The document discusses weight management and obesity. It covers several topics: 1) It describes methods for evaluating body weight and composition, including BMI, body fat distribution, and bioelectrical impedance analysis. 2) It explains that obesity is associated with increased health risks like diabetes, heart disease, and some cancers. Maintaining a healthy weight through diet and exercise can improve wellness. 3) Factors that contribute to excess body fat include genetics, metabolism, hormones, diet, physical activity levels, sleep, and environment. Weight gain occurs through small imbalances in calorie intake versus expenditure over time. 3) Adopting a healthy lifestyle through a balanced diet, portion control, regular physical

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Weight Management
Chapter 12
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Figure 12.1 Prevalence of obesity and severe
obesity among adults: United States, 2017 to 2018.
Access the text alternative for slide images.
SOURCE: Hales, C. M., et al. 2020. NCHS Data Brief No. 360. Hyattsville, MD: National Center for Health Statistics. 2

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Figure 12.2 Weight history and all-cause mortality.
Researchers followed more than 200,000 adults for 16 years and examined the
relationship between an individual’s maximum BMI over the period and subsequent
mortality. A maximum BMI above the normal category was associated with an excess risk
of death that increased with increasing BMI.
SOURCE: Yu, E., et al. 2017. Weight history and all-cause and cause-specific mortality in three prospective cohort studies. Annals of Internal Medicine 166(9): 613–620. 3

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Evaluating Body Weight and
Body Composition
Body composition:
Bodies are composed of fat-free mass and body fat.
Fat-free mass: non-fat tissues.
Body fat includes:
• Essential fat.
• Fat stored in fat cells (adipose tissue).
• Fat located in subcutaneous fat (under the skin) and around
major organs (visceral fat).
Percent body fat: the proportion of the body’s total
weight that is fat.
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Defining Healthy Weight,
Overweight, and Obesity
Is your body at a healthy weight?
• Overweight: total body weight above the recommended range
for good health.
• Obesity: more serious degree of overweight that carries
multiple health risks.
Several methods are used to evaluate body weight and
percent body fat.
• Body composition.
• Body mass index (BMI).
• Body fat distribution.
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Estimating Body Composition
Bioelectrical impedance analysis (BIA).
Skinfold measurement.
Scanning procedures.
• CT scan.
• MRI.
• Dual-energy X-ray absorptiometry (DEXA).
• Dual-photon absorptiometry.
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Body Mass Index 1
Body mass index (BMI) is useful for classifying the
health risks of body weight.
• Correlated with but does not directly measure body fat.
Body weight (in kilograms) divided by the square of
height (in meters).
• Alternatively, the weight in pounds divided by the square of
height in inches, multiplied by 703 (the conversion factor).
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Body Mass Index 2
Standards set by the NIH:
• Between 18.5 and 24.9 is healthy.
• Greater than 25 is overweight.
• Greater than 30 is obese.
• Under 17.5 is sometimes used as a diagnostic criterion for
anorexia nervosa.
BMI is not helpful for determining body composition
because it does not distinguish between fat weight and
fat-free weight.
• Can be inaccurate for shorter people, muscular athletes, and
older adults.
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Body Fat Distribution
Location of fat on your body is an important indicator
of health.
Waist circumference.
Waist-to-hip ratio.
Apple shape: android obesity.
• Upper regions of the body, particularly abdomen.
• Increased risk of high blood pressure, diabetes, early-onset
heart disease, stroke, and cancer.
Pear shape: gynoid obesity.
• Fat storage in the hips, buttocks, and thighs.
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What Is the Right Weight for You?
Body weight and body shape are influenced by
heredity.
Changes should be lifestyle changes.
Let a healthy lifestyle determine your weight.
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Body Fat and Wellness
Obesity doubles mortality rates and can reduce life
expectancy by 10 to 20 years.
Obesity is associated with a number of chronic
conditions.
• Diabetes, cardiovascular disease, and many others.
• Also associated with complications of pregnancy, psychological
disorders, and increased surgical risk.
Modest weight loss results in psychological
improvements and improved quality of life for many.
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Diabetes
Diabetes mellitus causes a disruption of normal
metabolism.
Type 1 diabetes:
• Immune system destroys insulin-producing cells in the pancreas.
Type 2 diabetes:
• Strongly associated with excess body fat.
• Pancreas does not produce enough insulin, body cells have
become resistant, or both.
Gestational diabetes.
Prediabetes.
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Figure 12.4
Diabetes mellitus.
During digestion, carbohydrates
are broken down in the small
intestine into glucose, a simple
sugar that enters the
bloodstream. The presence of
glucose signals the pancreas to
release insulin, a hormone that
helps cells take up glucose;
once inside a cell, glucose can
be converted to energy. In
diabetes, this process is
disrupted, resulting in a buildup
of glucose in the bloodstream.
Access the text alternative for slide images.
webphotographeer/Getty Images 13

