Chapter 5 - Weight management and the obesity epidemic

The types of procedures are as follows:

- Gastric bypass. - Banding. - Endoscopic sleeve gastroplasty. - Duodenal switch.

An estimated ___-____% of college students report using prescription stimulants to lose weight.

10-13%

An estimated _______ men and women are "morbidly obese" (100 or more pounds overweight).

15 million

Almost a quarter of undergraduates are overweight; another ____% are obese.

16%

Body mass index (BMI), a ratio between weight and height, is?

A mathematical formula that correlates with body fat.

Monitoring.

About 44% of registry members count calories, and almost all keep track of their food intake in some way, written or not. New technology-based apps have proven easier to use, more motivating, and more accurate in tracking food intake.

BMI is not useful for?

Growing children, women who are pregnant or nursing, or older adults.

The younger individuals are when they gain weight, ______ prevalence of type 2 diabetes and cardiometabolic disorders

Higher

Gastric bypass.

Surgeons create an egg-sized pouch with staples and reroute food around part of the upper intestine to block absorption of calories and nutrients. About 75 percent of bypass patients lose 50 to 75 percent of their excess weight within 2 years.

Americans spend $2.5 billion a year on programs and products to help them lose weight and keep it off. Yet there has been little scientific evidence to show whether or not these plans lead to successful long-term weight loss. T/F?

T

BMI, which was developed in Western nations, may not accurately indicate the risk of obesity-related diseases in Asian men and women. T/F?

T

Because so little solid research is available, the researchers' conclusion was inconclusive: "We still don't know whether a lot of these programs work." For years individuals have tried to lose or control weight by smoking; more recently, some have tried electronic cigarettes. Among those most likely to try "vaping" are overweight individuals who restrict calories, have poor impulse controls, and prefer coffee or vanilla flavors. T/F?

T

Being underweight is not an uncommon problem, particularly among adolescent and young adult men as well as among those who diet excessively or suffer from eating disorders. T/F?

T

Health courses or university programs that promote healthy behaviors have proven effective in leading to better nutritional choices, lower weights, and increased exercise. T/F?

T

If you have put on weight, you may be most concerned about looking fat or not fitting into your clothes. But the younger individuals are when they gain weight, the more health risks they may face over their lifetimes. T/F?

T

Percentage of body fat, absolute body fat, and BMI tend to increase in the first semester at school. Normal-weight college women who try to restrict or lose weight are, ironically, most likely to gain body fat in their freshman year. T/F?

T

Rather than focus on why dieters fail, the creators of the National Weight Control Registry study the habits and lifestyles of those who've maintained a weight loss of at least 30 pounds for at least a year. The nearly 6,000 people in the registry have maintained their weight loss for almost 6 years. T/F?

T

Recovery from compulsive eating can be challenging because people with this problem cannot give up the substance they abuse entirely. Like everyone else, they must eat. However, they can learn new eating habits and ways of dealing with underlying emotional problems. T/F?

T

While dieters may eat just as much or even more food, they ingest fewer calories and much less fat. In research studies, dieters have burned more calories by cutting back on carbohydrates. However, many people cannot stay on these diets for a sustained period. T/F?

T

An exercise program designed for both health benefits and weight loss should include both aerobic activity and resistance training. People who start and stick with an exercise program during or after a weight loss program are ?

consistently more successful in keeping off most of the pounds they've shed.

Regular exercise provides many health benefits while also helping to?

control weight.

For individuals with a BMI higher than 30 (or 27 for those with heart disease or its risk factors), the Food and Drug Administration (FDA) has approved several medications. Although they can lead to temporary weight loss, lifestyle changes are?

still needed to maintain a healthy weight.

Unhealthy eating behavior takes many forms, ranging from not eating enough to eating too much too quickly. Its roots are complex. In addition to media and external pressures, family history can play a role. Researchers have linked specific genes to some cases of anorexia nervosa and binge eating, but most believe that a variety of factors, including _________ and ____________, combine to cause disordered eating.

stress and culture

Eating disorders affect ethnic minorities as much as whites, and there are more overlapping risk factors shared among various ethnic groups than differences. In the few studies of eating disorders in minority college students that have been completed, African American female undergraduates had a slightly lower prevalence of eating disorders than did whites. Asian Americans reported fewer symptoms of eating disorders but more body dissatisfaction, concerns about shape, and more intense efforts to lose weight. Adolescents and adults with binge-eating disorder may be at higher risk of?

suicidal thoughts, plans, and attempts.

Although anorexia means "loss of appetite," most individuals with anorexia nervosa are, in fact, hungry all the time. For them, food is an enemy—a threat to their sense of self, identity, and autonomy. In the distorted mirror of their mind's eye, they see themselves as fat or flabby even at a normal or below-normal body weight. Some simply feel fat; others think that they are thin in some places and too fat in others, such as the abdomen, buttocks, or thighs. t/f?

t

BMI does not reliably reflect body fat, an independent and possibly more accurate predictor of health risk. t/f?

t

Obese and overweight students do not express greater concern about health or adapt different health-related behaviors than other undergraduates. t/f?

t

Students at 2-year colleges may be twice as likely to be obese as those at 4-year institutions. t/f?

t

A widening waist, or "apple" shape, is a warning signal of increased risk of heart disease, lung problems, and cancer. Particularly combined with a high BMI, it can also be an indicator of?

premature death

A variety of factors, ranging from behavior to environment to genetics, played a role in the increase in overweight and obesity in the United States. They include the following:

- Bigger portions - Consuming more calories than we burn - Fast food - Sugar-sweetened beverages - Physical inactivity - Screen Time - Emotional eating - Genetics - Social networks - Marriage - Perceived discrimination.

