IILE GROUP 10

CASE 1
LU III - GROUP 9
Alejandre, Alberto Carlos Tacuycuy
Benitez, Dana Lee Macasaet
Dela Cruz. Janine Marriah Gayosa
Dizon, Gio Philip Muoz
Eusebio,Maria Emilia Ruth Valdez
Herbosa, Maria Inez Banson
Hernandez, Ralph Bryan Bautista
Kho, Niel Benjamin DLT
Lapides, Jomel Garcia
Lim, Sondra Monina Sison
Limbo, Angelo Riel Camacho
Magabo, Mark Lester Villanueva
Mata, Maria Katrina Magpantay
Mendoza, Kaori
Pagulayan, Gianne Rosales

Submitted to:
Dr. Nemencio A. Nicodemus Jr.

IILE OS 201
Case 1

Prior to working as a call center agent, Tanya had normal weight. At the same time,
she consumed a balanced diet and regularly visited a fitness center.
After working two years as a call center agent, the now 38-year old Tanya weighs
89kgs(198lbs.) with a height of 1.63 meters (5 feet and 4 inches). Her work shift is from
8 pm to 6 am, during which she smokes and drinks coffee to stay awake. Her diet is
composed mainly of burgers, french fries and fried chicken. She and her friend, Hanna,
whose height and weight are the same, were offered free to work out sessions at a fitness
gym. Challenged by their office's "Biggest Loser" contest, they decided to try the freebie
requiring them to some treadmill exercises 30 minutes a day for 5x a week.
To augment their weight loss, they also tried several diets. First they tried limiting
caloric intake o almost starving (very low caloric diet) themselves for 2 weeks. They
noticed that they lost weight but they were not able to maintain it. The following months,
they tried different diet regimens like high protein and no carbohydrate diet. They noticed
modest weight loss but there was rebound weight gain.
Overview on Tanya's background information:

38 years old
Call center agent (graveyard/ night shift)
Diet composed mainly of burgers, french fries and fried chicken
Smoker, drinks coffee often
Weight: 89 kgs. (190 lbs.)
Height: 1.63 meters (5 feet and 4 inches)
BMI
Weight in kilograms
Height in meters
89 kgs.
(1.63 m.)
= 33.5 (OBESE)

Standard BMI Categories

Weight Status
BMI Range (kg/m )
Underweight
Below 18.5
Healthy weight
18.5 - 24.9
Overweight
25 - 29.9
Obese
30 or greater

OBJECTIVES:
1. To determine the effects of change in lifestyle specifically on diet, exercise, sleepwake

cycle, and habits.

a.) What is the role of the working environment in habit formation?

b.) What are the factors/reasons for their rebound weight gain (change in diet,
lifestyle)?
c.) What are the effects of caffeine and smoking on weight gain?
d.) What are the effects of having a support group in the process of weight loss?
e.) Exercise
i. What time should she exercise?
ii. What exercise works best?
f.) Diet
i. What is the right proportion of food?
g.) Sleep
i. What are the effects of alteration in the usual sleep-wake cycle?
2. To explain the integration of various metabolic pathways involved (obesity,
leptin).
a.) What is the role of leptin?
b.) What are the effects of obesity on the biochemical process involved in the body?
3. To propose an appropriate health and wellness plan to improve her lifestyle.

ANSWERS:
1. a. What is the role of the working environment in habit formation?
The Effects of Sedentary Lifestyle + Habit Formation (in the context of smoking)

