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Nutrition - Chapter 7 Notes
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Nutrition - Chapter 7 Notes

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    Nutrition - Chapter 7 Notes Nutrition - Chapter 7 Notes Presentation Transcript

    • Chapter 7 Lecture Outline Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display
    • Energy Balance
      • 65% of adults are overweight
      • 30% of total population is obese
      • Red flags:
        • 10 pounds of weight gain
        • 2-inch increase in waist circumference
    • Energy Balance
    • Estimating kcal Content in Food
    • Energy In vs. Energy Out Adaptive Thermogenesis Basal Metabolism Dietary Intake Physical Activity Thermic Effect of food
    • Basal Metabolism
      • Minimum energy expended to keep a resting, awake body alive
      • ~60-70% of total energy needs
      • Includes energy needed for maintaining heartbeat, respiration, body temperature
      • Amount of energy needed for basal metabolism varies between individuals
      • Approximately 1 kcal/minute
    • Factors that Influence Basal Metabolism
      • Body surface area (weight, height)
      • Lean body mass
      • Gender
      • Body temperature
      • Thyroid hormone
      • Nervous system activity
      • Age
      • Calorie intake
      • Pregnancy
      • Use of caffeine and tobacco
    • Physical Activity
      • Increases energy expenditure
      • More activity, more energy burned
      • Lack of activity is a major cause of obesity
    • Thermic Effect of Food (TEF)
      • Energy used to digest, absorb, and metabolize food nutrients
      • “Sales tax” of total energy consumed
      • ~5-10% above the total calories consumed
      • TEF is highest for protein > carbohydrate > fat
    • Adaptive Thermogenesis
      • Nonvoluntary physical activity
        • Triggered by overeating
        • Fidgeting and shivering
        • Maintenance of muscle tone
        • Maintenance of posture
      • Overeating
        • Increases sympathetic nervous system activity
      • Resists weight gain
    • Determination of Energy Needs
      • Direct calorimetry
        • Measures heat output
        • Expensive and complex
      • Indirect calorimetry
        • Measures the amount of oxygen consumed
        • Oxygen consumed is related to energy expended
    • Estimated Energy Requirement (EER)
      • Men 19 years and older:
      • EER= 662-(9.53 x AGE) + PA x (15.91 x WT + 539.6 x HT)
      • Women 19 years and older:
      • EER= 354- (6.91 x AGE) + PA x (9.36 x WT + 726 x HT)
        • PA = physical activity estimate
        • WT = weight in kg
        • HT = height in meters (inches / 39.4)
    • Physical Activity Estimate 1.45 1.48 Very Active (walks the equivalent of ~17 miles/day) 1.27 1.25 Active (walks the equivalent of ~7 miles/day) 1.12 1.11 Low Activity (walks the equivalent of ~2 miles/day) 1.00 1.00 Sedentary (no exercise) PA (WOMEN) PA (MEN) ACTIVITY LEVEL
    • What is a Healthy Body Weight?
      • Current height/weight standards
        • Weight associated with health and longevity
        • May not be the healthiest weight for individual
      • Review of family history
      • Personal weight history
      • Healthy lifestyle contribution
    • Weight-Related Conditions
    • A Healthy Body Weight
      • What is the lowest weight maintained for more than a year?
      • What weight was maintained without constantly feeling hungry?
