Chapter 9 Weight Control. The Art of Nutritional Cooking, 3 rd edition Baskette/Painter © 2009...

Chapter 9Weight Control

The Art of Nutritional Cooking, 3rd editionBaskette/Painter

© 2009 Pearson Education, Upper Saddle River, NJ 07458.

All Rights Reserved.2

Key Concepts Obesity is increasing in the US and reaching

epidemic proportions. Obesity is a major health problem in the US. The cause of obesity is multifactorial Successful obesity treatment has been elusive. Obesity incidence remains unimproved despite

numerous weight-reduction diets on the market.

Balancing individual caloric needs with exercise is the overall answer to obesity, but each individual must incorporate specific changes appropriate to his/her lifestyle.




Prevalence of Obesity Increasing in the United States and in other

countries at a disturbing rate 50% of adults are overweight, but more importantly

that one-third are obese

Worldwide 300 million people are clinically obese

The World Health Organization defines obesity as having a body mass index (BMI) of 30 or greater

Obesity may also be defined by a percentage over desirable weight




Obesity World-wide US population has one of the highest BMIs, but

there are many countries experiencing this problem as well

according to the Centers for Disease Control and Prevention, there were 44 million Americans who were considered obese in 2001

obesity in the US is more prevalent in African American and Hispanic populations as well as in middle age

over 50% of adult African American females being obese many developed countries are also experiencing an

increase in obesity including the United Kingdom, Russia, and Greece.

the occurrence of obesity in island nations is even more striking:

the percentage of obese females is 43% in French Polynesia

66% in American Samoa




The Causes of Obesity Many aspects influence its prevalence

coincides with certain lifestyle changes, such as sedentary routines

developments such as computers, cell phones, drive through restaurants, household appliances, the Internet and TV remote controls have decreased activity

Increased food availability, variety and quantity have added to the problem

over the past several decades, the proportion of total food dollars spent on food away from home has doubled

more food availability has lead to an increase in food consumption per capita

Portion sizes have also increased significantly since the introduction of fast food chains




Ill-effects of Obesity Excess weight creates a burden on the body

leading to disease, especially when the individual is two to three times heavier than their “normal” weight

Obesity enhances risk factors, such as elevated blood lipids in the form of low density lipoprotein (LDL) cholesterol (the unhealthy form), that can lead to heart disease

Hypertension, which damages coronary vessels and causes heart disease, is also associated with obesity




Other Problems with Obesity Obesity is also a risk factor for diabetes in

those who are genetically prone

Obese individuals suffer from osteoarthritis and gout more often in the obese population

People who are overweight are at particular risk for osteoarthritis of the knees and hands

Gallbladder disease is more prevalent in obese people




Treatment for Obesity

Dieting has been the typical treatment for obesity for many years

reviewing media reports from time to time illustrates myriad weight-loss diets consumers may follow

physicians incorporate diets for their patients who require weight loss

Exercise has been added to calorie-restricted diets to weight loss regimens to enhance the outcome

Other treatments include diet pills, behavior modification, bariatric surgery, and medication




The Problems with Dieting Frequently, the person who succeeds in

losing weight does so only temporarily Most dieters regain their weight within five

years Failure to stay lean leads to guilt and

repeated efforts at dieting Some individuals turn to highly restrictive

diets from unreasonable programs Many experience failure in the long run due

to the off-putting nature of these programs




Comparing Weight-loss Diets Although weight loss diet theories can appear conflicting and

misleading there are some common components of the diets that may be include as a part of a new lifestyle change

High-protein diets (e.g., Atkins, Zone, Carbohydrate Addict’s, Protein Power, SugarBusters!) are all based on a similar theory

High insulin levels (hyperinsulinemia) for prolonged periods can result in (insulin resistance), and this necessitates even more insulin production for the same amount of carbohydrate consumed

