Energy Balance, Eating Disorders, and Health at Every Size

Introduction

• We are constantly bombarded with images of what it means to be healthy, often associated with thinness, muscularity, and a specific body image.
• The world often equates having extra calories stored or eating a lot of food with being unhealthy, which is not necessarily true.
• The goal is to determine what is right for each individual and what they are willing to accept regarding body size and weight.

Weight and Health

• Weight is often the primary focus, but it does not always align with overall health.
• Being thin does not automatically mean you are healthy, and being overweight does not automatically mean you are unhealthy.
• The idea that everyone can and should be thin is an unrealistic expectation.
• Genetics play a role in determining our natural body size and weight.
• Eating better does not guarantee better health, and willpower alone is not always sufficient for maintaining a diet or reaching a certain weight.

Disease Risk and Correlations

• Disease risk is a primary reason for concern about body size.
• Correlations exist between obesity-related conditions and excess weight, such as heart disease, stroke, and high blood pressure, as well as between type 2 diabetes and high sugar intake.
• Correlation does not equal causation.
• Assumptions that one thing causes another are often untrue.
• There are many factors that impact weight and health, and a connection between two things does not necessarily mean one causes the other.
• Example: Increased autism rates are sometimes linked to organic food sales, but there is no scientific evidence that eating organic food increases the risk of autism.

Anthropometrics

• Anthropometrics involves measurements of people, including weight and height.
• Assessing percent body fat is important.
• The location of extra fat stores in the body also plays a role in health.

Body Mass Index (BMI)

• The BMI is a calculation that assesses weight and height.
• It is essential to avoid overemphasizing this assessment.
• The BMI is a general guideline that should be used as part of an overall health picture.
• BMI Classifications
  • Underweight: BMI under 18.5
  • Healthy range: BMI 18.5 to 24.9
• The BMI is based on the average person and may not be accurate for individuals who are not average.
• People with extra muscle mass (e.g., weightlifters) may be classified as overweight due to muscle weighing more than fat.
• Higher bone density or broader shoulders can also make the BMI less accurate.
• The BMI does not assess body composition, such as the percentages of bone, fat, and muscle.
• The BMI primarily assesses the overall risk for potentially developing diseases or issues later in life.
  *
• Equation:
  • $BMI =
    ewline weight(kg) / height(m^2)
  • To convert weight from pounds to kilograms: weight(kg) = weight(lbs) / 2.2
  • To convert height from inches to meters: height(m) = height(inches) / 39.4$$
• It is used as one piece of the puzzle for assessing overall health and risk for chronic diseases, not the main assessment.

Body Fat Distribution

• There is a correlation between where you store your excess body fat and potential health risks.
• Android (Male) Form
  • Body fat stores around the middle of the body.
  • Central area of the abdomen (apple shape).
• Gynoid (Female) Form
  • Excess body fat stored in the lower body.
  • Butt, hips, and thighs (pear shape).
• These are not exclusive; men can store fat as a pear shape, and women can store fat as an apple shape.
• Storing extra calories in the abdomen (android) is associated with an increased risk for developing diabetes, cardiovascular disease, and high blood pressure.
• Fat stores in the lower body (gynoid) do not seem to have the same associated risks.
• Android fat distribution tends to be easier to lose, reducing the risk for chronic diseases.
• Gynoid fat in the lower body can be more difficult to get rid of.
• After menopause, women may experience a change in body weight stores from the gynoid to the android form due to decreased hormone production.

Percent Body Fat Assessment

• Several methods exist for assessing percent body fat:
  • Underwater weighing (hydrodensitometry): very accurate.
  • Bod Pod: very accurate.
  • Skin fold thickness measurement: easy to do and transportable.
  • Bioelectrical impedance: easy to do.
  • DEXA scan: uses an x-ray machine.

Underwater Weighing (Hydrodensitometry)

• Based on the premise that fat weighs less than muscle.
• The more you float, the higher your percent body fat.
• The more you sink, the greater your lean body mass.
• Requires exhaling as much air as possible before being submerged to avoid buoyancy.