      • Establish a “personal” healthy weight
    • BMI: Overweight and Obesity
      • Underweight = BMI < 18.5
      • Healthy weight = BMI 18.5-24.9
      • Overweight = BMI 25-29.9
      • Obese = BMI 30-39.9
      • Severely obese = BMI >40
    • Height / Weight Table
    • Perspective on Weight
      • Aim for personal healthy weight
      • Avoid unrealistic goals
      • Listen to body’s cues (for hunger)
      • Eat a healthy diet
      • Be physically active
      • “Size acceptance”
    • Obesity
      • Excessive amount of body fat
        • Women > 35% body fat
        • Men > 25% body fat
      • Increased risk for health problems
      • Are usually truly overweight
    • Estimation of Body Fat
      • Underwater weighing
      • Most accurate
      • Fat is less dense than lean tissue
      • Fat floats
    • Estimation of Body Fat
      • Air displacement
      • Determines the body volume
        • Displace air in a sealed chamber
      • Body density =
      • Body wt/body volume
      • % Body fat=
      • (495/body density)-450
    • Skinfold Measurements
      • Insert Figure 7-10, p. 248Bioelectrical impedance
    • Estimation of Body Fat
      • Bioelectrical impedance
        • Low-energy current that measures the resistance of electrical flow
        • Fat is resistant to electrical flow; the more the resistance, the more body fat
      • DEXA (dual x-ray photon absorptiometry)
        • X-ray body scan that allows for the determination of body fat
        • Very accurate but expensive
    • Body Fat Distribution
      • Upper-body obesity, “Apple shape”
      • Associated with
        • Cardiovascular disease, HTN, type 2 diabetes
        • Testosterone and excessive alcohol
        • Abdominal fat is released into the liver and promotes inflammation in the body
      • Defined as
        • Waist measurement of > 40” for men
        • Waist measurement of >35” for women
    • Body Fat Distribution
    • Body Fat Distribution
      • Lower-body obesity, “Pear shape”
      • Encouraged by estrogen and progesterone
      • After menopause, upper-body obesity more common
      • Fewer health risks than upper-body obesity
    • Juvenile-Onset Obesity
      • Develops in infancy or childhood
      • Increase in the number of adipose cells
      • Adipose cells have long lifespan and need to store fat
      • Makes it difficult to lose fat (weight loss)
    • Adult-Onset Obesity
      • Develops in adulthood
      • Fewer (number of) adipose cells
      • Adipose cells are larger (store excess amount of fat)
      • If weight gain continues, the number of adipose cells can increase
    • Obesity and Nature Debate
      • Identical twins
        • When raised apart still have similar weights
      • Genes
        • Affect metabolic rate, fuel use, brain chemistry, body shape
        • Account for up to 70% of weight differences
      • Thrifty metabolism gene
        • More fat storage to protect against famine
    • Set-Point Theory
      • Weight is regulated by the body
      • Genetically predetermined body weight
      • Body resists weight change
      • Leptin assists in weight regulation
      • Reduction in calorie intake results in lower metabolic rate
      • Ability to shift the set-point weight?
    • Opponents of Set-Point Theory
      • Weight does not remain constant
      • Different environments can alter weight
      • People settle into a particular weight based on current circumstances
    • Obesity and Nurture Debate
      • Environmental factors influence weight
      • Learned eating habits
      • Activity factor (or lack of)
      • Poverty and obesity
      • Female obesity is rooted in childhood obesity
      • Male obesity appears after age 30
    • Nature and Nurture
      • Obesity is nurture allowing nature to express itself
      • Location of fat is influenced by genetics
      • Child of obese parents is especially at risk
      • Increased physical activity and moderate calorie intake can promote healthy weight
    • What Encourages Excess Body Fat?
    • Why Diets Don’t Work
      • Obesity is a chronic disease
        • Treatment requires long-term lifestyle changes
      • Dieters are misdirected
        • More concerned about weight loss than healthy lifestyle
        • Unrealistic weight expectations
    • Looking for a Sound Weight-Loss Program?
