Nutrition chapter 7

bioelectrical impedance

(BIA)- hand held equipment is also available -common method to assess body composition

air displacement

(bodpod) -common method to assess body composition

low carb diet

-30-50 percent of kcal from protein, restrict carbs to 40% of kcal or less -rapid initial weight loss due to fluid losses -Caution: metabolism of fat and protein for fuel can alter pH of blood -caution: excessive intake of high fat sources of animal protein can affect long term cardiovascular health and kidney health -can be successful weight loss strategy if kcal deficit can be maintained over time

BMI is a convenient screening tool for overweight and obesity but does not directly assess body composition

-BMI is a simple ratio of weight and height -body composition refers to the percent of the body that is lean vs. fat

proportion of american adults who are overweight and obese

-about 2/3 of american adults are overweight or obese -of these, about half or 1/3 are obese

factors taken into account when estimating EER

-age -male or female -height -weight -activity level

weight loss and maintenance of it will likely require more than 150 minutes per week of moderate intensity physical activity

-aimed to reduce risk of chronic diseases -weight loss usually requires more physical activity -duraition and consistancy are more important than intensity

EER varies by age, gender, and activity level

-as age increases, EER declines -men tend to have higher EER than women -EER increases as physical activity level increases

reality of weight loss

-as we lose weight, our energy needs decrease slightly -hormonal changes affect metabolic rate and appetite -unconscious adjustments in physical activity -it takes about 3 years to fully realize the effect of kcal defecit

mindful eating can enhance weight management efforts

-avoid triggers for overeating or unhealthy choices -improve awareness of hunger and satiety

risks of bariatric surgery

-bleeding -blood clots -hernias -infections -nutrient deficiencies - 2% risk of death

components of energy intake and energy expenditure from foods and beverages

-carbs -proteins -fat -alcohol

healthful strategies for increasing body weight

-choose energy dense foods -nuts and nut butters, vegetable oils, granola, dried fruit, bananas, avocados, dried milk powder to boost protein and calories, nutrient dense drinks,liquid nutritional supplements

energy density for controlling calorie intake

-comparison of kcal content to weight of food -foods high in fat are more energy dense than foods of mostly carbs but may not fill you up -foods high in water and fiber have low energy density but fill you up without many kcal

3 key elements of a sound weight loss program

-control calorie intake -perform regular physical activity -control problem behaviors

android (upper body) obesity

-deposition of fat around the waist -waist circumference over 40 inches for men and 35 inches for women -associated with increased risk of chronic diseases -fat is available to the liver; affects glucose and lipid metabolism -testosterone promotes android obesity (most common among men and post-menopausal women) -apple shaped

possible causes of underweight

-genetics -growth spurt -cancer -infectious disease -digestive tract disorders -extreme dieting -excessive physical activity

why are VLCDs not long term solutions for weight management

-include weight loss, but they do not change problem behaviors -weight regain is VERY common

discuss how following factors influence basal metabolism

-lean body mass -body surface area -male or female -body temp -thyroid hormone levels -stress -growth -caffeine use -tobacco use

very low calorie diet (VLCD)

-liquid diet providing 400-800 kcal per day; adequate in micronutrients and protein, but low in fat and carbs -use should be monitored by a physician -known as protein sparing modified fast

why are beverage choices just as important as food choices

-liquid kcal are not as satiating as food kcal, but can quickly add up -choose water

strategies to overcome weight loss plateau

-measure and monitor food intake; be aware of calorie creep -further reduction in kcal may be necessary if weight loss has resulted in decreased energy requirements -change intensity of physical activity -incorporate strength training to build lean mass and boost energy expenditure

basal metabolism

-minimal amount of energy required to keep a resting, awake body alive in a warm, quiet environment (energy for breathing brain function) -accounts for 60-75 percent of total energy expenditure

most successful weight loss plan is one that a person can stick with

-monotony leads to boredom -overly restrictive diets can lead to nutrient inadequacy -lack of flexibility makes some plans difficult to follow

