Figure 6-5 (continued fasting).

Energy Balance and Weight Energy Balance and Weight ManagementManagement

ENERGY INENERGY IN Regulation of food intake:Regulation of food intake: HungerHunger Satiation and satietySatiation and satiety AppetiteAppetite

ENERGY OUTENERGY OUT Energy expenditure at rest:Energy expenditure at rest: BMR - basal metabolic rate: rate of BMR - basal metabolic rate: rate of

energy expended at rest (kcal/hr or energy expended at rest (kcal/hr or kcal/day), also called RMR (resting kcal/day), also called RMR (resting metabolic rate). metabolic rate).

Factors that affect BMR (page 257)Factors that affect BMR (page 257)

ENERGY OUTENERGY OUT

Energy expenditure for physical activity: Energy expenditure for physical activity: Depends on the activity duration, type, Depends on the activity duration, type,

and intensity (page 255)and intensity (page 255) Also affected by body size and fitness Also affected by body size and fitness

levellevel

ENERGY OUTENERGY OUT

NEAT is the energy associated with NEAT is the energy associated with unintentional activities like fidgeting, unintentional activities like fidgeting, maintenance of posture, or spontaneous maintenance of posture, or spontaneous muscle contraction muscle contraction

ENERGY OUTENERGY OUT

Energy expenditure to process food:Energy expenditure to process food: Thermic effect of food (TEF) – the Thermic effect of food (TEF) – the

energy used to digest, absorb, and energy used to digest, absorb, and metabolize energy-yielding foodmetabolize energy-yielding food

TEF is lower for fat than for TEF is lower for fat than for carbohydrate and proteincarbohydrate and protein

TEF peaks one hour after eating, and TEF peaks one hour after eating, and normally dissipates within 5 hoursnormally dissipates within 5 hours

Accounts for ~10% of total energy Accounts for ~10% of total energy expenditureexpenditure

Components of Energy Components of Energy ExpenditureExpenditure

Physical Activity = 30-50%Physical Activity = 30-50% TEF = 10%TEF = 10% BMR = 50-65%BMR = 50-65%

MEASUREMENT of ENERGY MEASUREMENT of ENERGY EXPENDITUREEXPENDITURE

Estimating energy expenditure:Estimating energy expenditure: EER – an equation used to estimate REE EER – an equation used to estimate REE

based on age, weight, height, and sexbased on age, weight, height, and sex Page 257Page 257

BODY COMPOSITIONBODY COMPOSITION

Assessing body weight:Assessing body weight: weight tablesweight tables body mass index (BMI) =body mass index (BMI) =

weight (kg)weight (kg)

height (mheight (m22))

BODY COMPOSITIONBODY COMPOSITION

As the BMI table As the BMI table shows, healthy weight shows, healthy weight falls between a BMI of falls between a BMI of approximately 18.5 approximately 18.5 and 24.9.and 24.9.

BODY FAT DISTRIBUTIONBODY FAT DISTRIBUTION

gynoid obesity (pear-shaped figure), more gynoid obesity (pear-shaped figure), more common in women common in women

android obesity (apple-shaped figure), android obesity (apple-shaped figure), more common in menmore common in men increases risk of heart disease and diabetes increases risk of heart disease and diabetes

mellitus (Type II)mellitus (Type II)

“ “apple” “pear”apple” “pear”

WHAT CAUSES OBESITY?WHAT CAUSES OBESITY?Current Thinking Current Thinking

Hereditary and genetic factorsHereditary and genetic factors Sociocultural influencesSociocultural influences Age and lifestyleAge and lifestyle SexSex Race and ethnicityRace and ethnicity Socioeconomic statusSocioeconomic status EmploymentEmployment Psychological factorsPsychological factors

ENERGY IMBALANCE: ENERGY IMBALANCE: Overweight and ObesityOverweight and Obesity

Health risks (page 265)Health risks (page 265) Prevalence of overweight and obesity – it Prevalence of overweight and obesity – it

is a worldwide public health problem. We is a worldwide public health problem. We are now seeing an obesity epidemic in are now seeing an obesity epidemic in children as well as adults.children as well as adults.

