Energy Balance Exam

Recall approximately how many kcal/d young adult men and women need.

2500/d for men and 2000/d for women the average woman requires approximately 1800 to 2400 kcal and the average male requires 2200 to 3000 kcal

What is the difference between physical activity and exercise?

Physical activity is all movements of skeletal muscles while exercise is planned, repetitive and intended to improve physical fitness

What are the four components of energy intake?

Protein, carbohydrates, fat and alcohol

Limitations of BMI

Recognize that BMI is a convenient screening tool, but it does not actually measure body composition (i.e., the relative amounts of lean and fat mass in the body).

What proportion of adults in the United States have a BMI ≥25?

over 65% of all North American adults are overweight

What is a safe and sustainable rate of weight loss (pounds per week)?

1-2 lbs

Physical activity increases energy expenditure by how much beyond basal metabolism?

15-35%

Define healthy weight in terms of BMI

18.5-24.9

Define overweight in terms of BMI

25-29.9

Define obese in terms of BMI

30-39.9

Define underweight in terms of BMI

<18.5

Suggest some healthful strategies to increase body weight.

A combination of high-quality nutrition and strength training is needed to gain weight as muscle. Strength training slows muscle loss that comes with dieting and aging, increases the strength of your muscles and connective tissues, and increases bone density. When weight is lost, up to a quarter of the loss may come from muscle mass, which can slow basal metabolism. Immediately before and again after strength training, a serving of high-quality protein should be consumed to optimize performance and build lean muscle mass. It is also important to have some carbohydrate along with protein to increase the protein absorption, replete glycogen stores, and provide future fuel for workouts.

What happens to body weight if you have negative energy balance?

A decrease in weight change

What compound can be directly broken down to supply energy for cells?

ATP

What is the difference between aerobic and anaerobic?

Aerobic needs oxygen while anaerobic does not

Recall the amount of physical activity (minutes per week) recommended for all adults, according to the Physical Activity Guidelines for Americans.

Although some adults will need a higher level of physical activity than others, it is recommended that adults perform a minimum of 150 minutes of moderate-intensity aerobic activity each week to achieve and maintain a healthy body weight. Some individuals may need more than the equivalent of 300 minutes per week.

What happens to body weight if you have positive energy balance?

An increase in weight change

Explain the differences between android and gynoid body fat distribution. Which is most common among men with excess body fat? Which one is more dangerous in terms of risks for chronic disease?

Android body fat distribution is upper body obesity while gynoid is lower body obesity. Android is most common among men Android/upper body is more dangerous

What are the "big two" factors that influence body weight regulation?

Both genetic (nature) and environmental (nurture) factors can increase the risk for obesity

For short bursts of intense exercise, do the muscle cells rely mainly on the breakdown of carbohydrates, fats, or proteins to supply ATP?

Carbohydrates

Why is hydration so important for athletes?

Fluid needs for an average adult are about 9 cups per day for women and 13 cups per day for men. Athletes generally need even more water to regulate body temperature. Heat production in contracting muscles can rise 15 to 20 times above that of resting muscles. Unless this heat is quickly dissipated, heat exhaustion, heat cramps, and potentially fatal heatstroke may ensue.

How much protein do athletes need?

For athletes, the American College of Sports Medicine, the Academy of Nutrition and Dietetics, and the Dietitians of Canada recommend protein intake within the range of 1.2 to 2.0 grams of protein per kilogram of body weight.

What are some good food sources of iron?

Meat, poultry, seafood, tofu and dark leafy greens

Who should seek a physician's advice before beginning an exercise program?

Men aged 40 years or older and women aged 50 years or older, Page 478anyone who has been inactive for many years, or those who have an existing health problem should discuss their fitness goals with their primary care provider before increasing activity.

What is the most accurate method for assessing body composition?

Underwater weighing

Is it possible to drink too much water? What is this condition called?

Yes. Hyponatremia

What proportion of adults in the United States have a BMI ≥30?

about 50% (36% of the total population) are obese

Which macronutrient should make up the largest proportion of energy intake for athletes?

carbohydrates

Who are very-low-calorie diets, and bariatric surgery are typically reserved for?

clients with BMI ≥ 40 kg/m2 (or BMI ≥ 35 kg/m2 with comorbidconditions).

