1. Weight Management: Overweight,Weight Management: Overweight,
Obesity, & UnderweightObesity, & Underweight

2. Overweight and ObesityOverweight and Obesity
• Major health problem in the U.S.
• Growing concern worldwide
• Prevalence continues to increase
• Women, poor, blacks, and Hispanics
• Children
• BMI of 25 or greater
• Epidemic is worldwide
• Not merely among industrialized countries

3. Increasing Prevalence ofIncreasing Prevalence of
Obesity among US AdultsObesity among US Adults

4. Fat Cell DevelopmentFat Cell Development
• Energy in exceeds energy out
• Stored in fat cells of adipose tissue
• Body fat
• Number and size of fat cells
• Periods in life when fat cell numbers increase
• Cell proliferation
• Energy out exceeds energy in
• Fat cell size decreases; no change in number

5. Fat Cell DevelopmentFat Cell Development

6. Fat Cell MetabolismFat Cell Metabolism
• Lipoprotein lipase (LPL) activity
• Storage of triglycerides
• Obese people vs. lean people
• Activity in varying body regions
• Men vs. women
• Enzyme activity releasing and breaking
down fat
• Fat oxidation is not efficient
• Set point theory

7. Causes of Overweight & ObesityCauses of Overweight & Obesity
– Genetics & Epigenetics– Genetics & Epigenetics
• Causative role of genetics
• Genetic influences do seem to be involved
• Genetics may determine predisposition to
obesity
• Genes interact with:
• Diet and physical activity
• Satiety and energy balance
• Human genome

8. Causes of Overweight & ObesityCauses of Overweight & Obesity
– Genetics & Epigenetics– Genetics & Epigenetics
• Obesity gene
• Codes for the protein leptin
• Acts as a hormone in hypothalamus
• Promotes negative energy balance
• Suppresses appetite
• Increases energy expenditure
• Locations of leptin secretion

9. Mice with and without Leptin
Compared

10. Causes of Overweight & ObesityCauses of Overweight & Obesity
– Genetics & Epigenetics– Genetics & Epigenetics
• Obesity gene
• Genetic deficiency of leptin or genetic
mutation
• Rare
• Leptin resistance
• Fructose consumption
• Roles in the body
• Energy regulation
• Others

11. Causes of Overweight & ObesityCauses of Overweight & Obesity
– Genetics & Epigenetics– Genetics & Epigenetics
• Ghrelin
• Promotes positive energy balance
• Inverse correlation with body weight
• Roles in the body beyond energy regulation
• Uncoupling proteins
• Types of body fat
• Brown adipose tissue
• White adipose tissue

12. Causes of Overweight &Causes of Overweight &
Obesity – EnvironmentObesity – Environment
• Encountered daily circumstances
• Interaction between environment and
genetics
• Overeating
• Present and past eating and activity patterns
influence current body weight
• Availability
• Serving sizes
• Restaurant food

13. Causes of Overweight &Causes of Overweight &
Obesity – EnvironmentObesity – Environment
• Physical inactivity
• Life requires little exertion
• Modern technology
• Inactivity contributes to weight gain and poor
health
• Sedentary activities and weight gain
• DRI for prevention of weight gain
• 60 minutes of moderate activity every day

14. Problems of Overweight andProblems of Overweight and
Obesity – Health RisksObesity – Health Risks
• Three indicators
• BMI
• Waist circumference
• Disease risk profile
• Factors taken into account
• Beneficial weight loss
• Health status
• Motivation

15. Problems of Overweight andProblems of Overweight and
Obesity – Health RisksObesity – Health Risks
• Overweight in good health
• Sometimes health is not the motivation for
weight loss
• Obese or overweight with risk factors
• Two or more risk factors
• Obese or overweight with life-threatening
condition
• Recommendation to lose weight

16. Problems of Overweight & ObesityProblems of Overweight & Obesity
– Perceptions & Prejudices– Perceptions & Prejudices
• Most obese people do not successfully lose
weight and maintain the loss
• Social consequences
• Jobs, school, and in social situations
• Psychological problems
• Embarrassment
• Other feelings

