Energy Balance and Disordered Eating

Energy Balance

• Energy balance is the difference between energy consumed (food and beverages) and energy expended (bodily functions and physical activity).

• Energy balance affects weight status:

  • Positive energy balance: energy consumed > energy expended = weight gain
  • Balanced energy balance: energy consumed = energy expended = weight stable
  • Negative energy balance: energy consumed < energy expended = weight loss

• Factors influencing weight are complex and not solely determined by the energy balance equation.

Regulation of Food Intake

• Hunger signals the body's need for food.

• Appetite is influenced by various factors:

  • Psychological cues: e.g., smelling popcorn at a movie theater.
  • Environmental cues: e.g., being around others who are eating.
  • Social environments: e.g., eating different foods based on social context.
  • Emotions: e.g., stress influencing food choices.

• Healthy eating guidelines consider psychological, physical, and social aspects of eating.

Energy Output

• Energy output has three components:
  • Resting Metabolic Rate (RMR): energy for basic bodily functions at rest (60-75%).
  • Thermic Effect of Food (TEF): energy to digest food (10%).
  • Physical Activity: energy expended through movement (15-30%).

Resting Metabolic Rate (RMR)

• Energy for heartbeat, respiration, and organ function.

• Basal Metabolic Rate (BMR) is measured at total rest (no exercise for 12-14 hours, after overnight sleep).

• Factors increasing RMR:

  • Increased body size (weight, height).
  • More muscle mass (metabolically active).
  • Caffeine.
  • Smoking (not recommended due to negative health outcomes).
  • Extreme temperatures.

• Indirect calorimetry measures oxygen and carbon dioxide to determine energy use at rest.

Thermic Effect of Food (TEF)

• Energy to digest, absorb, breakdown, and store energy.

• Differs by macronutrient: protein > carbohydrates > lipids.

• TEF is only 10% of total energy output.

Physical Activity

• Most modifiable component of energy output.

• Energy expenditure varies based on body size, effort, and duration.

• Examples of energy use in sports:

  • Field Hockey (Highest)
  • Soccer
  • Snow Shoveling
  • Ultimate Frisbee (Lowest)

Factors Influencing Energy Outputs

• Cup of coffee: increases RMR due to caffeine.

• Running a marathon: increases physical activity.

• Skim milk latte to whole milk latte: decreases TEF (less energy to digest fat).

• Lifting weights regularly for one month: increases physical activity and RMR (more muscle mass).

Energy Calculations

• Based on RMR and physical activity coefficients.

• Estimations may not always be accurate.

• Equations are commonly used to calculate RMR.

• Harris-Benedict equation and International Olympic Committee equation are used in the course.

• Poor reliability compared to indirect calorimetry.

Example Calculation (Harris Benedict Equation)

• 25-year-old male

• Calculate RMR using weight, height, and age.

• $RMR = (13.75 \times weight<em>{kg}) + (5 \times height</em>{cm}) - (6.76 \times age_{years}) + 66$

• Multiply RMR by activity factor (based on daily activity minutes).

• Low activity level (cycling 180 minutes/week) = 1.4 to 1.59.

Acceptable Macronutrient Distribution Range (AMDR)

• Proportion of calories from macronutrients.

• Carbohydrates: 45-65% of total calories.

• Proteins: 10-35% of calories.

• Fats: 20-35% of calories.

• Adjustments based on energy system used (aerobic vs. anaerobic).

Calculating Macronutrient Needs Example

• Total energy: 2,300 calories

• Carbohydrates:

  • Low end: $2300 \times 0.45 = 1035$ calories, $1035 / 4 = 260$ grams
  • High end: $2300 \times 0.65 = 1495$ calories, $1495 / 4 = 375$ grams
    (4 calories per gram of carbohydrate)

Body Composition Changes for Athletes

• Assess current body composition and goals.

• Calculate energy needs via indirect calorimetry or equations.

• Dietitian assesses intake, adjusts diet, and monitors progress.

