NUTRITION CH 10
Treating Eating Disorders
A multidisciplinary group of experts in nutrition, mental health, and medicine is necessary for optimal treatment. Treatment should include psychotherapy and address critical nutritional needs and other medical conditions. Registered dietitian nutritionists play a critical role in assessing and treating eating disorders, including providing nutritional counseling.
Obese
BMI > 30
Hunger vs. satiety
Obesity: Contributing Factors --Hunger: uncomfortable feeling leading to a desire to eat • ---Satiety: sense that enough food was eaten
Weight gain occurs when...
Caloric intake consistently exceeds energy expenditure
Energy Expenditure
Energy cells use to carry out activities. • Basal and resting metabolism • Physical activity • Includes NEAT • Thermic effect of food (TEF)
Ghrelin
Hormones and peptides that regulate hunger: _________hormone, secreted mainly by stomach, that stimulates eating behavior
Metabolic Rate
Influencing Factors for ______ Thyroid hormone • Body composition • Sex (male versus female) • Body surface area • Age • Calorie intake • Fever • Stimulant drugs • Pregnancy and lactation • Recovery after exercise
For every decade past the age of 20, a male's basal metabolism declines by 3% per decade due to the steady decrease of lean body mass
Karl is 54 years old. He notices that now he cannot eat as much as he did when he was in his 30s without gaining weight. Why is this?
overweight
Marissa's BMI is 26.9. According to this information, Marissa is in the ________ BMI range.
Food Composition Factors
Obesity: Contributing Factors High-fat diets associated with excess kcal intakes and increasing obesity rates • Fatty foods often contain high amounts of added sugars High-fructose intakes associated with weight gain • fructose: • does not contribute to satiety • increases fatty acid synthesis
Genetic Factors
Obesity: Contributing Factors Inherited characteristics that influence weight include: • Metabolic rate • "Thrifty metabolism" • Hormone production • Body frame size • Pattern of fat distribution What is the set-point theory? • Scientific notion that body fat content is genetically predetermined. • Difficult to change
PYY
peptide secreted by intestines that reduces hunger
Negative Energy Balance
the state in which energy intake is less than energy expended, resulting in weight loss
Energy Intake
the amount of food a person eats; in other words, it is the number of kilocalories consumed ---Excess glucose stored as glycogen in muscle ---liver: glycogen or convert to triglycerides & released into bloodstream
Thermic Effect of Food (TEF)
the energy expended as a result of processing food consumed Energy used to: • digest foods and beverages • absorb nutrients • process the nutrients Typically 5 to 10% of total caloric intake
Positive Energy Balance
the state in which energy intake is greater than energy expended, generally resulting in weight gain
Female Athlete Triad
eating disorder, amenorrhea, osteoporosis --Common in appearance-based competitive sports • Gymnastics, for example Treatment goal: improving the patient's nutritional state to reverse the signs and symptoms
underweight
A person with a BMI of 16.2 would be classified as _______.
healthy
A person with a BMI of 20 would be considered in the _______ range.
Subcutaneous
Adipose Tissue All cells contain some lipids, but adipose cells store energy in a droplet of fat. Adipose cells are in: __________fat: Helps insulate • Protects muscles and bones from injury
Visceral
Adipose cells are in: __________fat: ---the omentum (structure that is under abdominal muscles and over stomach & intestines )
Males
Adult Classifications for Percentages of Body Fat Healthy - 13 to 21% Overweight - 22 to 25% Obese - 26 to 31% Extremely obese - 32% or more
Females
Adult Classifications for Percentages of Body Fat Healthy - 23 to 31% Overweight - 32 to 37% Obese - 38 to 42% Extremely obese - 43% or more
Muscle Dysmorphia
An unhealthy preoccupation with the body being too small or not muscular enough • Generally affects males
Air Displacement
Assesses body volume: • Subject sits in BOD POD chamber • Measures air in the chamber with a person in it compared to the volume of air in the chamber without the person Accurate, but the equipment is expensive and not practical to use.
