Chapter 14   © 2012 McGraw-Hill Higher Education. All rights reserved.
Introduction   National Institutes of Health     68% of American adults are overweight     2007-2008: 33.8% of adult me...
Figure 14.1 Obesity Prevalence, by Ageand Sex, of American Adults, 2007-2008                                              ...
Basic Concepts of Weight Management    One pound of fat = 3,500 calories    Body composition      Fat-free mass (or lea...
Energy Balance   Crucial to keep a healthy ratio of fat to     fat-free mass     Energy (calories from food)     Consum...
Figure 14.2The Energy Balance Equation                                                                           6        ...
Evaluating Body Weight andBody Composition   Body mass index (BMI) Measure of body weight for classifying health risks ...
Assessment of Body Weight   National Institutes of Health categories of BMI           Under 18.5 is classified as underw...
Figure 14.3 Body Mass Index (BMI)                                                                          9              ...
Body Composition Analysis   Most accurate way to evaluate body composition     is to determine percent body fat   Hydros...
Table 14.2 Percentage of Body Fat as the Criterion for Obesity                                                            ...
Excess Body Fat and Wellness   Health risks of excess body fat     Obese individuals have a mortality rate twice that of...
Figure 14.4 Diabetes Mellitus                                                                       13                    ...
Body Fat Distribution and Health   Apple shape      Android obesity     Upper regions of their bodies     Increase ris...
Body Image   Collective picture of the body as seen     through the mind’s eye     Perceptions     Images     Thoughts...
Problems Associated withVery Low Levels of Body Fat       Less than 8-12% for women and less than         3-5% for men  ...
What Is the Right Weight for You?       General guides         BMI         Percent body fat         Waist circumferenc...
Factors Contributing to Excess Body Fat   Genetic factors     Nutrigenomics      ○ Study of how nutrients and genes inte...
Lifestyle Factors Eating Physical Activity Psychosocial factors     Emotions      ○ Distraction from difficult feeling...
Adopting a Healthy Lifestyle forSuccessful Weight Management “Normal” body weight Diet and eating habits     Total calo...
Adopting a Healthy Lifestyle for       Successful Weight Management                 (continued)   Portion sizes   Energy...
Physical Activity and Exercise   30 minutes or more of moderate-intensity     physical activity every day     Walking   ...
Thinking and Emotions What do you think of yourself? Self-esteem Negative emotions “Ideal self” Beliefs and attitudes...
Coping Strategies   Adequate and appropriate strategies   Don’t use food as a way to cope with stress     Good communic...
Approaches to Overcominga Weight Problem Doing it yourself    ○ 0.5-2.0 pounds per week    ○ Initial weight loss from flu...
Weight-Loss Programs   Noncommercial     TOPS (Take Off Pounds Sensibly)     OA (Overeaters Anonymous)     ○ 12-step pr...
Weight-Loss Programs   Prescription drugs     Appetite suppressants control appetite     All have potential side effect...
Surgery   Severely obese –      5.7% of adult Americans is “morbidly” obese     NIH recommends gastric bypass for indiv...
Body Image   Severe body image problems     ○ Body dysmorphic disorder (BDD)        Affects about 2% of Americans       ...
Eating Disorders   Problems with body weight and weight     control   Characterized by severe disturbances in     body i...
Eating Disorders Central feature – dissatisfaction with   body image and body weight created by   distorted thinking Her...
Eating DisordersAnorexia Nervosa - failure to eat enough food Affects 3 million people – 95% are female     Typically d...
Eating Disorders   Bulimia Nervosa - recurring episodes of binge eating followed by purging    Bulimia Nervosa   Begins ...
Eating Disorders   Binge-eating disorder (BED) - similar to     bulimia, except no purging behavior     Affects about 2%...
Borderline Disordered Eating   Eating habits and body image run along a     continuum from healthy to seriously     disor...
Treating Eating Disorders   Combination of psychotherapy and medical management   Address eating disorder, misuse of foo...
Chapter 14© 2012 McGraw-Hill Higher Education. All rights reserved.
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  • Figure 14-1 Prevalence of overweight and obesity among American adults age 20-74
  • Figure 14-2 The energy balance equation
  • Figure 14.3 Body Mass Index (BMI)
  • Table 14-1 Percent Body Fat Classification
  • Figure 14.4 Diabetes mellitus
  • Bulimia – begin with stabilizing eating patterns, then changing the patterns of thinking that led to the disorder Treatment combines medical management and psychological treatment, individually or on a group basis. Sometimes treatment may involve the entire family. Hospitalization may be required in the most severe cases.
