Nutrition Module 3: Energy Balance and Weight Loss

Gynoid Obesity

"pear" shape, fat is stored in the lower body below the waistline. more common in females and describes a small waist with much of the fat deposited in the hips and thighs

1 Lb =

3500 calories

Cognitive restructuring

Changing your frame of mind regarding food. Rather than turning to food when you are stressed, you decide to exercise instead. After the exercise, if you still want to eat something, allow yourself a small portion of that food.

Low Carbs

Most of these diets have a severe carbohydrate restriction, which causes the body to turn to stored glycogen and protein for energy. This can lead to weight loss but also ketosis, constipation, headaches, and muscle cramps. The weight that is lost is often water weight. Failure usually occurs related to boredom with the diet. Several well-known low carbohydrate diets include the Atkins, South Beach, Zone, and Nutrisystem. **Recently there has been more emphasis on the glycemic load. Carbohydrates are limited, but emphasis is placed on low glycemic index foods, such as whole grains, fruits, and vegetables and limiting the high glycemic index foods. While not perfect, it is a more reasonable diet to follow and long-term success has been achieved. Examples of this type of diet include the New Glucose Revolution and the GI Diet.

Contingency Management

Preparing for situations that might trigger over eating such as a party or donuts at the office. If you have a board meeting to attend and you know the boss will be bringing in donuts, offer to bake a low-fat coffee cake as an alternative for those trying to watch their weight.

Amphetamines

The amphetamines stimulate the central nervous system and burn calories. These are only used short term as abuse or even a dependency can be developed.

Medications

Three classes: 1) amphetamines 2) appetite reduction drugs 3) fat absorption inhibitors

Where is Fat stored

adipose cells

How to determine your own healthy weight

consider weight history, where fat is distributed in the body, family health history, current weight, and activity status

Portion

he amount of food you choose to eat.

Serving size

is a specific measurement of food.

Extremely Low Calorie Diet

is an approach of consuming only 400-800 calories per day. Often this diet entails a low carbohydrate and high protein diet, often in liquid form. Careful monitoring by a physician is necessary.

Thermic Effect of Food (TEF)

is the energy used for digestion and absorption of food and accounts for approximately 10% of the calories expended. Larger meals and meals higher in protein result in a higher TEF.

Obesity and waist measurements

obese if greater than 40m or 35fm

Android Obesity

"apple" shape, fat is stored in the upper body (abdominal region) -common in males and linked to high blood testosterone levels and increased risk of diabetes and hypertension -alcohol consumption, smoking, and a diet with a high glycemic load can also contribute to this

Three components to weight loss

(1) control of calories, (2) physical activity, and (3) behavior modification.

Fad diet Characteristics

1. They promote quick weight loss. While you may shed the weight quickly, it is water weight, not fat, that is being lost. 2. They use celebrities or actors impersonating medical personnel to sell their product. 3. Food selections are limited and often you are encouraged to avoid one or more food groups. 4. They are expensive and often encourage you to buy nutritional supplements. 5. They cure all. Not only do you lose weight but you will have more energy, a better sex life, and decreased stress. 6. More importantly, they do not recognize the role of exercise or behavior modifications in weight loss.

Underweight Info

Although being overweight or obese is a health risk, being underweight can also be a cause for concern. Underweight is defined as a BMI of < 18.5. A low body weight can be often related to either genetics (you simply inherit a small frame size) or to a disease state. In most cases, the low weight is due to a GI disorder such as irritable bowel disease, where nutrients as well as calories pass through your GI tract without being absorbed properly. Additional diseases states such as AIDS or cancer can also cause an individual to be underweight. Apart from disease, additional causes for being underweight can range from an eating disorder to excessive dieting and exercise. For underweight individuals, sometimes gaining weight can be as difficult as losing weight. As with losing weight, the same principles can be applied to gain weight: controlling calories, physical activity, and behavior modification. Controlling calories is now done in terms of increasing calories, exercise is now used to build muscle mass, and appropriate behavior modifications are used to aid in replenishing body mass. Suggestions to increase weight include: adding healthy snacks several times daily, drinking beverages that are nutritious as well as a good calorie source, adding healthy fats to meals, and limiting fluid consumption to delay satiety. Just as there are risks to being overweight there are also risks related to being underweight. In females, loss of too much body fat will lead to cessation of the menstrual period. Once this occurs it can have long term health effects, including loss of bone mass, which places even young women at risk for fractures. Low body weight can also adversely affect your immune system, causing complications from surgery or delayed wound healing from an illness. However, if the low body weight is due to genetics and the person is otherwise healthy, there is little need to worry.

