intake is less crucial and toxicity risk is greater than for water-soluble vitamins.

13.        Summarize the roles of vitamin A and the symptoms of its deficiency.  

Vitamin A is important in vision, mucous membranes, skin; bone and tooth growth; reproduction; hormone synthesis and regulation; immunity; cancer protection. Symptoms of deficiency include anemia, diarrhea, general discomfort, depression, frequent respiratory, digestive, bladder, vaginal and other infections, abnormal tooth and jaw alignment, night blindness, .

14.        What is meant by vitamin precursors?

Compounds that can be converted into the active form of a vitamin.

15.        How is vitamin D unique among the vitamins? What is its chief function? What are the richest sources of this vitamin?  

With sunlight, vitamin D can be made from cholesterol. Its chief function is to promote mineralization of bones. Richest sources are fortified milk, fortified margarine, eggs, liver, fatty fish.

16.        Describe vitamin E's role as an antioxidant.

Vitamin E protects other substances from oxidation by being oxidized itself; it protects the lipids and other vulnerable components of the cell and its membranes from destruction. It is especially effective in preventing the oxidation of the polyunsaturated fatty acids.

17.        What is vitamin K's primary role in the body?

Synthesis of blood-clotting proteins and a blood protein that regulates blood calcium.

18.            The body generates water during the:

a.     Buffering of acids

b.     Dismantling of bone.

c.      Metabolism of minerals

d.     Breakdown of energy nutrients.

19.            The distinction between the major and trace minerals reflects the:

a.     Ability of their ions to form salts

b.     Amounts of their contents in the body

c.      Importance of their functions in the body

d.     Capacity to retain their identity afier absorption.

20.            Fat-soluble vitamins:

a.     Are easily excreted

b.     Seldom reach toxic levels

c.      Require bile for absorption

d.     Are not stored in the body’s tissues.

21.            Vitamin D can be synthesized from a precursor that the body makes from:

a.     Bilirubin

b.     Tocopherol

c.      Cholesterol

d.     Beta-carotene.

22.            Vitamin E’s most notable role is to:

a.     Protect lipids against oxidation

b.     Activate blood-clotting proteins

c.      Support protein and DNA synthesis

d.     Enhance calcium deposits in the bones.

23.            Without vitamin K:

a.     Muscles atrophy

b.     Bones become soft

c.      Skin rashes develop

d.     Blood fails to clot.

24.            Vitamins:

a.     Are inorganic compounds

b.     Yield energy when broken down

c.      Are soluble in either water or fat

d.     Perform best when linked in long chains.

25.            The rate at and the extent to which a vitamin is absorbed and used in the body is known as its:

a.     Bio-availability

b.     Intrinsic factor

c.      Physiological effect

d.     Pharmacological effect.

26.            Many of the B vitamins serve as:

a.     Co-enzymes

b.     Antagonists

c.      Antioxidants

d.     Serotonin precursors.

27.            Vitamin C serves as a(n):

a.     Co-enzyme

b.     Antagonist

c.      Antioxidant

d.     Intrinsic factor.

28.            The requirement for vitamin C is highest for:

a.     Smokers

b.     Athletes

c.      Alcoholics

d.     The elderly. 

Lecture 10 – a Healthy Diet

I.      Principles and Guidelines

Diet planning guides and dietary guidelines are tools that apply principles of good eating and offer practical advice on healthy habits. Using the diet planning tools together allows individuals to plan nutrient-dense, well-balanced diets that provide variety and moderation without excessive energy. Consuming food wisely and practicing healthy habits supports overall health.

      A.   Diet-Planning Principles

1.     Adequacy (dietary)—providing sufficient energy and essential nutrients

2.      Balance (dietary)—consuming the right proportion of foods

3.     kCalories (energy) control—balancing the amount of foods and energy to sustain physical activities and metabolic needs

4.      Nutrient density—measuring the nutrient content of a food relative to its energy content

5.      Empty-kcalorie foods denote foods that contribute energy but lack nutrients.

6.     Moderation (dietary)—providing enough but not too much of a food or nutrient

7.     Variety (dietary)—eating a wide selection of foods within and among the major food groups

      B.   Dietary Guidelines for Americans           

1.      Aim for fitness

a)     Aim for a healthy weight.

b)     Be physically active each day.

2.      Build a healthy base

a)     Use pyramid to guide food choices.

b)     Choose variety in grains, especially whole grains.

c)     Choose variety in fruits and vegetables.

d)     Keep foods safe to eat.

3.      Choose sensibly

a)     Choose a diet low in saturated fat and cholesterol and moderate in total fat.

b)     Choose beverages and foods that limit your intake of sugar.

c)     Choose and prepare foods with less salt.

d)     If you drink alcoholic beverages, do so in moderation.

