Nutrition Exam 3 (Ch 14-15)
U.S. health care system spends ________ annually on obesity-associated medical conditions.
$190 billion
Americans spend over _______ annually on weight-loss solutions.
$60 billion
What are behavior modification strategies?
- Stay busy - Plan meals ahead of time and shop sensibly - Pay attention to the number of calories in food - Cook wisely - Do not serve more food than you should eat - Use portion control in the diet and when dining out - Do not eat out more than once per week; when you do, eat low-fat meals - Eat slowly and at the table only - Make a commitment to change - Set realistic goals - Exercise regularly - Exercise control over you appetite - Consume less fat in the diet - Eliminate unnecessary food items from the diet - Include calcium-rich foods in the diet - Use craving-reducing foods in the diet -Avoid automatic eating
What are the components of TDEE
-Basal Metabolic Rate (BMR) 50-70% -Physical Activity 20-35% ▪Thermic Effect of Exercise (TEE) ▪Non-exercise Activity Thermogenesis (NEAT) ▪Adaptive Thermogenesis -Thermic Effect of Food (TEF) 10%
What are the types of fat?
-Brown adipose tissue -Essential fat ▪Essential for body to function ▪Women have more essential fat (12 percent) than men (3 percent).
How to break bad habits with behavior modification?
-Change people, places, and things related to overeating and sedentary lifestyle -Focus on changing eating behaviors that contribute to weight gain or impede weight loss. ▪Keep a food journal. ▪Control environmental cues that trigger eating when hungry. ▪Reward yourself for appropriate behaviors ▪Accountability ▪Learn how to better manage stress.
Can eating disorders be treated? If so, how?
-Effective treatment requires an experienced multidisciplinary team approach, including: ▪Psychological professionals ▪Medical professionals ▪Nutrition professionals -As some eating disorders can be life-threatening, a physician should closely monitor treatment. •Registered Dietitian Nutritionist can help someone with an eating disorder establish normal eating behaviors. •Nutritional approaches include: -Meal planning -Using food journals -Identifying binge triggers, safe and unsafe foods -Recognizing hunger and fullness cues •Full recovery from eating disorders is possible and most successful when the disorder is treated in the early stages.
What are the health consequences of Anorexia nervosa?
-Electrolyte imbalances -Drop in heart rate and blood pressure, weakness and fatigue, hair loss -Slowing of the digestive process -Inadequate nutrient intake and possible deficiencies -Inability to regulate internal body temperature
What is Gynecoid obesity?
-Excess fat around the thighs and buttocks -More common in women than men Gynoid "pear-shaped" fat distribution.
What is Central obesity (android obesity)?
-Excess visceral fat in abdomen -Increases risk for heart disease, diabetes, and hypertension -Visceral fat releases inflammatory substances (cytokines) and fatty acids that travel to the liver, causing insulin resistance, increased L D L, decreased H D L, and increased cholesterol. Android "apple shaped" fat distribution.
Weight loss is due to
-Food intake is reduced, more energy is expended through exercise, or both ▪Fat loss ▪Muscle loss ▪Loss of glycogen or water
How do hormones, starvation, environmental temperature, caffeine, and drugs affect basal metabolism?
-Hormones An increase in thyroid hormone increases B M R, whereas too little of this hormone lowers B M R. Hormone fluctuations during a woman's menstrual cycle lower B M R during the phase before ovulation. -Starvation Starvation and fasting for more than about 48 hours lower B M R. -Environmental temperature Being very cold or very hot can increase B M R. The change is minimal if clothing or air temperature are adjusted. -Caffeine Caffeine can raise B M R, but only slightly when consumed regularly in moderate amounts. -Drugs Nicotine may increase B M R.* Stimulant drugs such as amphetamine and ephedrine increase B M R.
How do lean body mass, age, gender, body size, genes, race, and stress affect basal metabolism?
