DNT 200 NUTRITION FOR HEALTH SCIENCES

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DNT 200NUTRITION FOR HEALTH SCIENCES

• METABOLISM AND ENERGY BALANCE

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METABOLISM AND ENERGY BALANCE

• Life is largely a matter of chemistry William
  J. Mayo, MD

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METABOLISM AND ENERGY BALANCE

• DEFINITIONS
• Metabolism -- the sum total of all the chemical
  reactions that go on in living cells
• Anabolism -- reactions in which small molecules
  are put together to build larger ones anabolic
  reactions consume energy
• Catabolism -- reactions in which large molecules
  are broken down into smaller ones catabolic
  reactions usually release energy

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METABOLISM AND ENERGY BALANCE

• EXAMPLES
• Anabolism
• Making of glycogen
• Making of triglycerides
• Making of protein
• Catabolism
• Breakdown of glycogen
• Breakdown of triglycerides
• Breakdown of protein

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METABOLISM AND ENERGY BALANCE

• BREAKING DOWN NUTRIENTS FOR ENERGY
• If the body needs energy, it may break apart any
  or all of the basic units (glucose, fatty acids,
  glycerol, and amino acids) into smaller fragments
• Glucose
• Glucose to Pyruvate
• Glycolysis is the metabolic breakdown of glucose
  to pyruvate
• Pyruvate (pyruvic acid C3H4O3) is a three
  carbon compound that, in metabolism, can be
  derived from glucose, certain amino acids, or
  glycerol
• Is a reversible process
• Is anaerobic (does not require oxygen) but cannot
  be sustained for long

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METABOLISM AND ENERGY BALANCE

• BREAKING DOWN NUTRIENTS FOR ENERGY
• Glucose
• Pyruvate to Acetyl CoA
• If the cell needs energy and oxygen is available,
  pyruvate can then be broken down into a smaller
  compound called acetyl CoA
• CoA is the coenzyme derived from the B-vitamin
  pantothenic acid -- is central to the energy
  metabolism of nutrients
• Acetyl CoA is a two carbon compound (acetate or
  acetic acid) to which a molecule of CoA is
  attached

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METABOLISM AND ENERGY BALANCE

• BREAKING DOWN NUTRIENTS FOR ENERGY
• Glucose
• Pyruvate to Acetyl CoA (cont)
• Is aerobic (requires oxygen)
• Is an irreversible step
• Can be used as a building block for fatty acids
• If energy is not needed, acetyl CoA will not
  enter the TCA cycle, but will be used to make
  fatty acids instead -- this is how carbohydrate
  eaten in excess of the bodys needs can lead to
  fat deposition
• Cannot be used to remake glucose

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METABOLISM AND ENERGY BALANCE

• BREAKING DOWN NUTRIENTS FOR ENERGY
• Glucose
• Pyruvate to Acetyl CoA (cont)
• When less oxygen is available, pyruvate is
  converted to lactic acid
• Lactic acid accumulates in the muscles causing a
  burning pain and fatigue
• To relieve this pain, relax the muscles
  frequently so the circulating blood can carry the
  lactic acid back to the liver to be converted
  back to glucose

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METABOLISM AND ENERGY BALANCE

• BREAKING DOWN NUTRIENTS FOR ENERGY
• Glucose
• Acetyl CoA to Carbon dioxide
• In a series of metabolic reactions called the
  tricarboxylic acid (TCA) cycle, acetyl CoA
  splits, carbon dioxide is released, and its
  energy is
• Stored
• Does the bodys work
• Produces heat
• Is aerobic (requires oxygen)

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METABOLISM AND ENERGY BALANCE

• BREAKING DOWN NUTRIENTS FOR ENERGY
• Glucose Summary
• Glucose Pyruvate Acetyl CoA
  Energy

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METABOLISM AND ENERGY BALANCE BREAKING DOWN
NUTRIENTS FOR ENERGY Glucose Summary
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METABOLISM AND ENERGY BALANCE

• BREAKING DOWN NUTRIENTS FOR ENERGY
• Glycerol
• Is broken down like glucose
• Is first broken down into pyruvate
• Is then broken down into acetyl CoA
• If the cell does not need energy, the acetyl CoA
  molecules combine with each other to make body
  fat
• GLYCEROL SUMMARY
• Glycerol
• Glucose Pyruvate Acetyl CoA
  Energy

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METABOLISM AND ENERGY BALANCE

• BREAKING DOWN NUTRIENTS FOR ENERGY
• Fatty Acids
• Converted directly into Acetyl CoA (no pyruvate
  step)
• Cannot be used to make glucose
• Because no pyruvate step
• Fats cannot normally therefore provide energy for
  the brain and nervous system that require glucose
• FATTY ACID SUMMARY
• Fatty Acids Acetyl CoA Energy

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METABOLISM AND ENERGY BALANCE

• THE FATS TO ENERGY PATHWAY

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METABOLISM AND ENERGY BALANCE

• BREAKING DOWN NUTRIENTS FOR ENERGY
• Amino Acids
• Will ideally be used to replace needed body
  proteins and will not be used for energy
• If they are needed/used for energy, they are
• Stripped of their nitrogen (deamination) -- which
  is used to make other compounds or excreted as
  urea through the kidneys
• Most of the amino acids can then be converted to
  pyruvate and therefore provide glucose
  (glucogeneic). Some are both glucogenic and
  ketogenic. Leucine is ketogenic only.
• Other amino acids are
• Converted into Acetyl CoA (ketogenic) or
• Enter the TCA cycle at a later point

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METABOLISM AND ENERGY BALANCE