Chain Breaking

Breaking the tie that connects two or more behaviors that encourage overeating. For example, instead of munching on snacks while watching TV, limit yourself to eating only in the kitchen while seated at the table.

Low Fat

Diet eliminates animal protein sources and oils. The focus is on fruit, vegetables, and grains. This can be a very healthful way of eating but with fat restricted to < 20% of calorie intake, it can get very monotonous. Improvements in cholesterol and blood pressure are often observed if people can follow this approach. Examples include: The Ornish or Pritikin diets, T-Factor Diet, and Eat More Weigh Less.

Novelty

Diet focuses on a gimmick. They promote certain foods or types of foods as having special weight loss qualities. There is no scientific evidence to back up any claims. Examples include The Cabbage Soup Diet, The Beverly Hills Diet, and The Cookie Diet. The bottom line with this type of diet: The weight loss results from lack of calories, not from the foods that are promoted. They are not nutritionally balanced and may lead to malnutrition if followed for long periods of time.

Moderate Calorie Restriction

Diet limits calories to 1200-1800 per day. If the plan includes a wide variety of foods from all food groups and encourages exercise, it may be an acceptable weight loss plan. Examples of this type of diet include: Weight Watchers, Jenny Craig, Dr. Phil's Ultimate Weight Solution, and Dieting for Dummies.

Negative Energy Balance

Fewer calories are consumed than expended -illness/trauma, extremely high amount of energy is needed to heal, burn victims

Stimulus Control

Finding ways to avoid temptation when we are hungry or bored. For example, not buying convenience foods you are fond of or limiting yourself to one small piece of chocolate daily.

Morbid Obesity

For some individuals, controlling calories, physical exercise, and behavior modification are not enough to achieve a healthy weight. Individuals with a BMI of >30, or > 27 with co-morbid health risks (referred to as morbid obesity) may require drastic weight loss measures such as (1) medications, (2) extremely low-calorie diets, and/or (3) surgery. Importantly, all of the above measures must be undertaken under the direction of a physician.

Self-Monitering

Keep a diary for several days, recording what you eat, when you eat it, how you felt and where you were when you ate. This helps to reveal patterns that may be negatively affecting your weight loss efforts. Behavior modification is extremely important in understanding our eating habits and helping us to make changes to meet our weight loss goals. In addition to the National Heart, Lung, and Blood Institute website (Links to an external site.), there are several other websites that provide trackers to help you record your food intake and physical activity:

Appetite reduction drugs

Meridia is an FDA approved medication used to decreases hunger sensations. The moderate reduction in appetite is helpful to people who eat a fairly healthy diet but consume excess quantities.

Positive Energy Balance

More calories are consumed than expended. -needed for periods of growth, pregnancy, childhood/adolescence -over time will lead to weight gain -500+ will lead to 1lb a week

Nature vs Nurture

Nature is the genetic factor, while nurture is the environmental factor. Studies have been done on identical twins that were separated at birth. Years later they exhibited similar body types in relation to weight and fat distribution. The genes they inherited seemed to be the determining factor versus the environment they were raised in. As genes account for 70% of an individual's body weight, we thus inherit specific body types. If a child has normal weight parents, that child has a 10% chance of being obese. If, however, one parent is obese, the percentage increases to 40%. If both parents are obese the chances of their children also being obese jumps to 80%.

Nurture and Weight

Over the years, we have witnessed significant changes as modern appliances have made our daily activities less strenuous. Most of us no longer have jobs that involve manual labor, and housework, such as washing clothes and dishes, takes little more than a push of a button. As our lifestyle has become more sedentary, our waistlines have become thicker. In addition to inactivity, there are many other environmental factors that affect our weight: socioeconomic status, friends and family, cultural and ethnic influences, availability of high fat foods, excessive TV viewing, lack of sleep, emotional eating, stress, fast food, and smoking cessation. In other words, our lifestyle in terms of physical activity and physiological factors clearly has an impact on our body size and fat composition.

