Obesity and Eating Disorders

• Overweight, obesity

• Causes of obesity• Complications of obesity.• Weight management• Nutrition therapy• Behavior modification• Promoting dietary adherence• Physical activity• Include Box 14.2 Choose my plate• Box 14.3 Behavior modification ideas

• Overweight is defined as having a BMI 25. It is related to an excessive body weight, not necessarily excessive body fat. Muscle, bone, fat, and water all contribute to body weight.

• Obesity is defined as having a BMI 30, a condition characterized by excess accumulation of body fat.

Causes of Obesity

1. Obesogenic Environment2. Genetics3. Gene–Environment Interaction

1. Obesogenic Environment

• The dramatic rise in obesity in the U.S. population suggesting that the root cause is lifestyle and environment,not biology (2009)

• this imbalance is due in large part to an

increased intake in food. A decrease in physical activity has also contributed to the calorie imbalance.

• The current environment, which encourages energy intake and discourages energy expenditure, has been labeled obesogenic. It, along with behavior, is believed to account for the increased prevalence of overweight and obesity in the world today (Corsica

and Hood, 2011).

Factors that contribute to an obesogenic environment include the following:

■ An plenty of readily accessible, low-cost, palatable, high-calorie foods in large portions

■ Increasing consumption of soft drinks and snacks ■ A great proportion of the food budget spent on

food away from home ■ The increasing portion size of restaurant meals

■ A decrease in energy expenditure related to labor-saving devices, such as remote control devices and motorized walkways

https://www.youtube.com/watch?v=4gy44ax2Ylg

■ An increase in sedentary leisure activities, such as watching television, playing video games, and sitting in front of a computer. HOW?

• Television watching may promote obesity by leaving less time for physical activity, lowering resting metabolic rate, and/or promoting greater meal frequency and food intake (Chaput et al., 2011).

• Energy Gap: the difference between caloriesconsumed and calories expended.

Genetics

• Calorie intake and expenditure may not completely explain the complexity of weight regulation in obesity (Isoldi and Aronne, 2008). Epidemiologic studies point to a genetic susceptibility (Herrera and Lindgren, 2010).

• Genetics is involved in how likely a person is to gain or lose weight in response to changes in calorie intake by influencing basal metabolic rate, where body fat is distributed, and response to overeating (O’Neil and Nicklas, 2007).

• Genetics may also account for the individual differences in weight loss that occur in response to calorie restriction (Loos and Rankinen, 2005) and may even account for nutrient-specifi c food preferences (Bauer et al., 2009). Supporting the

• case for a genetic basis to weight status is the tendency of adopted children to have similar weights to their biological parents, not their adoptive parents (Moll, Burns, and Lauer, 1991; Stunkard et al., 1986).

Gene–Environment Interaction

• Clearly there is a gene–environment interaction. Even when a genetic susceptibility exists, exposure to an obesogenic environment is necessary for obesity to develop (Herrera and Lindgren, 2010).

• Likewise, in people with a genetic predisposition to obesity, the severity of the disease is largely determined by lifestyle and environmental conditions (Loos and Rankinen, 2005).

https://www.youtube.com/watch?v=Pa53XynJXI0

Complications of Obesity

• Obesity significantly increases mortality and morbidity. It is associated with a wide variety of diabetes, hyperlipidemia, fatty liver disease, obstructive sleep apnea, gastroesophageal reflux disease, vertebral disk disease, osteoarthritis, and increased risk of certain cancers (Guh et al., 2009).

• Abdominal obesity, increases the risk of coronary heart disease and type 2 diabetes

• Obesity increases the risk of complications during and after surgery and the risk of complications during pregnancy, labor, and delivery.

• Overweight-obesity and physical inactivity are estimated to be responsible for nearly 1 in 10 deaths in the United States (Danaei et al.,2009).

• Obesity presents psychological and social disadvantages. In a society that emphasizes thinness, obesity leads to feelings of low self-esteem, negative self-image, depression, and hopelessness (Valtonen, Laaksonen, and Tolmunen, 2008).

