Exam 2 lecture 2 chapter 11 obesity

the largest number of calories expended by most people except for athletes during heavy training is from the

resting metaboloc rate 67% activity 23% TEF 10%

stats on preschoolers and teenagers for obesity

1/3 of preschoolers become obese as adults 80% of teanagers become obese school age 50%

BMI for normal, overweight, obese

18.5-24.9 25-29.9 30+

% of adults who tried to loose weight in previous year

33.8% men 47.9% women 55.5% obese men 63.6% obese women

during caloric restriction (dieting) the resting RMR......... the fat free mass....... with degree of decrease depending on the severity of the energy decrease

drops 5-30% drops 10-50%

how to estimate obesity

obesity can be estimated by using a mathematical formula called the body mass index (BMI) -weight in kilograms divided by height in meters squared (BMI= kg/m^2)

diagnositc criteria for anorexia nervosa

refusal to maintain normal body weight (85% of expected) intense fear of gaining weight or becoming fat, even though underweight -body image disturbed - amenorrhea 3 consecutive cycles

misconception #1 aerobic exercise accelerates weight loss significantly when combined with a reducing diet

some obese people have been led to believe that if they start brisk walking 2-3 miles/day or workout for 30-45 min day significant amount of body weight will be lost quickly this is not true

what was the 90day study of obese females

-90day study of 69 obese females all on 530 kcal/day formula aerobics -4day/week 20 min progressing to 60 min/sessions weights 4 days a week a d 2-3 sets of 6-8 reps

binge eating disorder

-About 25%-50% of obese people suffer from binge eating, defined as consuming large amounts of food at one sitting while feeling out of control. -Binge eating disorder is diagnosed using these criteria: -During a binge eating episode, large amounts of food are eaten rapidly until feeling uncomfortably full, often while alone because of embarrassment. -The amount of food eaten is definitely larger than most people would eat in a similar period of time, and there is a feeling that one cannot stop eating or control what or how much one is eating. -The binge eater experiences feelings of disgust, depression, and extreme guilt after overeating. -The binge eating occurs, on average, at least two days a week for six months. -Binge eating is NOT associated with purging, fasting, or excessive exercise

risk factors for bulimia nervosa

-Childhood obesity -Early onset of menarche -Weight concern -Perfectionism -Low self-esteem -Social pressure about weight and eating -Family dieting -Eating disorders among family members -Inadequate parenting -Parental discord -Parental psychopathology -Childhood sexual abuse -Chronic illnes

risk factors for anorexia nervosa

-High parental education and income -Early feeding problems Low self-esteem High neuroticism Maternal over-protectiveness Eating disorders among family members

exercise prescription guidelines

-Initially, moderate levels of physical activity for 30 to 45 minutes, 3 to 5 days per week, should be encouraged. -Starting a physical activity regimen may require supervision for some obese people. The need to avoid injury during physical activity is a high priority. -Extremely obese persons may need to start with simple exercises that can be intensified gradually. For most obese patients, physical activity should be initiated slowly, and the intensity should be increased gradually. -Initial activities may be increasing small tasks of daily living. With time, the patient may engage in more strenuous activities. -A regimen of daily walking is an attractive form of physical activity for many people, particularly those who are overweight or obese. -The patient can start by walking 10 minutes, 3 days a week, and can build to 30 to 45 minutes of more intense walking at least 3 days a week and increase to most, if not all, days. -All adults should set a long-term goal to accumulate at least 30 minutes or more of moderate-intensity physical activity on most, and preferably all, days of the week. -Reducing sedentary time is another approach to increasing activy ►Over short periods of time, such as a year, research shows that it is possible to achieve weight stability by doing the equivalent of 150-300 min/wk moderate-intensity walking at about a 4 mph pace. Muscle-strengthening activities may help promote weight maintenance, although not to the same degree as aerobic activity .►People who want to lose a substantial (>5% body weight) amount of weight and people who are trying to keep a significant amount of weight off once it has been lost need a high amount of physical activity unless they also reduce their caloric intake. Many people need to do more than 300 min/wk moderate-intensity activity to meet weight-control goals. ►Regular physical activity also helps control body fat % in children and adolescents. Exercise training studies with overweight and obese youth have shown that they can reduce their body fatness by participating in physical activity that is at least moderate intensity on 3-5 d/wk, for 30-60 min

diagnostic criteria for bulimia nervosa

-Recurrent episodes of binge eating (defined as eating a large amount of food within 2 h while feeling a lack of control) -Recurrent inappropriate compensatory behavior to prevent weight gain (vomiting, laxatives, diuretics enemas, medications, fasting, excessive exercise) -Binge eating and purging occur on average at least 2x/wk for 3 months -Body image disturbanc

weight loss drugs

-Weight Loss Drugs The NHLBI Obesity Education Initiative promotes FDA-approved weight loss drugs for long-term use as an adjunct to diet and physical activity for patients with a BMI≥30 and without concomitant obesity-related risk factors or disease. - Drug therapy may also be useful for patients with a BMI ≥27 who also have concomitant obesity-related risk factors or diseases. -In general, drugs should be used only as part of a comprehensive program that includes behavior therapy, diet, and physical activity. Appropriate monitoring for side effects must be continued while drugs are part of the regimen. Since obesity is a chronic disease, the short-term use of drugs is not helpful. The health professional should include drugs only in the context of a long-term treatment strategy.