-Lean body mass Lean body mass, which is mostly muscle mass, is more metabolically active than fat tissue, so more kilocalories are needed to maintain it. Athletes who have a large percentage of lean body mass due to their increased muscle mass have a higher B M R than individuals who aren't athletic. -Age For adults, B M R declines about 1-2 percent per decade after the early adult years but it increases by 15 percent during pregnancy. For children, B M R increases during times of rapid growth such as infancy and adolescence. -Gender Women have less lean body mass, and typically have a higher percentage of body fat than men. This results in women having a B M R up to 10 percent lower than men's. Women also tend to have a smaller body size. -Body size Taller individuals have a higher B M R due to increased surface area compared with shorter individuals. More surface area means more heat lost from the body, which causes the metabolism rate to increase to maintain the body's temperature. -Genes Research suggests that genes may affect B M R, as individuals within families have similar metabolic rates. -Race African Americans have B M R s that are about 10 percent lower than those of Caucasians. -Stress Hormones such as epinephrine, which are released during emotional stress, increase B M R. Physiological stress on the body caused by injury, fever, burns, and infections also causes the release of hormones that raise B M R. Heat loss from the body through wounds, as well as the response of the immune system during infection, increase B M R.
What are the factors that influence BMR
-Lean body mass -Age -Gender -Body size -Genes Ethnicity -Emotional and physical stress -Thyroid hormone levels -Nutritional state -Environmental temperature -Caffeine and nicotine intake
How does genetic variation affect weight and body composition?
-Making some people less hungry and others more hungry -Making some get fuller more quickly than others. -Promote easier gain or loss of adipose -Promote more or less accumulation of visceral fat ▪This can lead to some having more insulin resistance than others making it harder to lower blood glucose
What is air displacement plethysmography (BodPod)
-Measures air rather than water displacement -Accurate within 3 percent
What is a skinfold caliper?
-Measures fat in various locations -Can be accurate if applied by a trained technician
What is Bioelectrical impedance analysis (BIA)
-Measures resistance to low energy current as it travels through muscle and body fat -Not as accurate as body density tests
What is hydrostatic weighing?
-Method to assess body volume by underwater weighing -One of the most accurate assessment tools; 2 to 3 percent margin of error
What is dual energy x-ray absorptiometry (DEXA)?
-Most accurate method; margin of error 1 to 4 percent -Uses two low-energy X-ray beams to measure bone density and body mass
What health risks are associated with being overweight?
-Overweight and obesity are associated with increased risk of heart disease, hypertension, stroke, gallstones, hyperlipidemia, sleep apnea, and reproductive problems. -Increases risk of certain cancers, including colon, breast, endometrial, and gallbladder cancer -More than 80 percent of people with type 2 diabetes are overweight. -Metabolic syndrome is associated with central obesity.
What health risks are associated with being underweight?
-Symptomatic of malnutrition, substance abuse, or disease. -Higher risk of anemia, osteoporosis and bone fractures, heart irregularities, and amenorrhea -Correlated with depression and anxiety, inability to fight infection, trouble regulating body temperature, decreased muscle strength, and risk of premature death -May be unintentional and due to malabsorption associated with diseases such as cancer, inflammatory bowel disease, or celiac disease ▪Also may be due to certain medications, smoking, and substance abuse
What are the health consequences of Bulimia nervosa?
-Tears in the esophagus -Tooth decay and gum disease from stomach acid -Electrolyte imbalances -Dehydration and constipation -Impaired normal bowel function through laxative use -Depression and low self-esteem
Nutritional genomics
-The study of how your genetic makeup interacts with your diet ▪how a genetic mutation can affect diet
What are the warning signs for eating disorders?
