Weight Management - Family and Consumer Science
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Transcript Weight Management - Family and Consumer Science
Diet and Health Guidelines for Weight
Management
Presented by
Janice Hermann, PhD, RD/LD
OCES Adult and Older Adult Nutrition Specialist
Energy Balance
Energy Balance
Excess energy whether from
Fat
Carbohydrate
Protein
Alcohol
can be converted into fat and stored in fat cells
Energy Balance
If energy in = energy out
Maintain weight
If energy in > energy out
Gain weight
Stored as fat
If energy in < energy out
Lose weight
Body pulls on fat stores and lean tissue
Energy Balance
3,500 kcal = 1 pound
It only takes a small calorie imbalance to
impact weight over time
100 kcal excess per day = 10 pound gain per year
100 kcal deficit per day = 10 pound gain per year
“Energy In”
Food and beverages provide the “energy in”
The energy values of foods can be calculated
from the amounts of carbohydrate, fat and
protein, and alcohol in the foods
1 g carbohydrate = 4 calories/g
1 g fat = 9 calories/g
1 g protein = 4 calories/g
1 g alcohol = 7 calories/g
“Energy Out”
Body expends energy in three main categories
Basal metabolism
60-70%
Physical activity (most variable)
25-30%
Sedentary may be less than half of basal metabolism
Extremely active may be as much as basal metabolism
Thermic effect of food
5-10%
Assessing Weight and Health Risk
Assessing Body Weight
The first step in weight management is to take
a good look at current weight
Assessing body weight can be tricky
Body weight not a good indicator of health risk
Body weight includes:
Water
Lean tissue
Fat
Health NOT appearance - criteria for body weight
Body Fat and Health
Body fat normally higher for females than
males
Normal weight male 13 to 21%
Normal weight female 23 to 31%
Health problems typically develop when body
fat exceeds
22% young men
25% in men over 40 yr
32% in young women 35% in women over 40 yr
Body Mass Index (BMI)
BMI describes relative weight for height in
regards to health
BMI = weight(kg)/height (m)2
For adults, a BMI of:
BMI < 18.5 (underweight)
BMI 18.5 to 24.9 (healthy)
BMI 25 to 29.9 (overweight)
BMI ≥ 30 (obese)
BMI and Health Risks
BMI correlated with disease risk and life
expectancy
These are correlations, not causes
Epidemiological data show a J or U shaped
relationship between BMI and mortality
These mortality risks decline with age
Moderate overweight not as great of a health risk
among older adults
Health Risks Associated With
Underweight
Health risks of underweight
Underweight person, especially older adults, may
be unable to preserve lean tissue during a fight
against a wasting disease, such as cancer or
digestive disorder, especially if accompanied by
malnutrition
Underweight women have higher fertility
problems
Underweight women are at higher risk of
osteoporosis and bone fractures
Health Risks Associated With
Overweight and Obesity
Health risks of overweight and obesity
Diabetes
Hypertension
Cardiovascular disease
Sleep apnea
Osteoarthritis
Certain types of cancer
Gallbladder disease
Respiratory problems
Complications with pregnancy and surgery
Other Consequences Associated With
Overweight and Obesity
Perceptions and prejudices
Social consequences
Psychological consequences
Distribution of BMI’s in US Adults
BMI Limitations
BMI doesn’t measure body composition
A BMI in the healthy range may not be healthy
if a large percentage of weight is fat
A BMI in the overweight range my be healthy if
a large percent of weight is muscle or bone
Doesn’t consider ethnic and age
differences in body composition
Certain ethnic groups have higher bone density
Changes in body composition with age
Where Body Fat Located
Where fat located may be more critical than
total amount of fat
Abdominal fat (stored around the organs of the
abdomen) referred to as central obesity or upperbody fat
Associated with increased risks of cardiovascular disease,
type 2 diabetes, and hypertension, independently of
total body fat
Abdominal fat is most common in men and to a lesser
extent in women past menopause
Fat around the hips and thighs referred to as
lower-body fat
Not as associated with increased health risks
Most common in women during reproductive years
Waist Circumference
Waist circumference
Practical indicator of abdominal fat
Waist circumferences associated with central
obesity and increased health problems are:
Women: waist circumference > 35 inches
Men: waist circumference > 40 inches
Other Body Composition Methods
Health care professionals commonly use BMI
and waist circumference to evaluate weight
Easy to determine and inexpensive
More precise measures of body composition;
more evasive, expensive and require mastery
of technique