Bod Pod

• Measures air displacement.
• Complex machinery that requires specialized training to use.
• Provides a very accurate determination of percent body fat.

Skin Fold Measurements

• Measures the layer of fat right under your skin.
• Portable and easy to use, but not super accurate.
• Calculations determine total percent body fat based on the amount of fat under the skin.
• Potential for incorrect readings if muscle is grabbed under the tissue or if measurements are not taken at the exact same location each time.

Bioelectrical Impedance

• Electrodes measure how quickly electricity moves through your body.
• Based on the premise that water is a good conductor of electricity and muscle cells are about 70% water, while fat cells are only about 20% water.
• Faster current movement indicates a higher percent lean body mass and a lower percentage of fat cells.
• Slower current movement indicates a greater percent fat stores and a lower percentage of muscle.
• Hydration status is key for accurate readings; dehydration can mimic higher fat stores, and overhydration can mimic higher muscle mass.

DEXA Scan

• An x-ray scan that provides information on bone density and percent body fat.
• Considered the gold standard for body fat assessment.
• Not necessary for the average person, as other methods provide accurate estimates.

Does Body Fatness Determine Health?

• In many instances, it does not.
• Plenty of overweight and obese individuals are healthy.
• It's important to consider what goes into body weight: nature (genetics) versus nurture (environment).
• Genetics can play a role in the set point theory, which suggests that your body likes to be at a particular body weight.
• It is possible to establish a new set point, but it requires maintaining the new weight for a while for your body to recalibrate.
• Genetics also plays a role in susceptibility to various disease states.
• The environment, including education, living conditions, and food, also plays a role.
• It's essential to manage any disorders or conditions that may play a role.

Defining Health

• Health is being free from illness and injury.
• Includes: emotional state, diet, living conditions, working environment, and genetics.

Energy Balance

• Energy in (calories consumed) versus energy out (calories burned).
• Energy equilibrium: consuming as many calories as your body needs to burn, resulting in steady weight management.
• Positive energy balance: consuming more calories than you're spending, leading to weight gain.
• Negative energy balance: not consuming as many calories as you need to spend, leading to weight loss.
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• Primary Sources of Calories:
  • Protein
  • Carbohydrates
  • Fats
• Energy Output
  • Basal Metabolism (60-70%)
  • Physical Activity
  • Thermic Effect of Food (5%)
  • Thermogenesis

Bomb Calorimeter

• Used to assess the number of calories in food.
• Food is burned in an oxygen chamber, and the heat given off is measured by the change in temperature of the surrounding water.

Basal Metabolism

• 60-70% of our calories are burned through basal metabolism.
• Includes heartbeat, lung movement, brain waves, and intestinal movement.

Physical Activity

• Can be a large percentage depending on the person.

Thermic Effect of Food

• About 5% of calories are used to digest, absorb, and do all those things for the food.

Thermogenesis

• Heat generation to maintain body temperature at 98.6 degrees.
• NEAT (Non-Exercise Activity Thermogenesis): fidgeting, pacing, and other small movements that use calories.

Factors that Increase Basal Metabolic Rate

• Muscle mass: the greater the muscle mass, the higher the basal metabolic rate.
• Body surface area relative to body volume: the greater the body surface area, the more heat is lost.
• Growth stages: using more calories due to growth.
• Caffeine: mildly increases basal metabolic rate.
• Thyroid hormone: higher levels increase basal metabolic rate.

Factors that Decrease BMR

• Lower thyroid hormone levels.
• Less muscle mass.
• Aging: basal metabolic rate starts to slow down around age 30.

Measuring Energy Expenditure

• Direct Calorimetry: most accurate, measures the amount of heat your body is producing, used in high-level athletics or research.
• Indirect Calorimetry: measures the oxygen you take in and the carbon dioxide you put out, used in research and by professional athletes.
• Calculations: easiest method, involves using equations. (not on final exam)

Dieting

• Dieting is usually around restriction to lose weight.
• Diet means what you eat and drink on a normal basis.
• The weight loss and dieting industry is a multi-billion dollar industry.