-Weight is below 85% of ideal body weight. ex: Even if underweight, refusal to accept and maintain current body weight -Excessive exercise. ex: Often exercises daily for long periods of time to burn kilocalories and prevent weight gain. May skip work or class to exercise -Preoccupation with food and weight. ex: Constantly worries about amount and type of food eaten and potential weight gain. May check body weight daily or several times per day. -Refusal to eat appropriate variety and/or quantity of food ex: Will avoid food in order to lose weight or prevent weight gain. May avoid only certain foods, such as those with fat or sugar. -Avoidance of social eating ex: Wants to eat alone. Makes excuses to avoid eating with others. -Diet pill use or laxative use ex: Evidence of pill bottles, boxes, or packaging -Distorted body image: ex: Does not see himself/herself as he or truly is. May comment on being over or underweight -Changes in mood ex: May become more withdrawn, depressed, or anxious, especially around food -Loss of menstrual period ex: Periods become irregular or completely absent -Hair loss ex: Hair becomes thinner and falls out in larger quantities
In the early 1960s, fewer than _____ of Americas were overweight.
32%
More than ______ of adults and ______ of children are obese.
33%, 16%
Obese individuals have a ______ to ________ percent higher risk of dying prematurely than those at a healthy weight.
50, 100
Today, ______ of Americans are overweight.
67%
It is an increased health risk with a normal BMI if:
> 35 inches in women > 40 inches in men
Other specified feeding or eating disorder (OSFED)
A pattern of disordered eating that does not meet the criteria for anorexia nervosa, bulimia nervosa, or binge eating disorder; includes orthorexia and night eating syndrome
Night eating syndrome
A type of eating, sleeping, and mood disorder -A person consumes a majority of daily kilocalories after the evening meal and wakes up during the night to eat. Characteristics of the individual ▪Typically does not have an appetite during morning hours ▪Low self-esteem, depression, and stress ▪May feel guilty, ashamed, or embarrassed while eating at night, as well as the next morning ▪Common among young adults 18 to 30 years old
Basal metabolic rate (BMR)
Amount of energy spent to meet body's basic physiological needs (breathing, shifts in blood circulation, kidney function, etc)
Orthorexia
An obsession with "healthy or righteous eating" -Often begins with a person's desire to live a healthy lifestyle -Characteristics of the individual ▪Spends most of his or her time thinking about food and how it was prepared, processed, and overall health benefits of the food ▪Typically does not obsess over calorie content of foods -Contributors to healthy food obsession ▪Eliminates foods based on learning about a negative health effect from eating the food Restrictive nature can develop into anorexia
What is used in place of BMR and why?
B M R difficult to measure, so resting metabolic rate (R M R) is often used.
What will promote satiety and reduce food intake?
Certain macronutrients, especially protein, promote satiety and reduce food intake.
Nutrition analysis software or food composition tables
Determine kilocalories consumed
When does adipose tissue release fat?
During negative energy balance. -Adipocytes shrink and weight is lost -In positive energy balance, fat accumulates and adipose cells expand
Non-exercise activity thermogenesis (NEAT)
Energy expended from activities not considered exercise (activities of daily living)
Negative energy balance
Energy expended more than energy intake
Positive energy balance
Energy intake more than energy expended
However, height and weight tables are problematic because
Height and weight tables do not represent population as a whole, original data not standardized, and constructed with assumption that weight associated with body fat.
Thermic effect of exercise (TEE)
Increase in muscle contraction that occurs during physical activity. -Amount of kilocalories you need for TEE depends on the activity performed, duration of activity, and how much you weigh.
How does knowing energy expenditure help?
Knowing energy expenditure provides basis for either establishing energy balance to maintain weight or creating an energy imbalance to gain or lose weight.
What are the health consequences of Binge eating disorder?
May cause high blood pressure, high cholesterol, heart disease, type 2 diabetes, and gallbladder disease
What are the body composition reference standards for men and women ?
Men -Essential fat= 3% -Desirable fatness for good health= 10-20% -Overfat= 25%< x of body fat Women -Essential fat= 12% -Desirable fat for good health= 16-26% -Overfat= 30%< x of body fat
Epigenetics
Modification in genes caused by environmental factors
What is used in place of height and weight tables?
Most health experts use body mass index rather than height-weight tables to determine healthy weight.