• BREAKING DOWN NUTRIENTS FOR ENERGY
• AMINO ACID SUMMARY
• Glucogenic Ketogenic
• Amino Acids Amino Acids
• Glucose Pyruvate Acetyl CoA
  Energy
• Other amino acids enter the TCA chain directly

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METABOLISM AND ENERGY BALANCE
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METABOLISM AND ENERGY BALANCE

• BREAKING DOWN NUTRIENTS FOR ENERGY
• OVERALL SUMMARY
• PROTEIN STARCH OR
  FAT
• EATEN SUGARS EATEN
  EATEN
• AMINO FATTY
• ACIDS GLUCOSE
  GLYCEROL ACIDS
• BODY GLYCOGEN
• PROTEIN STORES
• FAT
• STORES
• GLUCOSE

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METABOLISM AND ENERGY BALANCE

• ECONOMICS OF FEASTING
• When you consume more energy than you expend,
  much of the excess is stored as body fat
• Fat can be made from an excess of any energy
  yielding nutrient you eat.
• Fat cells enlarge as they fill with fat
• Bodys fat-storing capacity seems to be able to
  expand indefinitely

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METABOLISM AND ENERGY BALANCE

• ECONOMICS OF FEASTING

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METABOLISM AND ENERGY BALANCE

• ECONOMICS OF FASTING
• Even when asleep and totally relaxed, the cells
  of many organs are consuming energy -- represents
  2/3 of the total energy expenditure per day
• Bodys top priority is to meet energy needs for
  this ongoing activity
• When food is not available, body must find other
  fuel sources in its own tissues

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METABOLISM AND ENERGY BALANCE

• ECONOMICS OF FASTING (continued)
• Activities in starving/fasting
• Glucose from the livers stored glycogen and
  fatty acids from the bodys stored fat supply
  energy to cells
• After several hours, glycogen stores are
  exhausted and low blood glucose concentrations
  signal to further promote fat breakdown
• Most of the bodys cells can use fatty acids as
  their fuel
• Nervous system and brain cells need glucose --
  cannot use fatty acids
• Body protein tissues (liver and muscles) break
  down to supply 90 of the needed glucose

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METABOLISM AND ENERGY BALANCE

• ECONOMICS OF FASTING (continued)
• Activities in starving/fasting

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METABOLISM AND ENERGY BALANCE

• ECONOMICS OF FASTING (continued)
• Activities in starving/fasting
• As the fast continues, brain finds a way to use
  fat as fuel
• Condenses acetyl CoA fragments (called ketone
  bodies) derived from fatty acids
• Meets about half of the nervous systems needs
• Many of the areas of the brain still rely
  exclusively on glucose -- body protein continues
  to be sacrificed
• As the fast continues, metabolism slows
• Body reduces its energy output
• Conserves both fat and lean tissue
• Fat loss falls to a minimum
• Therefore, although weight loss during fasting
  may be dramatic, fat loss may actually be less
  than when at least some food is supplied

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METABOLISM AND ENERGY BALANCE

• ECONOMICS OF FASTING (continued)
• Activities in starving/fasting

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METABOLISM AND ENERGY BALANCE

• ECONOMICS OF FASTING (continued)
• Activities in starving/fasting
• Other body adaptations
• Wasting of lean tissues
• Impairment of disease resistance
• Lowering of body temperature
• Disturbances of the bodys salt and water balance
• Minimal effect on
• Mental alertness
• Physical energy

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METABOLISM AND ENERGY BALANCE

• THE LOW CARBOHYDRATE DIET
• Presents the body with the same problems as a
  fast
• Once available glucose stores are spent, the only
  available significant glucose source is protein
• Most low carbohydrate diets provide some protein
  from food, some is still taken from body tissue
• Initial weight loss is, at best, 1-2 pounds of
  fat and 5-6 pounds of lean tissue, water, and
  minerals -- once off the diet, these are replaced
  and weight reverts to a few pounds of the
  starting point

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METABOLISM AND ENERGY BALANCE

• THE PROTEIN SPARING FAST
• Theory
• Eat only protein, which will spare lean tissue
  and provide needed glucose
• Fat breakdown will be at a maximal rate to meet
  other energy needs
• Has met with mixed results
• Has not been shown to be more effective than a
  diet containing a mixture of protein and
  carbohydrate
• Most people regain the lost weight

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METABOLISM AND ENERGY BALANCE

• MODERATE WEIGHT LOSS
• There is a limit to the rate at which body fat
  will break down -- the maximum rate, except in a
  very large, very active person is 1-2 pounds per
  week
• The most effective diet supplies all three energy
  nutrients in reasonable amounts
• Energy expenditure should include a reasonable
  level of physical activity

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METABOLISM AND ENERGY BALANCE

• ENERGY BALANCE
• If weight is within acceptable range for height,
  the person has a balanced energy budget
• A negative change in fat stores results from more
  energy out than energy in

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METABOLISM AND ENERGY BALANCE

• ENERGY BALANCE
• A pound of body fat stores approximately 3,500
  kcalories
• To loose a pound, a person must spend 3,500
  kcalories more than is taken in
• To gain a pound, a person must take in 3,500
  kcalories more than is spent
• On average, a deficit or excess of 500 kcalories
  per day brings about weight loss or gain of 1
  pound per week

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METABOLISM AND ENERGY BALANCE

• ENERGY IN THE kCALORIES OF FOOD
• Estimating Food Energy
• Amount of energy received from foods depends on
• The foods composition
• How much the person eats
• Methods of estimating food energy
• Direct measurement -- measuring the heat given
  off
• Indirect measurement -- measuring the amount of
  oxygen consumed in burning

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METABOLISM AND ENERGY BALANCE

