Chapter 16 Weight Management

Obesity
“global epidemic” – condition weighing more than 20% of ideal body weight
caused by:
– Decreased physical activity
– Increased intake of kcal (larger food portions)
– High intake of sugar based beverages
– Fast paced eating
– Pattern of overeating
Carb Intake
130g/day with emphasis on high-fiber foods e.g., legumes, whole grains, vegetables, and fruits
Satiety
the feeling of being satisfied or satiated, used to describe the point at which a person feels satisfied after eating a meal
Overweight
an excess of 10% body weight over an ideal weight body mass index greater than 27 is accepted as overweight
Extreme Obesity
Excess of 30% of standard weight
Underweight
10% below of recommended weight for height
BMI
Body Mass Index
A measurement tool that compares your height to your weight and gives you an indication of whether you are overweight, underweight, or a healthy weight for your height.

Wt in lbs
Ht in inches

[ Wt / (ht x ht) ] x 703 = BMI

Below 18 – underweight
18.5-18 – thin for weight
18.6-24.9 – healthy for weight – (21-25 is okay)
25-29.9 – overweight
Above 30 – overweight
30 – class I obesity
35 of higher – class II obesity
40 or higher – class III obesity (formerly known as “morbid obesity”)

Assessment
Identify medical and nutritional status (e.g., lab values, anthropometric dada [BMI, triceps skin fold and/or mid-arm circumference], diet history, medical conditions, learning style, barriers to change)
Anthropometry
A science that deals with body measurements (size, weight and proportions) and useful in screening individuals with:
Protein energy malnutrition (marasmus and kwashiorkor)
Severe anorexia nervosa may also have marasmus
Factors Altering BMI
Fluid retention
Dehydration
Triceps Skin Fold
Index of the body’s fat or energy stores
Mid-arm Circumference
Indicates the level of the body’s protein stores which are found mainly in the muscles
Elbow Breadth
Determines body frame size and a reliable measurement that changes little with age and is not affected by body fat stores
Adipokines
Hormones produced by adipose tissue: Leptin and Adiponectin
Leptin
helps regulate appetite, food intake, and energy balance
Adiponectin
Decreased levels found with:
– Low HDL cholesterol (HDL-C)
– High LDL-C and triglycerides
– Elevated uric acid (gout)
– Inflammation with elevated CRP levels
Thrifty Gene Theory
Some population groups may have survived over time because of an ability to preserve body mass during times of famine and to gain body mass easily during times of plenty
Important in hunger-gatherer lifestyle
Helps to explain occurrence of metabolic syndrome and development of central obesity when exposed to Westernized lifestyles (increased food intake and reduced physical activity)
DHEA
Dehydroepiandrosterone
An adrenal steroid known to decrease body fat and appears to play a role against insulin resistance and atherosclerosis
Thyroid
Insufficient levels of thyroid hormones cause a decrease in BMR leading to weight gain and may contribute to increase body weight as adults age
MSG
Monosodium Glutamate
Can develop problems with the interaction between nerve and hormonal systems
Apparently causes an increased appetite, which can be at least normalized with high-fiber foods and exercise
Medications
Antipsychotic (esp. clozapine and olanzapine) often induce weight gain
Weight Loss Approaches
Exchange lists
MyPyramid Food guidance system
Reading food labels
Very-low-fat diets
Low in fat, high in fiber
Moderate in fat, high in fiber
Low-glycemic diets
Very-low-carb-diet
Liquid diets
Prepackaged foods diet
Food-restrictive diets
Behavior modification
Non-Dieting Approach
Focuses on eating in response to physical hunger and satiety cues instead of sole focus on knowledge of what to eat
Bariatric Surgery
Surgical intervention for class III obese patients who have had no success with other weight loss approaches; or class II obese patients with high mortality risk
Malabsorption through surgically bypassing portions of the small intestine