Studies have shown that prolonged sedentary behavior has an effect on the
metabolism and circulation. Moreover, even individuals who are active outside the
workplace prove no more immune to the effects of prolonged sitting. Emerging evidence
has shown that sitting for prolonged periods of time is believed to not only affect
individuals who are not physically active, but also those who are. According to Yeager
(2013), even those who are active runners are at risk when glued to a chair for long
periods of time. Marc Hamilton, Ph. D., (as cited in Yeager, 2013) states that, sitting for
an extended period of time causes your body to shut down at the metabolic level. When
your muscles, especially certain leg muscles, are immobile, your circulation slows. So
you use less of your blood sugar and burn less fat, which increases your risk of heart
disease and diabetes. Healy et al. (2008) found that there are benefits to breaking up
sedentary time with physical activity. In essence, sedentary behavior must always be kept
at a minimums.
In a study by Boyce et al. (2007) on call center employees, it was found that after
the first 8 months of working in a call center, employees experienced substantial weight
gain. The researchers identified three risk factors based on results from a survey that they
conducted, which are as follows: obese when hired, history of previous injury and lack
of vigorous exercise (Boyce et al., 2007). Results showed that 68% of the employees
gained roughly 7.3kg in a span of 8 months, which was further associated with an
increase in different health risks.
In another study by Sorensen et al. (2007), the researchers studied the influence of
social context of health behaviour change. The researchers noted the importance of
strong social ties and social norms that were vital in influencing eating behaviour in
their subjects. In the context of smoking, a study by Marsh, Robertson, & Cameron
(2013) focused on the attitudes towards smoking on campus, smoke free campus policies,
implementation and enforcement of smoke free policies were of focus. The study was
conducted under the belief that education institutions like universities serve as an ideal
ground for tobacco control initiatives (Marsh, Robertson, & Cameron, 2013). As young
individuals, the time spent in college serves as a period of transition. This means these
individuals are prone to establishing certain behaviors, which include a shift from
experimentation to nicotine addiction (Marsh, Robertson, & Cameron, 2013). Moreover,
Marsh and colleagues (2013) believed that is was equally important to note that this
transitional period is also a time where young individuals decide to quit. The study also
presented how tertiary education provides good grounds for tobacco control strategies to
maintain the decline in smoking. According to Fichtenberg and Glantz (2002, as cited in
Marsh, Robertson, & Cameron, 2013, p. 88), individuals whose working environments
present more restrictions on smoking have lower smoking prevalence as well as consume
less tobacco. The university studied by Marsh and colleagues (2013) had a partial smoke
free policy in place. The survey given out presented a battery of multiple choice, sliding
scale, and free-text questions.
In a study by Fichtenberg and Glantz (2002), the researchers found the smoke-free
work places have the capacity to positively influence ones smoking habits protecting
them from the hazards of smoking, while encouraging current smokers to quit or at least

reduce consumption.
In relation to this, in order to maintain a healthy lifestyle, being physically active
should always be part of your routine especially since sedentary behaviour is related to
poorer health outcomes. Sitting for prolonged periods of time increases numerous health
risks both physically and physiologically. The immobility brought about by prolonged
sitting causes unhealthy metabolic changes (Sifferlin, 2012). Levine (2012) suggested
that the better solution is to generally decrease the time spent sitting. In essence, less
sitting and more moving overall (Levine, 2012). Complemented by good eating habits,
physical activity can control weight. More importantly, staying active helps regulate
bodily functions and in turn, reducing risks of heart disease and high blood pressure
among other diseases.
b. What are the factors/reasons for rebound weight gain? (change in diet, lifestyle)
Taking part in a diet in order to lose weight is practiced by many people with the
belief that less intake of food leads to a decrease in the numbers seen in the weighing
scale. However, studies have shown that people on diets only lose 5 to 10 percent of their
initial body weight in the first six months but then eventually regain more weight than
what was lost along the course of four or five years (Mann et. al, 2007). It appears that for
the majority of people diets are not capable of sustaining weight loss nor instilling health
benefits. Studies have also pointed that engaging on a diet is a consistent predictor of
future weight gain. Also, dieting appeared to be the most important predictor of new
eating disorders (Patton et. al, 2009).
The rebound in weight could be accounted to the absence of an unconditional
permission to eat, experienced by those who engage in a diet. Restrictions set by people
who engage in dieting strategies in which they dictate specific conditions on when, how
much, and what foods they can eat put them at a position of feeling deprived and
preoccupied with food (Tylka, 2006). The deprivation leads to a readiness to eat in
response to internal physiological hunger signals and the food craving. It has also been
found that people who limit themselves through a diet are influenced more by visual and
olfactory cues of foods to guide their food intake (Fedoroff et al., 1997).
Another reason is that those who have had a history of dieting tend to eat in order
to cope with their emotional fluctuations. Normally, for an individual eating is done in
order to satisfy the feeling of hunger and satiety. However, for people who restrict their
eating, there is a disinhibition of eating wherein it is no longer associated with the desire
to escape hunger but to compensate also for the negative emotion that the person is
experiencing. There is an apparent increase in food intake during times of negative affect
(Tylka, 2006).
The use of caffeine, was shown to have some effect on weight gain but not
necessarily the rebound of weight. The case has also mentioned that they were not able to
maintain their exercise. Dieting and exercise has been shown to bring hormonal and
regulatory changes that affect metabolism and induce weight gain (CNN, 2011). Also,