Genetics and environment influence of weight
Nutritional genomics, Nutritional genetics, Nutrigenomics and Epigenetics may influence weight control.
Binge eating disorder (BED)
Recurrent and persistent episodes of binge eating: Eating, in a discrete period of time, an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances A sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating) Binge eating episodes are associated with three (or more) of the following: Eating much more rapidly than normal Eating until feeling uncomfortably full Eating large amounts of food when not feeling physically hungry Eating alone because of being embarrassed by how much one is eating Feeling disgusted with oneself, depressed, or very guilty after overeating Marked distress regarding binge eating is present The binge eating occurs, on average, at least once a week for three months The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, or avoidant/ restrictive food intake disorder
Bulimia nervosa
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: Eating in a discrete amount of time (within a 2-hour period) large amounts of food Sense of lack of control over eating during an episode Recurrent inappropriate compensatory behavior in order to prevent weight gain (purging) The binge eating and compensatory behaviors both occur, on average, at least twice a week for 3 months Self-evaluation is unduly influenced by body shape and weight The disturbance does not occur exclusively during episodes of anorexia nervosa
Anorexia nervosa
Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health Intense fear of gaining weight or becoming fat, even though underweight Disturbance in the way one's body weight or shape is experienced, excessive influence of body weight or shape on self-esteem or denial of the seriousness of the current low body weight
What is satiety triggered by?
Satiety triggered by ventromedial nucleus.
Cholecystokinin (CKK) and peptide YY (PYY)
Secreted by small intestine to stimulate satiety
Total Daily Energy Expenditure (TDEE)
Total kilocalories needed to meet daily energy requirements
Underweight, Overweight, and Obesity measurements in adults
Underweight= <18.5 (kg/m2) Normal weight= 18.5-24.9 Overweight= 25-29.9 (10-15lbs above healthy weight) Obesity= 30-39.9 Severe obesity= >40
Waist circumference is
a quick indicator of health risk. It indicates where fat is located, not the percentage of body fat.
What is disordered eating?
abnormal and potentially harmful eating patterns. -Refusing to eat -Compulsive eating -Binge eating -Restrictive eating -Vomiting after eating -Abusing diet pills, laxatives, or diuretics
Hunger and satiety
affect desire to eat and stop eating.
Energy out
body processes and physical activity
What is hunger controlled by?
controlled by the lateral hypothalamus.
Satiety
feeling of ''fullness'' produced by consumption of food.
Energy in
foods and beverages consumed
Brown Adipose Tissue
has more mitochondria
Nutrigenomics
how diet and nutrients can affect genes
Hunger
physical sensation associated with need or intense desire for food.
What ae eating disorders?
psychological illnesses diagnosed by meeting specific criteria that include disordered eating behaviors and other factors. -Most common in young adults and adolescents, predominantly in white upper-middle- and middle-class families -Increasing among males, minorities, and other age groups
Physiological fuel values
reflect actual kilocalories transformed into energy in body. -Carbohydrate and protein: 4 kcals/gram -Fat: 9 kcals/gram -Alcohol: 7 kcals/gram
What controls feeding?
the brain and hormones
Energy imbalance results in
weight gain or loss
Number of fat cells
•Average adult has 30 to 50 billion adipocytes, which hold 0.4 to 0.5 micrograms of fat each. -Overweight or obese adults thought to have larger adipose cells (hold 0.6 to 1.2 micrograms of fat each). -Adipocytes shrink in size with weight loss but the number of cells does not decrease. -After weight loss, small fat cells readily filled with excess energy. -Fat growth and production of cells continue throughout life, but hyperplasia slows with age.
Adaptive Thermogenesis
•Body's regulation of heat production influenced by environmental changes such as stress, temperature, or diet -All result in change in metabolism. •Some researchers think it explains why two people can have similar diets and exercise patterns but differing body compositions.