Fatfold measure
Hydrodensitometry
Bioelectrical impedance
Air displacement plethysmography
Dual energy X-ray absorptiometry (DEXA)
Evaluating Health Risk
Three indicators used to evaluate health risk
relative to weight:
Body mass index (BMI)
BMI 25.0-29.9 = overweight
BMI ≥ 30 obese
Waist circumference
Men: >102 cm (>40 in)
Women: >88 cm (>35 in)
Disease risk profile
Family history, life-threatening diseases, and common
risk factors for chronic diseases
Evaluating Health Risk
Overweight in good health
People who are overweight by BMI standards but
otherwise in good health, might not benefit from
losing weight; instead they might focus on
preventing further weight gain
Evaluating Health Risk
Overweight/Obese with Risk Factors
Weight loss is recommended for people who are
obese and those who are overweight (or who have
a high waist circumference) with two or more risk
factors for chronic diseases
Hypertension
Cigarette smoking
High LDL
Low HDL
Impaired glucose tolerance
Family history of heart disease
Men ≥45 yr; women ≥55 yr
Evaluating Health Risk
Overweight/Obese with Life Threatening
Condition
Weight loss is also recommended for people who
are either overweight or obese and suffering from
a life-threatening condition such as cardiovascular
disease, diabetes, or sleep apnea
Fat and Fit versus Slim and Sedentary
Cardio-respiratory fitness plays a major role in
health, independently of BMI
Fit normal-weight people have lower health risks
than unfit normal-weight people
Fit overweight people have lower health risks than
unfit normal-weight people
Fitness, in and itself, offers many health
benefits
Causes of Overweight and Obesity
Causes of Overweight/Obesity
Prevalence of overweight and obesity in the
United States continues to rise across all:
Regions
Genders
Ages
Ethnic/racial groups
Socioeconomic groups
Education levels
Causes Of Overweight/Obesity
Many factors can affect food intake and
physical activity level which can lead to
weight gain:
Genetics
Environment
Causes of Overweight/Obesity: Genetics
Genetics plays a true causative role in few cases
of obesity
Example: Prader-Willi syndrome
Even if genetics does not cause obesity, genetic
factors may influence:
Metabolic pathways that lead to overweight/obesity
and maintain it
Food intake
Activity patterns
Causes of Overweight/Obesity: Genetics
Adopted children tend to be similar in weight
to their biological parents, not to their
adoptive parents
Identical twins are twice as likely to weight
the same as fraternal twins – even when
reared apart
Suggest an important role for genetics in
determining a person’s susceptibility to
overweight/obesity
Causes of Overweight/Obesity: Genetics
Genetics seem to makes some people more
or less likely to gain or lose weight when
overeating or under-eating
Some people gain more weight than others on
comparable intakes
Similarly, some people lose more weight than
other following comparable physical activity
routines
Causes of Overweight/Obesity: Genetics
Although genetics has a role with
overweight/obesity
Overweight/obesity rates have dramatically risen
over the past three decades while the gene pool
has remaining relatively unchanged
Causes of Overweight/Obesity: Environment
Environment includes all the circumstances we
encounter daily that push us toward weight gain
Overeating
Remember: doesn’t mean excessive 100 kcal/day = 10 lb/yr
Physical inactivity
Genetics and environmental factors are not
exclusive of each other; genetics can influence
eating and activity behaviors
Causes of Overweight/Obesity: Environment
Overeating
Energy balance must consider over time
Family/cultural environment
Family/cultural eating habits
Income
Time
Working mothers
Increased activities
Emotional stress
Override hunger, satiation, and satiety cues
Knowledge and skills
Causes of Overweight/Obesity: Environment
Overeating
Environment that exposes us to an abundance of
high-calorie, high-fat foods
Readily available
Relatively inexpensive
Heavily advertise
Taste great
Large portions
Especially restaurants
Trend towards large portions parallels prevalence of overweight
and obesity in the United States
Causes of Overweight/Obesity: Environment
Physical Inactivity
Decrease in daily activities
Technology replaced physical activity at home, work and
transportation
Increase in sedentary activities
Television, video and computer games
Require little activity
Replace time spent in more vigorous activities
People tend to eat while they do sedentary activities
Causes of Overweight/Obesity: Environment
Physical Inactivity
Other environmental issues
Safety
Cost
Access places to be physically active
Time
Working mothers
Increased activities
Injury/illness
Weight Loss
Key Concepts