II.     Diet-Planning Guides

Food guides sort food into groups based on nutrient content, origin, and/or energy content. Serving sizes and recommended number of servings per group assist consumers in practical meal planning. These guides are important in selecting foods for a nutritious diet providing balance, variety, adequacy and moderation. A combination of whole grains, vegetables, legumes, fruits, meats or meat alternates and milk products is essential to a healthy diet. Following diet-planning guides can help to meet nutrition and health goals.

A.   Food Group Plans are clusters of foods similar in origin and nutrient content.

1.      The Daily Food Guide         

a)     Five major food groups including breads, cereals and grains, vegetables, fruits, meat and meat alternates and milk products

b)     Fats, oils and sweets are used sparingly.

2.      Nutrient density

a)     Foods can be of high, medium or low nutrient density

b)     Must consider energy needs when choosing these foods

3.      Recommended servings vary depending on energy needs

a)     6 to 11 servings of breads and cereals

b)     3 to 5 servings of vegetables

c)     2 to 4 servings of fruits

d)     2 to 3 servings of meats and meat alternates

e)     2 servings of milk and milk products  (3 servings for older children, teens, young adults, pregnant and lactating women and some older adults)

4.      Serving sizes

a)     Differ among and within the food groups

b)     Smaller than people typically eat

c)     Can visualize serving sizes with common objects

5.      Food guide pyramid - graphic depiction of the Daily Food Guide to show variety, moderation and proportions

6.      Vegetarian food guide

a)     Reliance on plant foods such as grains, vegetables, legumes, fruits, nuts and seeds

b)     Similar food groups and servings sizes

c)     Use of meat alternates

7.      Healthy Eating Index consists of scoring system that combines principles in the Dietary Guidelines and the Food Pyramid.          

a)     Food Pyramid 50%

b)     Total Fat 10%

c)     Saturated Fat 10%

d)     Cholesterol 10%

e)     Sodium 10%

f)      Variety in the diet 10%

8.      Pyramid Shortcomings

a)     It does not distinguish between individual foods within each group.

b)     There are beneficial and harmful fats.

c)     Refined products that may have added sugars and fats still fit in the pyramid.

III.   Food Labels      

Food labeling is required on almost all packaged foods. Posters or brochures provide nutrition information for fresh meats, and produce. The Daily Values (DV) are based on a 2000 kCalorie reference diet. There are requirements and guidelines for ingredients lists, serving sizes and nutrition facts. Health and nutrient claims must follow FDA specified criteria.

A.    The Ingredient List

1.      All ingredients listed

2.      Descending order by weight

B.     Serving Sizes

1.      Facilitate comparisons among foods

2.      Need to compare to quantity of food actually eaten

3.      Do not necessarily match the Food Pyramid

C.   Nutrition Facts

1.      Listed by quantity and percentage standards per serving, called Daily Values

2.      kCalories listed as total kcalories and kcalories from fat

3.      Fat listed by total fat, saturated fat, and trans fat (required by January 1, 2006)

4.      Cholesterol

5.      Sodium

6.      Carbohydrate listed by total carbohydrate, starch, sugars, and fiber

7.      Protein

8.      Vitamin A, Vitamin C, Iron, and Calcium are listed in % DV only.

      D.   Nutrient Claims

1.      Must meet FDA definitions

2.      Must include conditions of use

3.      No implied claims

4.      General terms include free, good source of, healthy, high, less, light or lite, low, more, and organic.

5.      Energy terms include kcalorie-free, light, low kcalorie, and reduced calorie.

6.      Fat and cholesterol terms include percent fat-free, fat-free, low fat, less fat, saturated fat-free, low saturated fat, less saturated fat, trans fat-free, cholesterol-free, low cholesterol, less cholesterol, extra lean, lean, and light.

7.      Carbohydrate terms include high fiber and sugar-free.

8.      Sodium terms include sodium-free and salt-free, low sodium, light, light in sodium and very low sodium.

      F.   Health Claims

1.      Reliable health claims on the FDA “A” list are clear links between a nutrient and a disease or health related condition.

2.      “B” list health claims have supportive evidence but not conclusive.

3.      “C” list health claims have limited evidence and not conclusive.

4.      “D” list health claims have little scientific evidence to support the claim.

IV.   Highlight:  A World Tour of Pyramids, Pagodas, and Plates

Governments from around the world develop dietary guidelines based on the needs of their own population groups. The guidelines offer practical advice with the goal to support health, reduce chronic disease, and make policy and educational decisions. Although there are differences in the guidelines among nations, there are many similarities.