• ENERGY IN THE kCALORIES OF FOOD
• Estimating Food Energy
• Bomb Calorimeter is an instrument that measures
  the heat energy released when foods are burned

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METABOLISM AND ENERGY BALANCE

• ENERGY IN THE kCALORIES OF FOOD
• Estimating Food Energy
• Tables of food values -- reflect mathematically
  corrected calorimetry measurements
• Calculate from amounts of carbohydrate, protein,
  fat, and alcohol in the food
• Carbohydrate has 4 kcalories per gram
• Protein has 4 kcalories per gram
• Fat has 9 kcalories per gram
• Alcohol has 7 kcalories per gram
• Exchange system -- sorts foods of similar origin
  and nutrient content into groups

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METABOLISM AND ENERGY BALANCE

• ENERGY IN THE kCALORIES FOODS PROVIDE
• Determinants of Food Intake
• Hunger -- The physiological drive for food that
  initiates food-seeking behavior. Influenced by
• Empty stomach
• Gastric contractions
• Absence of nutrients in the small intestine
• GI hormones
• Brain peptides
• Thought, sight, smell, taste of food
• Presence of others special occasions
• Perception of hunger awareness of fullness
• Favorite, ethnic, or religious foods
• Time of day
• Abundance of food or free food
• Appetite

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METABOLISM AND ENERGY BALANCE

• ENERGY IN THE kCALORIES FOODS PROVIDE
• Determinants of Food Intake
• Satiation -- The feeling of satisfaction and
  fullness that occurs during a meal and halts
  eating satiation determines how much food is
  consumed during a meal

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METABOLISM AND ENERGY BALANCE

• ENERGY IN THE kCALORIES FOODS PROVIDE
• Determinants of Food Intake
• Satiation
• Food in the stomach triggers stretch receptors
  and the person begins to feel too uncomfortable
  to continue to eat
• Nutrients in the small intestine elicit hormones
  which send messages to the hypothalamus to stop
  eating (e.g. fat elicits cholecystokinin which
  slows gastric emptying)
• The hypothalamus is a brain center that controls
  activities such as appetite as well as the
  maintenance of water balance and regulation of
  body temperature

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METABOLISM AND ENERGY BALANCE

• ENERGY OUT THE kCALORIES THE BODY SPENDS
• Components of Energy Expenditure
• Basal Metabolism -- The energy needed to maintain
  life when a body is at complete rest after a 12
  hour fast
• Examples
• Beating heart
• Maintenance of body temperature
• Lungs breathing
• About 65 of the total energy needs support basal
  metabolism

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METABOLISM AND ENERGY BALANCE

• ENERGY OUT THE kCALORIES THE BODY SPENDS
• Components of Energy Expenditure
• Influencing factors on the basal metabolic rate
  (BMR)

DECREASE EE
INCREASE EE

• Aging
• Female gender
• Fasting/starvation
• Hypothyroidism
• Sleep

• Genes
• Some
• meds

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METABOLISM AND ENERGY BALANCE

• ENERGY OUT THE kCALORIES THE BODY SPENDS
• Components of Energy Expenditure
• Voluntary Activities -- Conscious and deliberate
  muscular work physical activity
• Examples
• Walking
• Lifting
• Climbing
• kCalorie expenditure depends on
• Larger muscle mass required
• Heavier the weight of the body part being moved
• Longer the activity takes
• The more intense the activity, the more kcalories
  spent
• Streamlined moves will conserve energy (e.g.
  swimming)

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METABOLISM AND ENERGY BALANCE

• ENERGY OUT THE kCALORIES THE BODY SPENDS
• Components of Energy Expenditure
• Thermic Effect of Food
• Includes digestion, absorption, utilization of
  nutrients
• Peaks 1 hour after eating
• Effect disappears 4 hours after eating also known
  as the specific dynamic effect of food
• Examples
• Muscles that move food through the intestinal
  tract speed up their rhythmic contractions
• Cells that manufacture and secrete digestive
  juices begin their tasks
• Represents 6-10 of the total energy taken in

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METABOLISM AND ENERGY BALANCE

• ENERGY OUT THE kCALORIES THE BODY SPENDS
• Components of Energy Expenditure
• Adaptive Thermogenesis -- adjustments in energy
  expenditure related to changes in environment
  such as cold and to physiological events such
  overfeeding, trauma, and changes in hormone
  status
• Changed circumstances may cause the body to do
  extra work
• Building tissue
• Producing enzymes and hormones
• Is quite variable and specific to individuals --
  is not included when calculating the energy RDA

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?

• Component Lean Man Lean Woman
• 
  
• Water 62 59
• Fat 16 22
• Protein 16 14
• Minerals 5-6 4-5
• Carbohydrate lt1 lt1

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Body Mass Index is an index of a persons weight
  in relation to height, determined by dividing the
  weight in kilograms by the square of the height
  (in meters) -- doesnt consider body fat
• Can also be expressed as Weight (lbs.) 705
• Height (in)2
• 64 of Americans are overweight by BMI (CDC)

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Body Weight/BMI says little about body fat
• A person who doesnt seem to weigh too much may
  be too fat
• A person who seems to weigh too much may not be
  too fat

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Weight is still the measure that people most
  commonly use as an index of body composition
• Obesity is a major problem in developed countries
• Health hazards associated with obesity include
• Abdominal hernias
• Arthritis (especially in knees, hips, and lower
  spine)
• Complications after surgery
• High blood cholesterol
• Hypertension
• Respiratory problems
• Varicose veins