  • Chapter 14

    1. 1. Chapter 14 © 2012 McGraw-Hill Higher Education. All rights reserved.
    2. 2. Introduction National Institutes of Health  68% of American adults are overweight  2007-2008: 33.8% of adult men and 35.5% of  adult women were obese  Managing body weight ○ Balance calories in with calories expended ○ Focus on long-term goals, change in lifestyle ○ Manage nutrition, physical activity, stress control 2 © 2012 McGraw-Hill Higher Education. All rights reserved.
    3. 3. Figure 14.1 Obesity Prevalence, by Ageand Sex, of American Adults, 2007-2008 3 © 2012 McGraw-Hill Higher Education. All rights reserved.
    4. 4. Basic Concepts of Weight Management  One pound of fat = 3,500 calories  Body composition  Fat-free mass (or lean body mass)  Body fat  ○ Essential fat  3-5% of total body weight in men, 8-12% in women  Amount of fat stored depends on many factors: - Gender - Age - Heredity - Metabolism - Diet  - Activity level  Overweight: total body weight above recommended range  Obesity: a more serious degree of overweight 4 © 2012 McGraw-Hill Higher Education. All rights reserved.
    5. 5. Energy Balance Crucial to keep a healthy ratio of fat to  fat-free mass  Energy (calories from food)  Consumption and/or expenditure of calories  Control over intake of calories  Negative energy balance  Positive energy balance  Neutral energy balance 5 © 2012 McGraw-Hill Higher Education. All rights reserved.
    6. 6. Figure 14.2The Energy Balance Equation 6 © 2012 McGraw-Hill Higher Education. All rights reserved.
    7. 7. Evaluating Body Weight andBody Composition Body mass index (BMI) Measure of body weight for classifying health risks Weight should be proportional to height Drawbacks of BMI Does not distinguish between fat weight and fat-free weight 7 © 2012 McGraw-Hill Higher Education. All rights reserved.
    8. 8. Assessment of Body Weight National Institutes of Health categories of BMI  Under 18.5 is classified as underweight  Between 18.5 and 24.9 is healthy (normal)  Between 25 and 29.9 is overweight  Between 30 and 34.9 is obese (Class I)  Between 35 and 39.9 is obese (Class II)  40 or greater is extreme obesity (Class III)  Under 17.5 is sometimes used as a diagnostic criterion for anorexia nervosa BMI Measurement. Example: 5’3” tall (63 inches), 130 pounds 1. Divide your body weight in pounds by 2.2 to convert the amount to kilograms: 130 / 2.2 = 59.1 2. Multiply height (in inches) by 0.0254 to convert to meters: 63 X 0.0254 = 1.6  3. Multiply the result of step 2 by itself to get the square of the height measurement: 1.6 X 1.6 =  2.56 4. Divide the result in step 1 by the result in step 3 to determine your BMI: BMI = 59.1 / 2.56 = 23.0 Alternative equation based on pounds and inches BMI = [weight / (height x height)] x 703 8 © 2012 McGraw-Hill Higher Education. All rights reserved.
    9. 9. Figure 14.3 Body Mass Index (BMI) 9 © 2012 McGraw-Hill Higher Education. All rights reserved.
    10. 10. Body Composition Analysis Most accurate way to evaluate body composition  is to determine percent body fat Hydrostatic (underwater) weighing and Bod Pod Skinfold measurements  Thickness of fat under the skin Bioelectrical Impedance Analysis  Electricity prefers fat-free tissue Scanning procedures  CT scan, MRI, dual-energy X-ray, dual-photon  absorptiometry, infrared reactance, total body electrical  conductivity  10 © 2012 McGraw-Hill Higher Education. All rights reserved.
    11. 11. Table 14.2 Percentage of Body Fat as the Criterion for Obesity 11 © 2012 McGraw-Hill Higher Education. All rights reserved.
    12. 12. Excess Body Fat and Wellness Health risks of excess body fat  Obese individuals have a mortality rate twice that of  non-obese ○ Reduces life expectancy by 10-20 years ○ Associated with:  unhealthy cholesterol and triglycerides,  impaired heart function, death from cardiovascular disease ○ Other health factors: hypertension, cancer, impaired immune  function, gallbladder and kidney disease, skin problems,  impotence, sleep disorders, back pain, arthritis, complications  with pregnancy, menstrual irregularities, urine leakage,  increased surgical risk, psychological problems ○ Strong association : Type 2 diabetes 12 © 2012 McGraw-Hill Higher Education. All rights reserved.