For lower-intensity, longer-duration exercise, what are the two main macronutrients that are broken down to supply ATP?

fats and carbohydrates

resting metablic rate (RMR) is ____ basal metabolic rate (BMR)

higher than

What are some good food sources of calcium?

milk, cheese and other dairy foods. green leafy vegetables - such as broccoli, cabbage and okra, but not spinach. soya beans. tofu.

What are the main ingredients of sports drinks and what is the purpose of each?

simple carbohydrate plus sodium and potassium

Define underweight in terms of BMI.

BMI less than 18.5

What are the three key elements of a sound weight-loss program?

(1) controlling calorie intake, (2) performing regular physical activity, and (3) engaging in positive behaviors. Decrease calorie intake by approximately 500 kcal per day to allow for slow and steady weight loss. Increase physical activity to the equivalent of more than 150 minutes of moderate-intensity aerobic activity each week. Make positive behavior changes to sustain lifestyle modifications promoting health.

Describe the characteristics of a sound fitness program.

5 days of Aerobic fitness 20-60 minutes/day 2-3 days of muscular fitness 1 to 3 sets of 8 to 12 repetitions of 8 to 10 different exercises 2-3 days of flexibility exercises 2 to 4 repetitions of 8 to 10 different exercises, held for 15 to 30 seconds each

How much of a calorie deficit (i.e., kcal/d) does it take to lose about 1 pound per week?

500 kcal

Describe how bariatric surgeries can induce weight loss.

Adjustable gastric banding adjustable gastric banding A restrictive procedure in which the opening from the esophagus to the stomach is reduced by a hollow gastric band. (also known as the lap-band®procedure) is a restrictive procedure in which the opening from the esophagus to the stomach is reduced by a hollow gastric band. This creates a small pouch and a narrow passage into the rest of the stomach and thus decreases the amount of food that can be eaten comfortably. The band can be inflated or deflated via an access port placed just under the skin.Studies have shown that adjustable gastric banding is more effective long term than a very-low-calorie diet (400 to 800 kcal) for people who are about 50 pounds overweight. Page 262 Gastric bypass (also called gastroplasty or stomach stapling) is another bariatric surgical procedure used for treating severe or morbid obesity. The most common bariatric procedure is vertical sleeve gastrectomy (VSG) followed by the Roux-en-Y gastric bypass (RYGBP). RYGBP works by reducing the stomach capacity to about 30 milliliters (the volume of one egg or a shot glass) and bypassing a short segment of the upper small intestine.

Besides the "big two," what other factors may influence body weight regulation?

Age Excess body fat is more common in adults and middle-age individuals due to loss of lean body mass and reduction in physical activity. Menopause Hormonal changes result in increased abdominal fat deposition. Gender Females have more fat mass than males due to less lean body mass and reduced surface area. Energy balance Over a long period, dietary patterns consistent with positive energy balance promote storage of excess body fat. Dietary consumption Excess calorie intake from saturated fat, alcohol, and calorie-dense foods and beverages contribute to obesity. Physical activity Sedentary behavior leads to positive energy balance and promotes body fat storage. Basal metabolism A low BMR due to factors such as thyroid problems or energy restriction is linked to weight gain. Thermic effect of food Some obese individuals metabolize nutrients more efficiently, and thus expend fewer calories for digestion and absorption. Increased hunger sensations Some individuals appear to have blunted satiety, which may be linked to various brain signals involved in food reward pathways. Ratio of fat to lean tissue A high ratio of fat mass to lean body mass is correlated with weight gain. Fat uptake by adipose tissue Efficiency of fat storage is high in some obese individuals and may even increase with weight loss. 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; and meals eaten away from home. Genetic predisposition Genetic factors may affect energy expenditure, deposition of adipose tissue or lean tissue, and the relative proportion of fat and carbohydrate used by the body. Ethnicity In some groups, higher body weight may be more socially acceptable, which may promote overeating. Certain medications Increased hunger/appetite can be a side effect of many medications. 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. 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.

Explain why it is important to pay attention to beverage choices when it comes to weight change.

Drinking a glass of water can also help decrease hunger pangs between meals. Some drinks are more nutritious and some have a higher energy density

Which athletes benefit most from using sports drinks?

As the projected duration of continuous activity approaches 60 minutes or longer, the advantages of sports drinks over plain water clearly emerge.