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Heart Disease and
Other Chronic Conditions
Overweight and obesity are risk factors for:
• Heart disease.
• Metabolic syndrome.
• Certain types of cancer.
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Problems Associated with Very Low
Levels of Body Fat
Low levels of body fat are a threat to wellness.
• Reproductive, circulatory, and immune system disorders.
Extremely lean people are more likely to suffer from
dangerous eating disorders.
Female athlete triad:
• Abnormal eating patterns (and excessive exercising).
• Amenorrhea: absence of menstruation.
• Decreased bone density (premature osteoporosis).
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How Did I Get to Be My Weight? 1
Energy balance is key to maintaining healthy body
weight and keeping a healthy ratio of fat to fat-free
mass.
Body takes in energy (calories) and uses energy
(calories) to maintain vital body functions.
To change weight, the balance must be tipped.
• Positive energy balance.
• Negative energy balance.
Carbohydrate-insulin model argues that the primary
cause of obesity is overeating refined carbohydrates.
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How Did I Get to Be My Weight? 2
Multi-factor model suggests that genetic, metabolic,
psychological, cultural, and socioeconomic factors are
all involved.
Genetic factors:
• Influence body size and shape, body fat distribution, and
metabolic rate.
• Affect the ease with which weight is gained and where on the
body it is added.
• Set point theory suggests our bodies are designed to maintain
a stable “set point.”
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How Did I Get to Be My Weight? 3
Fat cells:
• Amount of fat (adipose tissue) the body can store is a function
of the number and size of fat (adipose) cells.
• Overeating in childhood can create more fat cells.
Metabolism:
• Resting metabolic rate (RMR): energy (calories) required
while the body is at rest.
• Genetics affects metabolic rate.
• Exercise can have a modest positive effect on RMR.
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How Did I Get to Be My Weight? 4
Hormones:
• Especially in women, play a role in the accumulation of fat.
• Insulin, leptin, and ghrelin are all thought to be linked to
obesity.
Gut microbiota:
• Intestinal flora help digest foods and produce some vitamins.
• Lean people differ from overweight people in the composition
of their intestinal flora.
• Diets high in processed foods have been linked to less diverse
intestinal flora.
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How Did I Get to Be My Weight? 5
Psychology, culture, and behavior:
• Many people use foods as a means of coping.
• Binge eating and other unhealthy patterns can develop.
• Prevalence of obesity goes down as family income goes up.
Sleep:
• Short sleep duration and sleep debt are associated with
increased BMI and abdominal obesity.
Food marketing and public policy:
• “Obesogenic” environments encourage overconsumption and
discourage physical activity.
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Figure 12.5 The new (ab)normal.
Portion sizes have been growing. So have we. The average restaurant meal
today is more than four times larger than in the 1950s. Adults today are, on
average, 26 pounds heavier. To become healthier eaters, there are things
we can do for ourselves and our community. Order the smaller meals on
the menu, split a meal with a friend, or eat half and take the rest home.
Ask the managers at favorite restaurants to offer smaller meals.
SOURCE: Centers for Disease Control and Prevention; for more information, visit http://MakingHealthEasier.org/TimeToScaleBack. 21