    13. 13. Figure 14.4 Diabetes Mellitus 13 © 2012 McGraw-Hill Higher Education. All rights reserved.
    14. 14. Body Fat Distribution and Health Apple shape   Android obesity  Upper regions of their bodies  Increase risk of high blood pressure, diabetes, early- onset heart disease, stroke, cancer Pear shape  Gynoid obesity  Fat storage in the hips, buttocks and thighs Assessed by measuring waist circumference  Risk for men:  waist measurement over 40 inches  Risk for women:  waist measurement over 35 inches 14 © 2012 McGraw-Hill Higher Education. All rights reserved.
    15. 15. Body Image Collective picture of the body as seen  through the mind’s eye  Perceptions  Images  Thoughts  Attitudes  Emotions 15 © 2012 McGraw-Hill Higher Education. All rights reserved.
    16. 16. Problems Associated withVery Low Levels of Body Fat Less than 8-12% for women and less than  3-5% for men Extreme leanness linked to problems  Reproductive  Circulatory  Immune system disorders Female Athlete Triad 1. Abnormal eating patterns 2. Amenorrhea 3. Decreased bone density 16 © 2012 McGraw-Hill Higher Education. All rights reserved.
    17. 17. What Is the Right Weight for You? General guides  BMI  Percent body fat  Waist circumference measurement Let your lifestyle be your guide 1. Eat moderate amounts 2. Get plenty of exercise 3. Think positively 4. Learn to deal with stress 17 © 2012 McGraw-Hill Higher Education. All rights reserved.
    18. 18. Factors Contributing to Excess Body Fat Genetic factors  Nutrigenomics ○ Study of how nutrients and genes interact  Genetics 25-40% of an individual’s body fat  600 genes have been linked to obesity Physiological Factors  Resting metabolic rate (RMR)  Hormones  Fat cells 18 © 2012 McGraw-Hill Higher Education. All rights reserved.
    19. 19. Lifestyle Factors Eating Physical Activity Psychosocial factors  Emotions ○ Distraction from difficult feelings ○ Helps regulate emotions ○ Coping strategies Socioeconomic status Family and cultures 19 © 2012 McGraw-Hill Higher Education. All rights reserved.
    20. 20. Adopting a Healthy Lifestyle forSuccessful Weight Management “Normal” body weight Diet and eating habits  Total calories ○ MyPyramid suggestions ○ Best approach for weight loss is combining an  increase of exercise with moderate calorie restriction ○ Do not go on a crash diet 20 © 2012 McGraw-Hill Higher Education. All rights reserved.
    21. 21. Adopting a Healthy Lifestyle for Successful Weight Management (continued) Portion sizes Energy (calorie) density Eating habits  Eat small, frequent meals  Don’t skip meals  Consume most calories in daytime 21 © 2012 McGraw-Hill Higher Education. All rights reserved.
    22. 22. Physical Activity and Exercise 30 minutes or more of moderate-intensity  physical activity every day  Walking  Gardening  Housework  Walking 1 mile in 15-20 minutes 22 © 2012 McGraw-Hill Higher Education. All rights reserved.
    23. 23. Thinking and Emotions What do you think of yourself? Self-esteem Negative emotions “Ideal self” Beliefs and attitudes you hold 23 © 2012 McGraw-Hill Higher Education. All rights reserved.
    24. 24. Coping Strategies Adequate and appropriate strategies Don’t use food as a way to cope with stress  Good communication  Adequate exercise  Positive thinking and emotions  Effective coping strategies and behavior  patterns 24 © 2012 McGraw-Hill Higher Education. All rights reserved.
    25. 25. Approaches to Overcominga Weight Problem Doing it yourself ○ 0.5-2.0 pounds per week ○ Initial weight loss from fluids ○ Very low calorie diets need to be avoided  Diet books ○ Reject books with gimmicks or rotating levels of calories ○ Accept books that advocate a balanced approach  Diet supplements and diet aids ○ Formula drinks and food bars ○ Herbal supplements ○ Other supplements 25 © 2012 McGraw-Hill Higher Education. All rights reserved.