What is sports anemia?

At the start of an endurance training regimen, plasma volume expands, but the synthesis of additional red blood cells is slower to increase. This results in dilution of the blood; even if iron stores are adequate, blood iron tests may appear low. Sports anemia is not detrimental to performance, but it is hard to differentiate between sports anemia and true anemia. If iron status is low and not replenished, iron-deficiency anemia can markedly impair endurance performance.

Are there any specific RDAs for micronutrients for athletes?

At this time, there are not enough data to support separate DRIs specific to athletes for any of the micronutrients, but research continues

Patient selection criteria for bariatric surgery include:

BMI >40 BMI >35 when accompanied by obesity-related comorbidities. Obesity present for a minimum of 5 years, with failure of nonsurgical weight loss. Absence of contraindications (medical). No history of alcoholism or major untreated psychiatric disorders. Well-informed, compliant, and motivated patient.

What are the four components of energy expenditure?

Basal metabolism, thermic effect of food (TEF), physical activity and adaptive thermogenesis

When it comes to weight management, recognize that duration and consistency are more important than intensity of physical activity.

Calorie burning is enhanced both during and after physical activity. Therefore, activity greatly complements a reduction in calorie intake for weight loss. Many of us rarely do more than sit, stand, and sleep. More calories are used during physical activity than at rest. Expending only 100 to 500 extra kilocalories per day above and beyond normal daily activity, while controlling calorie intake, can lead to a steady and sustained weight loss.

What are some possible causes of underweight?

Can be caused by a variety of factors, such as cancer, infectious disease (e.g., tuberculosis), digestive tract disorders (e.g., chronic inflammatory bowel disease), and excessive dieting or physical activity.

Which is the biggest component of energy intake?

Carbohydrates

What is EER? You don't need to memorize the equation, but list the five factors that are included in the equation.

Estimated Energy Requirement EER = Estimated Energy Requirement AGE = age in years PA = physical activity estimate (see following table) WT = weight in kilograms (pounds divided by 2.2) HT = height in meters (inches divided by 39.4)

What is the best way to determine if an athlete is consuming enough calories?

Estimating daily intake from a food diary kept by the athlete is one way. Another option is to estimate the athlete's body fat percentage via skinfold measurements, bioelectrical impedance, or underwater weighing (review Section 7.3). Body fat should be the typical amount found for athletes in the specific sport practiced. This corresponds to 5% to 18% for most male athletes and 17% to 28% for most female athletes. The next step is to monitor body weight changes on a daily or weekly basis. If body weight starts to fall, calories should be increased; if weight rises and it is because of increases in body fat, the athlete should eat less.

What are the different types of exercise recommended by the Physical Activity Guidelines?

For substantial health benefits, adults should do at least 150 minutes per week of moderate-intensity, or 75 minutes per week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the week.

Know how to calculate body mass index (BMI)

body weight (in kilograms)/height(squared) (in meters) weight (pounds) × 703/height(squared) (inches)

How do lean mass, biological sex, body temperature, thyroid hormone levels, metabolic stress, and growth affect basal metabolic rate?

Greater lean body mass Larger body surface area per body volume (e.g., for a given weight, a tall person has greater body surface area compared to a short person) Male gender (caused by greater lean body mass) Body temperature (fever or cold environmental conditions) Thyroid hormones (elevated or hyperthyroid condition) Stress (release of norepinephrine) Pregnancy Caffeine and tobacco use (Using the practice of smoking to control body weight is not recommended as too many health risks are increased.)

What is mindful eating?

In contrast, the principles of mindful eating include being aware of the entire eating experience from food preparation to consumption, including recognizing and respecting the physical hunger and satiety cues, and being wise in eating decisions.

Of the interventions described in this section, which has the best long-term success?

In terms of long-term weight-loss success, bariatric surgeries have the best results of any intervention. Weight-loss statistics vary by surgical method, but on average, about 75% of people with severe obesity eventually lose and keep off 50% or more of excess body weight. In addition, many patients experience significant improvements in blood sugar, cholesterol, and blood pressure.

Why is iron particularly important for athletes?

Iron is involved in red blood cell production, oxygen transport, and energy production, so a deficiency of this mineral can noticeably detract from optimal athletic performance. Some of the consequences of iron deficiency include weakness, fatigue, and decreased work capacity.