success of bariatric surgery

-most successful long term result of any weight loss method -reduces development/progression of weight related conditions (type 2 diabetes, hypertension, cardiovascular disease)

use food labels to select food with lower energy density

-observe serving sizes -compare kcal content of various foods -compare kcal content of serving size

weight loss med that affects digestion and absorption of nutrients

-orlistat -liraglutide

weight loss medications that affect appetite

-phentermine -lorcaserin hydrochloride -phentermine + topiramate -buproprion + naltrexone -typically reserved for people with BMI over 30

health professionals and community organizations that are well equipped to help clients lose excess body weight

-physicians and nurses measure and monitor weight related health parameters -registered dietition nutritionists assist with nutrition assessment, education, and intervention -exercise phyiologists assist with fitness assessment, education, and intervention

characteristics of unreliable (fad) diets

-promote quick weight loss -limit food selections -use testimonials for marketing -promoted as cure-alls -recommend expensive supplements -behavior modification not included -exercise not included -critical/ skeptical about the scientific community

gynoid/lower body obesity

-refers to deposition of fat in the buttocks and thighs -not closely linked to chronic disease risk -estrogen and progesterone promote lower body gynoid obesity (most common among pre-menopausal women) -pear shaped

low fat diet

-restrict fat to 20% of kcal or less -choosing foods with lower energy density can promote satiety without contributing as many kcal -very strict approaches may reverse cardiovascular disease -caution: deficiencies of essential fatty acids or fat soluble vitamins are possible -can be a successful weight loss strategy if kcal deficit can be maintained over time

importance of self monitoring for weight management

-reveals problem behaviors -enable tracking of progress on behavior goals in addition to the numbers on the scale

kcal deficit that is typically required to lose 1 pound per week

-weight loss includes lean mass + fat mass - 1 pound of weight loss= 3500 kcal -3500 kcal/ 7 days a week = 500 kcal/ day -in theory, reducing kcal intake by about 500 below energy needs results in weight loss of about 1 pound per week -in reality weight loss is not linear and factors other than his simple math, so this overestimate weight loss

1 to 2 pounds per week is a safe and sustainable rate of weight loss

-when weight is lost, it is a combination of lean and fat mass; the goal is to maximize fat loss and minimize loss of lean tissue -rapid weight loss (>2 lb/ week) is likely due to loss of water; not sustainable

normal weight

18.5-24.9 BMI

overweight

25-29.9 BMI

underweight

<18.5 BMI

obese

> or equal to 30 BMI

basal metabolism on body weight

A low BMR due to factors such as thyroid problems or energy restriction is linked to weight gain

underweight

BMI < 18.5

ratio of fat to lean tissue

a high ratio of fat mass to lean body mass is correlated with weight gain

childbearing

a pattern of weight gain during the childbearing years can occur to support fetus. fat stored during pregnancy to support lactation may not be lost in women who do not breastfeed

skin disorders

accumulation and trapping of moisture and microorganisms in tissue folds

negative energy balance

calories in is less than calories out, more exercise than eating, decrease in weight

positive energy balance

calories in is more than calories out, more eating and less working out

skinfold thickness

common method to assess body composition

dual energy x-ray absorptiometry (DEXA)

common method to assess body composition -MOST ACCURATE but expensive and impractical for everyday use

premature death

comorbidities and greater risk factors for numerous chronic diseases and complications

direct calorimetery

determine energy expenditure by measuring heat released from the body

indirect calorimetery

determine energy expenditure by measuring oxygen uptake and carbon dioxide output

shorter stature

early onset of puberty

fat uptake by adipose tissue

efficiency of fat storage is high in some obese individuals and may even increase with weight loss

thermic effect of food

energy needed to digest, absorb, and metabolize nutrients; accounts for 5-10 percent of total energy expenditure

adaptive thermogenesis

energy spent on nonvoluntary activities that maintain body temperature; accounts for <5 percent of total energy expenditure