• Negative social consequences include stereotyping; prejudice; stigmatization; social isolation; and discrimination in social, educational, and employment settings.

• Abdominal Obesity: waist circumference exceeding 35 inches in women or 40 inches in men.

• Metabolic Syndrome: a cluster of interrelated symptoms, including obesity, insulin resistance, hypertension, and dyslipidemia, which together increase the risk of cardiovascular disease and diabetes

Goal of Treatment

Next Session

Goals of Treatment

• weight would fall into the healthy BMI category and would be maintained there permanently.

• This would be gradually accomplished with a 1- to 2-pound loss every week for the first 6 months of weight loss therapy

• After 6 months, when the rate of weight loss usually decreases, then, the focus would shift to maintaining that weight loss.

• After 6 months of weight maintenance, weight loss efforts would be repeated. The cycle would continue until healthy weight is achieved.

• People who have successfully lost weight havedone so by making extreme changes in their eating and exercise habits.

• A modest weight loss of 5% to 10% of usual body weight is associated with significant improvements in blood pressure, cholesterol and plasma lipid levels, and

• Compared with intense weight loss, modest weight loss is more attainable, easier to maintain over the long term

• Setting a modest weight loss goal and keeping that weight off are far more realistic than striving for thinness. Yet for some people, even modest weight loss may be unattainable.

• A more appropriate weight management goal for clients unable to lose weight is to prevent additional weight gain.

Evaluating Motivation to Lose Weight

• Why assessing the client’s level of motivation is crucial?

1. because weight loss is not likely to occur in people who are not motivated or not ready to change

2. Even worse, imposing treatment on an unmotivated or unwilling client may prevent subsequent attempts at weight loss when the client may be more likely to succeed.

Weight management

1. Nutrition therapy2. Behavior modification3. Promoting dietary adherence4. Physical activity• Include Box 14.2 Choose my plate• Box 14.3 Behavior modification ideas

Weight management: 1. Nutrition therapy

• The first priority in obesity treatment is to decrease calorie intake, usually by 500 to 1000 cal/day to achieve a weekly weight loss of 1 to 2 pounds (Seagle and Strain, 2009).

• This recommendation is based on the assumption that 1 pound of fat mass is approximately equivalent to 3500

• The appropriate calorie intake may be determined by subtracting 500 to 1000 calories from the client’s estimated total energy needs

• A more general approach is to choose a specific calorie level based on gender. The National Institutes of Health (NIH) recommends low-calorie diets of 1000 to 1200 cal/day for overweight women and 1200 to 1600 cal/day for overweight men and heavier (165 pounds)

• This level of calorie restriction can promote up to an 8% loss of body weight when followed for 3 to 12 months (Cannon and Kumar, 2009).

• A multivitamin and mineral supplement is recommended whenever calorie intake falls to 1200 calories or less.

• If 1200 calories can promote a 1 to 2 pound loss per week, will a more drastic calorie reduction speed the weight loss process?

• No, In reality, cutting calories too much, particularly when protein intake is low, may result in higher proportions of lean tissue loss, leading to a compensatory reduction in exercise tolerance. This makes weight loss and eventual weight maintenance more difficult.

The Bottom Line. • Low-calorie diets produce weight loss regardless of which

macronutrients they emphasize (Sacks et al., 2009). However,

■ There is a risk of not consuming adequate amounts of all micronutrients with either a very-low-carbohydrate diet or a very-low-fat diet.

■ lean muscle mass is better preserved among dieters who consume a higher protein intake and 25% to 30% of protein may also provide greater satiety (Schoellerm and Buchholz, 2005).

■ The “best” type of diet is individualized to the client’s preference and health status.

Portion Control

• Portion control is an important strategy to prevent weight gain as well as an integral component of weight loss programs (Seagle and Strain, 2009).

• Providing clients with common household equivalents to estimate portion sizes is a useful tool.

