Weight Control:

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Chapter 9

• Weight Control
• Overweight and Underweight

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I. Causes of Obesity

• A. Fat Cell Development
• 1. Fat cell number vs fat cell size
• a. obesity reflects both
• 2. Obese children have more fat cells
  than lean children
• 3. Prevention of obesity critical during
  early years

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Fat Cells (adipose tissue)
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Causes of Obesity (cont)

• B. Genetics
• 1. Obese parents give rise to obese
  children, even when reared apart
• 2. Twins are also likely to weigh the
  same whether reared together or apart
• 3. Laboratory animals
• a. Rodents appear identical to their litter
  mates however a few weeks after birth
  they begin to gain extraordinary amount of
  weight
• 1. ob/ob mice
• 2. certain strains of rats

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Causes of Obesity (cont) Genetics (cont)

• 4. Leptin
• a. Protein synthesized by adipose tissue
• 1. causes decreased food intake 2.
  Increase in activity
• b. Non-functional leptin or leptin receptors
• 1. No feedback to decrease food intake?

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Causes of Obesity (cont)

• C. Fat Cell Metabolism
• 1. Lipoprotein lipase activity
• a. increased activity increased efficiency
• b. activity high in obese
• c. activity increases after weight loss
  easier to regain weight
• 2. Unlikely cause

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Causes of Obesity (cont)

• D. Set Point Theory
• 1. Homeostasis
• a. body temperature, plasma glucose,
  electrolytes, but Weight??
• Controversial
• 2. Difficult to change body weight
• a. adaptive mechanism
• 1. weight lost decrease BMR
• 2. weight gain increase BMR

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Causes of Obesity (cont)

• E. Overeating
• 1. Controversial
• a. Do obese people eat more?
• 1. Conflicting data
• 2. Energy in energy out
• a. energy balance is the key
• F. Inactivity
• 1. Energy balance
• a. Energy in energy out
• G. Multiple Etiology

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II. Controversies in Treatment of Obesity

• A. Need for Weight Loss
• 1. Definition of Obesity
• a. greater than 120 IBW or BMI 30
• 2. 30 to 40 of women trying at any given
  time
• 3. 20 to 25 of men

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B. Motivation

• 1. Appearance
• 2. Health
• 3. Self-esteem
• C. Success
• 1. Only 5 of those who try to lose weight
  are successful
• D. Fraud
• 1. 30-40 billion dollar a year market
• 2. Compare success rate with number trying

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III. Treatment of Obesity Poor Choices

• A. Fad Diets
• 1. Exaggerated claims based on false
  theories
• 2. Potentially harmful
• B. Weight Cycling
• 1. Set point theory?
• 2. Psychological ramification

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Weight Cycling
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Psychology of Weight Cycling
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Treatment of Obesity Poor Choices (cont)

• C. Pills, Procedures and other
  Possibilities
• 1. Diuretics
• a. rapid loss of water and minerals
• 2. Amphetamines (speed)
• a. historical use
• b. not approved by FDA
• c. Addictive
• d. ineffective

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Treatment of Obesity Poor Choices (cont)

• 3. Prescription drugs
• a. interfere with fat absorption
• b. suppress appetite
• 1. dexfenfluramine
• a. increased serotonin (neurotransmit
  ter)
• b. psychological problems
• c. Heart problems
• 4. Over-the-Counter Drugs
• a. taste suppressants

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Treatment of Obesity Poor Choices (cont)

• 5. Surgery
• a. gastric stapling
• b. intestinal bypass
• c. gastric balloons
• d. wiring jaw closed (liquid diet)
• 6. Very-Low-Calorie Diets (VLCD)
• a. promote rapid weight loss
• b. physician supervised
• c. 800 kcal, 1 gram protein/kg body weight

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Treatment of Obesity Poor Choices (cont)
Very-Low-Calorie Diets (VLCD) (cont)

• d. little or no fat
• e. little CHO (not enough to spare protein)
• f. starvation
• g. Potential cardiovascular and respiratory
  problems

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IV. Treatment of Obesity Good Choices

• A. Eating Plans
• 1. Realistic energy intake
• a. rapid weight loss is protein and water
  loss
• b. rule of thumb 10 kcal/pound promotes
  weight loss

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Eating Plans (cont)

• 2. Nutritional Adequacy/Nutrient Dense
  Foods
• a. difficult to achieve on less than 1200
  kcal
• b. food guide pyramid principles (pg. 321)
• 3. Small portions consumed slowly
• 4. CHO not fats
• a. fiber rich satiety
• b. satiety signals delayed by 20 min. (CHO vs
  fat)