stats on obesity

Women > men mexican women >white women black women > white women black males >white males mexican male< white males black women significantly more

equation example for women 40 years old, 65 inches, 140 lbs

Women: 65 inches x 0.0254 = 1.65 meters 140 pounds x 0.4536 = 63.5 kg BMR (kcal/day) = 247 -(2.67 x age) + ( 401.5 x height) + (8.6 x weight) BMR (kcal/day) = 247 -(2.67 x 40 yr) + (401.5 x 1.65 m) + (8.6 x 63.5 kg) = 1,349

physical activity decreases in the direct relationship to the

degree of obesity

RMR estimation through equations

BMR prediction equations have been developed using easily and accurately measurable variables such as age, height, and body weight - the food nutrition board of the institute of medicine recently developed these equations for estimating BMR in adults Men: BMR (kcal/day) = 293 -(3.8 x age) + (456.4 x height) + (10.12 x weight) Women: BMR (kcal/day) = 247 -(2.67 x age) + (401.5 x height) + (8.6 x weight) -[Age is in years, height is in meters, and weight is in kilograms

high energy intake

- 3-7 day food record show that energy intake was similar between obese and non-obese people -obese people tend to underestimate intake by 20-50% - use of respiratory chambers and doubly labeled water show that obese people both extend and ingest more energy -when dietary fat intake is high, most adults and children tend to gain weight easily and quickly -obese compared to lean people tend to choose high fat and energy rich foods more often -high fat foods are more palatable prompting people to take in more energy

treatment of obesity is challenging

- about 1/3 of men and 1/2 women tried to loose weight in previous years -among adults trying to loose weight, only one in 5 follow 2 key recommendations, eat fewer calories, and increase physical activity - many obese people will not stay in treatment, and of those who do, most will not achieve ideal weight, of those who lose weight will regain it - regular exercise is a marker of long term success in maintaining weight loss

the surgeons general call to action to prevent and decrease overweight and obesity

-The Nation must take action to assist Americans in balancing healthful eating with regular physical activity. Individuals and groups across all settings must work in concert to: -Ensure daily, quality physical education in all school grades. -Reduce time spent watching television and in other similar sedentary behaviors. -Build physical activity into regular routines and playtime for children and their families. -Create more opportunities for physical activity at worksites. -Make community facilities available and accessible for physical activity for all people. -Promote healthier food choices, including at least 5 servings of fruits and vegetables each day, and reasonable portion sizes at home, in schools, at worksites, and in communities

health risks of obesity

-a psychological burden -increased high bp -dyslipidemia (high cholesterol, triglycerides, LDL-C, low HDL-c) -increased risk of callstones -increased osteoarthritis -increased diabetes -increased cancer (colon, rectum, prostate, pancreas, liver, kidney, breast, uterus, ovaries, gallbladder, bile ducts -increased mortality and early deaths -increased heart disease and stroke

how to lose weight: the NHLBI obesity education initiative

-in 1998, the first federal guidelines for the treatment of overweight and obesity in adults were released by the National Heart, Lung, and Blood Institute (NHLBI) as a part of their nationwide Obesity Education Initiative. -Key diet recommendations from this initiative include the following: -The initial goal of a weight loss regimen should be to reduce body weight by about 10%. With success, further weight loss can be attempted, if needed. -Weight loss should be about 1 to 2 pounds per week for a period of 6 months, with additional plans based on the amount of weight loss. Seek to create a deficit of 500 to 1,000 calories per day through a combination of decreased caloric intake and increased physical activity -Reducing dietary fat intake is a practical way to reduce calories. But reducing dietary fat alone without reducing calories is not sufficient for weight loss. - Each pound of body fat represents about 3,500 calories. To follow the NHLBI for weight loss, one must expend 500 to 1000 calories more than the amount taken in through the diet. This can be accomplished by increasing energy expenditure 200-400 calories a day through physical activity, and reducing dietary fat intake by 300-600 calories. Each tablespoon of fat represents about 100 calories, so an emphasis on low-fat dairy products and lean meats, and a low intake of visible fats is the easiest way to reduce caloric intake without reducing the volume of food eaten -The NHLBI recommends this diet for weight loss: -Eat 500-1,000 calories a day below usual intake. -Keep total dietary fat intake below 30% of calories, and carbohydrate at 55% or more of total calories. -Emphasize a heart-healthy diet by keeping saturated fats under 10% of total calories, cholesterol under 300 mg per day, and sodium less than 2,400 mg per day. -Choose foods high in dietary fiber (20-30 grams per day)