OBESITY in our CHILDRENOBESITY in our CHILDREN

National Center for Health Statistics National Center for Health Statistics suggests nearly 25% of children are suggests nearly 25% of children are overweight or obeseoverweight or obese

There are now about 5 million obese There are now about 5 million obese children in the United States – up by 50% children in the United States – up by 50% since 1991since 1991

OBESITY in our CHILDRENOBESITY in our CHILDREN

A 1999 Survey of Seattle High Schools A 1999 Survey of Seattle High Schools showed that:showed that:

9% of males and 6% of females were 9% of males and 6% of females were overweightoverweight

HEALTH CONSEQUENCESHEALTH CONSEQUENCES

Overweight children and adolescents are Overweight children and adolescents are more likely to become overweight or more likely to become overweight or obese adultsobese adults

Type 2 diabetes, high blood lipids, Type 2 diabetes, high blood lipids, hypertension, early maturation and hypertension, early maturation and orthopedic problems also occur with orthopedic problems also occur with increased frequency in overweight youthincreased frequency in overweight youth

ECONOMIC CONSEQUENCESECONOMIC CONSEQUENCES

In 2000, the total cost of obesity was In 2000, the total cost of obesity was estimated to be $117 billion estimated to be $117 billion

Most of the cost associated with obesity is Most of the cost associated with obesity is due to type 2 diabetes, coronary heart due to type 2 diabetes, coronary heart disease, and hypertensiondisease, and hypertension

WEIGHT MANAGEMENTWEIGHT MANAGEMENTWhat Works?????What Works?????

Unfortunately, there is no magic pill, no Unfortunately, there is no magic pill, no perfect diet. The simple fact is, if you perfect diet. The simple fact is, if you consume more calories than you burn, consume more calories than you burn, you will gain weightyou will gain weight

A slow weight loss (1-2 pounds per A slow weight loss (1-2 pounds per week) is the best wayweek) is the best way

To lose 1 pound of fat, you must burn an To lose 1 pound of fat, you must burn an extra 3500 calories (in one week that = extra 3500 calories (in one week that = 500 calories per day)500 calories per day)

WEIGHT MANAGEMENTWEIGHT MANAGEMENT

Important Components: Important Components: Diet compositionDiet composition Physical activityPhysical activity Behavioral changeBehavioral change Balancing acceptance and changeBalancing acceptance and change Support!Support!

DIET COMPOSITIONDIET COMPOSITION

A Healthful Eating Plan A Healthful Eating Plan Involves:Involves: Realistic energy intakeRealistic energy intake Nutritional adequacyNutritional adequacy Small portions, small Small portions, small

frequent mealsfrequent meals Reduced simple sugar Reduced simple sugar

and alcohol intakeand alcohol intake Adequate waterAdequate water

PHYSICAL ACTIVITYPHYSICAL ACTIVITY

Contributions to weight loss and maintenance:Contributions to weight loss and maintenance: Direct increases in energy output (muscles and Direct increases in energy output (muscles and

cardiovascular system)cardiovascular system) Indirect energy output (elevated BMR)Indirect energy output (elevated BMR) Appetite controlAppetite control Psychological benefitsPsychological benefits

Note: Note: Spot reducing is not possible.Spot reducing is not possible.

BEHAVIORAL CHANGEBEHAVIORAL CHANGE

Behavior Behavior modification: modification: the the changing of behavior changing of behavior by the manipulation of by the manipulation of antecedents antecedents (cues or (cues or environmental factors environmental factors that trigger behavior), that trigger behavior), the behavior itself, and the behavior itself, and consequences consequences (the (the penalties or rewards penalties or rewards attached to behavior).attached to behavior).

Figure 7-7 Food and Activity Diary

SUPPORTSUPPORT

• FamilyFamily• FriendsFriends• Weight Loss Support GroupsWeight Loss Support Groups

WEIGHT MANAGEMENTWEIGHT MANAGEMENT

Adjuncts to treatmentAdjuncts to treatment DrugsDrugs Self-help activitiesSelf-help activities Commercial programsCommercial programs Professional private counselorsProfessional private counselors Surgery: gastric bypass, gastric bandingSurgery: gastric bypass, gastric banding

Why is abdominal fat bad?Why is abdominal fat bad?

http://www.health.harvard.edu/http://www.health.harvard.edu/newsweek/Abdominal-fat-and-what-to-do-newsweek/Abdominal-fat-and-what-to-do-about-it.htmabout-it.htm