A.    Dietary guidelines are developed based on own population needs.

B.     Aim for a healthy weight to reduce risk of chronic disease.

C.     Being physically active each day helps with weight management and disease prevention.

D.    Let the pyramid guide your food choices to encourage a variety of foods.

E.     Choose a variety of grains daily, especially whole grains.

F.     Choose a variety of fruits and vegetables daily, especially deep green leafy and yellow-orange vegetables, citrus fruits, melons, berries and legumes.

G.    Keep foods safe to eat to reduce the prevalence and risk of foodborne illness.

H.    Choose a diet low in saturated fat and cholesterol and moderate in total fat but the specific recommendations vary among countries.

I.      Choose beverages and foods to moderate sugar intake especially foods with refined sugar.

J.      Choose and prepare foods with less salt, especially processed foods.

K.     Drink alcoholic beverages in moderation (if at all).

L.     All dietary guidelines support good health

M.   Eating pleasure is an important consideration

Study Questions with Answers

1.         Name the diet-planning principles and briefly describe how each principle helps in diet planning. 

Adequacy—providing all essential nutrients. Balance—providing foods of a number of types in proportion to each other so that foods rich in some nutrients do not crowd out foods rich in other nutrients. Kcalorie control—management of food energy intake. Nutrient density—selecting foods with high nutrient value and food energy. Moderation—providing enough but not too much of a dietary constituent. Variety—using different foods on different occasions; variety helps ensure adequacy and balance.

2.         What information can you expect to find on a food label? How can this information help you choose between two similar products?

The common or usual name of the product; the name and address of the manufacturer, packer, or distributor; the net contents in terms of weight, measure, or count; the ingredients in descending order of predominance by weight; the serving size and number of servings per container; the quantities of specified nutrients and food constituents. Consumers can use ingredient lists to compare nutrient density of products.

3.         What are the Daily Values? How can they help you meet health recommendations?

Daily Values are reference values developed by the FDA for use on food labels; they help people compare foods to their recommended intakes.

4.         What health claims have been approved by FDA for use on labels? What criteria must all health claims meet?

Calcium and osteoporosis; sodium and hypertension; dietary saturated fat and cholesterol and risk of coronary heart disease; dietary fat and cancer; fiber-containing grain products, fruits, and vegetables, and grain products that contain fiber, particularly soluble fiber, and risk of coronary heart diseases; fruits and vegetables and cancer. Food making a health claim must be a naturally good source of at least one of following nutrients:  vitamin A, vitamin C, iron, calcium, protein, or fiber; and foods cannot contain more than 20% of Daily Value for total fat, saturated fat, cholesterol or sodium.

5.              The diet-planning principle that provides all the essential nutrients in sufficient amounts to support health is:

a)       Balance

b)      Variety

c)       Adequacy

d)      Moderation.

6.              A person who chooses a chicken leg that provides 0.5 milligram of iron and 95 kcalories instead of two table- spoons of peanut butter that also provide 0.5 milligram of iron but 188 kcalories is using the principle of nutrient:

a)       Control

b)      Density

c)       Adequacy

d)      Moderation.

7.              According to the Food Guide Pyramid, which group provides the foundation of a healthy diet?

a)       Vegetables

b)      Milk, yogurt, and cheese

c)       Breads, cereals, rice, and pasta

d)      Meat, poultry, fish, dry beans, eggs, and nuts.

8.              Food labels list ingredients in:

a)       Alphabetical order

b)      Ascending order of predominance by weight

c)       Descending order of predominance by weight

d)      Manufacturer’s order of preference.

9.              Daily Values on food labels are based on a:

a)       1500-kcalolie diet

b)      2000-kcalorie diet

c)       2500-kcalorie diet

d)      3000-kcalorie diet.

 Lecture 11 – Energy Balance and Body Composition

I.      Energy Balance      

Body weight is stable when energy consumed is equal to energy expended. When energy consumed is greater than expended, weight increases. When energy consumed is less than expended, weight decreases.

II.     Energy In: The kCalories Foods Provide

Eating behaviors respond to different signals. Hunger and appetite encourage eating, while satiation and satiety stop eating. Messages are sent from the hormonal and nervous system.

      A.   Food Composition – a bomb calorimeter is an instrument that measures the heat energy released when foods are burned.

      B.   Food Intake     

1.     Hunger is the feeling that motivates us to eat.

2.     Appetite initiates eating through the sight, smell, thought or taste of food.

3.     Satiation is the feeling of satisfaction and fullness that causes us to stop eating.

4.     Satiety reminds us not to eat again.

5.     Overriding Hunger and Satiety

a)     Cognitive influences such as perceptions, memories, intellect, and social interactions.

b)     Stress eating is eating in response to arousal.

