Chapter 7 - Weight Management

Nutrition for Health and Health Care, 5th Edition
DeBruyne ■ Pinna © Cengage Learning 2014
Weight ManagementChapter 7

Causes of Obesity
• Genetics:
– Influences eating behavior
– Impacts body composition
– Affects risk of obesity
• Two to three times higher with family history of
obesity
– Interrelated with environment factors

Causes of Obesity (cont’d.)
• Research involving proteins
– Lipoprotein lipase (LPL) enzyme: higher level
of activity in fat cells of obese people
– Obesity (ob) gene: codes for the protein leptin
– What is the role of leptin, and what is leptin
resistance?
– Ghrelin: stimulates appetite and promotes
efficient energy storage

• Fat cells in obese people compared to
healthy-weight people
– Higher number
– Larger fat cells
• What happens to the number and size of
fat cells with weight loss?
– Set-point theory
• Body weight: physiologically regulated

• Environment
– Readily available high-kcalorie foods
– Large serving sizes
– Energy dense foods
• Psychological stimuli
– What is the difference between hunger and
appetite?
– Food behavior: linked to emotional needs

• Physical inactivity
– Sedentary screen time
– Technology
• Physical activity displaced at home, at work, at
school, and in transportation
– Obstacles to physical activity and healthy
foods
• Aspects of the built environment
• What are food deserts?

• National Academies’ Institute of Medicine
– National goals to counter obesity and improve
the nation’s health
• Make physical activity an integral and routine part
of American life
• Make healthy foods and beverages available
• Advertise and market what matters for a healthy life
• Activate employers and health-care professionals
• Strengthen schools as the heart of health

Obesity Treatment: Who Should
Lose?
• Factors
– Extent of overweight, age, health, genetics,
etc.
• Must weigh the benefits and risks of
weight loss

Inappropriate Obesity Treatments
• Over-the-counter (OTC) weight-loss
products
– Weight loss pills, powders, and other dietary
supplements
• Other gimmicks
– Steam and sauna baths
– Brushes, sponges, wraps, creams, and
messages

Aggressive Treatments of Obesity
• Obesity drugs
– Beneficial with modest weight loss
• As part of a long-term, comprehensive weight-loss
program
– Must consider risks of long-term use
– FDA-approved drugs for weight loss
(Table 7-1)

Aggressive Treatments of Obesity
(cont’d.)
• Surgery
– Most effective treatment for clinically severe
obesity (morbid obesity)
– Types of procedures
• Gastric bypass
• Gastric banding
– Laparoscopic weight-loss surgery
• Significant, long-term weight loss; shortens
recovery; and less invasive than open surgery

Reasonable Strategies for Weight
Loss
• Must integrate
– Healthy eating patterns, physical activities,
supportive environments, and psychosocial
support
• Successful strategies
– Embrace small changes, moderate losses,
and reasonable goals

Loss (cont’d.)
• Dietary Guidelines for Americans for
weight loss
– Consume fewer kcalories from foods and
beverages
– Increase physical activity
– Reduce time spent in sedentary behaviors

Loss (cont’d.)
• Reasonable goals to reduce weight to
lower disease risk
1. Reduce body weight by about 10 percent
over half a year’s time
2. Maintain a lower body weight over the long
term
3. At a minimum, prevent further weight gain

Loss (cont’d.)
• A healthful eating plan
– Energy intake
• Provides less energy than the person needs to
maintain present body weight
• Not too restrictive
– Eating pattern for safely losing weight
• Men: 1600 kcalories per day
• Women: 1200 kcalories per day

Loss (cont’d.)
– Breakfast is important
• Frequency is inversely associated with obesity
• Results in higher overall diet quality and lower
daily energy density
– Maintain nutritional adequacy
• Consume a minimum of 1200 kcal per day

Loss (cont’d.)
– Food selections
• Fresh fruits and vegetables; low-fat milk products
or substitutes; legumes; small amounts of lean
meats, seafood, poultry, or meat alternatives; nuts;
whole grains; and enough unsaturated oils to
support health
– Dietary supplement
• Vitamins and minerals at or below 100 percent of
the Daily Values

Loss (cont’d.)
– Small portions
– Foods with lower energy density
• Fruits, vegetables, and broth-based soups
– Limited intakes of added sugars and alcohol
– Small, frequent meals
– Adequate water

Loss (cont’d.)
• Physical activity
– Combined with energy restriction
• More likely to lose more fat, retain more muscle,
and regain less weight than diet alone
– Physical Activity Guidelines for Americans,
2008 (Table 1-5 – Chapter 1)
– Benefits
• Reduces abdominal obesity, improves blood
pressure, insulin resistance, etc.

Loss (cont’d.)
– Directly increases energy output
• Energy spent on various activities (Table 6-2 –
Chapter 6)
– BMR
• Elevated following physical activity
• Rises as more lean tissue is added
– Appetite control

Loss (cont’d.)
– Psychological benefits
• Curbs emotional eating
• Reduces stress
• Improves self-esteem
• What kind of physical activity is best for
health?

Loss (cont’d.)
• Behavior and attitude
– Behavior modification
• Manipulating antecedents, the behavior itself, and
consequences
– Behavior awareness: keep a diary
– Technology tools for tracking daily food and
physical activity
• Applications for smart phones
• Social media sites

Loss (cont’d.)
– Focus on desired behaviors and eliminating
unwanted behaviors
• Set small time-specific goals
– “How To” apply behavior modification to
manage body fatness
– Cognitive skills: “positive self-talk”

Loss (cont’d.)
– Identify stressors
• Learn to practice problem-solving skills
• Weight maintenance
– Long-term success behaviors
• Believe in ability to control weight (self-efficacy),
eat breakfast, stay physically active, monitor
weight once per week, maintain lower-kcalorie
eating patterns, etc.

Strategies for Weight Gain
• Underweight
– Affects about two percent of U.S. adults
– Focus on resistance training with increased
energy intake
• Energy-dense foods
– Choose high-kcalorie items from each food
group

Strategies for Weight Gain (cont’d.)
• Consume at least three healthy meals
daily
– Large portions at each meal
• Have extra snacks between meals
• Increase kcalories with beverages
– Juice and milk

Chapter 7 - Weight Management

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