Fad Diets Do not Work

Simply put, fad diets do not work. They cannot be followed long term, and this simply sets an individual up for failure. In fact, studies have found that women who have "yo-yo" dieted, repeated cycles between weight loss and weight gain, have greater health risks than those who are overweight. In addition, this weight loss-gain cycle can lead to feelings of guilt and loss of self-esteem. There are a number of fad diets on the market, but most fall under one of four categories: (1) moderate calorie restriction, (2) carbohydrate focused, (3) low-fat, or (4) novelty.

Portion size and the times

The National Heart, Lung, and Blood institute website provides a Portion Distortion Quiz (Links to an external site.) that helps summarize the relation between large portion sizes and excess weight. For example, 20 years ago an average bagel was 3 inches in diameter and provided 140 calories. Today's bagel is 6 inches in diameter and provides 350 calories...a full 210 calories extra! In order to burn off the extra 210 calories, a 130-pound person would need to rake leaves for 50 minutes. For additional help in calorie counting, the MyPlate Tracker and Menu Planner (Links to an external site.) can personalize your goals for reducing calories and making healthy eating changes.

Controlling Calories and high-fat foods

When controlling calories, a common strategy is also to limit high-fat foods. While decreasing your total intake of fat can have a positive impact on your waistline and health, food labels can be deceiving. Although food manufacturers have marketed low-fat and fat-free products for several years now, in many products, the calorie difference between low-fat and its regular counterpart can be marginal. To make up for the lack of fat, extra sugar or salt may be added to improve the taste of the product. After all, when it comes to the enjoyment of food, taste is a major factor. Additionally, the lack of fat or simply the knowledge that the product is lower in calories, may lead you to actually eat more of a low-fat product. The end result is often the consumption of more calories than if you had just ingested the regular product initially.

Obesity is a global epidemic

With the growing evidence that our children are heavier now than in any other decade, there is an increased need to develop public health strategies that focus on children and adolescents. Health care costs will soar as the current population ages and health conditions related to obesity become more prevalent. Current trends, rates, and statistics for the US population can be found on the CDC website (Links to an external site.). Despite research and intervention efforts, the percentage of the population who are overweight or obese is too high. While weight loss is not easy, the focus for adults should be a slow weight loss, decreased calorie intake, adequate nutrient intake, and increased physical activity. Once achieved, the long-term goal should become the maintenance of a healthy weight.

Body Mass Index

a measure of body weight relative to height BMI = weight (kg) / height(squared) meters not accurate for: children, teens, pregnant or breast feeding moms, short people, muscular, or elderly

Underwater weighing

a very accurate process where an individual is weighed on a scale and then again while under water. The difference between the two measurements (normal vs. underwater) is then used to estimate the total body volume. From this the percentage of lean muscle and body fat can be calculated.

Physical Activity

accounts for 15-40% of our energy expenditure. A number of factors, such as body size, fitness level, and the actual activity, determine how many calories are expended. Low physical activity and a "couch potato" mentality often lead to weight gain. Previous generations expended many more calories than we do today as jobs were physically demanding. In contrast, modern conveniences do much of the work for us. As a result, we live a much more sedentary lifestyle and must intentionally choose to be active.

Gastric Balloon

an additional approach for weight loss surgery. A gastric balloon is made out of soft silicone and the deflated form is inserted through your esophagus into the stomach. The procedure takes approximately 30 minutes with no incisions or surgery required. The balloon is then inflated to the size of a grapefruit. The balloon is not permanent and is removed after approximately 6 months. The key to success is that lifestyle changes are being taught and implemented throughout the process and continue after the balloon is removed.

Fat Cell Development

another biological factor related to our weight. Once a fat cell is formed, it will always be present. Further, our bodies are predisposed to want to fill the fat cells. While it is possible to shrink the size of fat cells, we cannot get rid of fat cells through dieting. Sex, age, race, and ethnicity also play key roles in our body composition.

Bioelectrical impedance

based on the principle that water conducts electricity and fat resists electricity. As muscle is primarily composed of water, an instrument with electrodes is connected to the body and a painless low energy electric current is sent through the body. Since fat resists electricity, higher levels of resistance indicate a higher percentage of body fat.