6.     Sustaining Hunger and Satiety

a)     Protein is the most satiating.

b)     Complex carbohydrates are satiating.

c)     High fat foods stimulate and entice people to eat more.

7.     The Hypothalamus integrates messages about energy intake, expenditure, and storage.

III.   Energy Out: The kCalories the Body Expends

Energy expenditure includes basal metabolic activities, physical activity and thermic effect of food. These energy requirements differ from person to person and are affected by age, gender, weight, and height. The intensity and duration of physical activity also make a difference.

      A.   Components of Energy Expenditure      

1.     Basal Metabolism (Basal metabolic rate, BMR)

a)     2/3 of energy expenditure

b)     Supports the basic processes of life

c)     Factors affecting BMR

(1)   Aging slows BMR

(2)   Height- the taller, the higher BMR

(3)   Growth increases BMR

(4)   Body Composition (lean body mass increases BMR)

(5)   Fever increases BMR

(6)   Stress increases BMR

(7)   Environmental Temperature, both heat and cold raise BMR

(8)   Fasting/Starvation slows BMR

(9)   Malnutrition slows BMR

(10) Hormones

(a)   Thyroid hormones can increase or decrease BMR

(b)   Premenstrual hormones can increase BMR

(11) Smoking increases BMR

(12) Caffeine increases BMR

(13) Sleep slows BMR

2.     Physical activity

a)     Most variable and changeable.

b)     Voluntary.

c)     It can be significant in weight loss and weight gain.

d)     Duration, frequency and intensity influence energy expenditure.

3.     Thermic effect of food (TEF) is estimated at 10% of total energy intake and involves digestion and absorption.

      B.  Estimating energy requirements is affected by many factors.

1.     Gender – men generally have a higher BMR

2.     Growth – BMR is high in people who are growing

3.     Age – BMR declines as lean body mass decreases

4.     Physical Activity – Activities are clustered by intensity and vary considerably

IV.   Body Weight, Body Composition and Health

Current weight standards use height and weight data and do not take body composition into consideration. These may be misleading.

      A.   Defining Healthy Body Weight

1.     Fashion     

a)     Society values change over time.

b)     Perceived body images

2.     Health

a)     Good health supercedes appearance

b)     Longevity is a criterion

3.     Body mass index (BMI) measures relative weight for height.    

a)     Overweight is a BMI above 25

b)     Underweight is a BMI below 18.5

c)     Obese is a BMI above 30

      B.   Health Risks Associated with Body Weight and Body Fat    

An appropriate weight for an individual depends on many factors which include body fat distribution, health history and current health history.

1.     Health Risks of Underweight

a)     Cannot Handle Medical Stresses

b)     Menstrual Irregularities and Infertility

c)     Osteoporosis and Bone Fractures

d)     Pregnancy Problems

2.     Health Risks of Overweight

a)     Diabetes

b)     Hypertension

c)     Cardiovascular Disease

d)     Sleep Apena

e)     Some Cancers

f)      Gallbladder Disease

g)     Respiratory Problems

h)     Complications in Pregnancy and Surgery

3.     Cardiovascular disease and diabetes have a strong relationship with obesity.

4.     Cancer risk increases with weight gain but the relationship is unclear.

V.    Highlight: The Latest and Greatest Weight-Loss Diet Again

Fad diets do not offer safe and effective plans for weight loss. Diet recommendations should be research based. There are guidelines for identifying fad diets and weight-loss scams.

Study Questions with Answers

1.          What are the consequences of an unbalanced energy budget?

Overfatness and underweight.

2.          Define hunger, appetite, satiation and satiety and describe how each influences food intake.

Hunger is the physiological need for food; appetite is the psychological desire for food. Satiation is the feeling of satisfaction and fullness that occurs during a meal and halts eating; satiety is a feeling of fullness after a meal. Hunger and appetite are likely to increase food intake. Satiation determines how much food is consumed during a meal. Satiety inhibits eating until the next meal; it determines how much time passes between meals. A high level of satiety is likely to decrease food intake between meals.

3.          Describe each component of energy expenditure. What factors influence each? How can energy expenditure be estimated?

Basal metabolism:  energy needed to maintain life when a body is at complete rest. Physical activity:  voluntary movement of the skeletal muscles and support systems. Thermic effect of food:  energy required to process food. Add the basal metabolism (1.0 kcal/kg for men; 0.9 kcal/kg for women X 24 hours/day) to the voluntary muscular activity expenditure (50-100% of the BMR depending on level of activity).