other factors like smoking and alterations in the sleep-wake cycle have possibly
contributed to the rebound weight gain.
c. What are the effects of caffeine and smoking on weight gain?
Effects of caffeine and smoking on weight gain
Caffeine and Weight Gain
As a stimulant, caffeine may aid in weight loss by enhancing physical activity and
initiating thermogenesis, wherein the body generates heat from the calories gained
through eating. It may also briefly reduce appetite (Cready & Kyle, n.d.).
However, the effects of caffeine on weight gain far outweigh its weight-loss
benefits. Excessive caffeine intake results in an increase in cortisol levels within the body.
A stress hormone, cortisol results in increased weight gain due to accumulation of
abdominal fat, resulting in increased risk of cardiovascular disease, Type 2 diabetes and
metabolic syndrome (Jacob, 2014). Specifically, cortisol initiates a fight-or-flight
response, wherein blood pressure heightens and metabolism of fats and carbohydrates
increases. Therefore, the level of the amount of blood sugar increases, along with levels
of insulin to facilitate glucose delivery to tissues. With the higher demand for blood sugar
(along with the effects brought by stress), the person feels the need to eat more, thus
resulting in weight gain. This is exacerbated by the nature of the stress, which in
contemporary times is often mental or emotional in nature, whereas physical stresses
would result in increased activity which can reduce the amount of calories taken in.
Continually elevated insulin levels would result in increased resistance to this hormone
(Smucker, 2014).
In addition, caffeine initiates hypoglycemia by activating the sympathetic nervous
system and the adrenal glands. This would lead to blood vessel constriction and a
decreased circulation to the brain, along with increased feelings of low blood sugar
levels. Therefore, an increased appetite occurs, especially for high-calorie foods. Lastly,
high caffeine intake increases levels of serum cholesterol (Raffeto et al., 2004).
Smoking and Weight Gain
Smoking and obesity are leading causes of cardiovascular diseases and death,
such that obese smokers have 13 years less of a life expectancy than non-obese, nonsmokers. Conflicting studies have attempted to display the relationship between smoking
and obesity, with most pointing to an inverse relationship (Dare et al., 2015).
Quitting smoking may actually result in weight gain, as some studies claim (Tian
et al., 2015). People who cease smoking may report an increase of up to 5 pounds in the
next year (National Health Service, 2014). This is because the nicotine present in
cigarettes acts to increase metabolic rate and also suppress appetite. For instance, heavy
smokers may use up to 200 more calories than nonsmokers daily. Relating to the
decreased appetite found in smokers, smoking can lessen the ability to taste and smell.

Lastly, smoking is viewed as a soothing activity especially for shy individuals, wherein
the comfort of eating comes secondary to what is dealt by smoking. To alleviate the
boredom and stress caused by forgoing cigarette use, nonsmokers resort to eating (Hicks,
2013; Folan & Fardellone, 2010). Lastly, as smoking leads to a higher risk of emaciating
diseases such as cancer, weight loss from such preclinical conditions will ensue (Chiolero
et al., 2008). As such, a persons body mass index and incidence of smoking follow an
inverse relationship (Rupprecht et al., 2015).
However, the relationship between smoking and BMI differs in obese and heavy
smokers. There is a higher magnitude of nicotine dependence in smokers with higher
BMI (Rupprecht et al., 2015). Long-term weight gain, which displays a strong correlation
to incidence of smoking (cigarettes per day) and baseline BMI, is highest in both heavy
smokers and obese individuals post-cessation of smoking (Veldheer et al., 2015; Dare et
al., 2015). In addition, current heavy smokers are reported to generally weigh more than
light or non-smokers.This may be due to other risky behaviors exhibited by heavy
smokers, such as a sedentary lifestyle and poor diet choices. Also, resistance to insulin is
increased by smoking (due to hormonal imbalance), resulting in fat accumulation and an
increased susceptibility to diabetes and metabolic syndrome. Altogether, these
complications lead to a higher risk of cardiovascular disease (Chiolero et al., 2008). On
the other hand, little weight gain is seen in light to moderate smokers after quitting (Dare
et al., 2015).
Post-cessation weight gain may decrease with time, however. In a study by Dare
et al (2015), it was discovered that the risk of obesity decreases to the point that the risk
between quitters and people who never smoked is the same, but with both being at greater
risk of obesity than current smokers. Initial heightened weight gains post-cessation of
smoking are thus temporary.
d. What are the effects of having a support group in the process of weight loss?
Social support and weight loss
Social support is believed to contribute to weight loss success. Numerous studies
(Cherrington et al., 2015; Kulik et al., 2015; Mache et al., 2015) have found that social
support, usually through family and peers, has been positively associated with weight loss
and other health behaviors. Similar to how group team sports were observed to improve
outcomes of physical activity greater than solitary exercise, sharing and enacting on
weight loss goals with a peer increases weight loss success. This is because of two
ubiquitous elements: cooperation and competition. Previous literature (Marker & Staiano,
2015) suggests that cooperative and competitive aspects of physical activity may affect
both physiological and psychosocial changes. Competitive play has been found to
increase energy expenditure and aggression in short bouts of exercise that increases
caloric expenditure and reduces weight faster. On the other hand, cooperative physical
exercise has been found to increase motivation, promote continued play, enhance selfefficacy, and increase pro-social behaviors. In one study, a cooperative condition also
resulted in significant weight loss for overweight and obese adolescents. However, it is

