Weight Management:

Overweight, , &
Underweight


Overweight
Overweight (BMI 25-29.9) and obesity
( 30) are widespread health problems
that are continuing to increase.
Many refer to overweight and obesity as
an epidemic.
For good health, weight management is
important.

Overweight
Fat Cell Development
Fat cell numbers
Fat cell numbers increase most rapidly in later
childhood and early puberty.

Fat cell numbers increase in times of positive
energy balance.

Hyperplastic obesity
Fig. 9-2, p. 283
During
growth, fat
cells increase
in number.
Hyper-
plastic
When energy
intake exceeds
expenditure, fat
cells increase
in size.
Hypertro-
phic
When fat cells have
enlarged and energy
intake continues
to exceed energy
expenditure, fat cells
increase in number
again.
With fat loss, the
size of the fat cells
shrinks but not the
number.
Stepped Art
Overweight
Fat Cell Development
Fat cell size
Fat cell sizes increase when energy intake
exceeds expenditure.

Hypertrophic obesity
The adverse effects of fat in non-adipose
tissue are called lipotoxicity.
Overweight
Fat Cell Metabolism
Lipoprotein lipase promotes fat storage.
Gender differences
Men are at increased risk for developing central
obesity and women are at increased risk for lower
body fat.
Overweight
Set-Point Theory
The bodys natural regulatory centers
maintain homeostasis at set point.
The human body tends to maintain a
certain weight.
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.
Causes of Obesity
Genetics
Leptin (also called the ob protein)
Protein that acts as a hormone to
increase energy expenditure and
decrease appetite
Produced by fat cells under the direction
of the ob gene
May be deficient in obese individuals
More research is needed.
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I'm in shape.

Round is a shape.

Causes of Obesity
Environment The gene pool of our
population remains relatively unchanged.
Overeating
Present and past eating influences current body weight.
Increased availability of convenient food, large portions,
and energy-dense foods
Physical Inactivity
Modern technology replaces physical activities.
Physical activity is important to allow people to eat
enough food to get needed nutrients.
Buy a lot of McDonalds
food and get a big, fat
ass, absolutely free.

Causes of Obesity
Environment The gene pool of our
population remains relatively unchanged.
Overeating
Present and past eating influences current body weight.
Increased availability of convenient food, large portions,
and energy-dense foods
Physical Inactivity
Modern technology replaces physical activities.
Physical activity is important to allow people to eat
enough food to get needed nutrients.
.
LAZINESS
IS NOT A HANDICAP
.
Obesity: Risk Factors
Genetics
Family history of obesity
Psychological factors
Social and cultural factors
Medical Illnesses
Medications
Alcohol consumption
Smoking Cessation
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.
Makes a point about a topic
Give a man a fish and
he will eat for a day.

Teach him how to fish,
and
he will sit in a boat and
drink beer all day.

Lets just say you weigh
too much and the less said
about your future the better
Problems with Obesity
Health Risks
Obese or overweight people with the
following life-threatening-conditions may
improve health by losing weight:
Heart disease
Type 2 diabetes
Sleep apnea
Problems with Obesity
Perceptions and Prejudices
Social Consequences
Prejudices and discrimination
Judged on appearance rather than character
Stereotyped as lazy and lacking self-control
Psychological Problems
Feelings of rejection, shame and depression are
common.
Ineffective treatments can lead to a sense of failure.
Fig. 9-4, p. 289
I am fat
and unhappy.
I lose a little
weight, but then
regain it (and
sometimes more).
I want to
be happy.
If I lose
weight, I will
be happy.
I try too hard to
reach an
unrealistic goal.
Stepped Art
Problems with Obesity
Dangerous Interventions
Fad Diets
False theories
Inadequate diets
Can be a danger to health
Treatment Modalities
Diet (proper Healthy nutrition)
Exercise
Behavior
therapy/modification/change
Pharmacotherapy
Surgery
Treatment Modalities
Diet vs proper nutrition
Exercise
Behavior
therapy/modification/change
Pharmacotherapy
Surgery
Dieting and Dollars
Dieting? Today ~40% of women, ~25%
of men
Nationwide, 55% trying to maintain
current weight.
Approximately 45 million Americans diet
each year.
80% of adult women have dieted
$40 billion annually trying to lose weight
or maintain weight.
~1 to 2 billion on weight lose programs.