4.          Distinguish between body weight and body composition.

Weight depends on frame size which is difficult to measure; body composition is more important than weight but is difficult to measure.

5.          What problems are involved in defining “ideal” body weight?

There is no standard weight against which weights can be compared.

6.          What is central obesity and what is its relationship to disease?

Central obesity is excess fat on the abdomen and around the trunk of the body. It presents a greater risk to health than fat elsewhere on the body.

7.          What risks are associated with excess body weight and excess body fat?

Increased risk of heart attacks, strokes, diabetes, high blood cholesterol, hypertension, surgery complications, gynecological problems, toxemia of pregnancy, certain types of cancer, arthritis, abdominal hernias, respiratory problems, gout, and accidents.

8.              A bomb calorimeter measures:

a.     Physiological heel

b.     Energy available from foods

c.      Kcalories a person derives from foods

d.     Heat a person releases in basal metabolism.

9.              The psychological desire to eat that accompanies the sight, smell, or thought of food is known as:

a.     Hunger

b.     Satiety

c.      Appetite

d.     Palatability.

10.            A person watching television after dinner reaches for a snack during a commercial in response to:

a.     External cues

b.     Hunger signals

c.      Stress arousal

d.     Satiety factors.

11.            The largest component of energy expenditure is:

a.     Basal metabolism

b.     Physical activity

c.      Indirect calorimetry

d.     Thermic effect of food.

12.            A major factor influencing BMR is:

a.     Hunger

b.     Food intake

c.      Body composition

d.     Physical activity.

13.            The thermic effect of an 800-kcalorie meal is about:

a.     8 kcalories

b.     80 kcalories

c.      160 kcalories

d.     200 kcalories.

14.            For health’s sake, a person with a BMI of 21 might want to:

a.     Lose weight

b.     Maintain weight

c.      Gain weight.

15.            Which of the following reflects weights and heights?

a.     Body mass index

b.     Central obesity

c.      Waist circumference

d.     Body composition

 Lecture 12 – Weight Management: Overweight and Underweight

I.      Overweight / obesity is a widespread health problem and continues to increase. Many refer to it as an epidemic.

      A.   Fat Cell Development   

1.     Fat Cell Numbers

a)     Fat cell numbers increase most rapidly in later childhood and early puberty.

b)     Fat cell numbers increase in times of positive energy balance and when energy intake exceeds expenditure.

II.     Causes of Obesity

Obesity may not be as simple as food intake exceeding metabolic needs. Some factors, such as overeating and inactivity, are within our control. Genetic, hormonal and emotional factors may require professional intervention. The gene pool of our population remains relatively unchanged.

      A.   Genetics

1.     Leptin (also called the ob protein)   

a)     Protein that acts as a hormone to increase energy expenditure and decrease appetite

b)     Produced by fat cells under the direction of the ob gene

c)     May be deficient in obese individuals

d)     More research is needed

2.     Ghrelin

a)     Protein that acts as a hormone to decrease energy expenditure and increase appetite

b)     Produced by stomach cells

      B.   Environment

1.     Overeating

a)     Present and past eating influences current body weight

b)     Increased availability of convenient food, large portions, and energy-dense foods

2.     Physical Inactivity

a)     Modern technology replaces physical activities

b)     Physical activity is important to allow people to eat enough food to get needed nutrients

III.   Problems with Obesity

Obesity problems depend on many factors such as the extent of overweight, age, health status and genetic makeup. Risk factors may differ among individuals. Health Risks are evaluated using BMI.

      A.   Perceptions and Prejudices

1.     Social Consequences

a)     Prejudices and discrimination

b)     Judged on appearance rather than character

c)     Stereotyped as lazy and lacking self-control

2.     Psychological Problems      

a)     Feelings of rejection, shame and depression are common

b)     Ineffective treatments with a sense of failure

B.   Dangerous Interventions

1.     Fad Diets

2.     Over-the-Counter Drugs

3.     Herbal Products and Dietary Supplements

a)     Ephedrine-containing products inhibit serotonin and suppress the appetite, but risks are high. It is not regulated under current law and FDA has issued warnings.

b)     Herbal laxatives have contributed to some deaths.

c)     Current laws do not require safety tests and effectiveness tests for these products.

4.     Other Gimmicks

a)     Don’t work

b)     There is no such thing as cellulite.

IV.   Aggressive Treatments of Obesity

Individuals with clinical severe obesity and major medical problems may benefit from drugs or surgery. But changing and improving eating and exercise habits offer the greatest benefit.

      A.   Drugs

1.     Sibutramine suppresses the appetite and is most effective when used with a reduced kCalorie diet and increased physical activity. There are many side effects.