important to take note that individual differences such as individual preferences,

competitiveness, weight status, age, gender, and ethnicity may moderate effects.
However, though social support is believed to contribute to weight loss success,
the type of support received is rarely assessed. To develop more effective weight loss
interventions, examinations of the types of support that are associated with positive
outcomes are needed. As mentioned earlier, motivation is an important factor in weight
loss. Self-Determination Theory suggests that support for an individuals autonomy is
beneficial and facilitates internalization of autonomous self-regulation (Gorin et al.,
2014). Because of this, it was examined that autonomy support and directive forms of
support were associated with weight loss outcomes in a larger randomized controlled
trial.
More to this, social support has also been found to be a significant factor not only
in weight loss but also in long-term maintenance after weight loss. Undoubtedly,
behavioral treatment programs have become increasingly effective in producing initial
weight loss; however, long-term maintenance remains even more problematic as relapse
have been too common. Participants typically regain one third of their initial weight loss
in the year following treatment (Wing, 1997). Correlational studies have shown that
supportive activities of both family and friends are related to long-term changes in diet
and exercise behavior (Heinzelmann & Bagley, 1970; Sallis, Grossman, Pinski, Patterson,
& Nader, 1987; Treiber et al., 1991). Experimental studies of the effect of natural social
support on weight loss or maintenance have been limited but appear promising (Wing &
Jeffery, 1999). This effect is largely because having a support system increases
accountability and adherence to long-term health behaviors such as diet and exercise. The
significance of social support focuses beyond the individual in isolation and consider his
or her social network and environment. Clusters of friends and family can help both
establish and spread healthy norms, such as regularly checking weight and blood sugar (if
diabetic), exercising, watching calories, and eating fresh fruits and vegetables. In a more
macro level, work site health promotion programs have also been identified as strongly
effective in decreasing body weight and increasing awareness and change in health
behavior (Mache et al., 2015), similar to what was mentioned in the case.
In conclusion, social support was found to increase and sustain both external and
internal motivation that was translated to weight loss. Weight loss takes patience, time
and dedication but with the support of family and friends, people are more likely to
achieve their weight loss goals and sustain them over time.
e. Exercise
Determining the best time for physical activities is not as easy as it might seem.
Many people associate the daytime with various activities, while nighttime is often linked
to rest. As cited in Skarnulis (2007), Cedric Bryant, PhD, stated that "research suggests in
terms of performing a consistent exercise habit, individuals who exercise in the morning
tend to do better." Bryant added that another reason for exercising in the morning
prevents other scheduling conflicts for the remainder of the day. Sally White, PhD, also