Researchers have identified the key components of a successful diet:

- Daily caloric intake of about 500 calories less than usual (or a recommended 1,200 calories for women and 1,500 for men). - Relatively high in protein. - Moderately low in calories. - Low glycemic index

Among young people, the most successful strategies for attaining and maintaining a healthy weight include:

- Drinking less soda. - Eating less junk food. - Drinking more water. - Increasing physical activity. - Weighing themselves regularly. - Adding more protein to their diets. - Watching less television. - Adding more fiber to their diets.

But as with losing weight, you should try to gain weight in healthy ways. Here are some suggestions:

- Eat more of a variety of foods rather than more high-fat, high-calorie foods. Get no more than 30 percent of your daily calories from fat. A higher percentage poses a threat to your heart and your health. - If your appetite is small, eat more frequently. Try for five or six smaller meals rather than a big lunch and dinner. - Choose some calorie-rich foods, such as dried fruits rather than fresh ones. Add nuts and cheese to salads and main dishes. - Drink juice rather than regular or diet soda. - Try adding a commercial liquid meal replacement as a snack. - Exercise regularly to build up both appetite and muscle.

There are two recognizable forms of anorexia:

- In the restricting type, individuals lose weight by avoiding any fatty foods and by dieting, fasting, and exercising. Some start smoking as a way of controlling their weight. Some college women may numb their pain by drinking alcohol, a problem the media have dubbed "drunkorexia." - In the binge-eating/purging type, individuals engage in binge eating, purging (through self-induced vomiting, laxatives, diuretics, or enemas), or both. Obsessed with an intense fear of fatness, they may weigh themselves several times a day, measure various parts of their body, check mirrors to see if they look fat, and try on different items of clothing to see if they feel tight.

Among its other benefits, exercise contributes to a healthy weight by:

- Increasing energy expenditure. - Building up muscle tissue. - Burning off fat stores. - Stimulating the immune system. - Possibly reprogramming metabolism so that more calories are burned during and after a workout.

Overweight men and women are also more likely to develop:

- Knee injuries that require surgery to repair. - Spinal disc degeneration, a common cause of lower back pain. - Alterations in various measures of immune function. - Greater risk of gallstones, kidney stones, and kidney disease. - Liver disease. - Less responsiveness to flu vaccination. - Cognitive problems and dementia. - Worsened symptoms of fibromyalgia, a musculoskeletal disorder. - Poor sleep, which could add to the risk of medical problems.

A multimillion-dollar industry thrives on marketing various diet aids, most of dubious value. Here is what you should know about some of the most widespread:

- Over-the-counter diet pills - Diet foods - Artificial sweeteners and fake fats

The characteristics of bulimia nervosa include:

- Repeated binge eating. - A feeling of lack of control over eating behavior. - Regular reliance on self-induced vomiting, laxatives, or diuretics. - Strict dieting or fasting, or vigorous exercise, to prevent weight gain. - A minimum average of one bingeing episode a week for at least 3 months. - A preoccupation with body shape and weight.

Anorexia, which affects about 0.4% of girls and young women per year, is 10 times more common in females than in males. Its key characteristics include the following:

- Restriction of food intake, leading to a significantly low body weight for their age, health, and sex. - Intense fear of gaining weight or of becoming fat. - Disturbance in the way individuals experience their body weight or shape.

The biggest Americans are getting bigger, as the following statistics indicate:

- The prevalence of severe, or "morbid," obesity is increasing faster than obesity itself. - The number of extremely obese adults—those at least 100 pounds overweight with BMIs over 40—has quadrupled in the past two decades from 1 in 200 to about 1 in every 50 men and women. - The number with BMIs greater than 50 has jumped from 1 in 2,000 in the 1980s to 1 in 400.

The following behaviors may signal a potential problem with compulsive overeating:

- Turning to food when depressed or lonely, when feeling rejected, or as a reward. - A history of failed diets and anxiety when dieting. - Thinking about food throughout the day. - Eating quickly and without pleasure. - Continuing to eat even when no longer hungry. - Frequently talking about food or refusing to talk about food. - Fear of not being able to stop eating after starting.

A recent study analyzed published studies on some of the most popular programs Here they are:

-Counseling plus calorie control (Weight Watchers and Jenny Craig). -Very-low-calorie and low-calorie meal replacement programs (Medifast, Optifast, and Health Management Resources). -Self-directed (Atkins and Slimfast). -Internet-based programs (The Biggest Loser Club, eDiets, and Lose it!).

During most of these episodes, binge eaters experience at least three of the following:

-Eating much more rapidly than usual. -Eating until they feel uncomfortably full. -Eating large amounts of food when not feeling physically hungry. -Eating large amounts of food throughout the day with no planned mealtimes. -Eating alone because they are embarrassed by how much they eat and by their eating habits.