2.     Orlistat blocks fat digestion and absorption. There are many side effects.

3.     Other drugs are still under study.

B.   Surgery     

1.     Gastric surgery has short-term and long-term problems and requires compliance with dietary instructions.

2.     Liposuction is a popular procedure that is primarily cosmetic but poses risk.

V.    Weight-Loss Strategies    

A life-long eating plan for good health, which includes nutritionally adequate eating, reasonable expectations, regular physical activity, and permanent lifestyle changes, is best for achieving  permanent weight loss.

A.   Eating Plans

1.    Weight loss of 1-2 pounds per week or 10% of body weight in six months is safe.

2.     Realistic Energy Intake

a)     300-500 kCalorie/day reduction for BMI between 27 and 35

b)     500-1000 kCalorie/day reduction for BMI ³ 30

c)     Dietary Guidelines should be followed.

3.     Diet should be nutritionally adequate following the Food Guide Pyramid.

4.     Smaller portions are recommended to feel satisfied not stuffed.

5.     Eating foods of lower energy-density, that are high in fiber, high in water and low in fat.

6.     Water is important to increase fullness and reduce hunger.

7.     Complex carbohydrates offer abundant vitamins, minerals and fiber with little fat.

8.     Choose fats sensibly and reduce the quantity of fat.

9.     Watch empty kcalories from sugar and alcohol.

B.   Physical Activity

1.     Activity and Energy Expenditure – Energy expended depends on time.

2.     Activity and Metabolism – Metabolic rates can rise with daily vigorous activity.

3.     Activity and Body Composition – Activity can decrease body fat and increase lean body mass.

4.     Activity and Appetite Control – Exercise may help to curb appetite.

5.     Activity and Psychological Benefits – Activity can reduce stress and improve self-esteem.

6.     Choosing Activities

a)     Timing does not matter.

b)     Low to moderate intensity for long duration is recommended.

c)     Choose activities that you enjoy and are willing to do regularly.

d)     Daily routines can incorporate energy activities.

C.   Behavior and Attitude

1.     Behavior modification requires time and effort.

2.     Awareness of behavior is the first key.

3.     Changing behaviors one at a time works best.

a)     Do not grocery shop when hungry.

b)     Eat slowly.

c)     Exercise while watching television.

4.     Personal attitudes toward food and eating must be understood.

5.     Support groups may be helpful for some people.

D.   Weight Maintenance

1.     Successful weight-loss maintenance programs use different criteria so they are difficult to compare.

2.     Vigorous exercise and careful eating plans are key.

3.     Frequent self-monitoring is recommended.

E.   Prevention

1.     Eat regular meals and limit snacking.

2.     Drink water in place of high-kcalorie beverages.

3.     Select sensible portion sizes and limit daily energy intake to energy expended.

4.     Limit sedentary activities and be physically active.

VI.   Underweight (BMI < 18.5)

Incidences of underweight and associated health problems are less prevalent than overweight and obesity problems.

      A.   Problems of Underweight

1.     Causes are diverse.

2.     Energy demands may be great and foods are needed to support growth and physical activities.

3.     Eating disorders are severe cases.

B.     Weight-Gain Strategies

1.     Energy-dense foods can be included but choose fat wisely.

2.     Regular meals each day must become a priority.

3.     Use large portions and expect to feel full.

4.     Consume extra snacks between meals.

5.     Juice and milk are easy ways to increase kcalories.

6.     Exercising to build muscles will support increases in muscle mass.

VII. Highlight: Eating Disorders

Many young females suffer from eating disorders. These include anorexia nervosa, bulimia nervosa and binge-eating disorders. The causes include a combination of socio-cultural, psychological, and perhaps neuro-chemical factors. Athletes are among the most likely group to develop eating disorders.

A.    The Female Athlete Triad    

1.     Amenorrhea

2.     Osteoporosis

B.     Disordered Eating habits can develop

1.     Desire to improve performance

2.     Enhance aesthetic appeal of their performance

3.     Meet unsuitable weight standards

      C.   Amenorrhea

1.     Characterized by low blood estrogen, infertility, and mineral losses from the bone

2.     Contributed by excessive training, depleted body fat, low body weight, and inadequate nutrition

      D.   Osteoporosis

1.     Stress hormones compromise bone health.

2.     Stress fractures are common bone injuries.

3.     Adequate calcium is recommended.

      E.   Other Dangerous Practices of Athletes

1.     Food and fluid restrictions to make weight in wrestling

2.     Muscle dysmorphia is a psychiatric disorder concerning obsession with building body mass.

      F.   Preventing Eating Disorders in Athletes

1.     Follow Food Pyramid Guide for food servings.

2.     Eat frequently, especially healthy snacks.

3.     Establish reasonable weight goal.

4.     Allow reasonable time to achieve weight goal.

5.     Weight maintenance support group.

      G.   Anorexia Nervosa

1.     Characteristics

a)     Role of the Family – inability to resolve family conflicts

b)     Self-starvation – tremendous self-control to limit eating

c)     Physical consequences are major and life-threatening.