argued that exercise raises body temperature and heart rate. This will make it difficult for
an individual to sleep after exercising late in the night.
These arguments make sense, but when the concept of the human circadian rhythm is
considered, the situation grows more complex. This rhythm, or what we commonly call
the "body clock," influences various body functions such as blood pressure, body
temperature, hormone levels, and heart rate (Skarnulis, 2007), all of which play vital roles
during exercise. Body clocks vary from person to person, and this implies that there is no
single optimum schedule of exercises for every individual. Some studies contradict each
other on whether exercising can cause phase changes in ones circadian rhythm. Reilly, T.
and Brooks, G. A. (1982) conducted a study which found that the circadian cycle
persisted at submaximal rates of workload, indicating no long-term phase change in the
cycle. However, in two similar studies conducted by Buxton, O. M. et al. (1997) and Van
Reeth, O. et al. (1994), physical activities during the night may cause phase delays in the
human circadian rhythm. In Tanyas case, her circadian rhythm might have already
shifted to fit her work schedule, because she has been working as a call center agent for
two years already. Tanya should consider this in determining the best time for her to
exercise.
Aside from the time of exercise, it is also important to determine the type of exercise
optimal for weight loss. Different articles arrive at similar conclusions that cardio or
aerobic workouts burn calories most efficiently. Sarnataro (2008) writes, In all cases,
however, you'll burn more calories with cardio (aerobic) exercise than with strength or
resistance training, and Smith (2012) further reinforces the thought with, Cardio is king
when it comes to calorie burning, Olson says, and youll see even better results if your
workout has an after burn effect. Strength training also burns calories; however,
aerobic exercises does so in a more efficient manner. For Tanyas case, the treadmill
exercises should work great for her to lose weight. Although while recovering her legs
from working the treadmill, she can also focus on other muscle groups like the arms or
the core muscles as long as she is able. In this way, she can fully utilize the fitness gym.
f. Diet
The right proportion of food
For every person, there is a recommended daily energy requirement (caloric intake)
that is determined by ones sex, age, weight, height, and type of lifestyle - whether
sedentary, somewhat active, active, or very active . For this particular case, with Tanya
being 38 years old, weighing 190 lbs with a height of 5 feet and 4 inches, and with a
somewhat active lifestyle, her estimated energy requirement is 2,873 kCal (12,029 kJ). If
a person is targeting weight loss, he or she must aim to intake less than the total energy
requirement or use up more than the energy requirement. According to an article provided
by the Centers for Disease Control and Prevention (2015), successful weight loss can be
attributed to a gradual and steady rate of about 1 to 2 pounds per week. Since 1 pound is
equal to 3,500 calories, one needs to reduce daily caloric intake by 500 cal per day to lose
1 pound in a week.

As for the proportion of food, there is really no right or wrong mixture of Protein,
Carbohydrate and Fat intake. The proportion of the different macronutrients in the diet is
usually associated with an individuals main goal: whether to build lean mass/muscles or
lose fat (Harrison, 2015). In a study by Boileau, et.al. (2003), there were 2 groups with
different diets who were monitored and compared, the first group having a Moderate
Protein diet and the other having a High Carbohydrate diet. At the end of 10 weeks, both
groups lost almost the same amount of weight (only differing by around 1 kg), reported
significant reductions in serum cholesterol. The CHO group was shown to have a higher
insulin response post-prandially while the Protein group reported greater satiety, had
significant reductions in triacylglycerols, and weight loss was attributed largely to fat
instead of lean muscle loss (as compared with CHO group). Basically, the results of the
study shows that having a higher proportion of protein in the diet positively affects body
composition, satiety, blood lipids and glucose homeostasis. In another study by Allaz,
et.al. (1996), in a 6 week period when obese adults were randomly assigned to one of two
diets composed of different percentages of macronutrients (either 32% protein, 15%
carbohydrate, and 53% fat; or 29% protein, 45% carbohydrate, and 26% fat), results show
that there was no significant difference in amount of weight lost by the 2 groups. The
study shows that in a short period of time, it is not the nutrient composition that
contributes to weight loss but rather, the amount of energy intake.
Since Tanya may be considered to have an Endomorph body type (soft, round or
pear-shaped, stocky, slower metabolism), it is recommended that she stick to a diet with a
lower percentage of carbohydrates for fat loss (Harrison, 2015).
G. Sleep
Effects of alterations in the usual sleep wake cycle.
Circadian rhythm refers to the cyclical changes that occur in the body within a 24hour period. This may include changes in temperature, hormone levels and sleep and is
driven by the bodys biological clock which is the brain, specifically the suprachiasmatic
nucleus (SCN) found in the hypothalamus. The SCN also synthesizes hormones and
neurotransmitters such as transforming growth factor-a (TGF-a), prokineticin-2 (PK2),
gamma-aminobutyric acid (GABA), and vasopressin. The rhythms are synchronized with
the external physical environment and the individuals social or work lifestyle. In
humans, light is the strongest synchronizing agent and helps individuals determine
when they should sleep (National Sleep Foundation [NSF], 2006 & Laposky, Bass,
Kohsaka and Turek, 2007).
Disruptions in the circadian rhythm occur when individuals try to stay awake against
the bodys sleep-wake schedule. This may be due to jet lag, sleeping disorders or even
changes in the individuals shift hours for work. This leads to compromises in the
individuals mental and physical performance (NSF, 2006).
Hormones that affect growth, energy regulation and control of metabolic and

