Weight Management in Adulthood Primer

Background
Weight management is a long-term approach to maintaining a healthy body weight, and
denotes the ability to control energy intake and expenditure to sustain healthy energy balance. In
early adulthood, a loss of lean muscle mass can lead to a reduction in basal metabolic rate,
causing surplus accumulation of adipose tissue (Evans & Lexell, 1995). To interrupt this process,
whole body energy imbalance must be altered by adjusting energy intake, energy output,
efficiency of energy use, or a combination of these mechanisms (Seagle et al., 2009). If excess
fat storage continues to a certain degree, subsequent health detriments will likely transpire.
Weight status according to body mass index (BMI) is as follows: Overweight, 25.0-29.9;
Obese, 30.0-39.9; Extremely Obese, 40. Excess abdominal fat is an independent predictor of
weight-related indisposition (NHLBI Obesity Education, 1998; National Heart, Lung, 1998).
Awareness of weight status among adults is imperative for achieving a positive health status.
Weight misperception has been repeatedly documented in overweight and obese adults, and may
influence unhealthy weight-control behaviors (Jauregui-Lobera et al., 2013). As the frequency
of obesity among adults has more than doubled between the 1980s and today, weight
misperception must be clinically addressed (Ogden et al., 2012). Currently, 34.9% of adults are
obese, compared with 22.9% in 1994 (Ogden et al., 2013). It has been hypothesized that
overweight and obese individuals who perceive themselves at a healthy weight may avoid
healthy behaviors, and may be less inclined to regularly emphasize nutrition and physical fitness
(Jauregui-Lobera et al., 2013).
All high-income and most middle-income countries show higher death rates resulting
from excess body weight than those resulting from under-nutrition (World Health
Organization, 2013). Weight-related diseases include cardiovascular disease (specifically heart
disease and stroke), diabetes, musculoskeletal disorders (specifically osteoarthritis), and some
cancers (World Health Organization, 2013). With the prevalence of overweight and obese
adults reaching such high numbers in the United States, health care providers must regularly
communicate weight status with their patients. Additionally, health professionals must be
skilled in proper weight loss and weight management techniques to direct interventions among
patients at risk for weight-related health conditions (Ogden et al., 2013).
Significance
It is estimated that 300,000 deaths in the US each year are attributable to obesity, and
individuals with a BMI over 30 have a 50 to 100 percent increased risk of early death compared
with those with a BMI of 20 to 25 (NHLBI Obesity Education, 1998). Middle-aged adults
have higher rates of obesity than older or younger adults, with obesity rates at 39.5% in 20112012, compared to 35.4% and 30.3%, respectively (Ogden et al., 2013). For those in this highrisk age group, common predictors of obesity include socioeconomic status, marital status,
gender, education, ethnicity, and employment status (Flegal et al., 2010, Coogan et al., 2010, &
Dorsey et al., 2009). The prevalence of obesity does not differ by gender when excluding race
as a variable (Ogden et al., 2013). When focusing on ethnicity specifically, however, gender
differences become significant. Among non-Hispanic black adults in 2011-2012, 56.6% of
women were obese compared with 37.1% of men (Ogden et al., 2013). Rates of obesity vary
greatly by ethnicity, as in 2011-2012 obesity rates among non-Hispanic blacks reached 47.8%,
rates for Hispanics reached 42.5%, rates for non-Hispanic whites reached 32.6%, and only 10.8%
of non-Hispanic Asian adults were obese (Ogden et al., 2013). This data becomes especially
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noteworthy when realizing the frequency of weight misperception among non-Hispanic blacks.
In a 2011 study of weight underestimation among a diverse ethnic sample of 459 black and white
men and women, 4.9% of blacks recognized their obesity, compared with 8.3% of whites. This
misperception was seen mostly in women (Hendley et al., 2011). Acknowledgement by
participants in similar studies that an overweight body type is more widely accepted among the
black community is a key factor in explaining racial weight disparity (Dorsey et al., 2009).
Health can be significantly improved even with minor weight losses; a 10% weight loss
may reduce or eliminate health risks associated with excess body fat (Seagle et al., 2009).
Reduction in weight has been shown to reduce serum triglycerides and total serum cholesterol
(including reductions in low-density lipoprotein cholesterol and improvements in high-density
lipoprotein cholesterol). Weight loss is also associated with reduced blood pressure in
overweight adults with or without hypertension, and reduced blood glucose levels in overweight
individuals with or without type 2 diabetes (NHLBI Obesity Education, 1998). It is necessary,
therefore, to proactively assess and treat at-risk weight status in adults.
Clinical Management
Body mass index and weight circumference should be assessed before and during weight
loss treatment to determine and monitor an individuals weight status. Nutrition professionals
must evaluate a patients motivation to engage in a weight loss program to ensure readiness and
commitment to treatment (NHLBI Obesity Education, 1998). Evidence indicates that longterm, moderate weight loss can be better maintained than more rapid, significant weight loss,
especially if some method of treatment continues (NHLBI Obesity Education, 1998; Seagle et
al., 2009). Most successful weight loss and maintenance is seen after a weight reduction of
approximately 10% from baseline, with further weight reduction occurring at a rate of 1 to 2
pounds per week (Seagle et al., 2009). Research suggests that slow weight loss is best achieved
through a combination of a reduced calorie diet and increased physical activity. Reducing
dietary fat alone is not satisfactory for weight loss, and a calorie deficit of 500 to 1,000 kcal/day
is a crucial component of any weight loss therapy program (NHLBI Obesity Education, 1998;
Seagle et al., 2009). Practitioners should encourage clients to participate in 150 minutes of
moderate intensity exercise each week, with a long-term goal of incorporating 30 minutes of
activity into all days of the week to increase and sustain cardiorespiratory fitness and aid muscle
strengthening (NHLBI Obesity Education, 1998; U. S. Department of Health, 2008).
Additionally, the treatment process must be designed in a way that minimizes negative effects of
weight loss on bone or muscle condition (NHLBI Obesity Education, 1998).
The majority of those who achieve desired weight loss, when released from clinical
guidance, frequently regain all or most of their weight (Seagle et al., 2009). Practitioners must
execute a well-designed weight maintenance program after approximately 6 months of weight
loss therapy to ensure an intervention with effective long-term results (NHLBI Obesity
Education, 1998). This can be achieved only through frequent communication between the
health professional and the patient to monitor and motivate continued healthy behaviors. Finally,
as the clinician leads the patient through treatment from start to finish, the patient must be
educated on the positive health consequences of excess weight reduction. It is imperative that
nutrition professionals help patients to realize that modest, sustainable weight change is most
effective for achieving potential health benefits, and are committed to safeguarding the adoption
of sustainable healthy lifestyle habits (Seagle et al., 2009).