2.     Treatment is multidisciplinary

a)     Food and weight

b)     Relationships with self and others

      H.  Bulimia Nervosa   

1.     Characteristics

a)     Role of the Family – unresolved family issues

b)     Binge eating – lack of control over eating, excessive kcalories from high-fat, low-fiber and high-carbohydrate foods at once

c)     Purging

2.     Treatment

a)     Weight maintenance

b)     Regular exercise

c)     Counseling

      I.    Binge-Eating Disorder is an unspecified eating disorder sharing some of the characteristics of anorexia nervosa and bulimia nervosa yet does not meet the criteria for diagnosis.

1.     Lack of self-control over eating with binges

2.     Consuming large quantities of food, eating quickly, feeling uncomfortably full, eating alone, and feeling disgusted or guilty

3.     Marked distress

4.     Occurrence of two times per week for six months

5.     Not associated with compensatory behaviors

      J.    Eating Disorders in Society occur more commonly in developed nations where food and money are plentiful. Learning to appreciate the uniqueness of oneself may be a key to its defense.

Study Questions with Answers

1.              Describe how body fat develops and suggest some reasons why it is difficult for an obese person to maintain weight loss.

Body fat develops when fat cells increase in number and size. Prevention of excess weight gain depends on maintaining a reasonable number of fat cells; when an obese person loses weight, the body attempts to return to the original weight, or its set point.

2.          What factors contribute to obesity?

Genetics (leptin, ghrelin, uncoupling problems, fat cell metabolism), overeating, inactivity.

3.          List several aggressive ways to lose weight and explain why such methods are not recommended for every overweight person.

Fad diets, diuretics, amphetamines, other prescription drugs, over-the-counter drugs, hot baths, machines that jiggle, brushes, sponges, massages, surgery, gastric partitioning, gastric balloons, jaw wiring, very-low-kcalorie diets. Reasons these are not recommended:  weight cycling, psychology of weight cycling, some methods do not work at all, others only provide temporary weight loss (not fat loss).

4.          Discuss reasonable dietary strategies for achieving and maintaining a healthy body weight.

Eating plans based on realistic energy intake, nutritional adequacy, physical activity, making small behavior modification changes, support groups.

5.          What are the benefits of increased physical activity in a weight-loss program?

Physical activity increases BMR, helps control appetite, provides psychological benefits. 

6.          Describe strategies for successful weight gain.

Eat energy-dense foods to provide excess of 700-1000 kcals per day, eat regular meals daily, eat large portions, eat extra snacks between meals, drink plenty of juice and milk, exercise to build muscle.

7.              With weight loss, fat cells:

a)       Decrease in size only

b)      Decrease in number only

c)       Decrease in both number and size

d)      Decrease in number, but increase in size.

8.              Obesity is caused by:

a)       Overeating

b)      Inactivity

c)       Defective genes

d)      Multiple factors.

9.              The protein produced by the fat cells under the direction of the ob gene is called:

a)       Leptin

b)      Serotonin

c)       Sibutramine

d)      Phentermine.

10.            Successful weight loss depends on:

a)       Avoiding fats and limiting water

b)      Taking supplements and drinking water

c)       Increasing proteins and restricting carbohydrates

d)      Reducing energy intake and increasing physical activity.

11.            Which strategy would not help an overweight person to lose weight?

a)       Exercise

b)      Eat slowly

c)       Limit high-fat foods

d)      Eat energy-dense foods regularly.

12.            Which strategy would not help an underweight person to gain weight?

a)       Exercise

b)      Drink plenty of water

c)       Eat snacks between meals

d)      Eat large portions of foods.