endocrine function are secreted when an individual is asleep. In the initial stages of sleep,
there is an increase in the amount of growth hormone (GH) secreted as well as an
increase in blood glucose concentration due to a reduction in the utilization of glucose by
non-insulin dependent and insulin dependent muscles. GH affects metabolism of an
individual by promoting hepatic gluconeogenesis and reducing insulin secretion by
pancreatic beta cells. This allows for the maintenance of glucose levels when the
individual is asleep. Towards the end of the sleeping cycle, there is an increase in the
amount of cortisol in the body which promotes glucose utilization. Less sleep combined
with aging lead to an even less amount of growth hormone production and can cause
individuals to gain weight or be overweight (NSF, 2006 & Laposky, et al, 2007).
Other studies have also shown that decreased sleep induces a decrease in the levels of
leptin and an in increase in levels of ghrelin in the body. Since leptin is in charge of
regulating carbohydrate metabolism, low levels of it can cause an individual to crave
carbohydrates even when a lot of calories were already consumed from other sources.
Ghrelin, on the other hand, increases appetite and fat storage. If an individual gives
in to this temptation, he or she will be taking in more calories which could potentially
lead to weight gain (NSF, 2006 & Laposky, et al, 2007).
As mentioned earlier, the SCN is responsible for the response of an individual to the
light and dark patterns of the environment. The ability of the SCN to control the circadian
rhythm is due to the presence of integrated circadian clock gene circuits which operate
through transcriptional-translational feedback loops with a periodicity of 24 hours. The
role these genes play in the metabolism of cells differ depending on the type of cell it is
located in. Some of these genes are clock controlled genes (CCGs) and a lot of these
CCGs are components of cellular metabolic pathways. The focus will be on the CCG:
nuclear receptors (NRs) (Laposky, et al, 2007).
According to Francis, Fayard, Picard and Auwerx (2003), NRs are important in
cellular metabolic pathways. The ligands of these receptors may be of dietary origin or
may be intermediates in metabolic pathways. Metabolic NRs serve to regulate
homeostasis in the body by activating the correct genes and metabolic pathways. This
may be through the following:
(a) energy and glucose metabolism through peroxisome proliferator-activated
receptor gamma (PPARgamma);
(b) fatty acid, triglyceride, and lipoprotein metabolism via PPARalpha, beta/delta,
and gamma;
(c) reverse cholesterol transport and cholesterol absorption through the liver X
receptors (LXRs) and liver receptor homolog-1 (LRH-1);
(d) bile acid metabolism through the farnesol X receptor (FXR), LXRs, LRH-1

Disruption of any of these pathways may lead to metabolic diseases such as obesity.
2.) Integration of metabolic pathways involved (leptin and obesity)

Image taken from LIPINCOTT, 6th ed

a. What is the role of leptin?
Vertebrates have developed the ability to store sufficient quantities of triglycerides in
adipose tissue in order to survive during periods of food deprivation. A part of this
complex physiological system that the human body has evolved to regulate fuel stores
and energy balance at an optimum level is leptin. It is is a hormone secreted by adipose
tissue that regulate fuel stores and energy balance at an optimal level. It acts on the
hypothalamus and other brain regions to decrease food intake and modulate glucose and
fat metabolism.

During starvation, leptin levels fall. This results to an activation of a behavioral,

hormonal, and metabolic response that is adaptive when food is available. While
increased leptin results in negative energy balance (energy expenditure > food intake),
decreased levels lead to positive energy balance (food intake > energy expenditure)
(Friedman, 1998). Hence, decreased levels of leptin is associated with overeating.
Other hormones involved:
Adiponectin hormone that instructs the body to burn fat for fuel. Its the bodys fat
burning torch. The more of this enzyme in the blood stream, the more fat you burn.
Ghrelin the more ghrelin you have in your system, the hungrier you are. Elevated
ghrelin levels are associated with difficulty in fighting cravings. It activates the
brains reward response to highly addictive sweet, fatty foods increasing the food
intake.
Insulin insulin imbalance results in excess glucose or sugar in the system. This
means that the bodys insulin becomes less effective in lowering blood sugars.
Instead of using the excess sugar to feed the muscles or burning it for energy most of
the carbohydrates get stored as fat. Hence, insulin resistance corresponds to
impossibility of losing fat.