Thermic Effect of Food (TEF)
•Energy used to process macronutrients and extract kilocalories from food (digestion and absorption) -Ten percent of kilocalories in food consumed. ▪Meals high in protein have greater TEF than those high in carbohydrate, which have greater TEF than those high in fat. -TEF is influenced by: ▪Type of nutrients consumed, composition of meal, alcohol intake, age, and athletic training status
How do fat cells grow and shrink?
•Enzymes control size of fat cells. -Lipoprotein lipase (LPL) increases lipogenesis. -Hormone-sensitive lipase (HSL) stimulates lipolysis. •Heavier people have increased LPL activity. -Men: LPL more active in visceral, abdominal fat cells Women: LPL activity higher in hips and thighs
Gaining Weight
•Gaining weight is challenging for those who are underweight. •Goal is to gain muscle, not all fat. •Methods to do this -Add 500 kilocalories in addition to daily energy intake. ▪Adds about one pound of extra body weight per week -Choose more energy-dense foods. -Include regular exercise and resistance training.
How does genetics influence the desire to movement and thermogenesis?
•Genes can dictate the inclination to move one's body -Fidgeters vs Non-Fidgeters •Also some genetically have more thermogenesis than others
Adipose Cells (Fat Cells)
•Growth of fat cells (adipocytes) occurs in two ways. -Can expand to store more fat (hypertrophy) -Once filled to capacity, stimulate the production of more fat cells (hyperplasia)
How can you estimate healthy body weight?
•Height and weight tables can provide a healthy weight range. -Provide a recommended desirable weight range for a given height based on gender and frame size
What does AMA consider obesity a disease?
•In 2013, American Medical Association declared obesity a "disease." •Benefits to declaring it a disease -Provides a clear warning of health hazards of being overweight -May make it easier for individuals to get insurance coverage for treatment -More research funding may be allocated to addressing the obesity problem in the United States. •Downside to declaring it a disease -It may encourage more use of drugs and medical procedures to address the epidemic rather than encouraging lifestyle changes.
Environmental factors
•Our current environment makes easier to have positive energy balance and gain weight. •Environmental factors involved with obesity -Lack of time ▪Most kilocalorie intake is from foods eaten away from home. ▪Dining out frequently is associated with a higher B M I. ▪Individuals who dine out are less likely to choose fruits and vegetables when they order. •Abundant food supply and portion distortion -People have easier access to food. -People eat or drink more when given larger portions. -People eat or drink more when the food is presented in a larger bowl, plate, or package. •Lack of physical activity and increased sedentary behavior -People do less manual labor in their jobs. -The more people drive, the less they engage in physical activity. -More time is spent in front of the T V or computer. •Genetics loads the gun and environment fires it -Genetic tendency can be overcome by lifestyle and environment manipulations -If it takes a lot more volume to feel full then eat high fiber which are more filling -If you have insulin resistance tendency then move more, keep calories controlled, eat less refined CHO
How does being overweight or underweight carry social and psychological risks.
•Overweight people treated differently from people at a normal weight. -Suffer more discrimination -More likely to be denied job promotions and raises -Obese females are less likely to be accepted into college, especially higher ranked colleges. -People perceive them as lazy or weak-willed. •Obese people have higher rates of suicide and are more likely to use drugs and alcohol. •Individuals who are underweight are more likely to be at greater risk for: -Irritability -Anger -Depression
Bariatric surgery or gastric bypass surgery
•Post surgery -Consume small, frequent meals. -Supplement: Iron, vitamin B12, calcium and vitamin C •Weight loss -Five to 15 l b s per week in the first 2 to 3 months -One to 2 l b s per week after first 6 months •Eliminates -Diabetes (76.8 percent) -Hypertension (70 percent)
What is body composition?