Refocus attention to achieving and maintaining
good health by focusing on:
Health, not appearance, weight management
priority
Setting realistic goals
Healthy eating, not “dieting”
Regular physically active
Key Concepts
Weight management aims at changes that
will last
Any lasting change will be slow and gradual
As a result, weight management is a
commitment to a healthful lifestyle and
should be viewed as an on-going process
No “Quick Fix”
Many weight loss programs imply weight loss
is simple
People lured into programs that promise a quick
and easy fix to a complex problem
If weight loss were simple the success rate
would be far greater than it is
No “Quick Fix”
Too often weight loss programs focus on
Severely restrictive diets
Unrealistic weight loss goals
Inability to reach unrealistic weight loss goals
and tendency to regain weight lost sets up an
endless cycle of failure and discouragement
Many people feel their weight loss efforts are
unsuccessful, when in actuality it may be their
weight loss goals are unrealistic
Weight-Loss Strategies
Unreachable goals ensure failure
Weight-Loss Strategies
Successful weight-loss strategies embrace:
Small changes
Moderate losses
Reasonable goals
Weight-Loss Strategies
A person who loses 10-20 pounds in a year by
choosing healthy nutrient-dense foods and
engaging in regular physical activity is more
likely to
Maintain weight loss
Gain health benefits
than if more weight is lost in less time by
radical methods
Weight Loss and Body Composition
Quick changes in body weight are not simple
changes in fat stores
Weight gained or lost rapidly includes:
Some fat
Large amount of fluid
Some lean tissue
Because 60% of body weight is water, retention or
loss of water dramatically affects body weight
Even long term changes in body weight
75% stored fat
25% lean tissue
Weight-Loss Strategies
Modest weight loss (5-10%), even if still
overweight, provides health benefits:
Improves blood glucose control
Lowers blood pressure
Lowers LDL cholesterol
Increased physical activity can:
Increase HDL cholesterol
Increase cardiovascular fitness
Weight-Loss Strategies
Dietary Guidelines advises those who need to
lose weight to aim for a slow, steady weight
loss by:
Decreasing calorie intake while maintaining
adequate nutrient intake and
Increasing physical activity
Weight-Loss Strategies
Reasonable goals
Reasonable weight loss rate
1 to 2 pounds per week
Reasonable time frame
10% of body weight over 6 months
Example: 250 pound person
10% loss over 6 months would be 25 pounds
Which is about 1 pound per week
Weight-Loss Strategies
Rapid weight loss typically results in:
Excessive loss of lean tissue
Including water loss
Lower BMR
Weight lost often regained
May set into motion eating disorders
Weight-Loss Strategies
Healthy eating NOT dieting
A non-restrictive approach to eating
including a variety of foods from the USDA
Daily Food Plan food groups with a
moderate reduction in calories
Total fat
20 to 35% of kcal
Saturated fat less than 10% of kcal
Cholesterol
less than 300 mg
Carbohydrate 45 to 65% of kcal
Protein
10% to 35% of kcal
Fiber
14 g/1,000 kcal
Weight-Loss Strategies
Eating plan: Healthy eating NOT dieting
Be realistic about energy intake-Moderate calorie
reduction
BMI 27-35: 300 to 500 calorie/day reduction
BMI ≥ 35: 500 to 1000 calorie/day reduction
Emphasize nutritional adequacy
Nutritional adequacy difficult with < 1200 kcalories/day for
females and < 1600 kcalories/day for males
Weight-Loss Strategies
Eating plans: Healthy eating NOT dieting
Eat smaller portions
Emphasize lower energy density foods
Remember water
Focus on complex carbohydrates (containing fiber)
Reduce foods high in fat and/or simple sugars
Watch for other empty kcalories such as beverages
Eat slowly - satiety signal sent after a 20-minute lag
Energy Density
Selecting grapes with their high water content
instead of raisins increases the volume and
decreases the energy intake
Energy Density
Even at the same weight and similar serving
sizes, the fiber-rich broccoli delivers twice the
fiber of the potatoes for about one-fourth the
energy
Energy Density
By selecting the low-fat version, a person can
enjoy the same amount of tuna for fewer
calories
Energy Density
Weight-Loss Strategies
Physical activity
People who combine healthy eating with physical
activity are more successful at losing and keeping
weight off
People who include physical activity are also more
likely to lose body fat and keep lean muscle tissue
Weight-Loss Strategies
Physical activity
Activity and energy expenditure
Calories spent in activity depends on body weight,
intensity and duration
Weight-Loss Strategies
Physical activity
Activity and metabolism
Activity increases metabolism