How does EER change as adults age?

It decreases?

Describe very-low-calorie diets. Are these effective for long-term weight management? Why or why not?

Known also as protein-sparing modified fast (PSMF), this diet allows a person less than 800 calories per day, often in liquid form. Of this, 120 to 480 calories are typically from carbohydrate, and the rest are mostly from high-quality protein. The VLCD is dangerous because of its rapid weight loss and potential for severe health complications, including heart problems and gallstones. Often providing less than 800 kcal per day, all VLCD programs should be administered under strict medical supervision, as careful monitoring by a trained clinician is crucial throughout this very restrictive form of weight loss.

What are some characteristics of an effective and sustainable weight-loss program?

Label reading Controlling hunger Understanding that healthy weight loss is slow

Is the dietary guidance for fat intake any different for athletes than for the general population?

Not really the AMDR is 20-35% of fat and up to 35% for athletes

What does recent research say about the 3500-kcal rule?

PLANT-BASED DIETARY PATTERN PROMOTES HEALTHY BODY WEIGHT Over 146,000 participants from the Nurses' Health Study (NHS), Health Professionals Follow-Up Study (HPFS), and Nurses' Health Study II (NHS II) were assessed for the effect of diet quality over time on body weight. Healthy diet quality scores were correlated with greater intakes of fruits and vegetables, whole grains, and nuts. Subjects who had greater adherence to a plant-based dietary pattern, especially younger women or overweight individuals, gained significantly less weight over a 4-year period. The results of this study underscore the importance of healthy dietary patterns in promoting healthy body weight.

How is self-monitoring important for weight management?

Self-monitoring can reveal problem eating behaviors—such as unconscious overeating—that may lead to weight gain. Records of dietary and physical activity behaviors can encourage new habits that will counteract unwanted behaviors. Obesity experts note this is the key behavioral tool to use in any weight-loss program

What is glycogen?

Storage form of glucose in the liver and muscle cells

List some health conditions that are linked to excess body fat.

Surgical complications Increased anesthesia needs; greater risk of wound infections (decrease in immune function) Pulmonary disease and sleep disorders Excess weight stressing the lungs and pharynx Type 2 diabetes Enlarged adipose (fat) cells poorly bind insulin and inadequately respond to insulin signals; reduced synthesis of factors that promote insulin action and increased synthesis of factors that counter insulin action 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 Cardiovascular disease (e.g., coronary heart disease and stroke) 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 Bone and joint disorders (including gout) Excess pressure placed on knees, ankles, and hip joints Gallstones Increased cholesterol content of bile Skin disorders Accumulation and trapping of moisture and microorganisms in tissue folds Various cancers Estrogen and other hormones contribute to tumor growth by adipose cells; increased hyperinsulinemia or insulin resistance; systemic inflammation associated with cancer risk; excess calorie intake may encourage tumor development (animal studies) Shorter stature (in some forms of obesity) Earlier onset of puberty Pregnancy risks More difficult delivery; increased birth defects and gestational diabetes; greater anesthesia needs Reduced physical agility and increased risk of accidents and falls Excess weight impairs physical movement and gait Menstrual irregularities and infertility Hormone imbalances; insulin resistance; increased oxidative stress Vision problems Higher rates of cataracts and other eye disorders Premature death Comorbidities and greater risk factors for numerous chronic diseases and complications Infections Reduced immune system activity Liver damage and eventual failure Excess fat accumulation in the liver (fatty liver) Erectile dysfunction in men Low-grade inflammation caused by reduced function of the cells lining the blood vessels and impaired blood circulation

How would you define physical fitness?

The ability to perform moderate to vigorous activity without undue fatigue.

How is energy density of food related to weight change?

The concept of energy density can help dieters choose more nutrient-rich foods with fewer calories per gram. With this technique, we can fill our plates with larger portions of low-energy-density foods, which are low in calories but high in volume. These low-energy-density foods enable us to eat fewer calories without eating less volume and help us feel full and satisfied while we are losing weight. Fruits and vegetables are great examples of low-energy-density foods.

Why is long-term follow-up important for clients who undergo bariatric surgery for weight loss?

