Chapter 9 NUTR

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Chapter 9 NUTR

  1. 1. Chapter 9 Weight Management:Overweight, Obesity, and Underweight © 2009 Cengage - Wadsworth
  2. 2. Overweight• Overweight (BMI 25-29.9) and obesity (≥ 30) are widespread health problems that are continuing to increase.• Many refer to overweight and obesity as an epidemic.• For good health, weight management is important. © 2009 Cengage - Wadsworth
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  4. 4. Overweight• Fat Cell Development Fat cell numbers • Fat cell numbers increase most rapidly in later childhood and early puberty. • Fat cell numbers increase in times of positive energy balance. • Hyperplastic obesity © 2009 Cengage - Wadsworth
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  6. 6. Overweight• Fat Cell Development Fat cell size • Fat cell sizes increase when energy intake exceeds expenditure. • Hypertrophic obesity The adverse effects of fat in non- adipose tissue are called lipotoxicity. © 2009 Cengage - Wadsworth
  7. 7. Overweight• Fat Cell Metabolism Lipoprotein lipase promotes fat storage. Gender differences • Men are at increased risk for developing central obesity and women are at increased risk for lower body fat. • Enzymes that break down fats affect men and women differently. © 2009 Cengage - Wadsworth
  8. 8. Overweight• Set-Point Theory The body’s natural regulatory centers maintain homeostasis at set point. The human body tends to maintain a certain weight. © 2009 Cengage - Wadsworth
  9. 9. Causes of Obesity• Obesity may not be as simple as food intake exceeding metabolic needs.• Some factors, such as overeating and inactivity, are within our control.• Genetic, hormonal and emotional factors may require professional intervention. © 2009 Cengage - Wadsworth
  10. 10. Causes of Obesity• Genetics Leptin (also called the ob protein) • Protein that acts as a hormone to increase energy expenditure and decrease appetite • Produced by fat cells under the direction of the ob gene • May be deficient in obese individuals • More research is needed. © 2009 Cengage - Wadsworth
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  12. 12. Causes of Obesity• Genetics Ghrelin • Protein that acts as a hormone to decrease energy expenditure and increase appetite • Produced by stomach cells • Has an inverse relationship with PYY © 2009 Cengage - Wadsworth
  13. 13. Causes of Obesity• Genetics Uncoupling Proteins • Influence energy metabolism • White adipose tissue stores fat to be used for energy. • Brown adipose tissue stores fat to be used for heat. • May oppose the development of obesity © 2009 Cengage - Wadsworth
  14. 14. Causes of Obesity• Environment – The gene pool of our population remains relatively unchanged.  Overeating • Present and past eating influences current body weight. • Increased availability of convenient food, large portions, and energy-dense foods  Physical Inactivity • Modern technology replaces physical activities. • Physical activity is important to allow people to eat enough food to get needed nutrients. © 2009 Cengage - Wadsworth
  15. 15. Problems with Obesity• Obesity problems depend on many factors such as the extent of overweight, age, health status and genetic makeup.• Risk factors may differ among individuals. © 2009 Cengage - Wadsworth
  16. 16. Problems with Obesity• Health risks are evaluated using BMI, waist circumference and disease profiles.  Overweight people who are in good health may not need to lose weight.  Obese or overweight people with risk factors could improve health by losing weight or using other diet and exercise strategies. Risk factors include: • Hypertension • Cigarette smoking • High LDL • Low HDL • Impaired glucose tolerance • Family history of heart disease • Men ≥ 45 years, women ≥ 55 years © 2009 Cengage - Wadsworth
  17. 17. Problems with Obesity• Health Risks Obese or overweight people with the following life-threatening-conditions may improve health by losing weight: • Heart disease • Type 2 diabetes • Sleep apnea © 2009 Cengage - Wadsworth
  18. 18. Problems with Obesity• Perceptions and Prejudices  Social Consequences • Prejudices and discrimination • Judged on appearance rather than character • Stereotyped as lazy and lacking self-control  Psychological Problems • Feelings of rejection, shame and depression are common. • Ineffective treatments can lead to a sense of failure. © 2009 Cengage - Wadsworth
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  20. 20. Problems with Obesity• Dangerous Interventions Fad Diets • False theories • Inadequate diets • Can be a danger to health © 2009 Cengage - Wadsworth
  21. 21. Problems with Obesity• Dangerous Interventions  Weight-Loss Products • Ephedrine-containing products inhibit serotonin and suppress the appetite. Supplements containing Ephedra have been banned by the FDA due to potential health risks. • Herbal laxatives do not prevent absorption. • Current laws do not require safety tests and effectiveness tests for these products.  Other Gimmicks • Don’t work • There is no such thing as cellulite. © 2009 Cengage - Wadsworth
  22. 22. Aggressive Treatments of Obesity• Individuals with clinically severe obesity and major medical problems may benefit from drugs or bariatric surgery.• But changing and improving eating and exercise habits offer the greatest benefit. © 2009 Cengage - Wadsworth
  23. 23. Aggressive Treatments of Obesity• Drugs Sibutramine suppresses the appetite and is most effective when used with a reduced kcalorie diet and increased physical activity. There are many side effects. Orlistat blocks fat digestion and absorption. There are many side effects. Other drugs are still under study. © 2009 Cengage - Wadsworth
