Chapter 11: Water and the Major Minerals

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11 Outline for today

• Fad diets, other methods of weight loss
• Anorexia, bulimia etc.
• Next time ?
• How to Get Reliable Nutrition Information
• Supplements

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Recap of last lecture

• Obesity
• Set-point theory
• Types of obesity
• Weight loss diets
• Recommendations for weight loss

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Information on Obesity

• Halting the obesity epidemicMarion Nestle and
  Michael Jacobson Public Health Reports, 115(1)
  12-24. 2000. Web Version http//www.cspinet.org/
  reports/obesity.pdf
• American Obesity Association Fact Sheets
  http//www.obesity.org/subs/fastfacts/aoafactshee
  ts.shtml

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• Obesity is a complex, multi-factorial chronic
  disease involving environmental (social and
  cultural), genetic, physiologic, metabolic,
  behavioral and psychological components. It is
  the second leading cause of preventable death in
  the U.S.
• Approximately 127 million adults in the U.S. are
  overweight, 60 million obese, and 9 million
  severely obese

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Overweight (BMI 25)
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What to do?
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Fad diets

• These are now a multi-billion dollar business.
  Its a real, and tragic, rip-off for the
  consumer.
  
• Its also a very easy way for unscrupulous
  individuals to make a lot of money.
  
• Physical problems may arise from some fad diets
  (including deaths) and "yo-yo" dieting
  exacerbates the problem

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Fad diets

• Promise quick and dramatic weight loss
• Severely restrict and limit food choices,
  generally are inadequate in minerals and
  vitamins
  
• Do not mention exercise
• Cite claims by personal testimony only (not
  refereed, published scientific studies),
  
• (There are a few sound diets being promoted, but
  they have been a very small minority).

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Fad Diets contd

• Often recommend expensive supplements
• No permanent lifestyle changes advocated
• Critical of the scientific community

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Fad diets

• Most highly popularized diets fall into one of
  the following categories essentially none of
  these are sound approaches to weight loss, most
  benefit someone financially.
• protein-sparing fast (very low Cal/Hi prot)
• low carbohydrate-high fat
• low carbohydrate-high protein
• high carbo-low fat
• ?drugs
• hormones

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Novelty Diets

• Rice diet
• Beverly Hills Diet
• Grapefruit Diet
• Food gets stuck in your body notion
• Food allergies

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Low-CHO Diets

• Weight loss rapid due to protein tissue loss
  (water)
  
• Low calories
• Limited fruits, vegetables, and grains
• Low fiber, some nutrients, phytochemicals

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Low-Fat Diets

• Usually high in CHO
• 5-10 of energy from fat
• Not harmful for healthy adults
• Difficult to follow and boring

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Regular Physical Activity

• Fat use is enhanced with regular physical
  activity
  
• Increases energy expenditure
• Duration and regularity are important
• Make it a part of a daily routine

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Behavior Modification

• Modify problem (eating) behaviors
• Chain-breaking
• Stimulus control
• Cognitive restructuring
• Contingency management
• Self-monitoring

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Weight Maintenance

• Prevent relapse
• Occasional lapse is fine, but take charge
  immediately
  
• Continue to practice newly learned behavior
• Requires motivation, movement, and monitoring
• Have social support
• Encouragement from friends/ family/ professionals

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Weight Loss Triad
Control Energy Intake
Control Problem Behaviors
Perform Regular Physical Activity
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Diet Drugs

• All have potential adverse health effects
• Amphetamine (Phenteramine)
• Prolongs the activity of epinephrine and
  norepinephrine in the brain
  
• Decreases appetite
• Not recommended for long term use (dependency)
• Sibutramine (Meridia)
• Enhances norepinephrine and serotonin activity
• Decreases appetite(eat less)
• Not recommended for people with HTN

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Diet Drugs

• Orlistat (Xenical)
• Inhibits fat digestion
• Reduces absorption of fat in the small intestine
• Fat is deposited in the feces with its side
  effects
  
• Must control fat intake
• Malabsorption of fat-soluble vitamins
• Supplements needed

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Very Low-Calorie Diets (VLCD)

• Recommended for people 30 above their healthy
  weight
  
• 400-800 kcal per day
• Low carbohydrates and high protein
• Causes ketosis
• Lose 3-4 pounds a week
• Requires careful physician monitoring
• Health risks includes cardiac problems and
  gallstones

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Gastroplasty - Stomach Stapling

• Common surgical procedure for treating severe
  obesity
  
• Reduces the stomach size (from 4 cups) to half a
  shot glass size (1 oz)
  
• Overeating will result in rapid vomiting
• Smaller stomach promotes satiety earlier
• 75 will lose 50 of excess body weight
• Costly
• Nonreversible

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Underweight is Also a Problem

• 15-25 below healthy weight or BMI of
• Associated with increased deaths, menstrual
  dysfunction, pregnancy complications, slow
  recovery from illness/surgery
  
• Causes are the same as for obesity but in the
  opposite direction

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Anorexia Nervosa, Bulimia Nervosa, and Eating
Disorders
Anorexia Nervosa is a life-threatening disease
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Fig. 12.4
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Table 12.1
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Table 12.2
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Anorexia Nervosa