Works Cited and Future Readings

Coogan, P. F., Cozier, Y. C., Krishnan, S., Wise, L. A., Adams-Campbell, L. L., Rosenberg, L.,
& Palmer, J. R. (2010). Neighborhood socioeconomic status in relation to 10-year weight
gain in the black womens health study. Obesity Journal, 18(10): 2064-2065.
Dorsey, R. R., Eberhardt, M. S., & Ogden, C. L. (2009). Racial/Ethnic differences in weight
perception. Obesity Journal, 17(4): 790-795.
Flegal, K. M., Carroll, M. D., Ogden, C. L., & Curtin, L. R. (2010). Prevalence and trends in
obesity among U.S. adults, 1999-2008. Journal of the American Medical Association,
303(3): 235-241.
Hendley, Y., Zhao, L., Coverson, D. L., Din-Dzietham, R., Morris, A., Quyyumi, A. A., Gibbons,
G. H., & Vaccarino, V. (2011). Differences in weight perception among blacks and
whites. Journal of Womens Health, 20(12): 1805-1811.
Jauregui-Lobera, I., Ezquerra-Cabrera, M., Carbonero-Carreno, R., & Ruiz-Prieto, I. (2013).
Weight misperception, self-reported physical fitness, dieting and some psychological
variables as risk factors for eating disorders. Nutrients, 5(11): 4486-4502.
Klos, L. (2013). Marital status and body weight, weight perception, and weight management
among U.S. adults. Eating behaviors, 14: 500-507.
Laroche, H. H., Wallace, R. B., Snetselaar, L., Hillis, S. L., Cai, X., & Steffan, L. M. (2013).
Weight gain among men and women who have a child enter their home. Journal of the
Academy of Nutrition and Dietetics, 113(11): 1504-1510.
Layman, D. K. (2009). Dietary Guidelines should reflect new understandings about adult protein
needs. Nutrition and Metabolism, 6(12): 1-6.
Leachman D, Fitzgerald N, Morgan KT. (2013). Position of the Academy of Nutrition and
Dietetics: The Role of Nutrition in Health Promotion and Chronic Disease Prevention.
Journal of the Academy of Nutrition and Dietetics, 113(7): 972-979.
National Heart, Lung, and Blood Institute. (1998). Body Mass Index Table 1. National Institutes
of Health. Retrieved from http://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.htm
NHLBI Obesity Education Initiative Expert Panel on the Identification, Evaluation, and
Treatment of Obesity in Adults. (1998). Clinical guidelines on the identification,
evaluation, and treatment of overweight and obesity in adults: The Evidence Report.
Bethesda, MD: National Heart, Lung, and Blood Institute: 12-19. Retrieved from
http://www.ncbi.nlm.nih.gov/books/NBK2003/
Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2012). Prevalence of obesity in the
United States, 2009-2010. NCHS Data Brief, 82: 1-8. Retrieved from
http://www.cdc.gov/nchs/data/databriefs/db82.pdf
Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2013). Prevalence of obesity in the
United States, 2011-2012. NCHS Data Brief, 131: 1-8. Retrieved from
http://www.cdc.gov/nchs/data/databriefs/db131.pdf

Seagle, H. M., Strain, G. W., Makris, A., & Reeves, R. S. (2009). Position of the American
Dietetic Association: Weight management. Journal of the American Dietetic Association,
109(2): 330-346.
Stitzel, K. F. (2006). Position of the American Dietetic Association: The Roles of Registered
Dietitians and Dietetic Technicians, Registered in Health Promotion and Disease
Prevention. Journal of the American Dietetic Association, 106(11): 1875-1884.
Ullmann, S. H., Goldman, M., Pebley, A. R. (2013) Contextual factors and weight change over
time: A comparison between U.S. Hispanics and other population sub-groups. Social
Science and Medicine, 90: 40-48.
U.S. Department of Agriculture and U.S. Department of Health and Human Services. (2010).
th
Dietary Guidelines for Americans, 2010. 7 Edition, Washington, DC: U.S. Government
Printing Office. Retrieved from http://www.cnpp.usda.gov/Publications/Dietary
Guidelines/2010/PolicyDoc/policyDoc.pdf
U. S. Department of Health and Human Services. (2008). 2008 Physical Activity Guidelines for
Americans. Washington, DC: U. S. Government Printing Office. Retrieved from
http://www.health.gov/paguidelines/guidelines/default.aspx
World Health Organization. (2013). Obesity and overweight: Fact Sheet 311. Who Media Center.
Retrieved from http://www.who.int/mediacentre/factsheets/fs311/en/
Evans, W. J., & Lexell, J. (1995). Human aging, muscle mass, and fiber type composition. The
Journals of Gerontology, 50(A): 11-16.