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WHO EVER INVENTED DIETS
SHOULD BE TAKEN OUT
AND SHOT!
Types of Weight Loss Diets
Low Carbohydrate aka High Protein

Low Fat aka High Carbohydrate

Very Low Calorie aka Modified Fast

Novelty Diets

Weight Loss Programs
Why Weight Loss Programs
Do Not Work
Negative Impact
Temporary
Perfect- Orientation
Project Mentality
Do not Address Cause
Consequences of Dieting
Decrease in rate of weight loss
Loss of lean tissue with fat loss
Decrease in metabolism, 10-40%
Decrease in Protein turnover
Preoccupation with food
Increase in irritability, moodiness
Tires easier, less physical activity
Apathy, depression
Re-feeding after Weight Loss
Increase in pre-dieting food intake
Preference for high fat foods
Regain in weight, but greater increase in % BF
Metabolism slow to return to normal
Regain Weight quicker with each diet
Increase in abdominal fat deposits
Less likely to return to pre-diet physical activity
Decrease in self-efficacy/esteem
Recognizing an Unsound Diet
Promotes Quick Weight Loss
Limits Food Selection
Testimonials or Famous People/Places
Expensive Supplements or Products
No Attempt to Permanently change eating or
physical activity
Critical of Scientific Community
They know more, or something new
Characteristics of a Sound Diet
Nutritionally adequate yet low in calories
Fit into current lifestyle
Foods that are liked
Slow rate of weight loss
Followed for life
Predicting Weight Loss
Positive Affirmations
Strong Motivation
Supportive Environment
Appropriate Behaviors
Changes in Body Shape
Predicting Weight Loss
Positive Affirmations
Self esteem
Self confidence/efficacy
Good attitude
Positive outlook
Predicting Weight Loss
Strong Motivation
Desire or want
Belief it is possible
Commitment to doing it
Positive attitude
Persistence

Predicting Weight Loss
Supportive Environment
Family and friends
Support group or organization
Professional
Predicting Weight Loss
Appropriate Behaviors
Healthy eating
Exercise that produces goal
Changing problem behaviors
Predicting Weight Loss
Changes in Body Shape
Body Composition changes
Circumference changes
Looks better, Cloths fit better, etc.
Predicting Weight Loss
Positive Affirmations
Strong Motivation
Supportive Environment
Appropriate Behaviors
Changes in Body Shape
I was going to buy the book
THE POWER OF POSITIVE
THINKING and then I thought
what the hell good would that
do!
Treatment Modalities
Diet proper Healthy nutrition
Exercise
Behavior
therapy/modification/change
Pharmacotherapy
Surgery

I see no reason
why you should not
engage in
strenuous activity
Exercise
In response to the question whether diet
plus exercise is more effective than diet
alone in causing weight loss, the
conclusion of the consensus panel was as
follows "---
in most studies exercise does not
significantly increase initial weight loss over
and above that obtained with diet only.
However, in almost all studies the diet
plus exercise group lost somewhat
more weight than the diet alone
condition."


THE 100 METER MOSEY
Exercise
Time minutes
%

o
f

c
a
l
o
r
i
e
s

e
x
p
e
n
d
e
d

100%
FAT
Carbohydrate
0 5 10 20
Three more, two more, one
more, okay!...Five million leg
lifts right leg first! Ready
Exercise
Two short sessions/day or
one long session?

Exercise
Two short sessions/day or
one long session?
Yes!

Exercise
Two short sessions/day or one long session?
Yes!

Mode: Walking, Daily Activity
Frequency: 5 - 7 times / week
Duration: 40-60 minutes
20-30 minutes X 2
Intensity: Moderately
My mother started walking five
miles a day when she was 60.

She's 77 now and I have no idea
where she is.

