Energy Balance, Weight Control and Eating Disorders Part 1 of 2

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Energy Balance, Weight Control and Eating
DisordersPart 1 of 2

• Chapter 10

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Learning Outcomes

• Describe the many factors that have resulted in
  an increase in obesity in the US
• What is energy balance and what are the
  components of energy balance?
• Know the methods used to measure energy
  expenditure by the body.
• Explain internal and external regulation of
  hunger, appetite and satiety.
• Describe the methods available to measure body
  composition. What tools are available to
  determine whether body weight and body
  composition are healthy?
• Discuss the impact of genetics and environment on
  body weight and composition.

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Obesity Trends Among U.S. AdultsBRFSS, 1990,
2000, 2010
(BMI ?30, or about 30 lbs. overweight for 54
person)
1990
2000
2010
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The prevalence of childhood obesity is also
increasing
Growth in Childhood Obesity Over Three Decades
Age 6 to 11 4? 13 Age 12 to 19 5?14
If obese at age 6 ? 50 chance of lifelong
obesity If obese at age 13 ? 75 chance of
lifelong obesity
Blacks Mexican Americans
50 more likely to be obese than whites

From NHANES
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How did we get from a prevalence of 45 to 65?
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Energy Balance
Energy intake
Energy expenditure
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Energy Balance

• Energy equilibrium
• Energy intake equals energy expenditure
• Positive energy balance
• Energy intake greater than energy expenditure
• Negative energy balance
• Energy intake less than energy expenditure

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Factors Affecting Energy Balance and Weight

• Role of environment
• Role of developmental behaviors
• Role of genetics
• Identical twins
• Set point theory
• Genetic and environment synergy
• Diseases and disorders

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Obesity A Multifactorial Disorder
Development Behaviors/likes, etc hard wired in
Genetics
Environment
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Energy Intake

• Energy intake
• Estimated via nutrient databases
• Calories based on bomb calorimeter
• Fat 9 kcal/gm
• Carbohydrates 4 kcal/gm
• Protein 4 kcal/gm
• Alcohol 7 kcal/gm

Energy intake
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Decrease your energy intake to lose weight

• Daily calories to maintain a weight of 300 pounds
  2600 kcal/day
• To lose 1-2 pounds/week, you need to deficit 3500
  kcal/pound
• For 1 lb 3500 kcal/7 days -500 kcal/day
• For 2 lbs 7000 kcal/7 days -1000 kcal/day
• Daily calories to lose 1 pound/week
  2100 kcal/day
• Daily calories to lose 2 pounds/week 1600
  kcal/day

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Why is reducing kcal so hard?

• Out of Control Environment
• Stress and busy schedules
• Skipped meals
• Calorie-dense foods
• Large portions
• Increased variety

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Contributions to Obesity Learned Behaviors

• Clean your Plate Club
• Food as a coping mechanism
• Food for celebration
• Food is love
• Food as a reward
• Food as comfort

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CHICKEN CAESAR SALAD
20 Years Ago
Today
390 calories 1 ½ cups
790 calories 3 ½ cups
Calorie Difference 400 calories
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If you walk the dog for 1 hour and 20 minutes,
you will burn approximately 400 calories.
Based on 160-pound person
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It is easy to avoid expending energy
Energy expenditure
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Energy Expenditure

• Basal metabolic rate (BMR)
• Minimum amount of energy in a fasting state
• Factors that increase basal metabolism
• Factors that decrease basal metabolism
• Other factors that go into TOTAL energy
  expenditure
• Physical activity
• Thermic effect of food
• Adaptive thermogenesis

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Measuring Energy Expenditure

• Direct calorimetry
• Measures body heat
• Indirect calorimetry
• Collecting expired air
• Stable isotopes
• Estimated energy requirements (EERs)
• Harris-Benedict equation

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Equations used to estimate energy needs
Harris Benedict Women 655 ( 4.35 x weight
in pounds ) ( 4.7 x height in inches ) - ( 4.7
x age in years )Men 66 ( 6.23 x weight in
pounds ) ( 12.7 x height in inches ) - ( 6.8 x
age in year ) EER Similar but has physical
activity built in to the equation Also, has
separate equations for adult men and women,
toddlers, boys and girls aged 3-18, and obese
girls and boys aged 3-18
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Increase your energy expenditure to lose weight

• To lose 1-2 pounds/week via exercise, you need to
  burn 3500-7000 kcal in a week
• You burn about 100 kcal/mile
• Number of miles extra to lose 1 lb/wk 35
  miles or 5 miles/day
• Number of miles extra to lose 2 lb/wk 70 miles or
  10 miles/day

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What controls energy balance?
Energy intake
Energy expenditure
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Eating Behavior Regulation

• Hunger
• Physiological drive for food
• Appetite
• Psychological drive for food
• Satiety
• Fulfilling either drive

Hypothalamus regulates food intake Gherlin,
Leptin, Endorphins
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Genes influence a persons appetite, metabolism,
and fat storage
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Genes influence a persons appetite, metabolism,
and fat storage
100 90 50 0
Rare (Prader Willi, No Leptin production) Leptin
Hormone made in fat tissue that decreases
appetite and increases energy expenditure
Lipoprotein lipase enzyme that promotes fat
storage More enzyme more storage Ghrelin
Protein secreted by stomach that stimulates
appetite and promotes energy storage Eat
anything and not gain weight
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Genetics dictate your set point
Forced dietary manipulation
Ad libitum fed
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Gene-Environment Interactions in Obesity
Then
Now
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Body Mass Index
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Estimating Body Weight and Composition

• Weight-for-height tables
• Body Mass Index (BMI)

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Weight and Health Calculating BMI

• BMI weight in pounds x 703
• (height, inches)2
• Or
• weight in kg
• (height, meters)2

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Assessing Body Fat Distribution

• Upper body (Android)
• Increased health risks
• Men waist greater than 40 inches
• Women waist greater than 35 inches
• Lower body (Gynecoid)
• Lower health risks

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Risk of Associated Disease According to BMI and Waist Size Risk of Associated Disease According to BMI and Waist Size Risk of Associated Disease According to BMI and Waist Size Risk of Associated Disease According to BMI and Waist Size
BMI Classification Waist 40in (M) or 35in (W) Waist gt 40in (M) or 35in (W)
lt18.5 Underweight -- --
18.5-24.9 Normal -- May increase risk
25.0-29.9 Overweight Increased High
30.0-34.9 Obese (Class I) High Very High
35.0-39.9 Obese (Class II) Very High Very High
40 Obese (Class III) Extremely High Extremely High
Type 2DM, HTN, and CVD
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Measuring Body Fat Content

• Underwater weighing
• Air displacement
• BodPod
• Skinfold thickness
• Bioelectrical impedance
• Dual energy X-ray absorptionmetry (DEXA)

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