type 2 diabetes

enlarged adipose cells poorly bind to insulin and inadequately respond to insulin signals; reduced synthesis of factors that promote insulin action and increased synthesis of factors that counter insulin action

various cancers

estrogen and other hormones contribute to tumor growth by adipose cells; increased hyperinsulinemia or insulin resistance; synthetic inflammation associated with cancer risk; excess calorie intake may encourage tumor development

age

excess body fat is more common in adults and middle-aged individuals due to loss of lean body mass and reduction in physical activity

dietary consumption

excess calorie intake from saturated fat, alcohol, and calorie-dense foods and beverages contribute to obesity

liver damage and eventual failure

excess fat accumulation in the liver

bone and joint disorders

excess pressure place don knees, ankles, and hip joints

reduced physical agility and increased risk of accidents and falls

excess weight impairs physical movement and gait

pulmonary disease and sleep disorders

excess weight stressing the lungs and pharynx

gender

females have more fat mass than males due to less lean body mass and reduced surface area

genetic predisposition

genetic factors may affect expenditure, deposition of adipose tissue or lean tissue, and the relative proportion of fat and carbs used by the body

vision problems

higher rates of cataracts and other eye disorders

menopause

hormonal changes result in increased abdominal fat deposition

menstrual irregularities and infertility

hormone imbalances; insulin resistance; increased oxidative stress

underwater weighing

hydrostatic weighing or hydrodensitometry -a common method to assess body composition

ethnicity

in some groups, higher body weight may be more socially acceptable, which may promote overeating

physical activity

includes activities of daily living and planned exercise; accounts for 15-35 percent of total energy expenditure

cardiovascular disease

increased LDL cholesterol and triglycerides; reduced HDL cholesterol; increased synthesis of blood clotting and inflammatory factors by enlarged adipose cells; potential for altered heart rhythm

surgical complications

increased anesthesia needs; greater risk of wound infection

gallstones

increased cholesterol content of bile

certain medications

increased hunger/appetite can be a side effect of many medications

hypertension

increased miles of blood vessels found in the adipose tissue, increased blood volume, and increased resistance to blood flow related to hormones made by adipose cells

overall kcal intake is more important than the specific distribution of carbs, fats, and proteins in the diet when it comes it losing weight

individuals can successfully lose weight with any combo (low carb-atkins, high carb- okinawan, moderate carb- mediterranian diet) -a defecit of kcal will lead to weight loss -a surplus of kcall will lead to weight gain

energy balance

intake equals outtake- calories in equals calories out

importance of portion control for controlling calorie intake

limit kcal intake by controlling portion sizes of each food in a meal

erectile dysfunction in men

low-grade inflammation caused by reduced function of the cells lining the blood vessels and impaired blood circulation

body mass index in metric and english

metric: kg over m squared english: lb over in squared X 703

pregnancy risks

more difficult delivery; increased birth defects and gestational diabetes; greater anesthesia needs

social and behavioral factors

obesity is associated with socioeconomic status; familial conditions, social networks, lifestyles, binge eating, availability of inexpensive "supersized" high fat food, patterns of leisure activities, increased screen time, smoking cessation, excessive alcohol intake

energy balance influence body weight

over a long period, dietary patterns consist with positive energy balance promote storage of excess body fat

infections

reduced immune system activity

region of residence

regional environmental and lifestyle differences, such as high-fat diets and sedentary lifestyles, especially in the South and Midwest, lead to higher rates of obesity

physical activity influence on body weight

sedentary behavior leads to positive energy balance and promotes body fat storage

increased hunger sensations

some individuals appear to have blunted satiety, which may be linked to various brain signals involved in food reward pathways

thermic effect of food on body weight

some obese individuals metabolize nutrients more efficiently, and thus expend fewer calories for digestion and absorption

bariatric surgery

surgical treatment for extreme obesity that restricts food intake, induces malabsorption of nutrients, or both -for people with BMI over 4o