The document discusses obesity as a major health problem in the United States, providing statistics on overweight and obesity rates. It then covers topics related to weight management including the basics of weight control, evaluating body weight and composition, factors that influence weight gain and loss, and various approaches to weight loss including lifestyle changes, programs, drugs, and surgery.

1. Chapter 14
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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
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3. Figure 14.1 Obesity Prevalence, by Age
and Sex, of American Adults, 2007-2008
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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
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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
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6. Figure 14.2
The Energy Balance Equation
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7. Evaluating Body Weight and
Body 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
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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
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9. Figure 14.3 Body Mass Index (BMI)
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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
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11. Table 14.2 Percentage of Body
Fat as the Criterion for Obesity
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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
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13. Figure 14.4 Diabetes Mellitus
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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
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15. Body Image
 Collective picture of the body as seen
through the mind’s eye
 Perceptions
 Images
 Thoughts
 Attitudes
 Emotions
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16. Problems Associated with
Very 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
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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
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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
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19. Lifestyle Factors
 Eating
 Physical Activity
 Psychosocial factors
 Emotions
○ Distraction from difficult feelings
○ Helps regulate emotions
○ Coping strategies
 Socioeconomic status
 Family and cultures
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20. Adopting a Healthy Lifestyle for
Successful 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
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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
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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
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23. Thinking and Emotions
 What do you think of yourself?
 Self-esteem
 Negative emotions
 “Ideal self”
 Beliefs and attitudes you hold
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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
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25. Approaches to Overcoming
a 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
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26. Weight-Loss Programs
 Noncommercial
 TOPS (Take Off Pounds Sensibly)
 OA (Overeaters Anonymous)
○ 12-step program with spiritual orientation
 Commercial
 Online
 Clinical
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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)
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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
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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
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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
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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
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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
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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
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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
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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
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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
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37. Chapter 14
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