Chapter 7: Weight Management

Weight
Management
77
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© Cengage Learning 2017
Causes of Obesity
• Genetics and weight
– Genes influence eating behavior
– Impact body composition
– Affect risk of obesity
• 30% to 70% chance of obesity for individuals with
at least one obese parent
– Complex interactions among genes
– Interrelated with environment factors

Causes of Obesity:
Genetics and Weight (cont’d.)
• Lipoprotein lipase (LPL)
– Cell surface enzyme that hydrolyzes
triglycerides and promotes fat storage
– Higher level of LPL activity in fat cells of
obese people
• Makes fat storage efficient

Causes of Obesity:
• Leptin
– Protein (hormone) coded for by obesity (ob)
gene
– What is the role of leptin, and what is leptin
resistance?
• Ghrelin
– Hormone that stimulates appetite and
promotes efficient energy storage

Causes of Obesity:
• Fat cell development
– Fat cells increase in size and often in number
with increased fat storage
– Compared to healthy-weight people, obese
people have:
• More fat cells
• Larger fat cells
– What happens to the number and size of fat
cells with weight loss?

Fat Cell Development

Causes of Obesity:
• Set-point theory
– Idea that body weight is physiologically
regulated
• A certain “set-point” weight is maintained
– Decrease in metabolic rate with weight loss
• Intestinal bacteria
– Intestinal microbiota may influence energy
balance and/or chronic disease risk

Causes of Obesity (cont’d.)
• Environmental stimuli
– Overeating
• Readily available high-kcalorie foods
• Large portion sizes
• Energy-dense foods (e.g., fast foods)
• Legislation requires chains (20+ locations) to
provide kcalorie information on menus

Causes of Obesity:
Environmental Stimuli (cont’d.)
• Learned behavior
– What is the difference between hunger and
appetite?
– What are satiation and satiety?
– Food behavior is linked to emotional needs

Causes of Obesity:
Environmental Stimuli (cont’d.)
• Physical inactivity
– Sedentary screen time
– Technology replaces activity at home, work,
and school, in transportation
• Neighborhood obstacles to physical
activity and healthy foods
• Aspects of the built environment
• What are food deserts?

Obesity Treatment: Who Should Lose?
• Weight-loss advice does not apply equally
to all overweight people
• Many factors should be considered
– 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
– Dietary supplements are not associated with
successful weight loss and maintenance
• Other gimmicks (all ineffective)
– Steam and sauna baths, brushes, sponges,
wraps, creams, and massages

Aggressive Treatments of Obesity
• Obesity drugs
– Assist 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 7-2)

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

Reasonable Strategies for Weight Loss
• Obesity treatment should integrate healthy
eating patterns, physical activities,
supportive environments, and
psychosocial support
• Successful strategies embrace small
changes, moderate and sustained losses,
and reasonable goals

(cont’d.)
• Reasonable goals to reduce weight to
lower disease risk:
– Reduce body weight by about 5% to 10% over
6 months
– Maintain a lower body weight over the long
term
– At a minimum, prevent further weight gain

(cont’d.)
• A healthful eating plan
– A realistic energy intake
• Provides less energy than the person needs to
maintain present body weight
• Not too restrictive
• Men: 1500-1800 kcalories per day
• Women: 1200-1500 kcalories per day

Reasonable Strategies for Weight Loss:
A Healthful Eating Plan (cont’d.)
• Nutritional adequacy
– Difficult to achieve on <1200 kcal/day
– Nutrient-dense food selections:
• Fruits, vegetables, legumes, whole grains
• Fish
• Unsaturated oils, low-/non-fat dairy (moderate
amounts)
– Dietary supplement with ≤100% of Daily
Values for minerals/ vitamins

• Small portions
– Less food at each meal
– Prepared meal plans can assist with portion
control
• Lower energy density
– Fruits, vegetables, broth-based soups

Energy Density

• Sugar and alcohol
– Limit intakes
• Meal spacing
– Flexible
– Total quantity consumed should be controlled
• Adequate water
– Substitute for nutrient-poor kcaloric beverages

(cont’d.)
• Physical activity
– More likely to lose more fat, retain more
muscle, and regain less weight when physical
activity is combined with energy restriction
– Reduces abdominal obesity; improves blood
pressure, insulin resistance, fitness of heart
and lungs

Physical Activity (cont’d.)
• Energy expenditure
– Directly increases energy output
– Energy spent on various activities differs
(Table 6-2 in Chapter 6)
• Basal metabolic rate (BMR)
– Elevated following vigorous physical activity
– Rises over time as more lean tissue is added

• Appetite control
• Psychological benefits
– Curbs emotional eating
– Reduces stress
– Improves body image
– Improves self-esteem

• Choosing activities
– What kind of physical activity is best for
health?
– Total energy expenditure is the main factor
• Spot reducing
– Fat is released from fat cells all over the body,
not just in the area being exercised
– Resistance exercise improves tone

(cont’d.)
• Behavior and attitude
– Behavior-modification therapy
• Manipulating antecedents, the behavior itself, and
consequences
– Becoming aware of behaviors
• Keep a diary
• Technology tools for tracking daily food and
physical activity
– Applications for smart phones, social media sites

Food and Activity Diary

Behavior and Attitude (cont’d.)
• Making small changes
– Focus on learning desired behaviors and
eliminating unwanted behaviors
– Set small, time-specific goals
– Box 7-1 provides suggested strategies

Behavior and Attitude (cont’d.)
• Cognitive skills
– Changes to conscious thoughts with the goal
of improving adherence
– Problem-solving skills; correction of false-
negative thoughts
• Personal attitude
– Identify stressors that trigger overeating
– Practice problem-solving skills

(cont’d.)
• Weight maintenance
– Key: accept that this is a lifelong endeavor
– Long-term success behaviors (Table 7-6)
• Self-efficacy
• 1 hour physical activity daily
• Weekly weight monitoring
• Consistently low-kcal, high-fiber, high-water eating
patterns
• Quick attention to lapses

Strategies for Weight Gain
• Underweight affects ~2% of U.S. adults
• Physical activity to build muscles
– 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.)
• Three meals daily
• Large portions
– More food at each meal
• Extra snacks
• Juice and milk
– Increase kcalories with beverages
– High-protein, high-kcal formulas for people
who are underweight due to illness

Nutrition in Practice: Fad Diets
• Freedom of the press allows unfounded
claims in books or on the Internet
• Fad diets work through kcal restriction
– Most sample menus provide ~1200 kcal/day
• Often inadequate in vitamins and minerals
• Particularly ineffective for weight
maintenance

Nutrition in Practice: Fad Diets (cont’d.)
• Macronutrient compositions of fad diets
– Long term, any low-kcal diet produces about
the same degree of weight loss
– Somewhat higher protein intakes (1.2 to 1.6
g/kg/day) may improve diet adherence
• Plain yogurt, peanut butter, walnuts, other nuts,
skinless chicken, low-fat cheese, seafood
• Most people need specific instructions and
meal plans like those offered by fad diets

Chapter 7: Weight Management

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