Moving Down a Weight Class

• Focus on healthy eating patterns instead of restrictive diets.

• Portion control strategies:

  • Fruit serving = fist size
  • Vegetables serving = two open hands
  • Meat serving = deck of cards or palm of hand
  • Fats serving = tip of thumb

• Plate model: half vegetables, quarter starch, quarter protein.

• Choose foods that keep you fuller longer (high fiber, high protein).

• Avoid extreme hunger: eat frequently, choose nutrient-dense snacks.

• Avoid rapid weight loss (glycogen depletion, dehydration, loss of lean muscle, heart muscle changes).

Moving Up a Weight Class

• Similar dietary changes as losing weight, plus weight training and increased protein intake.

• Consume protein-rich snacks after workouts.

• Small, frequent meals.

• Limit fiber if food volume is an issue.

• Aim for a higher carbohydrate diet (maximize glycogen stores).

Disordered Eating

• Cultural focus on diet and body can lead to disordered eating habits.

• Mindfulness of food and body image thoughts is important.

• Athletes are at higher risk of disordered eating due to environment emphasizing exercise, weight, and perfection.

• Disordered eating behaviors: restriction, purging, overeating, disordered body image.

Relative Energy Deficiency in Sport (REDS)

• Significant restriction + excessive exercise.

• Negative outcomes on body and performance (glycogen depletion, decreased muscle strength, mental health, increased injury risk).

Female Athlete Triad

• Decreased bone health + menstrual function + restrictive energy intake.

• Loss of period (amenorrhea) and osteoporosis.

What to Do

• Seek social support.
  • Check accredited sources like NEDIC.
  • Seek support from counseling services or treatment centers.

Weight Stigma

Definitions:

• Weight Bias: Negative attitudes/beliefs about people in larger bodies.

• Weight Discrimination: Actions based on weight bias, leading to unfair treatment.

• Weight Stigma: Prejudice experienced due to body size, including stereotypes and judgments.

Weight Stigma Effects:

• Can be external (from others) or internalized (self-stigma).

• Internalized weight stigma linked to poor mental health outcomes.

Weight & Health

• Larger body sizes are often associated with poor health.

• Evidence suggests weight bias/stigma, rather than body size directly, contributes to negative health outcomes.

Internalized weight stigma causes increased cortisol (linked to chronic diseases).
Weight discrimination from healthcare providers can delay access to appropriate care.
People in larger bodies may avoid healthcare due to past negative experiences.

Experiments and reviews show that experiencing weight stigma makes folks more likely to gain weight.

Weight bias internalization: people agree with the negative stereotypes about their bodies, and that is really dangerous.

Making people feel bad about their weight doesn't help anyone.

Reducing Weight Stigma (10 Key Values)

1. Promote Weight Inclusivity

Respect and appreciate diverse body shapes/sizes.

2. Focus on Health Enhancement

Support policies improving equitable access to health information and services.

3. Emphasize Respectful Care

Be mindful of biases and avoid discriminatory behavior.

4. Focus on Eating Well

Practice flexible, individualized eating based on internal hunger cues.

5. Promote Life-Enhancing Movement

Encourage enjoyable movement, not regulated activity for weight control.

6. Decouple Weight and Health

Avoid assumptions about health status based on body weight.

7. Respect Bodies

Appreciate unique bodies and avoid assumptions about health, lifestyle, or worth based on appearance.

8. Promote Inclusivity

Create environments that respect all bodies, breaking down barriers.

9. Oppose Intentional Weight Loss

Recognize potential harm and lack of long-term sustainability.

10. Challenge Body Size Oppression

Promote body liberation, emphasizing respect and equal opportunities for all bodies.

11. Reject Healthism

Prioritizing health even at the expense of other aspects of well-being.
It also can lead to blaming where we say individuals are not putting in the appropriate amount of time, effort, or sacrifice to achieve the physical health that we deem should be most appropriate.