The

biological response to changes in leptin levels. Image rom Friedman (1998).

In humans, diet-induced weight loss results to a decrease in plasma leptin
concentration explaining the high failure rate of dieting. In a study by Wadden et al
(2013) that examined the effects of caloric restriction and weight loss on serum leptin
concentrations in obese women in a 40-week weight loss program involving a 1000
Cal/day diet, it was found that the weight and serum leptin fell significantly in women
undergoing this diet. It was then found that caloric restriction contributed significantly to
the change in leptin levels by the 6th week because leptin fell precipitously in response to
caloric restriction but increased when they discontinued the 1000 Cal/day portion
controlled diet and began consuming a higher calorie diet of conventional foods. This
explains yo-yo dieting or the phenomenon where one gains back the weight he/she has
tried to lose. Losing weight reduces fat mass which leads to a significant reduction in
leptin levels. When leptin goes down, this leads to hunger, increased apetite, reduced
motivation to exercise, and decreased amount of calories burned at rest since reduced
leptin makes the brain think it is starving. Leptin does its job of protecting us from
starvation and stimulates the brain to initiate mechanisms to regain that lost body fat
compelling dieters to eat back the lost weight (Gunnars, 2014).
b.) What are the effects of obesity on the biochemical process involved in the body?
According to Ferrier (2014), the primary effects of obesity on metabolism include
dyslipidemia, glucose intolerance, and insulin resistance. These metabolic abnormalities
result from the changes in the molecular signals from the increased mass of adipocytes.
Effect on carbohydrate metabolism
Insulin is known to decrease blood glucose levels by increasing glucose uptake in
muscles and adipocytes via the GLUT4 transporter and by downregulation of hepatic
glucose production. In all forms of obesity, normal GLUT4 transporters are present in
skeletal muscles. However, in adipose tissue, there is downregulation of the GLUT4
transporter resulting in inability to take in glucose due to impaired transport and fusion of
GLUT4-containing vesicles from the cytoplasm into the plasma membrane. This results
in insulin resistance, reduced glucose disposal (rate of glucose uptake from extracellular
matrix into the cell) and increased glucose levels in the blood or hyperglycemia (Singla,
Bardoloi & Parkash, 2010). Thus, obesity is highly associated with Diabetes Mellitus
Type II. In effect, there is also reduced glycolysis in adipose tissues of obese individuals
since glucose molecules are not able to enter the cells where glycolysis and oxidative
phosphorylation occurs resulting in lower ATP production in adipocytes.
The down regulation of the GLUT4 transporter in adipose tissue is may be due to
the increased production of TNF-a(lpha). Adipose tissue is a major site of endogenous
TNF-a production, hence, its increase in concentration when the person is obese.
According to Singla, et al., (2010), TNF-a inhibits intracellular signaling through the
serine phosphorylation of IRS-1 (involved in the signal cascade of insulin action) and