7.       a

8.       d

9.       a

10.     d

11.     d

12.     b

Eating Attitudes Test

Answer these questions using the following responses:

A=Always        U=Usually        O=Often            S=Sometimes    R=Rarely          N=Never

              1.  I am terrified about being overweight.

              2.  I avoid eating when I am hungry.

              3.  I find myself preoccupied with food.

              4.  I have gone on eating binges where I feel that I may not be able to stop.

              5.  I cut my food into very small pieces.

              6.  I am aware of the calorie content of the foods I eat.

              7.  I particularly avoid foods with a high carbohydrate content.

              8.  I feel that others would prefer if I ate more.

              9.  I vomit after I have eaten.

            10.  I feel extremely guilty after eating.

            11.  I am preoccupied with a desire to be thinner.

            12.  I think about burning up calories when I exercise.

            13.  Other people think I am too thin.

            14.  I am preoccupied with the thought of having fat on my body.

            15.  I take longer than other people to eat my meals.

            16.  I avoid foods with sugar in them.

            17.  I eat diet foods.

            18.  I feel that food controls my life.

            19.  I display self-control around food.

            20.  I feel that others pressure me to eat.

            21.  I give too much time and thought to food.

            22.  I feel uncomfortable after eating sweets.

            23.  I engage in dieting behavior.

            24.  I like my stomach to be empty.

            25.  I enjoy trying new rich foods.

            26.  I have the impulse to vomit after meals.

Very-Low-kCalorie Diets

During the 1980s, obesity treatments aggressively strived to reduce body weight to the ideals set in standard weight-for-height tables. To that end, medical centers offered obese people very-low-kcalorie diets (VLCD).

VLCD plans provide 800 kcalories, at least 1 gram of high-quality protein, per kilogram of body weight, little or no fat, and a minimum of 50 grams of carbohydrate (not enough to spare protein). Clients receive an assortment of vitamins and minerals from supplements. Meals consist of a limited number of foods (primarily lean meats, fish, and poultry) each day, a powdered formula available by prescription, or a combination of the two.

VLCD formulas are designed to be nutritionally adequate, but the body responds to this severe energy restriction as if the person were starving—conserving energy and preparing to regain weight at the first opportunity. As Chapter 7 described, several changes occur in hormone concentrations, metabolic activities, fluid and electrolyte balances, and organ functions in the effort to meet the challenge of living on a much-less-than-adequate energy intake. For these reasons, a VLCD is appropriate only for short-term use (four months) and under close medical supervision. The accompanying table lists common side effects of VLCD.

Possible Physical Consequences of Very-Low-kCalorie Diets

Without doubt, weight losses on VLCD are dramatic. Unfortunately, weight regains are almost certain. With weight loss comes a slower BMR and slower fat oxidation—conditions that favor weight gain. Such rapid losses followed by steady gains are detrimental to both physical and psychological health.

How to Change Behaviors to Support Weight Loss

1.  To eliminate inappropriate eating cues:

·       Buy foods that are low in fat

·       Shop when you are not hungry.

·       Serve low fat meals.

·       Let other family members buy, store, and serve their own sweets (monitor children’s intakes).

·       Change channels or look away when food commercials appear on television.

·       Shop only from a list and stay away from convenience stores.

·       Carry appropriate snacks from home and avoid vending machines.

2.  To suppress the cues you cannot eliminate:

·       Eat only in one place (at a table), and in one room; use plates, bowls, and eating utensils.

·       Clear plates directly into the garbage.

·       Create obstacles to the eating of problem foods (for example, make it necessary to unwrap, cook, and serve each one separately).

·       Minimize contact with excessive food (serve individual plates, don’t put serving dishes on the table, and leave or clean the table when you have finished eating).

·       Make small portions of food look large by spreading food out and serving on small plates.

·       Control deprivation (eat regular meals, don’t skip meals, avoid getting tired, avoid boredom by keeping cues to fun activities in sight).

3.  To strengthen the cues to appropriate eating and exercise:

·       Encourage others to eat appropriate foods with you.

·       Keep your favorite appropriate foods in the front of the refrigerator.

·       Learn appropriate portion sizes and prepare one portion at a time.

·       Establish specific times for meals and snacks.

·       Prepare foods attractively.

·       Keep your walking shoes (ski poles, tennis racket) by the door.

4.  To engage in desired eating or exercise behaviors:

·       Eat only at planned times; plan not to eat after a specified time (say, 7:00 or 8:00 p.m.).

·       Slow down (pause several times during a meal, put down utensils between mouthfuls, chew thoroughly before swallowing, swallow before reloading the fork, always use utensils).

·       Leave some food on the plate.

·       Engage in no other activities while eating (such as reading or watching television).

·       Move more (shake a leg, pace, fidget, flex your muscles).

·       Join in and exercise with a group of active people.

5.  To arrange or emphasize negative consequences of inappropriate eating:

·       Eat your meals with other people.

·       Ask that others respond neutrally when you deviate from your plan (make no comment). This is a negative consequence because it withholds attention.

·       If you slip, don’t punish yourself.

6.  To arrange or emphasize positive consequences of appropriate behaviors:

·       Update records of food intake, exercise, and weight change regularly.

·       Arrange for rewards for each unit of behavior change or weight loss.

·       Ask family and friends for reinforcement (praise and encouragement).