As the gap between reality and ideal grows, both sexes struggle with issues related to body image, although men and women report different concerns as follows:

-Women express greater worry about thinness and more dissatisfaction with their lower rather than their upper bodies. -College women are more likely to overestimate their weight, while men tend to underestimate their actual weight. -The greater the discrepancy between a woman's current view of her body shape and the ideal she considers most attractive to men, the more likely she is to worry about how others will view her and to doubt her ability to make a desirable impression. -"Social physique anxiety" occurs often in women who feel they do not measure up to what they or others consider most desirable in terms of weight or appearance. Those reporting the greatest distress because of body image are at highest risk for eating disorders. -Women compare their appearance to that of celebrities and models as well as peers more frequently than men and worry more that others will think negatively about their looks. Yet appearance matters just as much to men, who are as likely as women to engage in efforts to improve their bodies. -Men often want either to lose or gain weight or to add muscle and bulk. -College men in the United States overwhelmingly associate greater muscularity with feeling sexier, more confident, and more attractive to women. Pursuit of this idealized body type can lead to a dangerous obsession called muscle dysmorphia or reverse anorexia. Men with this disorder are at higher risk for depression and anxiety, abuse of substances such as anabolic steroids, and suicide.

Many factors contribute to weight gain in college. Students in a hurry often opt for fast food and consume more fatty foods and sugared drinks, which increase their risks of obesity and other health problems. Limited finances are a common reason for students' unhealthy choices, but it is possible to hold the line on calories as well as costs. According to researchers' analysis, the primary cause of weight gain among students is?

A decline in exercise frequency and, even more significantly, in exercise intensity

Hydrostatic (underwater) weighing

According to the Archimedes' principle, a body immersed in a fluid is buoyed by a force equal to the weight of the displaced fluid. Since muscle has a higher density than water and fat has a lower density, fat people tend to displace less water than lean people.

Emotional eating.

College students who are prone to boredom and have difficulty coping with negative emotions are likely to eat when they have nothing else to do or are feeling upset.

Genetics.

Scientists have identified a particular variation in a gene associated with fat mass and obesity, called FTO, that increases the risk of excess weight by 20 to 30 percent. However, physical activity can counteract its effect.

Every year, sometimes every season, seems to bring a breakthrough diet that promises to take off pounds, reshape your body, and recharge your life. You can "shred" 4 inches in 6 weeks, fast your way to a lower weight and longer life, or follow the dictates of Doctor Oz, Phil, or Ornish. Or you can try diets with roots in the Paleolithic Age, South Beach, Beverly Hills, or Park Avenue. T/F?

T

Extreme dieters may think they know a great deal about nutrition, yet many of their beliefs about food and weight are misconceptions or myths. For instance, they may eat only protein because they believe complex carbohydrates, including fruits and whole-grain breads, are fattening. Nutritional education alone can sometimes help change these eating patterns, but many extreme dieters who deny that they have a problem with food may need counseling to change their potentially dangerous eating behavior. T/F?

T

Handheld devices and stand-on monitors sold online and in specialty stores promise to make measuring your body fat percentage as easy as finding your weight. None has been extensively tested. T/F?

T

In college women, the strongest correlation of weight gain was with an increased workload, which may lead to more stress-related eating, greater snacking, or less exercise. T/F?

T

Many see excess weight as a psychological burden, a sign of failure, laziness, or inadequate willpower. Overweight men and women often blame themselves for becoming heavy and feel guilty and depressed as a result. In fact, the psychological problems once considered the cause of obesity may be its consequence. Obesity is associated with a higher prevalence of suicide risk in women, but not necessarily in men. T/F?

T

No one diet or commercial weight loss program helped all these formerly overweight individuals. Many, through years of trial and error, eventually came up with a permanent exercise and eating program that worked for them. T/F?

T

Only about 5% of students gain the legendary "freshman 15," although most put on some weight, an average of about 11 pounds. The students who gain the most weight tend to be less physically active than their peers. T/F?

T

When is a waist too wide? Various studies have produced different results, but the general guideline is that a waist measuring more than 35 inches in a woman or more than 40 inches in a man signals greater health risks. The larger the waist, the greater the risk of premature death. T/F?

T

Bioelectrical Impedance Analysis (BIA)

This noninvasive method is based on the principle that electrical current applied to the body meets greater resistance with different types of tissue. Lean tissue, which contains large amounts of water and electrolytes, is a good electrical conductor; fat, which does not, is a poor conductor. In theory, the easier the electrical conduction, the greater an individual's lean body mass.

Recent studies have shown that high-protein diets are effective in?

controlling appetite, reducing body fat, maintaining lean body mass, and improving blood pressure and other health biomarkers.

A BMI between 35.0 and 39.9 (class 2 obesity) means increased risk of?

premature death.

Brief interventions, such as 4-hour Healthy Weight programs, have proven effective in?

preventing the onset of various forms of disordered eating.

Foods made with fat substitutes may have fewer grams of fat, but they don't necessarily have significantly fewer calories. Many people who consume reduced-fat, fat-free, or sugar-free sodas, cookies, chips, and other snacks often cut back on more nutritious foods, such as fruits and vegetables. They also tend to eat more of the low- or no-fat foods so that their daily calorie intake either?

stays the same or actually increases.