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Obesity Trends Among U.S. AdultsBRFSS, 1985
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1990
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1995
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 2002
(BMI 30, or 30 lbs overweight for 5 4 woman)
(BMI ?30, or 30 lbs overweight for 54 person)
No Data lt10 1014
1519 2024 25
Source Behavioral Risk Factor Surveillance
System, CDC
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Obesity Trends Among U.S. AdultsMENS FITNESS
MAGAZINE, 2005
Source, Non-scientific study Mens Fitness
Magazine, 2005
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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Location of fat on the body may be as critical
  (or even more critical) than the total amount
• Fat around the abdomen may represent a greater
  risk to health than fat elsewhere around the body
• Abdominal fat (even in the absence of obesity) is
  associated with
• Heart disease
• Diabetes
• Hypertension
• Fat around the hips and thighs (most common in
  females) seems relatively harmless

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Causes Of Weight Gain
• Most Common
• Energy input gt energy output
• Too many calories and/or not enough aerobic
  exercise
• Less Common Causes
• Medical Disposition
• Hypothyroidism
• Genetics
• Medications
• Prescribed steroids
• Some hormonals

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Fat Cell Development
• The amount of fat on a persons body reflects
  both the number and size of the fat cells
• When fat cells reach their maximum size they may
  also divide
• A gain or loss in weight can take place through
  an increase or decrease in either the size or
  number of fat cells
• People with the greatest number of fat cells
  (hyperplastic obesity) are least likely to loose
  weight successfully

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Fat Cell Development

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Genetics
• Tendency toward obesity is inherited but the
  environment is influential in the sense that it
  can prevent or permit the development of obesity
  when the potential is there

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Learned Behavior
• Habits learned in childhood tend to persist
  throughout life
• Overeating at mealtimes
• Rapid eating
• Excessive snacking
• Eating to meet needs other than hunger

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Set Point Theory
• The body sends out signals to establish,
  regulate, and maintain a set body weight
• Not only do these signals maintain a constant
  body weight, they defend that body weight when it
  is challenged

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Environmental Factors
• People overeat because they are pushed to do so
  by factors in their surroundings -- foremost
  among them, the availability of a multitude of
  delectable foods

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Deep Emotional Needs
• Primitive fear of starvation
• Infants association of food with motherly love

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Drugs
• Diuretics
• Temporary water retention may add several pounds
  to a persons weight
• Water does not cause obesity
• Obesity does not cause water retention
• When people take diuretics they loose water, not
  fat
• Weight loss is temporary and may result in
  dehydration and mineral imbalances

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Drugs (cont)
• Amphetamines
• Speeds up metabolism
• No longer approved by the FDA for weight loss
• Are highly addictive
• Side effects include dizziness, irritability,
  blurred vision, nausea, vomiting, and diarrhea
• Have not been proven effective in treating obesity

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Drugs (cont)
• Other Drugs
• Mechanisms include appetite suppression and
  reduced nutrient digestion and absorption
• Significant side effects include
• Increased blood pressure
• Intestinal gas, cramping, and diarrhea
• Tremors
• Cardiac events

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Drugs (cont)
• Prescription Drugs
• Safe and effective prescription drug therapy has
  proven elusive
• Sibutramine (Meridia)
• Inhibits serotonin reuptake (may produce enhanced
  satiety) and inhibits norepinephrine reuptake
  (raises metabolic rate)
• Doesnt work that well

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Drugs (cont)
• Prescription Drugs
• Orlistat (Xenical )
• A gastrointestinal lipase inhibitor
• Decreases the absorption of fat
• May reduce absorption of fat soluble vitamins and
  beta carotene
• Still need to follow a low Calorie diet
• Venlafaxine (Effexor )
• A combined serotonin and norepinephrine reuptake
  inhibitor
• Decreases weight in 43 of patients
• Side effects include dry mouth, sexual
  dysfunction, insomnia, nausea

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Drugs (cont)
• Over-The-Counter Drugs
• Phenylpropanolamine
• Suppresses appetite
• Enhances weight loss when used in conjunction
  with a low kcalorie diet
• Side effects include dry mouth, rapid pulse,
  nervousness, sleeplessness, hypertension,
  irregular heartbeats, kidney failure, seizures,
  and strokes
• Benzocaine
• Comes in a candy or gum form
• Anesthetizes the tongue reducing taste sensations

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Drugs (cont)
• Herbal Products
• St. Johns Wort
• Contains substances that enhance seratonin (a
  neurotransmitter important in appetite control)
  and thus suppresses appetite
• Ephedrine
• Often St Johns Wort is prepared in combination
  with the herbal stimulant ephedrine
• Some ephedrine-containing supplements have been
  implicated in heart attacks and seizures and have
  been linked to a number of deaths

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Drugs (cont)
• Herbal Products
• Herbal Laxatives
• Commonly sold as dieters tea
• Commonly cause nausea, vomiting, diarrhea,
  cramping, and fainting
• Laxatives act on the lower large intestine --
  nutrient absorption occurs primarily in the upper
  small intestine therefore kcalories are not
  saved
• Other treatments
• Hot baths -- may dehydrate individuals resulting
  in lost water weight
• Brushes, Sponges, Wraps, Creams, Massages -- are
  ineffective

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Very Low kCalorie Diets (VLCD)
• Provide 800 kcalories, at least 1 gram high
  quality protein per kilogram of body weight,
  little or no fat, and a minimum of 50 grams
  carbohydrate
• Vitamin and mineral supplements given
• Meals consist of a limited number of foods each
  day and/or a powdered formula available by
  prescription
• Body reacts as to prepare for starvation
• VLCDs appropriate for short-term use only and
  under medical supervision
• Many side effects to include a decline in cardiac
  output, irregular heartbeats, formation of
  gallstones and kidney stones, nausea, vomiting,
  diarrhea, abdominal discomfort, diminished immune
  response, headaches, and sleeplessness
• Weight loss can be dramatic but weight regains
  are almost certain