Basal Metabolic Rate (BMR)

defined as the number of calories used by the body while in a fasting state and accounts for approximately 60-70% of energy expenditure -Males require 1kcal/kg/hour -Fmales require .9 support various organ functions and stay alive -varies from person to person depending on gender, lean body mass, body size, temperature, age, nervous system activity, levels fo caffeine intake, and smoking. -if someone is trying to lose weight, their BMR will decline (mechanism to prevent starvation) -declines 1-2% per decade

Energy Balance

energy intake = energy expenditure Calories in = calories out

"thrifty metabolism"

fewer calories than normal are used to maintain body function. Someone with a thrifty metabolism is thus prone to weight gain as their unusually low basal metabolic rate results in fewer calories being burned, which in turn encourages the generation and storage of fat.

Social Support

from family, friends, social programs, and/or professional help is complementary to behavior modification and perhaps equally important for weight loss and maintenance. Family and friends can have a positive or negative impact. Studies show eating out at restaurants with overweight people puts you at risk for overindulging. It is important to make sure family and friends understand why you desire to lose weight and that you seek their encouragement and support. Social programs may include hospitals, community colleges, and restaurants as they can be good resources for healthy cooking classes. Strength training programs offered through Coop extension programs are also examples of social programs. Professional help would include physicians, exercise physiologists, and registered dietitians. These professions have been trained to help clients make wise food and exercises choices. Reliable weight loss programs are also available and include TOPS (take off pounds sensibly), Weight Watchers, Nutra System, and Jenny Craig. The more knowledge and support you have the greater your success at weight loss and long-term maintenance.

Hyperplasia

is an increase in the number of fat cells often occurring during periods of growth, such as adolescence or pregnancy.

Hypertrophy

is an increase in the size of fat cells, most often seen in periods of low growth and maintenance, such as throughout adulthood.

Waist to hip ratio

measure around the waist (at the level of the belly button) while relaxed. Next measure the hips around the largest part of the butt. Divide the waist by hip The desired ratio in males is <0.9 and in females < 0.8. Exceeding the respective values would be indicative of a health risk.

Direct Calorimetry

measures the amount of heat given off by the body. An insulated chamber surrounded by a thin layer of water is used to measure the amount of heat emitted by the subject in the chamber. This method is used infrequently due to the expense and complexity of the procedure.

Fad diet

often emphasizes one food group and includes many gimmicks. Regardless if you are overweight, underweight, or at a healthy weight, there is a high probability that you have heard of, if not tried, a fad diet. You find them advertised everywhere: the Internet, newspapers, radios, magazines, books, and even celebrity endorsements. In all likelihood, you can lose weight following a fad diet. However, it is important to consider if the apparent weight loss is because of the fad diet or simply the result of limiting calories throughout the day.

Surgery

often the last resort when medications and diets fail. Bariatrics is the branch of medicine that focuses on the cause, prevention, and treatment of obesity. Currently, several bariatric surgeries are available in the treatment of severe obesity. Gastric banding is a restrictive procedure where the opening from the esophagus to the stomach is restricted using a gastric band, forming a small pouch in the stomach (Figure 3.5). The band can be inflated or deflated to control the amount of food a person can consume and still be comfortable.

Label reading

process of comparing labels on similar products in terms of serving size, number of calories per serving, and the amount of fat per serving. When looking at labels and comparing products, remember that calories are important, regardless of whether they come from fat, carbohydrates, or protein. For example, compare the labels shown in Figure 3.4. The first has 238 calories and the other 190 calories. The first is also slightly higher in fat and carbohydrate content. Therefore, the second option would be the healthier choice.

Controlling Calories

regulating the number of calories you consume daily (no magic formula) 1-2lbs a week, steady weight loss wil result in weight maintenance standard for fm= 1200 males=1500

Set point Theory

states that each of us has a genetically predetermined body weight and that the body will resist change beyond this set point. This set weight is a weight that was not difficult to maintain on your part. Studies have been conducted where a test subject is fed large quantities of calories while in a controlled environment. The result of course is weight gain. After the calories are decreased to appropriate amounts for the individual, the subject's weight will return to his set point. However, it does appear that it is easier to gain weight than to lose weight, and the set point may change as we age. This process is not well understood but is related to various hormones and enzymes. One hormone in particular is leptin, and studies are being conducted to determine its exact role in weight regulation.