Bisexual and lesbian female undergraduates are more likely to be obese than heterosexual women and may be at greater risk for unhealthy dietary, exercise, and weight control behaviors. t/f?

t

College students of different ethnic and racial backgrounds express as much concern about their body shape and weight as whites—and sometimes more. In a study of university students, black and white men were similar in their ideals for body size and in their perceptions of their own shapes. Both black and white women perceive themselves as smaller than they actually are and desire an even smaller body size. However, black women are more accepting of larger size. t/f?

t

Individuals with bulimia nervosa go on repeated eating binges and rapidly consume large amounts of food, usually sweets, stopping only because of severe abdominal pain or sleep, or because they are interrupted. Those with purging bulimia induce vomiting or take large doses of laxatives to relieve guilt and control their weight. In nonpurging bulimia, individuals use other means, such as fasting or excessive exercise, to compensate for binges. t/f?

t

More than 1/3 of undergrads report being overweight, obese, or severely or extremely obese. A recent study found a significant association between body mass index (BMI) and academic performance, with students who gained weight over 4 years of college getting lower grades in junior/senior college-level courses. t/f?

t

The American Psychiatric Association has developed practice guidelines for the treatment of patients with eating disorders, which include medical, psychological, and behavioral approaches. One of the most scientifically supported is cognitive-behavioral therapy. Mindfulness also has shown promise in helping individuals with or at risk for eating disorders. t/f?

t

The overall prevalence of obesity is higher among black and Hispanic adults than among white and Asian adults. t/f?

t

Women have long been bombarded by idealized images in the media of female bodies that bear little resemblance to the way most women look. Increasingly, more advertisements and men's magazines are featuring idealized male bodies that bear little resemblance to the bodies most men have. t/f?

t

The younger individuals are when they gain weight, there will be a ___% chance of becoming overweight or obese throughout life

A 70 percent chance.

The most commonly reported by those with binge-eating disorders is?; the least common,?

"stuffing oneself with food" ; eating or drinking in secrecy.

Complementary and alternative medicine (CAM) is defined as?

"varied medical and health-care systems, practices, and products that are not considered to be part of any Western health-care system"

The most common eating disorders are binge-eating disorder, anorexia nervosa, and bulimia nervosa. Among the factors that increase the risk are:

- Genetic predisposition. - Preoccupation with a thin body. - Body dissatisfaction. - Dieting. -Overeating. - Social pressure. - Perfectionism and excessive cautiousness, which can reflect an obsessive-compulsive personality.

The individuals most likely to benefit from obesity surgery generally:

- Have a BMI over 40. - Have a BMI over 35 and a serious obesity-related problem, such as type 2 diabetes or severe sleep apnea (when breathing stops for brief periods during sleep). - Have made repeated unsuccessful attempts to lose weight. -Do not have any significant or untreated psychological problems. - Are well-informed about the risks of the surgery. Recognize the need for lifestyle changes and daily vitamin and mineral supplements.

Relatively few weight loss approaches reach the national standards developed by the American Heart Association, the American College of Cardiology, and the Obesity Society:

-High-intensity interventions of at least 14 sessions over a 6-month period. - An evidence-based diet. - Physical activity guidelines. - Self-monitoring tools such as food tracking. -No endorsement of nutritional supplements.

According to the Agency for Healthcare Research and Quality, three of four bariatric surgery patients lose 50 to 75 percent of their excess weight within 2 years and keep it off. Among its other potential benefits are the following:

-Improvement in or elimination of diabetes in some people, including teenagers. -Alleviation of high cholesterol, hypertension, and sleep apnea. -Reduction of odds of dying by nearly half. -Reduction of cardiovascular disorder, such as heart attack or stroke, and heart-related deaths. -Lower risk of gestational (pregnancy) diabetes.

Despite the immense variety, their customized approaches share certain characteristics:

-Personal responsibility for change. -Exercise. -Monitoring. -Vigilance. -Frequent eating.

Not all diets are safe or effective. The National Council Against Health Fraud cautions dieters to watch for these warnings of dangerous or fraudulent programs:

-Promises of very rapid weight loss. -Claims that the diet can eliminate "cellulite" (a term used to describe dimply fatty tissue on the arms and legs). -"Counselors" who are really salespersons pushing a product or program. -No mention of any risks associated with the diet. -Unproven gimmicks, such as body wraps, starch blockers, hormones, diuretics, or "unique" pills or potions. -No maintenance program.

More than ___ in ___ adults have extreme obesity.

1 in 20

An estimated 1 - 2% of adolescent and young American women develop bulimia. Some experiment with bingeing and purging for a few months and then stop when they change their social or living situation. Others develop longer-term bulimia. Among males, this disorder is about 1/10 as common. The average age for developing bulimia is?

18

A healthy BMI ranges from?

18.5 to 24.9

About ____ in ____ adults are obese.

2 in 5

The prevalence of obesity among children ranges from ____% for those ages 2-5; ___% for those ages 6-11; and _____% for 12-19 years old.

2-5yrs: 14% ; 6-11yrs: 18% ; 12-19: 21%

Whether or not they are enrolled in college, young adults gain an average of ____lb's between ages 18-35.

30 pounds

The prevalence of obesity among women has remained relatively stable, at about _____%, since 2000, but the prevalence among men has increased from _____%-___ _%

35 percent ; 27.5 percent to 35.5 percent

Although people lose weight on any diet that helps them eat less, most dieters lose only about __% of their initial weight and gain some of that back. However, even such a modest weight loss can lower cardiovascular risk factors, such as elevated blood pressure, total cholesterol, and blood glucose.

5%

The younger individuals are when they gain weight, increased risk of premature death. Obesity, smoking, and high blood sugar levels significantly increase the risk of dying before age ____.

55

About 1/5 of teenagers are obese--and may face an increased risk of dying of heart disease or stroke by middle age. An estimated ___-____% of all teenagers will become obese

75-80%

Marriage.

Although marriage confers many health benefits, it also puts on pounds—particularly among the happily married. The reason may be that, having found a mate, spouses no longer try to stay slim to attract a partner.

Herbal supplements.