Immediately (slightly elevated for several hours after
intense and prolonged activity)
Long term (Increasing lean tissue – muscle has a higher
metabolic rate)
Activity and body composition
Increases lean tissue, decreases body fat
NOTE: Muscle weighs twice as much as fat - may have
more gradual weight loss, but will be more fat loss and
less muscle
Weight-Loss Strategies
Physical activity
Activity and appetite control
During activity body releases stored energy to support
physical activity, also suppresses digestion
Physical activity can help reduce appetite related to
boredom, anxiety or depression
Activity and psychological benefits
Health benefits
Lowers risks for type 2 diabetes, cardiovascular disease,
hypertension, colon cancer
Weight-Loss Strategies
Physical activity
Choosing activities
Activities they enjoy and are willing to do regularly
Spot reducing
Muscles do not "own" the fat that surrounds them
Fat cells from all over the body release fat in response
to the demand for physical activity
Physical activity can firm and strengthen muscles in a
particular area
Weight-Loss Strategies
How Much Physical activity
Activity of low-to-moderate intensity that
expends at least 2,000 calories per week is
especially helpful for weight management
Dietary Guidelines physical activity
recommendations:
For substantial health benefits
150 minutes of moderate-intensity per week or
75 minutes of vigorous-intensity per week
For additional health benefits
300 minutes of moderate-intensity per week or
150 minutes of vigorous-intensity per week
Weight-Loss Strategies
Physical activity doesn’t have to be at one
time
Try two to three 10-minute bouts rather than one
continuous 30 minutes
If you haven’t been physically active build up
time gradually
Before You Begin
A health care provider should be consulted
before becoming more physically active,
especially if
Chronic health problem such as heart disease,
hypertension, diabetes, osteoporosis, or obesity
Arthritis or joint problems
High risk for heart disease
Over age 40 for men or 50 for women
Hitting A Plateau
People often lose much of their weight within
6 months and reach a plateau
Hitting a plateau is normal
Body requires fewer calories to function as weight
decreases
This slow down can be disappointing, but is
an opportunity for the body to adjust to its
new weight
Hitting A Plateau
Attempting to lose additional weight at this
point can result in failure, instead focus on
maintaining the weight loss
After successfully maintaining an initial
weight loss for 6 months gradually increasing
the amount of physical activity may help a
continued weight loss
Prescription Medications
The FDA has approved several prescription
medications for appetite control
Prescription medications are not "Magic
Pills," they are used in combination with
moderate calorie restriction and increased
physical activity
Prescription Medication
Weight loss medications are serious medicine
for serious obesity
They should only be used under medical
supervision
They are only recommended for people with
serious weight problems, not for people who want
to lose a few pounds
Weight-Loss Strategies
Behavior and attitude
Behavior modification
Become aware of behaviors
Change behaviors
Personal attitude
Support groups
Weight Gain
Weight Gain
For some people weight management may
translate into weight gain
Although being underweight is a less
prevalent problem than being overweight, for
some people the struggle to gain weight is
just as difficult as weight loss is for others
Weight Gain
Healthy weight gain is accomplished through
a combination of:
Increased calories
Increased physical activity to build muscle mass
Weight gain can occur with increased
calories and no physical activity, but it will
be mostly fat, which is detrimental to health
just as being underweight
Weight-Gain Strategies
The foundation of a healthy diet, even for
weight gain, follows the USDA Daily Food Plan
Increase calories
Healthy eating for weight gain focuses on eating
foods that provide many calories in a small volume
Energy intake should exceed output (including
increased needs for physical activity by about 500
calories per daily
Expect weight gain to take time (1 pound per
month would be reasonable)
Weight-Gain Strategies
To gain weight, increase calorie intake by:
Eating regular meals
Taking larger portions
Selecting calorie dense foods
Consuming extra snacks and beverages
Weight-Gain Strategies
Physical Activity
Healthy physical activity for weight gain focuses on
strengthening activities to build muscle mass
Muscle tissue weighs nearly twice as much as fat
tissue
Remember energy intake should exceed output
(including increased needs for physical activity)
by about 500 calories per daily