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Surgery
• Gastric Partitioning
• Limit food intake by reducing the size of the
  stomach
• Size of outlet is also reduced, delaying the
  passage of food from the stomach into the
  intestine
• Complications include vitamin and mineral
  deficiencies as well as psychological problems
• Lifelong medical supervision necessary

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Gastric Surgery is on the Rise
• JADA 9/04

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Surgery
• Liposuction
• Does not treat obesity but removes the evidence
• Has little effect on body weight but can alter
  the body shape slightly in specific areas

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Eating Plans
• Should be realistic
• Emphasize nutrient-dense foods that you like
• Make tasty vegetables and fruits central
• Encourage complex carbohydrate-rich foods high in
  bulk
• Use fats cautiously
• Drink plenty of water
• Anticipate a plateau
• Learn, practice and eat right for the rest of
  your life

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Exercise
• Helps to speed weight loss
• To loose fat, exercise intensely and expend as
  much energy as your time allows
• Activity speeds up the basal metabolism
• Remains elevated as long as the person keeps
  exercising regularly
• Over long term, daily vigorous activity gradually
  changes body composition toward more lean tissue
• Metabolic rate rises accordingly
• Supports continued weight loss or maintenance

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Exercise (cont)
• Activity helps to control appetite
• Immediately after an intense workout, most people
  do not feel like eating
• Body has released fuels from storage to support
  exercise
• Glucose and fatty acids are abundant in the blood
• Digestive functions are suppressed

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METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Exercise (cont)
• Activity helps to reduce stress
• Stress can cue eating
• Fit person looks and feels healthy, increasing
  self esteem
• Types of activities
• Sustained physical activity of moderate intensity
  (aerobic activities) are more effective in weight
  control than short bursts of vigorous exercise
• Do what you enjoy doing and do it often

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METABOLISM AND ENERGY BALANCE
80
METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Exercise (cont)
• Spot reducing
• Muscles do not own the fat around them
• Fat cells all over the body release fat in
  response to the demand of physical activity for
  use by whatever muscles are active
• No exercise can remove the fat from any one
  particular area
• Strength training can help to improve the tone of
  muscles in a trouble area

81
METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Behavior and Attitude
• Become aware of behaviors
• Keep a record of eating and exercise behaviors
• Establish a baseline against which to measure
  future progress
• Change behaviors
• Eliminate inappropriate eating cues
• Buy foods that are low in fat
• Shop when you are not hungry

82
METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Change behaviors (cont)
• Suppress the cues you cannot eliminate
• Eat only in one place (at a table) and in one
  room
• Make small portions of food look large by
  spreading food out and serving on small plates
• Strengthen cues to appropriate eating and
  exercise
• Keep your appropriate foods in the front of the
  refrigerator
• Learn appropriate portion sizes and prepare one
  portion at a time

83
METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Change behaviors (cont)
• Engage in desired eating or exercise behaviors
• Eat only at planned times plan not to eat after
  a specified time
• Slow down (pause several times during a meal, put
  down utensils between mouthfuls, chew thoroughly
  before swallowing, swallow before reloading the
  fork, always use utensils)
• Arrange or emphasize negative consequences of
  inappropriate eating
• Eat your meals with other people
• Ask that others respond neutrally when you
  deviate from your plan (make no comment). This
  is a negative consequence because it withholds
  attention

84
METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Change behaviors (cont)
• Arrange or emphasize positive consequences of
  appropriate behaviors
• Update records of food intake, exercise, and
  weight change regularly
• Arrange for rewards for each unit of behavior
  change or weight loss

85
METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• Behavior and Attitude
• Personal Attitude
• Those who fully understand their personal
  relationships with food are best prepared to make
  healthful changes in eating and exercise behavior
• Support Groups
• Is important when making life changes
• Some find groups such as Take Off Pounds
  Sensibly, Weight Watchers, and Overeaters
  Anonymous helpful in providing support in efforts
  to loose weight

86
METABOLISM AND ENERGY BALANCE
87
METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• National Weight Control Registry
• A research study developed by Rena Wing and James
  Hill in 1993
• Identified nearly 3,000 individuals who have lost
  significant amounts of weight and kept it off for
  long periods of time

88
METABOLISM AND ENERGY BALANCE

• WEIGHT HOW MUCH IS TOO MUCH?
• Treatments For Obesity
• National Weight Control Registry
• Characteristics of successful weight losers
• Rarely ate at fast food restaurants
• Used a variety of weight loss efforts
• Consumed a low fat diet
• Ate all foods but limited the quantity
• On average, ate five times per day (smaller but
  more frequent meals
• 80 ate breakfast
• Exercised
• Weighed themselves regularly
• Have an improved quality of life

89
METABOLISM AND ENERGY BALANCE

• WEIGHT CONTROL
• Diet Planning Using Exchange Lists
• Food Groups sort foods by protein, vitamin, and
  mineral content
• Exchange Lists sort foods by energy,
  carbohydrate, protein, fat, and portion size
• Exchange Lists are diet planning tools that
  organize foods by their proportions of
  carbohydrate, protein, and fat.
• Foods on any single list can be used
  interchangeably
• Were originally developed for diabetic diets but
  were so useful they are now in general use for
  diet planning

90
METABOLISM AND ENERGY BALANCE

• WEIGHT CONTROL
• Diet Planning Using Exchange Lists

91
METABOLISM AND ENERGY BALANCE WEIGHT CONTROLDiet
Planning Using Exchange ListsCarbohydrate
GroupStarch List (Examples)