•Ratio of fat tissue to lean body mass (muscle, bone, and organs) -Usually expressed as percent body fat -Important for measuring health risks associated with too much body fat
Weight control strategies
•Reasonable rate of weight loss. -Lose 10 percent of body weight over six months. ▪1-2 lbs / week -Modify diet, physical activity, and behavior. •Remember that kilocalories count. -Choose lower kilocalorie foods. -Reduce portion sizes. -Increase kilocalories burned. •Eat more vegetables, fruit, and fiber. •Be mindful. Avoid mindless eating. •Add volume to meals: water, whole grains, fruits and veggies •Eat lower energy density foods •Add some protein and fat to meals. -Protein promotes satiety. ▪Focus on lean protein. -Fat slows movement out of the stomach. ▪Focus on healthy fats in moderation. ▪Limit fats high in saturated-fats. •Increase physical activity to lose weight. -Increases kilocalories burned and displaces sedentary activity -Sixty to 90 minutes daily of moderate-intensity physical activity to aid in weight loss, prevent weight gain -Incorporate cardiorespiratory and strength-training activities. -Move more in everything you do. ▪10,000 steps per day
Measuring Energy Expenditure
•Simple calculations can estimate total energy expenditure. -Based on age, gender, height, weight, and level of physical activity -Estimated energy requirement (EER)
How to maintain weight?
•Successful weight maintainers -Maintain the energy-gap reduction in kilocaloric need to maintain the weight loss. ▪Reduce kilocalorie intake by decreasing portions and fatty foods. ▪Eat smaller, more frequent meals; make sure it does not turn into "grazing." ▪Maintain a high level of physical activity. -Weekly self-weighing can help individuals maintain their weight loss. -Accountability Relapse prevention
Why weight management?
•Weight management is maintaining body weight within healthy range (BMI of 18.5 to 24.9). •Healthy weight is body weight that does not increase risk for developing weight-related health problems or diseases. •Healthy weight lowers risk for chronic disease.
Medical Interventions for Extreme Obesity
•Weight-loss medications -Sibutramine (Meridia) ▪Suppresses appetite -Orlistat (Xenical) ▪Inhibits fat absorption -Lorcaserin ▪Stimulates satiety and may reduce food intake •Evaluate the side effects of all weight loss medications to determine if experiencing these effects are worth taking the drug. •Must stay on to keep weight off
BMI is not
•a direct measure of percent of body fat. •accurate for everyone. -Athletes and some individuals: BMI > 25 but have high muscle mass and low body fat -Older adults with chronic weight loss: May have healthy BMI but significant loss of muscle mass and depletion of nutrient stores Individuals less than 5 feet in height may have a high BMI, but not be unhealthy
Body Mass Index (BMI)
•calculates body weight in relation to height. -Useful screening tool to determine an individual's risk for disease -BMI = [Weight (lbs)/Height (inches)2 ] x 703 -Example: 175 lbs, 5'10" (70 inches) BMI = [175/70x70] x 703= 25
Appetite
•desire to eat food whether or not there is physical hunger. -Triggered by factors such as time of day, social occasions, emotions, or the sight or smell of food
Energy varies for individual based on:
▪Basal metabolism ▪Thermic effect of food (TEF) ▪Thermic effect of exercise (TEE) ▪Non-exercise Activity Thermogenesis (NEAT) ▪Adaptive thermogenesis
Stored fat
▪Found in adipose tissue ▪Subcutaneous fat is located under the skin. ▪Visceral fat stored around the organs in abdominal area. -Insulates body from cold temperatures -Protects and cushions internal organs
Leptin
▪Produced in adipose tissue ▪Decreases hunger and food intake ▪Regulates amount of fat stored ▪Decreases with weight loss and intake of certain vitamins and minerals ▪Drop in leptin when adipose tissue shrinks stimulates hunger
Neuropeptide Y
▪Produced in hypothalamus and activated by ghrelin ▪Stimulates hunger and LPL activity
Ghrelin
▪Secreted by stomach ▪Increased production tells hypothalamus body needs energy. ▪Stimulates hunger during fasting or on a low-kilocalorie diet ▪Lean individuals have higher ghrelin levels.
Weight gain is due to
▪increased muscle mass, increased adipose tissue, or both ▪Periods of growth: Pregnancy, childhood, and adolescence