Although widely advertised, the researchers concluded that "the evidence in support of their effectiveness is either nonexistent or points to a negligible effect."

Consuming more calories than we burn.

American adults have been eating steadily fewer calories for almost a decade, but may still not be getting enough exercise to burn the calories they do consume.

Perceived discrimination.

Among African Americans, perceived everyday discrimination may contribute to a higher BMI, larger waist circumference, and greater risk of obesity.

Over-the-counter diet pills.

An estimated 15 percent of adults—21 percent of women and 10 percent of men—have used weight loss supplements. The weight loss prescription drug Orlistat (Xenical) is available as an over-the-counter weight loss pill called Alli. The drug, which blocks about one-quarter of the fat consumed, works best with a low-fat diet. If dieters eat a meal made up of more than 15 grams of fat, they can suffer nasty side effects, including flatulence, an urgent need to defecate, oily stools, and diarrhea.

Some popular diets are high in protein; others are low in complex carbohydrates. Some allow no fat; others ban sugar or gluten. Which ones work?

As long as you are burning more calories than you consume, they all do. But not all diets are practical, inexpensive, easy to stay on, or good for your overall nutrition and health.

What race has the lowest obesity rates? (12.7%)

Asian Americans

Rather than rely on a range of ideal weights for various heights, as they once did, medical experts use various methods to assess body composition and weight, including?

BMI, waist circumference, waist-to-hip ratio, and body fat.

the rapid consumption of an abnormally large amount of food in a relatively short time—often occurs in compulsive eaters. The 25 million Americans with a this disorder typically eat a larger-than-ordinary amount of food during a relatively brief period, feel a lack of control over eating, and binge at least once a week for at least a 3-month period.

Binge eating

BMI is not an accurate indicator of cardiometabolic health, which is more accurately reflected by?

Blood pressure, lipids (fats), glucose, insulin resistance, and C-reactive protein

Very-low-calorie and low-calorie meal replacement programs (Medifast, Optifast, and Health Management Resources).

Consumers using these products initially reported greater weight loss than those given counseling alone, but attrition was high and the difference was not statistically significant by 9 months. The very-low-calorie methods increased the risk of gallstones.

Diet foods.

Diet products, including diet sodas and low-fat foods, are a very big business. Many people rely on meal replacements, usually shakes or snack bars, to lose or keep off weight. If used appropriately—as actual replacements rather than supplements to regular meals and snacks—they can be a useful strategy for weight loss. Yet people who use these products often gain weight because they think that they can afford to add high-calorie treats to their diets.

Duodenal switch.

Duodenal switch or biliopancreatic diversion, a more extensive operation that removes a portion of the stomach and bypasses a large portion of the small intestine, may lead to greater long-term weight loss but carries a risk of more comDuodenal switch or biliopancreatic diversion, a more extensive operation that removes a portion of the stomach and bypasses a large portion of the small intestine, may lead to greater long-term weight loss but carries a risk of more complications.plications.

Acupuncture.

In randomized trials, acupuncture was more effective than lifestyle modification and placebo in reducing BMI and weight. However, scientists have criticized the design and validity of the studies.

Banding.

In this newer, less risky procedure, surgeons slip an inflatable silicon band around the stomach; it can be tightened or loosened at a doctor's office without the need for further surgery. Patients lose about 40 to 55 percent of excess weight but may be more likely to regain lost pounds. The band also may slip or erode.

Self-directed (Atkins and Slimfast).

Individuals following the Atkins diet reported greater weight loss than those in education-counseling programs at 6 and 12 months. Adherence was not reported; the most common complication was constipation. Slimfast users lost more weight than a control group but had results similar to those who received counseling alone.

Frequent eating.

Individuals who manage to maintain a significant weight loss typically eat more frequently (an average of three meals and two snacks a day) than those who eat less often.

This approach remains controversial, in part because they have variable effects on blood cholesterol in different people. However, a diet like this one can have positive effects on other cardiovascular risk factors, possibly because it reduces hunger so dieters consume fewer calories. A recent review concluded that this dietary pattern, while "not suitable for everyone," is a "safe and efficacious dietary option" for others. What is this diet./approach called?

Low-Carbohydrate, High-Fat Diets

Age and sex affect obesity rates. About ____% of men between ages 20-39 are obese, compared with ____% of those between ages 40-50. Among women ages 20-39, some _____% are obese, compared with _____% of those between ages 40-59. Americans of all races carry excess pounds, but there are racial differences.

M (20-39): 35 percent ; M (40-50): 41 percent ; W (20-39): 37% ; W (40-59): 45%

More than ___/_____ of severely obese men and about ____/_____ of severely obese women live in the United States, where nearly ___% of adults are classified as obese.

M: 1/4 (a quarter) ; W: 1/5 (a fifth) ; Adults: 40%

Global obesity rates have risen to ____% among men and ___% among women.

M: 11 percent ; W: 15 percent

Ideal body fat percentages for men range from ____-___% and for women from ____-___%. Methods of assessing body composition include a variety of approaches.

M: 7-25 % ; W: 16-35 %

Long-term dangers—both physical and psychological—are unknown.

Middle-aged and even older people may gain a boost in survival from gastric bypass surgery, but researchers have found no survival benefit for obese individuals under age 35 and also an increase in "externally caused deaths," including accident injuries, assaults, and suicides. For obese teenagers, who generally do not respond well to dietary restrictions or medical treatments, bariatric surgery leads to a dramatic weight loss, but nearly three in four develop long-term nutritional deficiencies.