• Extreme weight loss
• Perceived body image
• Desire for acceptance
• Psychological conflict and depression
• Lack of appropriate coping mechanism
• Intense fear of obesity and weight gain
• Begins with a simple diet and leads to
  semistarvation
  
• Denial of hunger

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Profile of An Anorexic

• Occurs between the age of 12-18
• 5-10 are male
• Experiencing physical changes associated with
  puberty
  
• False body perception
• From middle or upper SES with a overbearing
  mother and high expectations
  
• Demonstrates ritual involving food
• Finds security in control is obsessive
• Preoccupation with food
• Lack of menses for girls

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Warning Signs

• Abnormal eating habits and eating very little
  food
  
• Hiding and storing food
• Exercise compulsively
• Prepares large meals for others
• Withdraws from friends and family
• Critical of self and others
• Sleep disturbance and depression
• Ammenorrhea

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Physical Changes

• Skin and bone appearance
• Conservation of energy
• Lowering of body temperature
• Appearance of lanugo and loss of hair
• Lower BMR, decrease heart rate
• Iron deficient anemia and other nutrient
  deficiency
  
• Rough, dry, scaly, cold skin
• Low white blood cell count, potassium
• Constipation, ammenorrhea
• Changes in neurotransmitter

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Intervention

• Necessary if person falls below 75 of expected
  weight
  
• Love ones confront them
• Multidisciplinary team
• Eating disorder clinic
• Gaining trust and cooperation of the patient

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Treatment

• Nutrition
• Increase food intake so to raise the BMR
• Prevent further weight loss
• Restore appropriate food habits
• Ultimately weight gain
• Psychological
• Cognitive behavior therapy
• Determine underlying emotional problems
• Reject the sense of accomplishment associated
  with weight loss
  
• Family therapy, support group

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Bulimia Nervosa

• A psychological conflict depression
• Low self esteem
• Preoccupied with food
• Involves episodes of bingeing followed by
  attempts to purge
  
• Recognize behavior is abnormal
• Many not be diagnosed

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Profile of a Bulimic

• Young (usually female) adults (college students)
• May be predisposed to becoming overweight
• Usually at or slightly above normal weight
• Tried frequent weight-reduction diets as a teen
• Impulsive
• Usually from disengaged families

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Secret Lives of Bulimics

• Many are not diagnosed
• Hide their binge and purge habits
• Food rules
• Single binge may consist of 10,000-15,000 kcal
• Binge consists of convenience, high sugar, high
  fat foods
  
• Purging by vomiting in hopes that food do not get
  absorbed

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Purging

• 33-75 of all energy are absorbed even after
  vomiting
  
• 90 of all energy is absorbed when laxatives are
  used
  
• Can cause weight gain
• Hypergymnasia (excessive exercise)
• Guilt, depression, low self-esteem
• High food bills

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Vicious Cycle of a Bulimic
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Health Problems With Bulimia Nervosa

• Vomiting causes the most problems
• Demineralization of teeth
• Drop in blood potassium
• Swelling of the salivary glands
• Ulcers
• Constipation
• Ipecac syrup is poisonous

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Treatment of Bulimia Nervosa

• Decrease episodes of binge purge
• Psychotherapy to improve self-acceptance
• Change the all-or-none attitude and
  misconceptions about food
  
• Correct misconceptions about food
• Establish good, normal eating habits
• Group therapy
• Possible anti-depressant drugs

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Female Athlete Triad

• Demonstrates disorder eating
• Irregular or ammenorrhea
• Female athletes participating in appearance-based
  and endurance sports
  
• Seen in 15 swimmers, 62 gymnasts, and 32 of
  all other sport
  
• Bone density similar to 50-60 year olds
• Bone loss is irreversible (osteoporosis)

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Binge-Eating Disorder (Compulsive Overeating)

• Binge-eating episodes not accompanied by purging
  at least 2x/wk
  
• Complex and serious eating disorder
• Occurs in 30 -50 of subjects in weight control
  programs (40 are males)
  
• More common with obese individuals with history
  of restrictive dieting
  
• 50 exhibit clinical depression
• Not preoccupied with body shape

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Characteristics of a Binge-Eater

• Consider self as hungrier than normal
• Isolate self to eat large quantities
• Triggered by stress, depression, anxiety,
  loneliness, anger, frustration
  
• Usually binge on junk foods
• Eat without regards to biological need
• Food is used to reduce stress, provide feeling of
  power and well-being

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Treatment for Binge-Eating

• Learn to eat in response to hunger
• Learn to eat in moderation
• Avoid restrictive diets which can intensify
  problems
  
• Address hidden emotions
• Overeater Anonymous
• Antidepressants

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Baryophobia

• The fear of becoming heavy
• Children are given a low-fat, restricted diet in
  hopes to ward off obesity or heart disease
  
• Detrimental to children affect growth and
  development
  
• Self-imposed restrictive diets by young adults to
  avoid obesity
  
• Lack of appropriate nutrition information

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Treatment for Baryophobia

• Nutrition education
• Nutrition required for proper growth
• Appropriateness of sweets and fats in the diet

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Dying To Be Thin

• Normal to be concerned about diet, health, and
  body weight
  
• Weight normally fluctuates
• Treat physical and emotional problems early
• Discourage restrictive diets
• Correct misconception about foods
• Thin is not necessary better