Treatment Modalities
Diet proper nutrition
Exercise
Behavior therapy
modification/change
Pharmacotherapy
Surgery




To make a long story
short, what ever you
are doingSTOP IT!
Behavior therapy
Behavior modification
To lose weight and keep it off, you need to
make changes in your lifestyle. But there's
more to changing your lifestyle than choosing
different foods and putting more activity into
your day. It also involves changing your
approach to eating and activity, which means
changing how you think, feel and act.
Behavior therapy
A behavior modification program can help
make lifestyle changes

Behavior modification programs may
include examining current habits to find
out what factors or situations may have
contributed to excess weight.
Exploring current eating and exercise
habits gives a place to start when
changing behaviors.
Behavior therapy
First identify those that are a problem
Choose those that you are willing to
change
Take responsible for your behavior
Have a plan to make better choices
Remember the benefit
Focus on the positive

Behavior therapy
Have a plan. People do NOT plan to fail,
they simply fail to plan!
Work out a strategy that will gradually
change habits and attitudes.
Consider how often and how long to
exercise.
Determine a realistic eating plan that
includes plenty of water, fruits and
vegetables.
Write it down and choose a start date.
Behavior therapy
Set realistic goals.
Weight-loss goals can be process goals, such as
exercising regularly, or outcome goals, such as
losing 20 pounds in four months.

Make sure process goals are realistic,
specific and measurable. For example,
you'll walk for 30 minutes a day, five days a
week.
For outcome goals, aim to lose weight at a safe
pace of 0.5 or 2 pounds a week. Losing
weight more rapidly means losing water weight
or muscle tissue, rather than fat.
Behavior therapy
Avoid food triggers. (Cues)
Distract from the desire to eat with
something positive, such as calling a friend,
taking a walk, reading a book (not a recipe
book).
Practice saying No to unhealthy foods
and big portions.

Eat when actually hungry not when the
clock says it's time to eat.
This is my relaxation tape
its the sound of ocean waves crashing onto
the shore, snatching my teachers body off his
beach chair and carrying him out to sea.



Treatments of Obesity
Individuals with clinically severe obesity
and major medical problems may
benefit from drugs or bariatric surgery.
But changing and improving eating and
exercise habits offer the greatest
benefit.
Treatment Modalities
Diet proper nutrition
Exercise
Behavior therapy
modification/change
Pharmacotherapy
Surgery
Problems with Obesity
Dangerous Interventions
Weight-Loss Products
Ephedrine-containing products inhibit
serotonin and suppress the appetite.
Supplements containing Ephedra have
been banned by the FDA due to potential
health risks.
Herbal laxatives do not prevent
absorption.
Current laws do not require safety tests
and effectiveness tests for these
products.


To help you lose weight, take one aspirin
every day. Take it for a jog, then take it to the gym,
then take it for a bike ride






Treatments of Obesity
Drugs
Sibutramine suppresses the appetite and
is most effective when used with a reduced
kcalorie diet and increased physical
activity. There are many side effects.
Orlistat blocks fat digestion and
absorption. There are many side effects
including anal leakage.
Treatment Modalities
Diet proper nutrition
Exercise
Behavior therapy
modification/change
Pharmacotherapy
Surgery
Treatments of Obesity
Surgery
Surgery is an option for those who have tried
weight loss programs and failed, have a BMI
35, and are having health problems due to
their weight.

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

Liposuction is a popular procedure that is
primarily cosmetic but poses risk.
Predicting Weight Loss
Positive Affirmations
Strong Motivation
Supportive Environment
Appropriate Behaviors
Changes in Body Shape
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.
Weight loss of 0.5-2 pounds per
week or 10% of body weight in six
months is safe.
Weight-Loss Strategies
Eating Plans
Be Realistic about Energy Intake
300-500 kcalories/day reduction for BMI between
27 and 35
500-1000 kcalories/day reduction for BMI 35
Dietary Guidelines should be followed.
Diet should be nutritionally adequate while
avoiding excessive consumption.
Smaller portions are recommended to feel
satisfied, not stuffed.
Weight-Loss Strategies
Eating Plans
Eat foods of lower energy density, that are
high in fiber, high in water and low in fat.
Water is important to increase fullness and
reduce hunger.
Complex carbohydrates offer abundant
vitamins, minerals and fiber with little fat.
Choose fats sensibly and reduce the quantity
of fat.
Watch empty kcalories from sugar and alcohol.
Meal Planning
Plan meals throughout the day
Eat a variety o Foods (at each meal)
Center Meals around the
carbohydrate foods
Minimize the addition of FAT all the
time and sugar at any one time
Dont worry about protein
Plan Meals thru the Day
Think about what you are going to eat instead of
eating by habit or impulse!