• Bread, 1 slice
• Ready-to-eat Cereal, 3/4 cup
• Cooked Pasta, 1/2 cup
• Cooked Rice, 1/3 cup
• Cooked Beans, 1/2 cup
• Corn, 1/2 cup
• Potato, 1 small (3 oz)
• Bagel or English Muffin, 1/2
• Tortilla, 1
• Cooked Cereal, 1/2 cup
• Peas, Green, 1/2 cup

• Animal Crackers, 8 ea
• Graham Crackers, 3 ea
• Popcorn (no fat added), 3 cups
• Lima Beans, 2/3 cup
• Hot Dog or Hamburger Bun, 1 ea
• Sugar Frosted Cereal, 1/2 cup
• Saltine Crackers, 6 ea
• French Fried Potatoes, 16-25 ea (omit one fat)
• Waffle, 4-1/2 Square, 1 ea (omit one fat)
• Pancake, 4, (omit one fat)

92
METABOLISM AND ENERGY BALANCE WEIGHT CONTROLDiet
Planning Using Exchange ListsCarbohydrate
GroupFruit List (Examples)

• Apple, 1 small
• Applesauce, Unsweetened, 1/2 cup
• Banana, 1small (4 oz)
• Peach, 1 small
• Orange, 1 small
• Pear, 1 small
• Grapefruit, 1/2 ea
• Orange Juice, 1/2 cup
• Grapefruit Juice, 1/2 cup
• Grapes, 15 small (3/4 cup)
• Cantaloupe, 1/3 (3/4 cup)

• Canned Pineapple, 1/2 cup
• Apple Juice, 1/2 cup
• Grape Juice, 1/3 cup
• Prune Juice, 1/3 cup
• Raisins, 2 Tablespoons
• Dried Prunes, 3 ea
• Unsweetened Fruit Cocktail, 1/2 cup
• Fresh Cherries, 12 ea (3 oz)
• Unsweetened Canned Pears 1/2 cup
• Unsweetened Canned Peaches, 1/2 cup
• Strawberries, 1-1/4 cup whole berries

93
METABOLISM AND ENERGY BALANCE WEIGHT CONTROLDiet
Planning Using Exchange ListsCarbohydrate
GroupMilk List (Examples)

• Non-Fat
• Non-Fat Milk, 1 cup
• Plain Non-Fat Yogurt, 1 cup
• Non Fat or Low Fat Buttermilk, 1 cup
• Evaporated Non Fat Milk, 1/2 cup
• Non-Fat Dry Milk, 1/3 cup

• Low Fat
• 2 Milk, 1 cup
• Plain Low Fat Yogurt, 1 cup
• Whole
• Whole Milk, 1 cup
• Evaporated Whole Milk, 1 cup
• Whole Yogurt, Plain, 1 cup

94
METABOLISM AND ENERGY BALANCE WEIGHT CONTROLDiet
Planning Using Exchange ListsCarbohydrate
GroupOther Carbohydrates (Examples)

• Angel Food Cake, 1/12 (2 carbohydrates)
• Frosted Cake, 2 Square (2 carbohydrates and 1
  fat)
• Glazed Donut, 3-3/4 across (2 carbohydrate and 2
  fat)
• Regular Gelatin, 1/2 cup (1 carbohydrate)
• Ice Cream, 1/2 cup (1 carbohydrate and 2 fats)
• Regular Jam or Jelly, 1 Tbsp (1 carbohydrate)

• Fruit Pie (2 crusts), 1/6 pie (3 carbohydrates
  and 2 fats)
• Potato Chips, 12-18 (1 oz) (1 carbohydrate and 2
  fats)
• Canned Spaghetti or Pasta Sauce, 1/2 cup (1
  carbohydrate and 1 fat)
• Sweet Roll or Danish , 2-1/2 oz, 2-1/2
  carbohydrates and 2 fats)
• Pancake Syrup, 1 Tbsp (1 carbohydrate)
• Low Fat Frozen Yogurt, 1/3 cup (1 carbohydrate
  and 1 fat)
• Vanilla Wafers, 5 ea (1 carbohydrate and 1 fat)

95
METABOLISM AND ENERGY BALANCE WEIGHT CONTROLDiet
Planning Using Exchange ListsCarbohydrate
GroupVegetable List (Examples)

• Cooked Carrots, 1/2 cup
• Cooked Greens, 1/2 cup
• Cooked Brussels Sprouts, 1/2 cup
• Cooked Beets, 1/2 cup
• Cooked Asparagus, 1/2 cup
• Cooked Broccoli, 1/2 cup
• Cooked Zucchini, 1/2 cup
• Cooked Mixed Vegetables (no corn, peas, or
  pasta), 1/2 cup
• Cooked Cabbage, 1/2 cup
• Sauerkraut, 1/2 cup

• Raw Tomatoes, 1 cup
• Raw Peppers, 1 cup
• Raw Carrots, 1 cup
• Raw Onions, 1 cup
• Raw Celery, 1 cup
• Raw Cucumber, 1 cup
• Salad Greens, 1 cup
• Canned Tomatoes, 1/2 cup
• Tomato Sauce, 1/2 cup
• Tomato Juice, 1/2 cup

96
METABOLISM AND ENERGY BALANCE WEIGHT CONTROLDiet
Planning Using Exchange ListsMeat and Meat
Substitute GroupMeats, Very Lean (Examples)

• Poultry
• Chicken or Turkey (white meat, no skin), 1 oz
• Cornish Hen (no skin), 1 oz
• Fish
• Fresh or Frozen Cod, Flounder, Haddock, Halibut,
  Trout Tuna, fresh or canned in water, 1 oz
• Shellfish
• Clams, Crab, Lobster, Scallops, Shrimp, Imitation
  Shellfish, 1 oz