The risks of bariatric surgery are serious and include death and both early and late postoperative complications, such as bleeding, blood clots, hernias, electrolyte imbalances, and severe infections. Risk of death from these demanding and complex surgeries can be as high as 2%. These risks depend on many factors related to the surgeon and facility, the Page 263patient, and the procedure.

Name some red flags to help you identify unreliable (fad) diets.

They promote rapid weight loss. This is the primary temptation that attracts the dieter. As mentioned, this initial weight loss primarily results from water loss and lean muscle mass depletion. They often limit food selections and dictate specific rituals, such as eating only fruit for breakfast or cabbage soup every day. They use testimonials from famous people and tie the diet to well-known cities, such as Beverly Hills or South Beach. They bill themselves as cure-alls. These diets claim to work for everyone, whatever the type of obesity or the person's genetic or environmental makeup. They often recommend expensive supplements or meals. No attempts are made to change eating habits permanently. Dieters follow the diet until the desired weight is reached and then revert to old behaviors; they are told, for example, to eat rice for a month, lose weight, and then return to old habits. They are generally critical of and skeptical about the scientific community. The lack of a quick fix from medical and dietetic professionals has led some of the public to seek advice from those who appear to have the answer. They claim that there is no need to exercise. Probably the cruelest characteristic of these diets is that they essentially guarantee failure for the dieter. Fad diets are not designed for permanent weight loss. Habits are not changed, and the food selection is so limited that the person cannot follow the diet in the long run.

Can you build muscle mass simply by eating extra protein?

To date, there is little evidence that protein intake above 2.0 grams per kilogram of body weight will benefit the athlete. Protein intakes above this amount result in an increased use of amino acids for energy needs; no further increase in muscle protein synthesis is seen.

How does an athlete know he or she is getting enough fluid?

To determine fluid needs, the athlete should first calculate 2% of his or her body weight. Next, it is useful to know the body's hourly sweat rate, which can be calculated by comparing weight loss during exercise to the amount of fluid consumed during exercise. This will require some self-monitoring of pre- and post-workout weight and fluid intake during workouts. For reference, sweat rates during prolonged exercise can range from 3 to 8 cups (750 to 2000 milliliters) per hour. If weight change cannot be monitored, urine color is another measure of hydration status (see Fig. 9-8). Urine color should be no more yellow than lemonade.

What is self-monitoring?

Tracking foods eaten and conditions affecting eating; actions are usually recorded in a diary, along with location, time, and state of mind. This is a tool to help people understand more about their eating habits.

Recall the cutoffs for waist circumference that indicate increased risk for chronic diseases for men and women.

Upper-body obesity is assessed by measuring the circumference of the abdomen at the waist. A waist circumference more than 40 inches (102 centimeters) in men and more than 35 inches (88 centimeters) in women indicates risk for upper-body obesity

What are some simple ways to assess the intensity of exercise?

Use a heart rate monitor Another way of determining the intensity of exercise is the Rating of Perceived Exertion (RPE) scale. One version includes a range of 0 to 10, with each number corresponding to a subjective feeling of exertion. For example, the number 0 is "nothing at all" (e.g., sitting at a table), and the number 10 is considered close to maximal effort or "very, very strong" Intensity is how hard you work when you exercise—that is, how much you increase your heart rate or how much resistance you use when you lift weights.

There are many weight-management strategies. What works for one person may not work for another person.

When evaluating a "diet," consider these two factors: 1.) Is it nutritionally adequate? 2.) Can it be maintained over time?

How could mindful eating assist efforts in weight management?

Why do I eat? When do I want to eat? What do I eat? How do I eat? How much do I eat? Where does the energy go? A key component of mindful eating is a nonjudgmental awareness of eating patterns that will hopefully lead to a healthier relationship between you and food.

Identify some sports that tend to increase risks for disordered eating.

athletes who competed in sports with weight classes (e.g., wrestlers, boxers, judoists, and oarsmen) would try to lose weight before a competition.

Why is calcium particularly important for athletes?

greater concern are women athletes who have stopped menstruating because their arduous training and low body fat interferes with the normal secretion of reproductive hormones. Disturbing evidence shows that female athletes who do not menstruate regularly have spinal bones far less dense than those of both nonathletes and female athletes who menstruate regularly. They are more likely to suffer stress fractures during training and will be susceptible to bone injuries throughout life.