17. The Psychology of WeightThe Psychology of Weight
CyclingCycling

18. Problems of Overweight andProblems of Overweight and
Obesity – Dangerous InterventionsObesity – Dangerous Interventions
• Intervention dangers
• Diet books and weight-loss programs
• Little success with weight loss maintenance
• Fad diets
• Weight-loss products
• Herbal products
• Laws for dietary supplements
• Other gimmicks

19. Aggressive Treatments forAggressive Treatments for
Obesity – DrugsObesity – Drugs
• Strategies for weight reduction depend on:
• Degree of obesity
• Risk of disease
• Use drugs as part of long-term
comprehensive weight-loss programs
• Assist with modest weight loss
• FDA approval

20. FDA Approved Drugs for
Weight Loss

21. Aggressive Treatments forAggressive Treatments for
Obesity – SurgeryObesity – Surgery
• Clinically severe obesity
• 200,000 surgeries performed each year
• Reduces food capacity of stomach
• Effectively limits food intake
• Reduce production of ghrelin
• Health-related benefits
• Long-term safety and effectiveness
• Liposuction

22. Gastric Surgery Used in theGastric Surgery Used in the
Treatment of Severe ObesityTreatment of Severe Obesity

23. Weight Loss StrategiesWeight Loss Strategies
• Successful strategies
• Small changes
• Moderate losses
• Reasonable goals
• Reasonable rate of weight loss
• Benefits of modest weight loss
• Incorporation of healthy eating and physical
activity

24. Reasonable Weight Goals vs.Reasonable Weight Goals vs.
Unrealistic ExpectationsUnrealistic Expectations

25. Weight Loss Strategies –Weight Loss Strategies –
Eating PatternsEating Patterns
• Be realistic about energy intake
• Provide less energy than is needed
• Avoid restrictive eating
• Avoid rapid weight loss
• Goal: nutritional adequacy without excess
• Deficit of 500 to 1000 kcalories per day
• Breakfast frequency
• Inversely related to obesity

26. Weight Loss Strategies –Weight Loss Strategies –
Eating PatternsEating Patterns
• Nutritional adequacy
• Minimum of 1200 kcalories a day
• Eat small portions
• Eat less food at each meal
• Feel satisfied, not stuffed
• Structured meal replacement plans
• Lower energy density
• Cost

27. Daily Amounts from Each FoodDaily Amounts from Each Food
GroupGroup

28. Weight Loss Strategies –Weight Loss Strategies –
Eating PatternsEating Patterns
• Remember water
• Assistance with weight management
• Focus on fiber
• Low in energy and high in nutrients
• Require effort to eat
• Speed of food consumption
• Choose fats sensibly
• Energy density and satiation

29. Weight Loss Strategies –Weight Loss Strategies –
Eating PatternsEating Patterns
• Select carbohydrates carefully
• Artificial sweeteners
• Impact on energy intake
• Watch for empty kcalories
• Fat, sugar, and alcohol

30. Weight-Los Strategies

31. Weight Loss Strategies –Weight Loss Strategies –
Physical ActivityPhysical Activity
• Best approach to weight management
• Moderate physical activity plus activities of
daily life
• Combination of diet and physical activity
• Lose more fat
• Retain more muscle
• Regain less weight
• Reduction of abdominal fat

32. Weight Loss Strategies –Weight Loss Strategies –
Physical ActivityPhysical Activity
• kCalorie expenditure
• Body weight, intensity, and duration
• Greater the energy deficit, greater the fat
loss
• Discretionary kcalorie allowance
• Metabolism
• Speeds up with activity
• Immediate and long-term benefits

33. Influence of Physical ActivityInfluence of Physical Activity
on Discretionary kCalorieson Discretionary kCalories

34. Weight Loss Strategies –Weight Loss Strategies –
Physical ActivityPhysical Activity
• Body composition
• Fat decreases and lean body mass increases
• Strength-training exercises
• Abdominal fat
• Appetite control
• Delayed appetite
• Inappropriate appetite

35. Weight Loss Strategies –Weight Loss Strategies –
Physical ActivityPhysical Activity
• Psychological benefits
• Self-esteem
• Choosing activities
• Ones you enjoy & are willing to do regularly
• Low-to-moderate intensity
• 2000 calories per week
• Energy-expending daily activities
• Spot reducing