The high-carbohydrate, low-fat diet theories (US Department of Agriculture, American Dietetic Association, American Heart Association, Pritikin, and Ornish) are more concerned with reducing dietary saturated and total fat content in order to reduce cholesterol levels and decrease heart disease risk




Diets do Agree Decreasing refined carbohydrates

Increasing vegetable consumption

Increase exercise




Balancing Energy Intake and Expenditure

The key to maintaining a healthy weight is to balance energy intake and expenditure

To determine energy need, a dietitian performs a nutrition assessment to evaluate an individual’s nutritional status

a nutrition assessment includes an individual’s current weight and ideal body weight as well as other factors, such as a diet history, food preferences, and laboratory values (if available)




Nutrition Assessment and Determining Normal Weight

The old method of assessing weight is to compare weight to Metropolitan weight charts

Today individualized formulas are used for determining healthy weigh

the most common method is to use body mass index (BMI)

the Dietary Guidelines for Americans recommend a BMI of 19 to 25 kg/m2 for adults under 35 years and a BMI of 21 to 27 kg/m2 for adults over the age of 35

a BMI exceeding the recommendation but less than 30 kg/m2 is considered overweight,

BMI over 30 kg/m2 is considered obese




Determining Calorie Need Basal calorie requirements and

physical activity levels dictate calorie needs

basal calorie needs are determined by age, muscle mass, and overall body weight

The amount of food we eat does not necessarily match what we require




Formula For sedentary individuals, 25 to 30 calories/kg

For moderately active individuals, 30 to 35 calories/kg

For very active individuals, 35 to 40 calories/kg

Adjust for age: For individuals aged 35 to 45, 94% of calories For individuals aged 45 to 55, 92% of calories For individuals over age 55, 89% of calories




Making Healthy Food Choices Rich desserts and sweet beverages have many

calories because of the large amounts of fat and sugar they contain

Some dieters experience guilt after eating sweets

they feel they have failed to stay on the diet because they gave in to their craving for something sweet

usually sweets and desserts are considered “off limits” to dieters

There is nothing wrong with eating dessert, if consumed in moderation




Behavior Modification Behavior modification is another

approach to weight loss that involves careful analysis of activities leading to eating

after keeping careful records of food consumption with times food is eaten, the obese person can train him/herself to disrupt activity that leads to overeating by substituting another activity

the individual plans behavior ahead of time, such as before attending celebrations and social situations involving food, so that binging will not occur




Environmental Factors

Two influential factors, visibility and convenience, impact how much we eat




Exercise and Weight Control Fad diets fail partially because dieting

causes a decrease in muscle mass with a corresponding metabolism reduction

slowed metabolism burns fewer calories causing the dieter to gain weight

basal metabolic rate may remain suppressed for years after going off a severely calorie-restricted diet

to keep the metabolic rate up while dieting, individuals must maintain muscle mass with exercise




More than just Aerobics Aerobic activity is an important type of

exercise because it increases burns calories

Other types of exercise are also important

strengthening exercise is important because it increases muscle mass

additional muscle mass increases an individual’s basal metabolic rate because muscle burns more calories than fat




Appetite Suppressants In the 1960s, amphetamines were the

popular diet pills they sped up metabolism, were addictive, caused mood swings

Amphetamines were replaced by newer appetite suppressants

fenfluramine (Pondimin) Phentermine

The new drug, dexfenfluramine (Redux) works like FenPhen, increasing serotonin levels in the brain




The Problem with Redux The FDA announced in September 1997

that about 30% of patients who were taking Redux and who were evaluated for heart valve function had abnormal echocardiograph readings, even without symptoms

Redux was also found to cause a rare, but deadly, condition called primary hypertension

with this condition, the blood vessels that supply the lungs thicken making the heart work harder

manufacturers withdrew Redux and Pondimin from the market upon FDA request

Chapter 9 Weight Control. The Art of Nutritional Cooking, 3 rd edition Baskette/Painter © 2009...

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