Gastroplasty

stomach stapling works by reducing the stomach capacity and bypassing a small portion of the small intestine (Figure 3.6). The stomach can now only hold 30 milliliters or the volume of 1 egg. The majority of individuals who undergo this form of surgery lose approximately 50% of their weight. Post-op individuals feel full quickly and learn not to over eat as abdominal discomfort and vomiting will occur. While this approach has been proven to be effective for weight loss, it must be performed under a physician's supervision with behavior modification techniques encouraged. Extensive counseling and a patient's history is often reviewed prior to surgery approval. Health risks include bleeding, clots, hernias, infection, nutrient deficiencies, and increased risk of death. The procedure is costly and may involve an additional surgery in order to remove excess skin once weight loss is achieved. The client needs to thoroughly understand the risks associated with the procedure and be willing to make lifestyle changes, including adding exercise to their daily activities.

Thermogenesis

the ability to regulate body temperature and activities such as fidgeting, maintaining body posture, and shivering. The amount of energy burned through thermogenesis is very small. Recently scientists have begun to study the link between brown adipose (fat) tissue and weight maintenance. Brown adipose tissue is found in infants below the collar bone. The brown fat metabolizes the energy yielding nutrients, which results in heat production to be used by the body. Most adults have little brown fat, but lean adults have been found to have higher levels than their heavier counterparts. Studies are underway to see how this knowledge could be used to benefit those that struggle with being overweight.

Dual Energy Xray absorpimetry (DEXA)

the most accurate measure of body fat composition as well as bone mass. An instrument that emits small doses of radiation determines the amount of fat, lean tissue, and bone in an individual. However, it is very expensive and rarely used.

Anthopometrics

the science of measuring the proportions and size of the body, offers a more practical method to determine body fat composition. Skin fold measures using a caliper, one important type of anthropometric measure, can be done quickly and fairly accurately—if the person doing the measurements is trained properly. By measuring the fat layer just under the skin at several locations, the percent body fat can be calculated.

Physical Activity and weight loss

the second key to weight loss and maintenance. Being physically active does more for you than just burn calories. Physical activity can decrease your stress level, improve your mood, increase productivity, maintain bone health, and increase lean body mass, which in turns leads to more efficient use of calories even at rest. Regular activity is the key to good health and positive results. Current recommendations are for 60-90 minutes of activity per day, as well as 10,000 steps. Although it was once thought any activity had to be continuous for 60 minutes to be beneficial, this is now known not to be the case—small increments of activity throughout the day that add up to 60 minutes can be just as beneficial. In addition to cardio activities, adding resistance exercises and stretches daily has been shown to be beneficial. Resistance exercises builds muscle and lean body mass. Although changes in the number on the scale may not be readily evident, resistance and stretching exercises tone the body. At the same time, bone mass is being preserving which will help fight osteoporosis later in life. As a whole, taking care of your body now through physical exercise will help to ensure a smooth transition later into the last decades of life.

Behavior Modification

the third key to weight loss and maintenance and describes how certain factors (or behaviors) can prevent us from reaching our weight loss goals. Clearly defining such factors and learning how to manage them are important to a successful outcome. After all, most people find it very difficult to maintain their weight loss. The majority of successful losers end up regaining the weight they lost within five years. This is why behavior modification strategies are so important—they provide strategies that can be followed long term regardless of what stage of life you are in.

Fat Absorption Inhibitors

to decrease fat absorption, the FDA approved Orlistat (also known as Xenical). Orlistat inhibits lipase enzymes from breaking down fat in the small intestine. The result is approximately a third of the dietary fat taken in (ingestion) is not absorbed. The fat then passes out of the body in the feces. Side effects include gas, bloating, and diarrhea if excess fat is consumed while taking this medication. A low dose form of Orlistat, Alli, is available over the counter.

Indirect Calorimetry

uses oxygen intake and carbon dioxide output, along with scientific formulas, to measure energy expended. It is convenient, fairly cheap, easy, and very portable.