Healthy
BMI 18.5-24.9
Overweight
BMI 25-29.9
Underweight
BMI <18.5
Weight Loss Supplements: Evaluating the Hype
Be wary of claims that the supplement: • Causes rapid and extreme weight loss • Requires no need to change dietary patterns or physical activity • Results in permanent weight loss • Is scientifically proven or doctor endorsed • Includes a money-back guarantee • Is safe or natural • Is supported by satisfied customers • Relies on before-and-after photos as "proof" of effectiveness
Total body fat
Body composition 2 components: Adipose tissue • Essential fat in cell membranes, certain bones, and nervous tissue
Fat-free mass
Body composition 2 components: ---Body water, mineral-rich tissues, and protein-rich tissues
Disordered eating
Chaotic and abnormal foodrelated practices (usually temporary) • Occurs when under stress or person wants to lose some weight quickly • Can become a lifestyle that leads to an eating disorder
Central body obesity
Characterized by excessive abdominal (visceral) fat. --Central-body fat distribution is more associated with increased risk for cardiovascular disease and type 2 diabetes than lower-body fat distribution.
Underwater weighing
Compares weight on land to weight when completely submerged in a tank of water • Very accurate Problems: • inconvenient, expensive, and impractical
Obesity
Condition characterized by excessive and unhealthy amounts of body fat ---In 2013-2014: • 70.6% of American adults were either overweight or obese
Obesity: Contributing Factors
Environment • Food advertising influences appetite • Increased portion sizes • Conditions that reduce a person's physical activity Mood Self-esteem Emotions Societal pressure
Factors contributing to underweight
Genetics, lifestyle practices, chronic diseases, psychological disturbances • Chronic diseases, such as cancer, TB, AIDS, or inflammatory bowel disease, are associated with severe weight loss. To gain weight: • Add calorie-dense healthy foods, such as fatty fish like salmon, olives, avocados, seeds, nuts, nut butters, or granola, to diet.
Overweight
Having extra weight from bone, muscle, body fat, and/or body water ----Overweight and obesity are widespread nutritional problems in the U.S.
Skinfold Thickness
Measured at multiple body sites by a trained person. Benefits: Relatively easy and inexpensive to perform. Problems: May underestimate total body fat on overfat people.
Bioelectrical Impedance
Measures conduction of a weak electrical current through the body. Problems: • Method can be reliable, if body hydration status is normal. • Scientific data about accuracy of devices designed for home use are lacking.
Bariatric surgery
Medical Treatments for Obesity Weight-loss medications: Few drugs have FDA approval for long-term weight loss. Bariatric surgery: Often effective for treating obesity • Surgery reduces size of stomach, limiting the amount of food that can be eaten.
Basal metabolism
Minimal number of calories used for vital physiological activities after fasting and resting for 12 hrs. • Resting metabolism is slightly higher. • Estimating calories for basal metabolism: • Rule of thumb: Men: 1.0 kcal/kg/hr; Women 0.9 kcal/kg/hr
BMI (body mass index)
Numerical value of relationship between body weight and risk of certain chronic health problems Weight (lbs) ÷ Height (in)2 × 703
Characteristics of Fad Weight Loss Diets
Offers a "quick fix" with rapid weight loss Limits food selections to a few food groups Requires buying a book or various gimmicks, such as supplements (see Table 10.7) Promoters use outlandish and unscientific claims to support its usefulness Relies on testimonials of famous people Does not emphasize the need to change eating habits and physical activity patterns.
Bulimia Nervos
Often has healthy or overweight BMI Characteristic physical signs include: • Scrapes or scars on knuckles • Dental enamel erosion • Fluid & electrolyte imbalances Vomiting can result in tears, bleeding, or rupture of the esophagus or stomach May abuse alcohol and other drugs Increased risk of death (25% commit suicide)
Diabulimia
People with diabetes manipulate body weight by skipping insulin injections or using less insulin than prescribed
Night-Eating Syndrome
Person consumes a considerable amount of calories after evening meal or when wakens from sleep during the overnight hours • Not followed by purging
Eating disorders
Psychological disturbances that lead to certain physiological changes and serious health complications Anorexia Nervosa • Bulimia Nervosa • Binge-eating Disorder Risk factors include: • Genetic and biological factors • Psychological and personality factors • Occupation • Lifestyle choices
Binge-Eating Disorder
Recurrent episodes of overeating that are NOT followed by purging. • Affected person eats an unusually large amount of food within a 2-hour period. Most common eating disorder in the U.S. People with BED often have other psychological disorders, including: • Bipolar Depressive Anxiety, and • Substance abuse disorders
Dual-Energy X-Ray Absorptiometry
Uses multiple low-energy x-rays to scan body • Provides detailed "picture" of internal structures, including adipose tissue (fat) deposits Problems: Very expensive and not widely available outside of clinical settings
Bulimia Nervosa
Repeated episodes of binge eating followed by purging • People typically binge on cakes, cookies, ice cream, and other high-fat, high-carbohydrate foods. • Affected person feels lack of control over eating behaviors • Conceals food binges from others • Ashamed of food-related practices and efforts to conceal them • Suffers from depression and feelings of guilt • Negative feelings about body weight & shape • Low self-esteem, depression, bipolar, & personality disorders • More common in females
use a tape measure to determine her waist circumference
Samantha would like a quick and convenient way to determine whether her distribution of body fat is unhealthy. Based on this information, she should _______.