  24. 24. Aggressive Treatments of Obesity• Surgery  Surgery is an option for those who have tried weight loss programs and failed, have a BMI ≥ 35, and are having health problems due to their weight.  Gastric surgery has short-term and long- term problems and requires compliance with dietary instructions.  Liposuction is a popular procedure that is primarily cosmetic but poses risk. © 2009 Cengage - Wadsworth
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  26. 26. Weight-Loss Strategies• A life-long eating plan for good health, which includes nutritionally adequate eating, reasonable expectations, regular physical activity, and permanent lifestyle changes, is best for achieving permanent weight loss.• Weight loss of 1-2 pounds per week or 10% of body weight in six months is safe. © 2009 Cengage - Wadsworth
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  29. 29. Weight-Loss Strategies• Eating Plans  Be Realistic about Energy Intake • 300-500 kcalories/day reduction for BMI between 27 and 35 • 500-1000 kcalories/day reduction for BMI ≥ 35 • Dietary Guidelines should be followed.  Diet should be nutritionally adequate while avoiding excessive consumption.  Smaller portions are recommended to feel satisfied, not stuffed. © 2009 Cengage - Wadsworth
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  31. 31. Weight-Loss Strategies• Eating Plans  Eat foods of lower energy density, that are high in fiber, high in water and low in fat.  Water is important to increase fullness and reduce hunger.  Complex carbohydrates offer abundant vitamins, minerals and fiber with little fat.  Choose fats sensibly and reduce the quantity of fat.  Watch empty kcalories from sugar and alcohol. © 2009 Cengage - Wadsworth
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  33. 33. Weight-Loss Strategies• Physical Activity  An individual’s body weight as well as intensity and duration of activity influence energy expenditure.  Physical activity increases the amount of discretionary kcalories that can be consumed.  Metabolic rates can rise with daily vigorous activity.  Activity can decrease body fat and increase lean body mass.  Exercise may help to curb appetite.  Activity can reduce stress and improve self- esteem. © 2009 Cengage - Wadsworth
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  35. 35. Weight-Loss Strategies• Physical Activity  Choosing Activities • Choose activities that you enjoy and are willing to do regularly. • Low to moderate intensity for long duration is recommended. • Daily routines can incorporate energy activities.  Spot Reducing • Regular aerobic exercise and weight loss will help trouble spots. • Strength training can improve muscle tone. • Stretching can help flexibility. © 2009 Cengage - Wadsworth
  36. 36. Weight-Loss Strategies• Behavior and Attitude  Behavior modification requires time and effort.  Awareness of behavior is the first key.  Changing behaviors one at a time works best. • Do not grocery shop when hungry. • Eat slowly. • Exercise while watching television.  Personal attitudes toward food and eating must be understood.  Support groups may be helpful for some people. © 2009 Cengage - Wadsworth
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  38. 38. Weight-Loss Strategies• Weight Maintenance Successful weight-loss maintenance programs use different criteria so they are difficult to compare. Vigorous exercise and careful eating plans are key. Frequent self-monitoring is recommended. © 2009 Cengage - Wadsworth
  39. 39. Weight-Loss Strategies• Prevention Eat regular meals and limit snacking. Drink water in place of high-kcalorie beverages. Select sensible portion sizes and limit daily energy intake to energy expended. Limit sedentary activities and be physically active. © 2009 Cengage - Wadsworth
  40. 40. Weight-Loss Strategies• Public health programs have been suggested to: Develop safety standards for foods. Control commercial advertising. Control conditions under which foods are sold. Control prices to reduce consumption. © 2009 Cengage - Wadsworth
  41. 41. Underweight• Incidences of underweight and associated health problems are less prevalent than overweight and obesity problems. © 2009 Cengage - Wadsworth
  42. 42. Underweight• Problems of Underweight Causes are diverse. Energy demands may be great and foods are needed to support growth and physical activities. Eating disorders are severe cases. © 2009 Cengage - Wadsworth
  43. 43. Underweight• Weight-Gain Strategies  Energy-dense foods can be included but choose fat wisely to avoid the associated cardiac risks.  Regular meals each day must become a priority.  Use large portions and expect to feel full.  Consume extra snacks between meals.  Juice and milk are easy ways to increase kcalories.  Exercising to build muscles will support increases in muscle mass. © 2009 Cengage - Wadsworth
  44. 44. The Latest and GreatestWeight-Loss Diet--Again © 2009 Cengage - Wadsworth
  45. 45. The Latest and Greatest Weight-Loss Diet--Again• Fad diets do not offer safe or effective plans for weight loss.• Diet recommendations should be research based.• There are guidelines for identifying fad diets and weight-loss scams. © 2009 Cengage - Wadsworth
  46. 46. The Diet’s Appeal• There are many misconceptions and distortions of facts.• Results are not long lasting. © 2009 Cengage - Wadsworth
  47. 47. The Diet’s Achievements• Don’t Count kCalories• Satisfy Hunger• Follow a Plan• Limit Choices © 2009 Cengage - Wadsworth
  48. 48. The Diet’s Shortcomings• Too Much Fat• Too Much Protein• Too Little of Everything Else © 2009 Cengage - Wadsworth
  49. 49. The Body’s Perspective• Adverse side effects of low- carbohydrate, ketogenic diets Nausea Fatigue Constipation Low blood pressure Elevated uric acid Stale, foul taste in the mouth Fetal harm and stillbirth © 2009 Cengage - Wadsworth

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