conservative treatment guidelines

-obesity should be treated as a chronic condition not an acute illness - incorporate change in diet, increase in physical activity, and change in behavior -aim for about 0.502 lbs of weight loss a week -each lbs of fat=3,599 calories

genetic and parental influences

80% offspring of 2 obese parents become obese 40% with one 14% with none - twin studies show that identical twins reared apart have bmis as close as when reared together - adults adopted before age 1 have bmis most similar to biologic parents -inheritance accounts for 25% of variance in fatness lifestyle 45% 25-40 based on genetic basis

maintenance of weight loss over 5 years after treatment

begining started to lose a lot of weight a year later they lose 1/2 their progress, and 5 years later they end up gaining more than before

misconceptions reguarding the role of exercise in weight loss

accelerates weight loss significantly when combined with a reducing diet -causes the RMR to stay elevated for a long time after the bout, burning extra calories - counters the diet includes decreases in RMR -counters the diet include decreases in fat free mass

eating disorders

an estimated 0.5-3.7% of females suffer from anorexia nervosa and 1.1-4.2% in their lifetime -85% of eating disorders have their onset during the adolescent age period -among the obese 20-40% report problems with binge eating

health risks are worse for

androids )waist circumference >35 inches for women and >40 for men

the power behind weight loss

eating less has the biggest impact on weight loss -exercise helps, but most exceed 60min a day to be meaningful more than most obese individuals are willing to endure - exercise is more imporatant in improving the health of the obese individuals during weight loss than in accelerating weight loss -thus in the battle of the bulge, jab with exercise and deliver the knock out blow with diet

obesity/overwieght prevalence

effects 32% of adults with highest rates among poor and minority groups -66% overweight.obese -compared to 1960 average adult now weighs 24lbs more (men 195, women 165) -among children and adolescence 17% are rated as overweight

what factors best explain the obesity epidemic in america

genetic and parental influences high energy intake low energy expenditure

obesity trends since 1960

healthy weight at all time low, overweight or obese at all time high obese at all time high 6-11 year olds at all time high for overweight 12-19 year olds at an all time high but not as high as 6-11 year olds

low energy intake

humans expend energy in 3 ways -the resting metabolic rate is directly related to body weight, high in obese peope, lower in lean, and parallels changes in weight -regular physical activity is related to a reduced risk of bod weight gain -physical activity is significantly lower in obese people -thermic effects of food 10% is slightly lower in the obese

so then why exercise when trying to lose weight

improves heart ling fitness - improves the blood lipid profile, with an increase in HDL-c and decreases triglycerides -improves psychological state, especially increased genera wellbeing and vigor and decreased anxiety and depression -enhance group social support - improves overall health, and decreases the risk of obesity related disease such as heart disease , stroke and cancer and hypertension -helps maintain weight loss and prevent future weight gain

misconception #3 exercise counters the diet induced decrease in RMR

most studies have found that exericse during dieting does not counter the decrease in RMR and fat free mass - 65 obese 8 week formula diet at 70%RMR aerobics 3/wk leg/arm cycling weighs 3x/wk 3x6, 8 stations

gastric reduction surgery

the NHLBI obesity education initiative promotes weight loss surgery is an option for weight reduction in patientes with clinically severe obesity, defined as a bmi>40 or a BMI >35 with comorbid conditions -weight loss surgery should be reserved for clinically severe obese patients in whom other methods of treatement have failed

very low calorie diets

the VLCD provides 400-800 calories/day :long term success is poor -the NHLBI recommends that the VLDC's not to be used routeninly for weight loss therapy: - energy deficits are too great -nutritional inadequacies will occur without supplements -moderate energy restictions is just as effective over the long term -rapid weight reduction does not promote gradual change in eating behavior -linked to increase risk of gallstones -require special monitoring

resting metabolic rate RMR

the absal metabolic rate BMR represents the energy needed to support the basic cost of living including the metabolic activities of cell and tissues and blood circulation, respiration, and gastrointestinal and kidney functions

why is misconception #1 wrong

the net energy expenditures of exericse is small only about 135 kcal per 3 mile walk. to be accurate the RMR and potential informal activity calories must be subtracted out

energy expenditure and body mass change

the resting metabilic rate is directly related to body weight (higher in the obere, lower in the lean) and parallels changes in weight

misconception #2 exercise causes the resting metabolic rate to stay elevated for a long time after the bou, burning extra calories

the truth is that energy expenditures after aerobic exercise is small unless a greater amoung of high intensity exercise is engaged in -Moderate intensity exercise for 30 min increases the RMR for only 20-30 min, burning 10-20 extra calories. -High intensity exercise for 30 min increases the RMR for 35-45 min, burning 15-30 extra calories. -Thus when the obese individual walks for 20-30 min, about 10 extra calories will be burned afterwards, hardly enough to be meaningful.

what are practical conclusions

to sum up, individuals adopting a moderate exercise program to lose weight should not count on a revved up metabolism to burn a significant amount of extra calories beyond that linked to exercise itself

most obese people are in denial this study showed that obese subjects

underestimate food intake by 50% and overestimate pysical activity by 33%