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Adopting a Healthy Lifestyle for
Successful Weight Management 1
Slow weight gain is a major cause of overweight and
obesity.
Dietary patterns and eating habits:
Dietary Guidelines for Americans; MyPlate; DASH.
Pay attention to total calories.
• To maintain weight, calories consume must equal calories
expended.
Pay attention to portion sizes.
Replace energy-dense foods with nutrient-dense foods.
Eat regular, balanced meals.
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Adopting a Healthy Lifestyle for
Successful Weight Management 2
Physical activity and exercise:
Positive effects on metabolism.
• Increased muscle mass.
Improves cardiovascular and respiratory health.
Enhances mood, sleep, self-esteem, and your sense
of accomplishment.
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Adopting a Healthy Lifestyle for
Successful Weight Management 3
Thinking and emotions:
Weight problems are associated with low self-esteem
and negative emotions.
• “Ideal self.”
• Self-talk can be self-deprecating or positively motivating.
Coping strategies:
Develop appropriate coping strategies to deal with
the stresses of life.
• Analyze your eating habits with fresh eyes.
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Approaches to Overcoming a
Weight Problem 1
Doing it yourself:
Set reasonable goals.
• Loss of 1 to 2 pounds per week recommended.
Develop a plan that you can maintain over the long
term.
Diet media:
• Reject gimmicks.
• Seek books that advocate a balanced approach.
Dietary supplements and diet aids:
• Formula drinks and food bars, herbal supplements, and
others: claims are often false.
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Approaches to Overcoming a
Weight Problem 2
Weight loss programs:
• Noncommercial: TOPS (Take Off Pounds Sensibly); OA
(Overeaters Anonymous).
• Commercial: Weight Watchers.
• Commitment and a plan for maintenance are important.
• Online diet websites combine self-help with group support.
• Clinical weight loss programs are medically supervised.
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Approaches to Overcoming a
Weight Problem 3
Prescription drugs:
• Appetite suppressants.
• All have potential side effects.
• Work best in conjunction with behavior modification.
• Once drugs are stopped, most individuals return to their original
heavy weight.
• Good option for the very obese who need help getting started.
Surgery:
Severe obesity is a medical condition.
• NIH recommends gastric bypass for individuals with a BMI of 40,
or greater than 35 with an obesity-related illness.
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Body Image and Eating Disorders 1
Body image: the mental representation a person holds
about his or her body, consisting of perceptions,
images, thoughts, attitudes, and emotions.
Severe body image problems:
Body dysmorphic disorder (BDD).
• Constant preoccupation with body imperfections.
• Related to obsessive-compulsive disorder.
Muscle dysmorphia.
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Body Image and Eating Disorders 2
Eating disorders are psychological disorders,
characterized by severe disturbances in body image,
eating patterns, and eating-related behaviors.
• Anorexia.
• Bulimia.
• Binge-eating disorder.
• Other specified feeding or eating disorder (OSFED).
Heredity and environment both play roles, as do
turning points in life.
• Coping with stresses.
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Anorexia Nervosa 1
Anorexia nervosa involves a refusal to eat enough food
to maintain a reasonable body weight.
Characteristics:
• Fear of gaining weight or becoming fat.
• Distorted self-image.
• Compulsive behaviors and rituals.
• Excessive exercise.
• Some may also binge and purge.
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Anorexia Nervosa 2
Health risks of anorexia nervosa:
• Amenorrhea.
• Cold intolerance.
• Low blood pressure and heart rate.
• Dry skin, and swelling of the hands and feet.
• Medical complications, including disorders of the
cardiovascular, gastrointestinal, endocrine, and skeletal
systems.
• Depression and suicide.
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Bulimia Nervosa 1
Bulimia nervosa is characterized by recurring episodes
of binge eating followed by purging.
Characteristics:
• Rapid consumption of food, followed by purging.
• Eating in secret.
• After a binge, feeling ashamed, disgusted, and physically and
emotional drained.
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Bulimia Nervosa 2
Health risks of bulimia nervosa:
• Eroded tooth enamel.
• Deficient calorie intake.
• Liver and kidney damage.
• Cardiac arrhythmia.
• Chronic hoarseness.
• Esophageal tearing.
• Rupture of the stomach.
• Menstrual problems.
• Depression.
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Binge-Eating Disorder
Binge-eating disorder: incontrollable eating followed by
feelings of guilt and shame about weight gain.
• Characterized by very rapid eating, eating until uncomfortably
full, eating when not hungry, and preferring to eat alone.
Often, eating is a way of coping.
Likely to be obese.
High rates of depression and anxiety.
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Other Patterns of Disordered Eating
Feeding or eating disorders that do not meet the
diagnostic criteria for anorexia, bulimia, or binge-eating
disorder may be classified as other specified feeding or
eating disorders (OSFED).
• Atypical anorexia nervosa.
• Bulimia nervosa with limited duration.
• Purging disorder.
• Night eating syndrome.
• Avoidant restrictive food intake disorder (ARFID).
• Orthorexia.
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Treating Eating Disorders
Must address eating behaviors and misuse of food to
manage stress and emotions.
Psychotherapy and medical management.
Anorexia nervosa: averting a medical crisis.
• Adequate body weight; psychological aspects.
Bulimia nervosa and binge-eating disorder: stabilizing
the eating patterns.
• Identifying and changing the patterns of thinking.
• Improving coping skills.
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Positive Body Image: Finding Balance
Knowing when you’ve reached the limits of healthy
change is crucial.
Weight management must take place in a positive and
realistic atmosphere.
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Review
• Discuss methods for assessing body weight and body
composition.
• Explain the effects of body fat on wellness.
• Explain factors that contribute to excess body fat.
• Describe lifestyle factors associated with successful
weight management.
• Name and describe approaches to overcoming a
weight problem.
• Explain the relationship between body image and eating
disorders and the associated health risks.

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