36. Weight Loss Strategies –Weight Loss Strategies –
Environmental InfluencesEnvironmental Influences
• Factors surrounding eating experience and
the food itself
• Atmosphere
• Pleasant and comfortable equals more food
• Accessibility
• Less effort needed to obtain food, more food
eaten

37. Weight Loss Strategies –Weight Loss Strategies –
Environmental InfluencesEnvironmental Influences
• Socializing
• Duration of meal
• Visual cues
• Distraction
• Distractions
• Initiating eating
• Interfering with internal controls
• Extending duration of eating

38. Weight Loss Strategies –Weight Loss Strategies –
Environmental InfluencesEnvironmental Influences
• Multiple choice
• Large assortments of foods increase
consumption
• Package and portion sizes
• Serving containers

39. Weight Loss Strategies –Weight Loss Strategies –
Behavior & AttitudeBehavior & Attitude
• Behavior modification
• Positive, matter-of-fact attitude
• Become aware of behaviors
• Keep record
• Change behaviors
• Set small, specific goals
• Practice
• Reward

40. Weight Loss Strategies –Weight Loss Strategies –
Behavior & AttitudeBehavior & Attitude
• Cognitive skills
• Problem solving
• Cognitive restructuring
• Replace negative thoughts
• Personal attitude
• Understand personal relationship with food
• Sound emotional health
• Support groups

41. Weight Loss Strategies –Weight Loss Strategies –
Weight MaintenanceWeight Maintenance
• Successful weight loss
• Plateau
• Appropriate goal at this point
• Prevalence of successful weight loss
• Difficult to determine
• Weight loss
• Without formal program
• Maintained for at least a year

42. Weight Loss Strategies –Weight Loss Strategies –
Weight MaintenanceWeight Maintenance
• Components of successful weight loss
• Vigorous exercise regimens
• Careful eating patterns
• Frequent self-monitoring
• Changes in metabolism
• Takes more to prevent weight regain than to
prevent weight gain

43. Preventing Weight GainPreventing Weight Gain
• Preventing weight gain would benefit many
people
• Strategies are similar to losing weight
• Start earlier

44. Community ProgramsCommunity Programs
• Possibly change environment through public
health law
• Stretch beyond individual
• Social networks
• Community institutions
• Government policies

45. Community Strategies toCommunity Strategies to
Prevent ObesityPrevent Obesity

46. UnderweightUnderweight
• Affects no more than 2% of U.S. adults
• Weight gain is a matter of health
• Individual matter
• Weight gain may be difficult
• Physical conditioning combined with high
energy intakes

47. Problems of UnderweightProblems of Underweight
• Demand for energy contributes to
underweight
• Physical activity
• Growth and development
• Difficult to gain weight
• Adaptive thermogenesis
• Learn new habits and like new foods
• Underweight vs. anorexia nervosa

48. Weight-Gain StrategiesWeight-Gain Strategies
• Key diet planning strategies
• Adequacy and balance
• Energy-dense foods
• Regular meals daily
• Large portions
• Extra snacks
• Juice and milk
• Exercise to build muscles

49. The Latest andThe Latest and
Greatest Weight-Greatest Weight-
Loss Diet – AgainLoss Diet – Again
Highlight 9Highlight 9

50. Fad DietsFad Diets
• Outrageous claims
• No requirements to prove the claims
• Do not have to support with credible research
• Distorted research
• Numerous fad diet plans

51. Fad DietsFad Diets’ Appeal’ Appeal
• Market for weight-loss products is huge
• Greatest appeal
• Tend to ignore dietary recommendations
• Sophisticated and often erroneous
explanations
• Tend to work for short time
• Fail to produce long-lasting results

52. DonDon’t Count kCalories’t Count kCalories
• Claim to disregard kcalories
• Designed to have low energy intake
• Tend to lack variety
• Monotonous
• Often recommend dietary supplement
• Follow a plan
• Most fad diets cannot support optimal health
over time

53. The Real DealThe Real Deal
• Fad diet “magical powers”
• Tipping the energy balance equation to
greater energy expenditure
• Weight loss
• Long-term lifestyle changes
• Healthy plan
• Flexibility and variety