About 1/3 of children and adolescents age 6-19 are overweight or obese. The key factors contributing to childhood obesity include?

More hours of screen time (including television viewing and use of computers and mobile devices) and diets high in saturated fat and sugar-sweetened beverages and low in protein.

Type 2 diabetes.

More than 80% of people with type 2 diabetes are overweight. According to the International Diabetes Foundation, the rise in obesity may lead to a "catastrophic" epidemic of diabetes, affecting as many as 642 million people around the world by 2040. Although the reasons are not known, being overweight may make cells less efficient at using sugar from the blood. This then puts stress on the cells that produce insulin (a hormone that carries sugar from the blood to cells) and makes them gradually fail. Those with BMIs of 35 or more are approximately 20 times more likely to develop diabetes. Excess weight also increases the risk of premature death among people with type 2 diabetes.

Sugar-sweetened beverages.

More than half of adults in the United States consume at least one or more sugar-sweetened beverage per day, which researchers calculate could lead to a pound of weight gain every 20 days.

Artificial sweeteners and fake fats.

Nutritionists caution to use these products in moderation and not as substitutes for basic foods, such as grains, fruits, and vegetables. A recent review of studies of "non-sugar sweeteners" found no conclusive evidence of either benefit or harm.

Cancer.

Obesity contributes to more than 100,000 cases of cancer—among them cancers of the endometrium, esophagus, pancreas, gallbladder, kidney, breast, ovaries, and colon—in the United States every year. Excess weight may account for 14% of all cancer deaths in men and 20% of those in women. Obesity quadruples the risk of prostate cancer in black men. Women who were overweight as children or teens may have a greater risk of colon cancer as adults. Losing weight, researchers estimate, could prevent as many as 1 in ever 6 cancer deaths.

Strokes.

Obesity increases the danger of a particular type of stroke in women who take oral contraceptives, although the absolute risk is low.

is becoming the most popular weight loss approach for the estimated 15 million men and women who qualify as "morbidly obese" (100 or more pounds overweight) because of their increased health risks. It has proven effective in promoting weight loss among teenagers as well as older adults. WHAT IS THIS?

Obesity, or bariatric, surgery

The fifth leading cause of death, accounting for nearly 3.4 million deaths annually. what is this?

Overweight and obesity

Cardiovascular disease and heart attacks.

People who are overweight are more likely to suffer from high blood pressure, high levels of triglycerides (blood fats), harmful low-density lipoprotein (LDL) cholesterol, and low levels of beneficial high-density lipoprotein (HDL) cholesterol. Even relatively small amounts of excess fat—as little as 5 pounds—can add to the dangers in those already at risk for hypertension. People with more body fat have higher blood levels of substances that cause inflammation, which may raise heart disease risk. Obesity is implicated in 40% of severe heart attacks, which *are striking younger, fatter Americans.*

Vigilance.

Rather than avoid the scale or tell themselves their jeans shrank in the wash, successful losers keep tabs on their weight and size. About one-third check the scale every week. If the scale notches upward or their waistbands start to pinch, they take action.

Exercise.

Registry members report an hour of moderate physical activity almost every day. Their favorite exercise? Three in four say walking, followed by cycling, weightlifting, aerobics, running, and stair climbing. On average, they burn about 2,545 calories per week through physical activity.

Social networks.

Researchers are not sure if overweight people seek out other overweight people or whether normal-weight individuals become heavier as a result of their relationships with heavier partners.

Internet-based programs (The Biggest Loser Club, eDiets, and Lose it!).

Results varied, with Biggest Loser Club members showing greater weight loss than a control group at 3 months but no difference between eDiets and LoseIt! participants and controls.

Ultimately, all weight problems result from a prolonged energy imbalance caused by consuming too many calories and burning too few in daily activities. How many calories you need depends on your?

Sex, age, body-frame size, weight, percentage of body fat, activity level, and basal metabolic rate (BMR)—the number of calories needed to sustain your body at rest.

Unplanned daily activity, such as fidgeting or pacing, can make a difference in preventing weight gain. Scientists use the acronym NEAT (nonexercise activity thermogenesis) to describe such "nonvolitional" movement, which may be an effective way of burning calories. In research on self-confessed couch potatoes, the thinner ones sat an average of 2 hours less and moved and stood more often than the heavier individuals. TRUE OR FALSE?

TRUE

Vigilance helps keep weight off. If the number on the scale creeps upward, what should you do?

Take action immediately

Physical inactivity.

The heaviest individuals tend to move the least. Obese men and women are much more sedentary and log more hours sitting or reclining than others.

Bigger portions.

The size of many popular restaurants and packaged foods has increased two to five times during the past 20 years. According to studies of appetite and satiety, people presented with larger portions eat up to 30 percent more than they otherwise would

Counseling plus calorie control (Weight Watchers and Jenny Craig).

These are the only two programs backed by scientific evidence showing that their clients maintained weight loss for at least a year. Nutrisystem clients also lost weight but were followed for only 3 months.

Extreme dieters go beyond cutting back on calories or increasing physical activity. They become preoccupied with what they eat and weigh. Although their weight never falls below 85% of normal, their weight loss is severe enough to cause uncomfortable physical consequences, such as weakness and sensitivity to cold. Technically, these dieters do not have anorexia nervosa (discussed later in this chapter), but?

They are at increased risk for it.

The Bod Pod®

This large, egg-shaped fiberglass chamber uses an approach based on air displacement plethysmography—that is, the calculation of the relationship between pressure and volume—to derive body volume.