Fad Diets

• Fad Diet is something that comes in and out of favor very quickly.
• Many of these fad diets have a negative reputation.
• They often prey on unhealthy ideas, such as promising very rapid weight loss or listing good and bad foods without a scientific basis.
• Partial truths and celebrity testimonials are common in fad diets.
• Short-term weight loss can be due to water weight rather than fat loss.

Professional Treatment for Overweight and Obesity

• Programs like Weight Watchers can aid in weight loss.
• Medical methods, such as drugs, are reserved for people with morbid obesity and chronic conditions.
• Very low-calorie diets (400-800 calories a day) require medical supervision.

Gastroplasty

• Surgery, such as stomach stapling or gastric bypass, can be used for weight loss.
• Gastric banding involves putting a band around the lower part of the stomach to decrease its size.
• Gastric bypass involves stapling off the top portion of the stomach and rewiring the small intestine.
• Dieting typically does not work long term because people do not build habits.
• Dieting can cause both physical and mental harm.

Disordered Eating

• Disordered eating means you are not following the normal patterns of food consumption that we have deemed to be quote unquote normal.
• Disordered eating is something as simple as skipping breakfast.
• In some instances, disordered eating can lead to eating disorders.

Eating Disorders

• Eating disorders are psychological disorders that manifest themselves through food.
• To treat an eating disorder successfully, we must treat the psychological disorder.

Anorexia

• Decreased food consumption down to 200-500 calories a day.
• Limits nutrient intake and causes physiological changes.
• Only about 20% of people that develop anorexia are cured.
• Part of anorexia is a lack of acknowledging that there is a problem, making it hard to treat.
• Anorexia is about control.

Bulimia

• Bulimia is all about lack of control.
• Bulimia involves purging through vomiting, excessive exercise, or the use of laxatives.

Binge Eating Disorder

• Binge eating disorder is essentially bulimia without the purge.

Health Complications

• Anorexia: muscle damage, damage to the heart and kidneys, bone damage, hair loss, fatigue, and potentially death due to heart failure.
• Bulimia: tooth decay, damage to the esophagus, digestive system damage, and electrolyte imbalances.
• Binge Eating: Health complications are those typically associated with obesity, high blood pressure, diabetes, heart disease.
• These eating disorders are determined over time and involve the disease condition progressing.

Health at Every Size (HAES)

• Focusing on health rather than weight is important.
• Health means having a healthy mental outlook, not just being the right weight on the scale.
• HAES involves recognizing genetics and mental happiness.
• Mindful eating involves paying attention to hunger cues and recognizing other cues.

Hunger, Satiety, and Appetite

• Satiety: the feeling of fullness.
• Hunger: the physiological need to eat.
• Appetite: usually based on things outside of us. (external desire to consume)
• Hunger is an internal cue to consume, while appetite is an external desire to consume.
• Recognize your cues and assess what your body is telling you.

Non-Dietary Approach to Health

• Focus on finding joy in movement and what you enjoy doing.
• Everything is okay as long as we manage the amount.
• Listen to your body and what you are hungry for.

Myths and Misconceptions

• HAES can be misunderstood, but the idea is to make good food choices regardless of physical state.
• People should still be concerned about nutrition and exercise.
• Avoid black and white thinking about food and diet.
• Understand cravings and emotional eating and know when you might be triggered by that.

Examples of Black and White Thinking

• "I feel guilty when I eat bad food chips."
  • Instead allow yourself to have a few chips now and then.
• "If I eat this, I have to work out extra."
• "Instead of having one extreme, getting into the combination of things that are going to make us better."

Hunger Versus Appetite

• Hunger: the internal drive.
• Appetite: psychological or external.
• Recognize the difference between these and focus primarily on hunger.

Tips

• Plan for eating and make sure you have healthy things in the house.
• Having some healthy snacks around the house.
• Restrictions. Everything is okay as we talked about. Focus on being be aware.

Mindless Eating

• Be aware of your physical state and the food choices you're making.

Changing Our Focus

• Important to send positive messages to our clients, friends, and families.
• Everyone to be healthy and know that body size does not dictate health.