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Eating Plans (cont)

• 5. Adequate water
• a. sense of fullness
• B. Physical Activity
• 1. Activity and BMR
• a. activity increases BMR
• 2. Activity and appetite control
• a. energy released from stores (plasma
  glucose normal)
• b. digestive functions are suppressed

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Physical Activity (cont)

• 3. Activity and psychological benefits
• a. reduce stress
• b. sense of doing something, enhanced esteem
• C. Behavior and Attitude
• stimuli º behavior º consequence
• 1. Awareness of behavior
• a. why do I eat, when, where
• 2. Make small changes to behavior
• a. behavior modification
• b. result (positive)

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Behavior and Attitude (cont)

• 3. Maintaining weight
• a. lifelong process
• b. Difficult
• 4. Personal attitude
• a. being aware of difficulties while realizing
  it is possible
• b. self-concept

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Behavior and Attitude (cont)

• 5. Support groups
• a. required for success
• 1. Emotional support, positive attitude,
  identity, similar problems, solutions
• b. many treatments do not have this component

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V. Underweight

• A. Incidence
• 1. Less than 10
• B. Health Consequences
• 1. Infertility
• a. Body fat
• 2. body not prepared to deal with stress
• a. insufficient energy reserves
• 3. low birth weight babies
• a. increase in problems

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C. Weight Gain Strategies (Energy dense foods
and exercise)

• 1. Energy dense foods
• a. opposite of food group plan for weight loss
• 1. pick highest caloric food from each group
• 2. still try to limit saturated fat intake
• b. increase caloric intake by 700-1000 kcal/d
  (lb./wk)
• 2. Regular meals daily
• a. try to eat most food within the first 20
  min. (Satiety)

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Weight Gain Strategies (cont)

• 3. Large portions
• 4. Extra snacks
• 5. High caloric liquid supplements
• 6. Exercise
• a. body composition
• 1. Maintain lean body tissue

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VI. Eating Disorders

• A. Anorexia Nervosa (Starvation)
• 1. Occurrence
• a. Females
• b. Young (
• c. Affluent Background
• 2. Criteria to be considered anorexic
• a.
• b. weight loss of more than 25

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Anorexia Nervosa (cont)

• c. distorted views about food
• d. denial of illness
• e. distorted body image (Extreme Thinness)
• 3. Other symptoms of anorexia a.
  amenorrhea
• b. hypotension
• c. lanugo
• d. bradycardia
• e. bulimia (if forced to eat)
• f. vomiting/laxatives/exercise Abuse

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Eating Disorders (cont)

• B. Bulimia (Bingeing/purging)
• 1. Occurrence
• a. young women mid teens 30's
• b. colleges-20 women binge 5 men
• c. US. population 5 women 1 men
• 2. Criteria to be considered bulimic
• a. recurrent bingeing with inappropriate
• compensatory behavior
• 1. Vomiting
• 2. laxative abuse
• 3. diuretic abuse
• 4. excessive exercise

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Bulimia (Bingeing/purging) (cont)

• b. eat high calorie foods
• c. secretive
• d. aware of abnormal eating pattern
• e. depressed mood during binge
• f. may look normal usually normal weight or
• slightly overweight
• 3. Medical problems of bulimia
• a. vomiting
• 1. esophageal rupture
• 2. heartburn

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Medical problems of bulimia (cont) vomiting
(cont)

• 3. loss of tooth enamel
• 4. aspiration pneumonitis
• 5. metabolic alkalosis
• 6. heart arrhythmia
• 7. gastric rupturing
• b. laxative abuse
• 1. dehydration
• 2. mineral imbalances
• 3. cathartic colon
• 4. constipation

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Eating Disorders (cont)

• C. Binge Eating
• 1. excessive intake of high-calorie foods
• 2. 3000-4000 kcals consumed at one time
• 3. no compensatory behavior
• 4. usually not hungry, but have little control
  over urge to eat
• 5. two or more binges per week
• 6. usually overweight or obese

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VII. Treatment of Eating Disorders

• A. Professional Help Needed to Control Eating
  Disorders
• B. Most Successful Interventions Use a Team
  Approach
• C. Team Approaches Include Various Combinations
  of the Following Therapies
• 1. individual therapy
• 2. nutritional therapy
• 3. family therapy
• 4. group therapy