    26. 26. Weight-Loss Programs Noncommercial  TOPS (Take Off Pounds Sensibly)  OA (Overeaters Anonymous) ○ 12-step program with spiritual orientation Commercial Online Clinical  26 © 2012 McGraw-Hill Higher Education. All rights reserved.
    27. 27. Weight-Loss Programs Prescription drugs  Appetite suppressants control appetite  All have potential side effects  Once drugs are stopped, most return to original  heavy weight  Good option for very obese who need help getting  started - permanent life style change  Two drugs approved for longer-term use:  Sibutramine  Orlistat (Xenical) 27 © 2012 McGraw-Hill Higher Education. All rights reserved.
    28. 28. Surgery Severely obese –   5.7% of adult Americans is “morbidly” obese  NIH recommends gastric bypass for individuals  with a BMI of 40 or higher  Roux-en-Y gastric bypass  Vertical banded gastroplasty (VBG)  Lap-Band – variation of VGB ○ Adjustable band  Liposuction 28 © 2012 McGraw-Hill Higher Education. All rights reserved.
    29. 29. Body Image Severe body image problems ○ Body dysmorphic disorder (BDD)  Affects about 2% of Americans  Usually before age 18 ○ Muscle dysmorphia Acceptance and change Know when the limits to healthy change have  been reached Know the unrealistic cultural ideal 29 © 2012 McGraw-Hill Higher Education. All rights reserved.
    30. 30. Eating Disorders Problems with body weight and weight  control Characterized by severe disturbances in  body image, eating patterns, and eating- related behaviors Disordered eating affects an estimated  10 million American females and 1 million  males 30 © 2012 McGraw-Hill Higher Education. All rights reserved.
    31. 31. Eating Disorders Central feature – dissatisfaction with  body image and body weight created by  distorted thinking Heredity  Over 50% of the risk Turning points in life  Coping with stress 31 © 2012 McGraw-Hill Higher Education. All rights reserved.
    32. 32. Eating DisordersAnorexia Nervosa - failure to eat enough food Affects 3 million people – 95% are female  Typically develops between the ages of 12 and 18 Characteristics  Fear of gaining weight  Distorted self-image  Compulsive behaviors and rituals  Excessive exercise Health risks of anorexia nervosa  Stop menstruation  Intolerant of cold  Low blood pressure and heart rate  Dry skin  Hands and feet may swell and take on a blue tinge  Depression and suicide Medical complications  Disorders of the cardiovascular, gastrointestinal, endocrine, and  skeletal systems 32 © 2012 McGraw-Hill Higher Education. All rights reserved.
    33. 33. Eating Disorders Bulimia Nervosa - recurring episodes of binge eating followed by purging Bulimia Nervosa Begins in adolescence or young adulthood Increasingly younger (11-12 years) and older (40-60 years) ages Characteristics Rapidly consumes food, then purges Done in secret After a binge, feels ashamed, disgusted, and drained both physically and  emotionally Health risks Erodes tooth enamel Deficient calorie intake Liver and kidney damage Cardiac arrhythmia Chronic hoarseness Esophageal tearing Rupture of the stomach Menstrual problems Increased depression 33 © 2012 McGraw-Hill Higher Education. All rights reserved.
    34. 34. Eating Disorders Binge-eating disorder (BED) - similar to  bulimia, except no purging behavior  Affects about 2% of American adults  Uncontrollable eating, usually followed by  guilt and shame  Often eat as a way of coping  Likely to be obese  High rates of depression and anxiety 34 © 2012 McGraw-Hill Higher Education. All rights reserved.
    35. 35. Borderline Disordered Eating Eating habits and body image run along a  continuum from healthy to seriously  disordered  Some have symptoms of disorder  Do not meet full diagnostic criteria for disorder  Behaviors  Danger signs  Seek help 35 © 2012 McGraw-Hill Higher Education. All rights reserved.
    36. 36. Treating Eating Disorders Combination of psychotherapy and medical management Address eating disorder, misuse of food, and managing  emotions  Anorexia nervosa ○ Avert a medical crisis  Adequate body weight ○ Psychological aspects  Bulimia nervosa ○ Stabilize the eating patterns ○ Identify and change thinking patterns ○ Improve coping skills ○ Drug treatment:  Binge-eating ○ Similar treatment protocol as bulimia nervosa 36 © 2012 McGraw-Hill Higher Education. All rights reserved.
    37. 37. Chapter 14© 2012 McGraw-Hill Higher Education. All rights reserved.

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