Eat more earlier when more active

Eat less later when less active
i.e. a little often vs. a lot at once
The later you eat, the lighter you eat
Eat a Variety of Foods
(at Each Meal)
Provides more nutrition
Each member of the family can choose
what they want at that time
Controls eating one food in excess
Exposes a person to different foods
Makes a better meal

Center Meals around the
Carbohydrate Foods
Answers the question
What am I supposed to eat?
Provides the best source of energy.
Provides a lot of most nutrients,
(including fiber)
Low in fat, and has the good type and
contains no cholesterol.
Most have protein, certainly enough.
Are not fattening--fats are!
Minimize FATS and SUGAR
Fats are fattening
Fats can lead to other health problems
Minimize fat intake, dont eliminate it
Sugar in large amounts is a problem
Sugar is an enjoyable taste and may displace
foods with more nutrition and be
concentrated
Fat and Sugar mix well with each other: the
real problem

Dont worry about PROTEINS
Important for growth (height) and
development
Needed in smaller amount than most people
think (.8 grams/kilogram BW)
Can be gotten from a variety of carbohydrate
foods as well as the protein foods (meat,
dairy)
Use as a part of the meal, not as the meal
(eat lean, less and last)
Weight-Loss Strategies
Physical Activity
An individuals body weight as well as intensity and
duration of activity influence energy expenditure.
Physical activity increases the amount of discretionary
kcalories that can be consumed.
Metabolic rates can rise with daily vigorous activity.
Activity can decrease body fat and increase lean body
mass.
Exercise may help to curb appetite.
Activity can reduce stress and improve self-esteem.
Weight-Loss Strategies
Physical Activity
Choosing Activities
Choose activities that you enjoy and are willing to do
regularly.
Low to moderate intensity for long duration is
recommended.
Daily routines can incorporate energy activities.
Spot Reducing
Regular aerobic exercise and weight loss will help trouble
spots.
Strength training can improve muscle tone.
Stretching can help flexibility.
Weight-Loss Strategies
Behavior and Attitude
Behavior modification requires time and effort.
Awareness of behavior is the first key.
Changing behaviors one at a time works best.
Do not grocery shop when hungry.
Eat slowly.
Exercise while watching television.
Personal attitudes toward food and eating must be
understood.
Support groups may be helpful for some people.
Weight-Loss Strategies
Weight Maintenance
Successful weight-loss maintenance
programs use different criteria so they are
difficult to compare.
Vigorous exercise and careful eating plans
are key.
Frequent self-monitoring is
recommended. Weekly weight, food diary,
exercise journal, circumference measurements
Weight-Loss Strategies
Prevention
Eat regular meals and limit snacking.
Drink water in place of high-kcalorie
beverages.
Select sensible portion sizes and limit daily
energy intake to energy expended.
Limit sedentary activities and be physically
active.
Underweight
Incidences of underweight and
associated health problems are less
prevalent than overweight and obesity
problems.
Underweight
Problems of Underweight
Causes are diverse.
Energy demands may be great and foods
are needed to support growth and physical
activities.
Eating disorders are severe cases.
Underweight
Weight-Gain Strategies
Energy-dense foods can be included but choose
fat wisely to avoid the associated cardiac risks.
Regular meals each day must become a priority.
Use large portions and expect to feel full.
Consume extra snacks between meals.
Juice and milk are easy ways to increase kcalories.
Exercising to build muscles will support increases
in muscle mass.