Endoscopic sleeve gastroplasty.

This new alternative for people who are mildly to moderately obese involves using an endoscope, a flexible tube inserted through the mouth. When the endoscope reaches the stomach, the surgeon places sutures in the stomach, making it smaller and changing its shape. In a small study, the procedure resulted in a loss of about 50 percent of excess weight.

Although the students viewed eating disorders as both mental and physical problems and felt that individual therapy would be most helpful, all said that they would first turn to a friend for help. Women in sororities are at slightly increased risk of an eating disorder compared with those in dormitories. Loneliness has also emerged as a risk factor for eating disorders in college women. True or False?

True

Major diseases linked to obesity include the following:

Type 2 diabetes, Cardiovascular disease and heart attacks, strokes, cancer,

For women, a ratio of _____ or less is considered safe; for men, the recommended ratio is _____ or less. For both men and women, a ___ or higher is considered "at risk" or in the danger zone for undesirable health consequences, such as heart disease and other ailments associated with being overweight.

W: 0.80 ; M: 0.90 ; both: 1.0

More than _/_ of college women and about ___/___ of college men intend to lose weight. However, individuals vary in their readiness to change their diets, increase their physical activity, and seek professional counseling.

W: 1/2 ; M : 1/3

Screen Time.

Watching television, playing video games, and using computers and mobile devices may contribute to lower fitness and higher weights.

Mindfulness.

Weight loss programs that incorporate mindfulness along with diet and exercise have proven effective in helping participants shed pounds, but the impact of mindfulness alone is not clear.

Personal responsibility for change.

Weight loss winners develop an internal locus of control. Rather than blame others for their weight problem or rely on a doctor or trainer to fix it, they believe that the keys to a healthy weight lie within themselves.

Dual-energy X-ray absorptiometry (DXA)

X-rays are used to quantify the skeletal and soft tissue components of body mass. The test requires just 10 to 20 minutes, and radiation dosage is low (800 to 2,000 times lower than a typical chest X-ray). Some researchers believe that DXA will supplant hydrostatic testing as the standard for body composition assessment.

A BMI of 25 or greater defines overweight and marks the point at which excess weight increases the risk of disease. If your BMI is between 25 (23.4 for Asians) and 29.9, your weight is undermining the quality of your life. What happens to you in life?

You suffer more aches and pains. You find it harder to perform everyday tasks. You run a greater risk of serious health problems.

Fast food.

Young adults who eat frequently at fast-food restaurants gain more weight and develop metabolic abnormalities that increase their risk of diabetes in early middle age.

Skinfold measurement is determined using? The usual sites include the chest, abdomen, and thigh for men and the tricep, hip, and thigh for women. Various equations determine body fat percentage, including calculations that take into account age, sex, race, and other factors. This relatively simple and low-cost method requires considerable technical skill for an accurate reading.

a caliper to measure the amount of skinfold.

If you lose weight suddenly and don't know the reason, talk to a doctor. Rapid weight loss can be an early symptom of?

a health problem.

A BMI of 40 or higher indicates class 3 or severe obesity, which is a?

a truly life-threatening condition.

Surveys of people who lost significant amounts of weight and kept it off for several years show that most did so on their own—without medication, meal substitutes, or membership in an organized weight loss group. "Weight loss maintainers" are more?

active, have fewer TVs in their homes, and don't keep high-fat foods in their pantries.

In the last decade, the prevalence of overweight and obesity increased from 62.2-67.1% among young men and from 51.7-55.8 percent among young women age ___-___.

age: 20-39

Obese American adults die an average of almost 4 years earlier than those with normal weight, and middle-aged obese adults face the highest risk of early death. According to recent research, obesity is associated with at least a 20% increased risk of death from?

all causes or from heart disease.

More than 2 in 3 adults are?

are overweight or obese.

Binge eaters may spend up to several hours eating and consume 2,000 or more calories in a single binge—more than many people eat in a day. After such binges, they usually do not do anything to control weight but simply get fatter. As their weight climbs, they become ?

depressed, anxious, or troubled by other psychological symptoms to a much greater extent than others of comparable weight.

In a 12-month weight loss diet study, there was no significant difference in weight change between a healthy low-fat diet and a healthy low-carbohydrate diet. Dieters who cut back on added sugars, refined grains, and highly processed foods, while eating more vegetables and whole grains, without limiting calories or portion sizes, lost the most significant amounts of weight. The behavioral strategies that lead to the greatest weight loss focus on?

dietary impulse control, weight-loss planning and monitoring, motivational support, information seeking, and self-monitoring.

In a survey at a large, public, rural university in the mid-Atlantic states, 17% of the women were struggling with disordered eating. Younger students (ages 18-21) were more likely than older students to have an eating disorder. In this study, eating disorders equally affected women of ?

different races (Caucasian, Asian, African American, Native American, and Hispanic), religions, athletic involvement, and living arrangements (on or off campus; with roommates, boyfriends, or family).

The younger individuals are when they gain weight, Physiological changes that are the equivalent to 20 years of aging, including increased risk of cardiovascular disease, diabetes, cancer, rheumatoid arthritis, sleep apnea, gout, and liver disease, as well as?

difficulties in walking, balance, and rising from a chair.

College students—particularly women, including varsity athletes—are at risk for unhealthy eating behaviors. Researchers estimate that only about 1/3 of college women maintain healthy eating patterns. Some college women have full-blown eating disorders; others develop "partial syndromes" and experience symptoms that are not severe or numerous enough for a diagnosis of anorexia nervosa or bulimia nervosa. Distress about body image increases the risk of all forms of ?

disordered eating.