• Game
• Duck or Pheasant (no skin), Venison, Buffalo,
  Ostrich, 1 oz
• Cheese (with 1 gram or less fat per ounce)
• Non-Fat or Low Fat Cottage cheese, 1/4 cup
• Fat-Free Cheese, 1 oz
• Other
• Processed Sandwich Meats (with 1 gram or less fat
  per ounce), 1 oz
• Egg Whites, 2 ea
• Hot Dogs (with 1 gram or less fat per ounce) 1 oz

97
METABOLISM AND ENERGY BALANCE WEIGHT CONTROLDiet
Planning Using Exchange ListsMeat and Meat
Substitute GroupMeats, Lean (Examples)

• Beef
• USDA Select or Choice Grades of Lean Beef
  Trimmed of Fat Such As Round, Sirloin, and Flank
  Steak Tenderloin Roast (Rib, Chuck, Rump)
  Steak (T-Bone-Porterhouse, Cubed) Ground Round, 1
  oz
• Pork
• Lean Pork Such As Fresh Ham Canned, Cured, or
  Boiled Ham Canadian Bacon Tenderloin, Center
  Loin Chop, 1 oz
• Lamb
• Roast, Chop, Leg, 1 oz

• Veal
• Lean, Chop, Roast, 1 oz
• Poultry
• Chicken, Turkey (Dark Meat, No Skin) Chicken
  (White Meat With Skin)
• Fish
• Herring, 1 oz
• Salmon (Fresh or Canned), Catfish, 1 oz
• Tuna (canned in oil, drained) 1 oz
• Cheese
• Cheeses with 3 grams or less fat per ounce, 1 oz

98
METABOLISM AND ENERGY BALANCE WEIGHT CONTROLDiet
Planning Using Exchange ListsMeat and Meat
Substitute GroupMeats, Medium Fat (Examples)

• Beef
• Ground Beef, Meat Loaf, Corned Beef, Short Ribs,
  Prime Grades of Meat Trimmed Of Fat (Such As
  Prime Rib), 1 oz
• Pork
• Top Loin, Chop, Boston Butt, Cutlet, 1 oz
• Lamb
• Rib Roast, Ground, 1 oz
• Veal
• Cutlet (Ground or Cubed, Unbreaded), 1 oz

• Poultry
• Chicken (Dark Meat, With Skin) Ground Turkey or
  Ground Chicken Fried Chicken (With Skin), 1 oz
• Fish
• Any Fried Fish Product, 1 oz
• Cheese
• Cheeses with 5 grams Or Less Fat Per Ounce, 1 oz
• Other
• Egg, 1
• Sausage (With 5 Grams or Less Fat Per Ounce), 1 oz

99
METABOLISM AND ENERGY BALANCE WEIGHT CONTROLDiet
Planning Using Exchange ListsMeat and Meat
Substitute GroupMeats, High Fat (Examples)

• Pork
• Spareribs, Ground Pork, Pork Sausage, 1 oz
• Cheese
• All Regular Cheeses Such As American, Cheddar,
  Monterey Jack, Swiss, 1 oz

• Other
• Process Sandwich Meats With 8 Grams Or Less Fat
  Per Ounce (Such As Bologna, Pimento Loaf,
  Salami), 1 oz
• Sausage (Such As Bratwurst, Knockwurst, Polish),
  1 oz
• Hot Dog (Turkey Or Chicken), 1 (10/lb.)
• Bacon, 3 slices
• Peanut Butter
• Peanut Butter, 2 Tbsp

100
METABOLISM AND ENERGY BALANCE WEIGHT CONTROLDiet
Planning Using Exchange ListsFats (Examples)

• Monounsaturated Fats
• Avocado, medium, 1/8 (1 oz)
• Oil (Canola, Olive, Peanut), 1 tsp
• Black Olives, 8 large
• Green Stuffed Olives, 10 large
• Almonds, Cashews, 6 ea
• Peanuts, 10 ea
• Polyunsaturated
• Margarine (Stick, Tub, Squeeze), 1 tsp
• Regular Mayonnaise, 1 tsp
• Reduced Fat Mayonnaise, 1 Tbsp
• Regular Salad Dressing, 1 Tbsp
• Reduced Fat Salad Dressing, 2 Tbsp

• Saturated Fats
• Bacon, Cooked, 1 slice
• Stick Butter, 1 tsp
• Butter, Whipped, 2 tsp
• Chitterlings, Boiled, 1 Tbsp
• Regular Cream Cheese, 1 Tbsp
• Reduced Fat Cream Cheese, 2 Tbsp
• Shortening or Lard, 1 tsp
• Regular Sour Cream, 2 Tbsp
• Reduced Fat Sour cream, 3 Tbsp

101
METABOLISM AND ENERGY BALANCE

• WEIGHT CONTROL
• How To Plan A Diet Using Exchange Lists
• Estimate Desirable Body Weight
• Males -- Allow 106 pounds for the first 5 feet
  then add 6 pounds for every inch over 5 feet
• Females -- Allow 100 pounds for the first 5 feet
  then add 5 pounds for every inch over 5 feet
• Add 10 for large frame individuals subtract 10
  for small frame individuals
• For children, refer to growth charts in textbook
  appendix

102
METABOLISM AND ENERGY BALANCE

• WEIGHT CONTROL
• How To Plan A Diet Using Exchange Lists (cont)
• Determine whether individual needs a weight loss
  or weight maintenance diet
• Calculate energy needs in kilocalories
• Simplified method
• Multiply the desirable body weight by 15 for men
  and active women
• Multiply the desirable body weight by 13 for most
  women, sedentary men, and adults over 55
• Multiply the desirable body weight by 10 for
  sedentary women, obese people, and sedentary
  adults over 55