reduces the expression of GLUT4. As a result, there is down regulation of the transporter
and insulin resistance.
Effect on Lipid metabolism
Dyslipidemia in the context of obesity, refers to an increased amount of fasting and
postprandial triglyceride and LDL while a low amount of HDL-C. During obesity, free
fatty acids are increased in the circulation. This results into the delivery of free fatty acids
to other fat depots such as the visceral, pericardiac, and perivascular adiposity. It might
also be delivered to non adipose tissues such as the liver. In addition, free fatty acid
delivery into the liver results into increased hepatic secretion and triglyceride enrichment
of very-low density lipoprotein (VLDL), which is clinically manifested as elevated
fasting triglyceride.
Once in the circulation, hepatically derived VLDL particles undergo enzymatic
exchanges with other lipoprotein particles such as high-density lipoproteins (HDL) and
low-density lipoproteins (LDL), via cholesteryl ester transfer protein (CETP). Once these
TG-rich lipoprotein particles are subjected to various lipases, then the HDL particles may
become smaller and more apt to undergo metabolism and excretion by the kidney,
resulting in low HDL cholesterol (HDL-C) levels. Similarly, when TG-rich LDL particles
interact with lipases, they may also become smaller and denser. The VLDL particles may
undergo further lipolysis, resulting in VLDL remnants, which are also atherogenic.
3. Health and Wellness Plan
Exercise is an important aspect but in order to gain its maximum effects, the exercise
that should be performed by the individual should be specific to her target objectives. It
is recommended that she should lift weights before doing her cardio exercise. This is
because doing cardio exercise only will not result in continuous weight reduction since
fat burning is not sustained for a long time. With the help of weights, more muscles are
utilized. Thus, burning of fat is still on process even though you are not actively
exercising because a big group of muscles were involved in weightlifting. It should also
be noted that cardio exercise should be done after weightlifting. Intense cardio workouts
before lifting depletes your glycogen stores too much thus leaving you less stores for the
lifting. But doing this in a reverse manner consumes glycogen in more efficient way,
making the exercise routine more effective.
Even if weight loss is minimal, obese individuals showing a good level of
cardiorespiratory fitness are at reduced risk for cardiovascular mortality than lean but
poorly fit subjects. Thirty to 45 minutes of physical activity of moderate intensity,
performed 3 to 5 days a week, should be encouraged. All adults should set a long-term
goal to accumulate at least 30 minutes or more of moderate-intensity physical activity on
most, and preferably all days.
Public health interventions promoting walking are likely to be the most successful.

Indeed, walking is unique because of its safety, accessibility, and popularity. It is

noteworthy that there is a clear dissociation between the adaptation of cardiorespiratory
fitness and the improvements in the metabolic risk profile that can be induced by
endurance training programs. It appears that as long as the increase in energy expenditure
is sufficient, low-intensity endurance exercise is likely to generate beneficial metabolic
effects that would be essentially similar to those produced by high-intensity exercise.
The focus should be on the improvement of the metabolic profile rather than on
weight loss alone. Realistic goals should be set between the clinician and the patient, with
a weight loss of approximately of 0.5 to 1 pound per week. It should be kept in mind that
since it generally takes years to become overweight or obese, a weight loss pattern of 0.5
or 1 pound per week will require time and perseverance to reach the proposed target.
Diet Considerations
Altering dietary percentage composition by macronutrient group has not been proven
to directly cause weight loss. Instead, it has been observed that weight reduction is
primarily because of a net decrease in total caloric intake, and not because of specific
increase or decrease in macronutrient intake. Thus, it is recommended that she follow the
desirable percentage contribution of each macronutrient, and not deprive herself of any
specific component, provided there are no co-existing biochemical derangements (such as
hypercholesterolemia) and co-morbidities.

Image taken from: www.google.com

It should be emphasized that 70% of carbohydrate intake must come from complex
variants and not more than 10% from simple sugars.We then compute for the daily caloric
requirement of Tanya, taking into consideration her basal metabolic rate (a factor of
weight, height, age, and sex) and activity level.
For a 38-year old female weighing 89 kg, standing 1.63 m, and with moderate to
active lifestyle (assuming exercise regimen is being followed already), the daily caloric
requirement is 2500-2800 calories per day. Since we are attempting to have weight loss,
we subtract 500 calories from this value, giving us 2000-2300 calories daily.
We then allocate this into the different macronutrient groups: CHO = 1200-1400
calories (60%), CHOO = 600-700 calories (30%), and CHON = 200-250 calories (10%).
Next, we divide the caloric contribution by the amount of calories each gram of

macronutrient can provide, to get the amount in grams needed for each, hence:
CHO = 300-350 grams (4 cal/g)
CHOO = 70-80 grams (9 cal/g),
CHON = 50-60 grams (4 cal/g).
Lastly, we divide this into 3 major meals and 2 snacks a day, making sure that we do not
go beyond the allocation.
Important things to teach Tanya include:
Calorie counting most products have nutrition labels, which will directly provide
you how much of each macronutrient is present per serving of the product. For those
products that do not have labels, the diet exchange list may be utilized (FNRI). Avoid
eating empty calories.
Consistency and variety stick to the diet regimen; frequent changes involve
relapses, during which the starved body stimulates the hunger drive to the point of
overeating
Slow pace of taking meals eating slowly allows for the timely release of satiety
hormones, which can induce a feeling of satiation even if only a small amount of
food had been ingested
Dietary fiber, 20-25 grams a day increases bulk in diet and hence produces a mild
feeling of bloating and a sense of fullness

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