A BMI of 30.0 or greater defines obesity and marks the point at which excess weight increases the risk of death. If your BMI is between 30.0 and 34.9 (class 1 obesity), you face all the preceding dangers plus one more, which is?

dying

There are only two effective strategies for losing weight, which are? unfortunately, most people search for easier alternatives that almost invariably turn into dietary dead-ends or unexpected dangers

eating less and exercising more.

The younger individuals are when they gain weight, greater likelihood of high total cholesterol levels and other cardiovascular disease risk factors such as?

elevated blood pressure

In our calorie-conscious and thinness-obsessed society, obesity also affects quality of life, including?

emotional and physical pain.

A certain percentage of incoming students—about 1/4-1/3 in different studies—lose weight during their _____ year.

first

Excess weight is associated with symptoms of depression, significantly ________ rates of lifetime trichotillomania (hair-pulling disorder) in obese male undergraduates, and ______ rates of panic disorder in overweight and obese college women.

higher ; higher

In male students, ________ alcohol consumption and peer pressure to drink account for extra pounds.

increased

Bariatric surgery has proven more effective in?

inducing weight loss and remission of type 2 diabetes and metabolic syndrome than other approaches.

Some mental health professionals describe compulsive eating as a food addiction that?

is much more likely to develop in women. - According to Overeaters Anonymous (OA), an international 12-step program, many women who eat compulsively view food as a source of comfort against feelings of inner emptiness, low self-esteem, and fear of abandonment.

Obesity also has social consequences. Heavy women are ______ likely to marry, earn ____, and have _____ rates of college graduation. Obese individuals of both sexes often experience unfair treatment, which can contribute to binge eating, irregular mealtimes, and greater consumption of convenience foods, because of their body weight.

less ; less ; lower

Some popular diets are based on the premise that the correct proportions of various nutrients, particularly carbohydrates, fats, and proteins, lead to hormonal balance, weight loss, and greater vitality. They also promise additional health benefits, including?

lower blood pressure and cholesterol.

Although physical activity and exercise can prevent weight gain and improve health, they typically burn up just 200 calories a day and do not lead to significant weight loss. However, when combined with a low-fat diet, exercise helps preserve lean body mass, helps keep off excess pounds, and promotes greater cardiovascular fitness. Moderate exercise, such as 30-60 minutes of daily physical activity, reduces the risk of heart disease and other health threats. More exercise—a minimum of 200-300 minutes weekly of moderately intense activity—is necessary to?

maintain weight loss.

The incidence of anorexia nervosa has increased in the past three decades in most developed countries. The peak ages for its onset are 14.5 to 18 years. Cases are increasing among ?

males, minorities, women of all ages, and possibly preteens.

Extreme obesity poses extreme risks to health and survival and undermines quality of life. The options for treating this dangerous condition include?

medication and surgery.

Waist circumference indicates "central" obesity, which is characterized by fat deposited deep within the central abdominal area of the body. Such "visceral" fat is ____ dangerous than "subcutaneous" fat just below the skin because it moves more readily into the bloodstream and directly raises levels of harmful cholesterol.

more

Many popular diets emphasize more protein and fewer carbohydrates. The Institute of Medicine considers a range of 10-35% of calories from protein as acceptable for adults, and some diets advise even higher levels. Protein is more satiating than carbohydrates and fat, so dieters complain less of hunger. However, severe restriction of carbohydrates can induce ketosis, which is caused by an incomplete breakdown of fats that can lead to?

nausea, fatigue, and light-headedness and can worsen kidney disease and other medical problems.

As with other medical problems, the best approach to excess weight and obesity is?

prevention. "Self-regulation" by eating less and exercising more can prevent weight gain. However, losing excess pounds and keeping them off may take more. In a study of about 600 people (average age, 28), big changes, such as cutting back 500 to 1,000 calories a day and engaging in moderate exercise 250 minutes a week (more than the standard recommendation of 150 minutes), produced a much greater weight loss compared with smaller changes, such as eating about 100 calories less a day and exercising a little more. The "big changers" were more likely to maintain their weight loss during 3 years of follow-up.

Binge eating is? ; An estimated 8-19% of obese patients in weight loss programs are binge eaters.

probably the most common eating disorder.

About how many people around the world are overweight or obese than underweight?

some 2.1 billion

Millions of Americans, including some who are not overweight, take over-the-counter pills, powders, herbs, and other supplements to shed extra pounds. However?

they (the supplements) have not been extensively tested and may not be either safe or effective.

People who eat compulsively cannot stop putting food in their mouth. They eat fast, and they eat a lot. They eat even when they're full. They may eat around the clock rather than at set mealtimes, often in private because?

they are embarrassed about how much they consume.

Muscular individuals, including athletes and bodybuilders, may be miscategorized as overweight or obese because?

they have greater lean muscle mass.

What percent of Americans are overweight/obese?

two-thirds of Americans

Men of all ages are more prone to develop the "apple" shape characteristic of central obesity; women in their reproductive years are more likely to accumulate fat around the hips and thighs and acquire a pear shape. Another indicator of shape-related health risks is your? In addition to measuring your waist, measure your hips at the widest part. Divide your waist measurement by your hip measurement.

waist-to-hip ratio (WHR)

Your waist-to-hip ratio can indicate if?

you are at risk for undesirable health conditions.