      • Seek advice from a Registered Dietitian
      • Control calorie intake
      • Increase physical activity
      • Acknowledge need for lifelong changes to maintain healthy weight
    • Weight-Loss Triad
    • Control Calories
      • Sedentary society---requires less calories
      • Low-fat, high-fiber approaches
        • Most successful in long-term studies
      • No diet has a “metabolic advantage”
      • Read food labels
      • Keep a food log (portion size awareness)
    • Regular Physical Activity
      • Important for weight maintenance
      • Promotes steady weight loss
        • Expends 100-300 kcal while controlling calories
      • Boosts self-esteem
      • Add weight resistance
        • Increase lean body mass
        • Increase fat use
        • Increase bone health
        • Increase metabolic rate
    • Physical Activity Recommendations
      • 60 minutes/day to maintain body weight
      • 60-90 minutes/day for maintenance of weight loss
      • Pedometer
        • Goal 10,000 steps a day
    • What it Takes to Lose a Pound
      • Body fat contains 3500 kcal per pound
      • Fat storage (body fat plus supporting lean tissues) contains 3300 kcal per pound
      • Must have an energy deficit of about 3300 kcal to lose a pound per week
    • Do the Math To lose one pound, you must create a deficit of 3300 kcal So to lose a pound in 1 week (7 days), try cutting back on your kcal intake and increase physical activity so that you create a deficit of about 500 kcal per day - 500 kcal x 7 days = - 3500 kcal = ~ 1 pound of weight day week loss in 1 week
    • Sound Weight Loss Program
      • Rate of loss
      • Flexibility
      • Intake
      • Behavior modification
      • Overall health
    • Behavior Modification
      • Modify problem (eating) behaviors
      • Chain-breaking
      • Stimulus control
      • Cognitive restructuring
      • Contingency management
      • Self-monitoring
    • Chain-Breaking
      • Breaking the link between two behaviors
      • These links can lead to excessive intake
    • Stimulus Control
      • Altering the environment
        • Minimize the stimuli for eating
      • Putting you in charge of temptations
    • Cognitive Restructuring
      • Changing your frame of mind regarding eating
      • Replacing eating due to stress with “walking”
    • Contingency Management
      • Forming a plan of action
        • Response to a situation
      • Rehearsing appropriate responses
        • The pressure of eating at parties
    • Self-Monitoring
      • Tracking foods eaten and conditions affecting eating
      • Understanding your eating habits
    • Weight Maintenance
      • Prevent relapse
        • Occasional lapse is fine, but take charge immediately
        • Continue to practice newly learned behavior
        • Requires “motivation, movement, and monitoring”
      • Have social support
        • Encouragement from friends/ family/ professionals
    • Diet Drugs
      • Amphetamine (Phenteramine)
        • Prolongs the activity of epinephrine and norepinephrine in the brain
        • Decreases appetite
        • Not recommended for long-term use (dependency)
      • Sibutramine (Meridia)
        • Enhances norepinephrine and serotonin activity
        • Decreases appetite
        • Not recommended for people with HTN
    • Orlistat (Xenical)
      • Inhibits (lipase) fat digestion
      • Reduces absorption of fat by 30% in the small intestine
      • Dietary fat is deposited in the feces, with resulting side effects
      • Must still control fat intake
      • Malabsorption of fat-soluble vitamins
      • Supplement needed at bedtime
      • Alli---Low dose of Orlistat, available OTC
    • Treatment of Severe Obesity
    • Very Low-Calorie Diets (VLCD)
      • Recommended for people >30% above their healthy weight
      • 400-800 kcal per day
      • Low carbohydrate and high protein
      • Cause ketosis
      • Lose ~3-4 pounds a week
      • Require careful physician monitoring
      • Health risks include cardiac problems and gallstones
    • Bariatric Surgery
    • Adjustable Gastric Banding
      • Reduces opening from esophagus to stomach by gastric band
      • Decreases amount of food eaten
      • Band can be inflated or deflated
    • Gastroplasty - Stomach Stapling
      • Most common surgical procedure for treating severe obesity
      • Reduces the stomach size
        • From 4 cups to 1 oz (shot glass size)
      • Overeating will result in rapid vomiting
      • Smaller stomach promotes satiety earlier
      • 75% will lose ~50% of excess body weight
    • Gastroplasty
    • Criteria for Gastroplasty
      • BMI > 40
      • Obese for > 5 years
      • No history of alcoholism
      • No history of major psychiatric disorder
      • Costly procedure
      • Follow-up needed after procedure loss
      • Requires major lifestyle changes
    • Underweight is Also a Problem
      • BMI of <18.5
      • Associated with increased deaths, menstrual dysfunction, pregnancy complications, slower recovery from illness/surgery
    • Treatment for Underweight
      • Intake of energy-dense foods (energy input)
      • Encourage regular meals and snacks
      • Reduce activity (energy output)
      • Increase portion size
      • Strength training
    • Fad Diets
      • Promote quick weight loss
      • Limited food selections
      • Use of testimonials
      • Cure-alls
      • Recommend expensive supplements
      • No permanent lifestyle changes advocated
      • Critical of the scientific community
    • Types of Popular Diets
      • Low or restricted carbohydrates
      • Carbohydrate focused diets
      • Low-fat approaches
      • Novelty diets
      • Meal replacements
    • Popular Diets