• While clients may not have any idea what 3 oz of meat looks like, they can visual the size of a deck of cards to estimate reasonable meat portions.

Eating Frequency

• Regular, frequent meals and snacks may help clients avoid periods of hunger, thereby increasing the likelihood of dietary adherence.

• An individualized pattern that prevents periods of hunger is recommended.

Meal Replacements

• If self-selection or portion control is difficult, meal replacements can be an effective weight loss and weight loss maintenance strategy (Seagle and Strain, 2009).

• Commercial diet programs, such as Jenny Craig and Nutrisystem, feature one to two meals per day of vitaminand mineral-fortified, low-calorie “meals,” this to make risk of poor food choices is reduced.

Behavior Modification

1. Self-monitoring involves keeping a detailed record of the time, amount, description,preparation, and calorie content of all foods and beverages consumed.

• Recording additional information, such as the client’s emotional state, intensity of hunger, and activities at the time of eating, may help identify “problem” behaviors.

• The primary purpose of using food records is to increase awareness of how often and under what circumstances the client engages in behaviors that support weight loss efforts.

• Self-monitoring is often considered one of the most essential components of behavior modification

2. Goal setting: may involve specific calorie, fat gram, and physical activity goals designed to achieve a 1- to 2-pound weight loss per week, or it may involve specific eating behaviors in need of improvement. • Goals should be realistic, specific, and measurable so

that success can be achieved, thereby engendering a sense of accomplishment and boosting motivation.

e.g: Instead of a goal to “eat better,” a goal may be to “eat oatmeal and fruit for breakfast 5 days per week.”

3. Stimulus control involves restructuring the environment to avoid or change cues thattrigger undesirable behaviors 1. (e.g., keeping “problem” foods out of sight or

out of the house) 2. or instituting new cues to elicit positive

behaviors (e.g., putting walking shoes bythe front door as a reminder to go walking).

4. Problem solving involves identifying eating problems or high-risk situations, planning alternative behaviors, implementing the alternative behaviors, and evaluating the plan to determine whether or not it reduces problem eating behaviors.

5. Cognitive restructuring involves reducing negative self-talk, increasing positive self-talk,setting reasonable goals, and changing inaccurate beliefs.

6. Promoting Dietary Adherence:

• Only one in six overweight and obese adults report ever having maintained weight loss of at least 10% of their body weight for 1 year (Kraschnewski et al., 2010).

• Adding structure to a low-calorie diet may improve adherence by limiting food choices in meal plans and including actual grocery lists, menus, and recipes.

Physical Activity

• In most studies, physical activity and improved fitness reduce the health risks of obesity regardless of the degree of obesity or baseline health status (Lee, Sui, and Blair, 2009).

• With or without weight loss, increasing activity lowers blood pressure and triglycerides, increases HDL cholesterol, and improves glucose

• Current physical activity guidelines recommend the following (Donnelly et al., 2009): ■ Approximately 30 minutes of moderate to

vigorous physical activity (MVPA) 5 to 7 days per week to prevent weight gain

■ 150 to 420 minutes/week of MVPA for weight loss ■ 200 to 400 minutes/week of MVPA to maintain

weight loss

• Physical activity and calorie restriction work synergistically when paired together (Blackburn

et al., 2010). • Compared to weight loss from dieting, weight loss from

exercise produces a greater percentage of fat loss as well as a greater decrease in abdominal and visceral fat (Ross et al., 2000).

• After weight loss, regular exercise is the primary predictor of weight maintenance (USDHHS, 2008).

What type of exercises?

• Moderate-intensity aerobic activity (e.g., walking, cycling, swimming) is most commonly recommended for weight loss and maintenance.

Promoting Exercise Adherence

• Strategies that may promote exercise adherence include encouraging clients to ■ Exercise at home rather than at on-site or

supervised exercise sessions. ■ Exercise in multiple short bouts (10 minutes

each), instead of one long session. ■ Adopt a more active lifestyle, such as taking the

stairs instead of the elevator or pacing while on the phone instead of sitting down.

Thank You