Anorexia nervosa
Severe psychological disturbance characterized by self-imposed starvation • Fear of weight gain • Results in rapid weight loss and maintenance of unhealthy low body weight • Denial of emaciated appearance • Females are more likely to have AN than males
Anorexia Nervosa
Signs • Distorted body image • Severely restricts food intake • Overly concerned about becoming fat/gaining weight • Avoids "fattening foods" • After eating, engages in one or more purging efforts, such as: • Self-induced vomiting • Abuse of laxatives • Excessive exercise Highest mortality of any psychological disorder • Causes of death: Suicide, heart failure, alcoholism
Having some extra body fat can provide an energy reserve that enables a very ill person to survive an extended illness.
Some body fat is necessary for good health, but too much adipose tissue contributes to many chronic disorders
Metabolism
Sum of all chemical changes or reactions that constantly occur in living cells • Anabolic reactions require energy. • Catabolic reactions release energy.
Nonexercise activity thermogenesis (NEAT)
The energy expended for everything we do other than sleeping, eating, or sports-like exercise. --Involuntary skeletal muscle movements
daily energy needs
To estimate___________ , add together energy (kcal) used for: • Basal metabolism (BM) • Physical activity (PA) • Thermic effect of food (TEF)
Treating Eating Disorders
Treatment can occur in inpatient hospitalization or a in a residential facility that specializes in treatment of eating disorders. Treatment most often occurs in outpatient care settings. May require prescription medications Cognitive behavioral therapy (CBT) is a major treatment approach for BN and BED. • CBT teaches people healthy coping strategies to use when under stress.
Camille began to follow a low-carbohydrate, high-protein diet. At this point, she's lost 10 pounds, but her rate of weight loss seems to have slowed. Why does a low-carbohydrate, high-protein diet promote weight loss?
When a person's usual carbohydrate intake drops, so does the water weight that is associated with glycogen storage. A high-protein diet lowers the metabolic rate, and the body loses more water through perspiration as a result. Without adequate dietary carbohydrate, the liver makes glucose from amino acids taken from the body's tissue proteins; protein tissue contains a lot of water and dismantling that protein results in water loss in the urine.
They exercise, on average, for one hour daily, They eat low-calorie, low-fat diets, They weigh themselves once a month, They eat breakfast daily
While researching healthy ways to lose weight, Ahmed found the website of the National Weight Control Registry (NWRC). According to the site, most NWCR participants engage in certain behavior(s)
Physical activity
___________increases energy needs above basal energy needs • Voluntary skeletal muscle movements: Person can easily alter (increase or decrease) --Caloric expenditure depends on: • Type of activity • Duration • Intensity • Weight of the person
National Weight Control Registry
___________successful weight loss and maintenance involves: • Eating low-calorie, low-fat diets. • Eating breakfast every day. • Weighing at least once a week. • Exercising on average for 60 minutes each day. • Limiting television watching to less than 10 hours per week.
Biological Fuels
_________are macronutrients in foods and beverages. • Body uses a mixture of macronutrients for energy • Glucose and fatty acids are the main fuels. • Small amounts of amino acids are also metabolized for energy. • Alcohol, which is not a nutrient, also provides energy. About 40% of the energy in macronutrients is captured in the molecule ATP. Most of the energy is released as heat
Distribution
_________of excess body fat is more closely associated with obesity-related diseases than the percentage of total body fat.
Waist circumference
_______is a quick and easy way to determine obesity-related risk. Desirable circumferences: • Men < 40 inches • Women < 35 inches
Energy output
amount of fuel you expend for basic body functions, physical activity, and processing of food ---Glycogen broken down to supply glucose
CCK (cholecystokinin)
hormone secreted by small intestine that reduces hunger
Leptin
hormone, secreted by adipose cells, that reduces hunger and inhibits fat storage in the body