103
METABOLISM AND ENERGY BALANCE

• WEIGHT CONTROL
• How To Plan A Diet Using Exchange Lists (cont)
• Children
• Need about 100 kilocalories daily for the first
  year of life plus 100 kilocalories per year up to
  2000 kilocalories by age 11
• For children 12-15, add 100 kilocalories per year
  for girls and 200 kilocalories per year for boys
• Harris-Benedict Equation -- Can also be used to
  determine energy requirements
• Males -- 66(6.165pounds)(12.82inches)-(6.8age
  )
• Females -- 655(4.32pounds)(4.359inches)-(4.7a
  ge)

104
METABOLISM AND ENERGY BALANCE

• WEIGHT CONTROL
• How To Plan A Diet Using Exchange Lists (cont)
• Add factors
• Activity
• 20 for sedentary
• 35 for moderate
• 50 for active
• Stress
• 10-15 for uncomplicated elective surgery
• 20-40 for complicated surgery/fractures
• 50-100 for major burns
• Fever
• 13 for each degree Celsius over normal body
  temperature

105
METABOLISM AND ENERGY BALANCE

• WEIGHT CONTROL
• How To Plan A Diet Using Exchange Lists (cont)
• Growth (if necessary)
• 5 for moderate weight loss
• 10-15 for moderate to severe weight loss
• For Overweight -- For people who are greater than
  125 of their IBW
• Adjusted body weight (Actual body weight -
  Ideal body weight)125

106
METABOLISM AND ENERGY BALANCE

• WEIGHT CONTROL
• How To Plan A Diet Using Exchange Lists (cont)
• Case Study
• Subject Female, moderately active, 50 years
  old, 65 inches tall, 150 pounds
• Step 1 -- Calculate BEE
• Harris-Benedict Equation
• 655 (4.32pounds) (4.359inches) -
  (4.7age)
• 655 648 283 - 235
• 1351
• Add 35 for moderate activity
• 1351 1.35
• 1824 (Round to 1800)

107
METABOLISM AND ENERGY BALANCE

• WEIGHT CONTROL
• How To Plan A Diet Using Exchange Lists (cont)
• Case Study
• Step 2 -- Determine Grams of CHO, Fat, and
  Protein
• 55-60 of kcalories come from CHO
• 180055 900 kcalories
• 900 kcalories/4 247.5 grams
• 25-30 of kcalories come from Fat
• 180025 450 kcalories
• 450 kcalories/9 50 grams
• 12-20 of kcalories come from Protein
• 180020 360 kcalories
• 360 kcalories/4 90 grams

108
METABOLISM AND ENERGY BALANCE

• WEIGHT CONTROL
• How To Plan A Diet Using Exchange Lists (cont)
• Case Study
• Step 2 -- Translate The Diet Prescription Into A
  Meal Plan
• Become familiar with the clients usual pattern
  of meals, likes, and dislikes
• Include basic foods to ensure adequate levels of
  minerals and vitamins
• 2-3 exchanges of milk
• 3-5 exchanges of vegetables
• 2-4 exchanges of fruit
• 6-11 exchanges of starch
• 4-6 exchanges of meat

109
METABOLISM AND ENERGY BALANCE WEIGHT CONTROLHow
To Plan A Diet Using Exchange Lists (cont)Case
Study

• Step 2a -- Translate The Diet Prescription Into A
  Meal Plan
• List the carbohydrate, protein, and fat values
  for the milk, vegetables, and fruit
• Subtotal the carbohydrate
• Subtract this subtotal from the carbohydrate
  level prescribed, in this case 247.5 grams - 99
  grams
• The resultant answer is 148.5 grams

110
METABOLISM AND ENERGY BALANCE WEIGHT CONTROLHow
To Plan A Diet Using Exchange Lists (cont)Case
Study

• Step 2b -- Translate The Diet Prescription Into A
  Meal Plan
• We know each exchange of bread contains 15 grams
  of carbohydrate
• The balance of 148.5 grams of carbohydrate allows
  for 10 bread exchanges (148.5/15)
• Since there is no carbohydrate in Meat or Fat,
  the total amount of carbohydrate is 249 grams
• Subtotal the protein

111
METABOLISM AND ENERGY BALANCE WEIGHT CONTROLHow
To Plan A Diet Using Exchange Lists (cont)Case
Study

• Step 2c -- Translate The Diet Prescription Into A
  Meal Plan
• Subtract this subtotal from the protein level
  prescribed, in this case 90 grams - 52 grams
• The resultant answer is 38 grams
• We know each exchange of meat contains 7 grams of
  protein
• The balance of 38 grams of protein allows for 5
  meat exchanges (38/7)
• Since there is no protein in Fat, the total
  amount of protein is 87 grams
• Subtotal the fat

112
METABOLISM AND ENERGY BALANCE WEIGHT CONTROLHow
To Plan A Diet Using Exchange Lists (cont)Case
Study

• Step 2d -- Translate The Diet Prescription Into A
  Meal Plan
• Subtract this subtotal from the fat level
  prescribed, in this case 50 grams - 15 grams
• The resultant answer is 35 grams
• We know each exchange of fat contains 5 grams of
  fat
• The balance of 35 grams of fat allows for 7 fat
  exchanges (35/5)

113
METABOLISM AND ENERGY BALANCE WEIGHT CONTROLHow
To Plan A Diet Using Exchange Lists (cont)Case
Study

• The resultant pattern of exchanges compares
  favorably with the prescription of 247.5 grams of
  carbohydrate, 90 grams of protein, and 50 grams
  of fat yielding 1794 kcalories