ENERGY BALANCE AND WEIGHT CONTROL

ENERGY BALANCE
State in which energy intake, in the form of food and /or alcohol, matches the energy expended, primarily through basal metabolism and physical activity Positive energy balance Energy intake > energy expended
Results in weight gain

Negative energy balance Energy intake < energy expended

Results in weight loss

ENERGY BALANCE

ESTIMATING KCAL CONTENT IN FOOD

Bomb calorimeter Burns food inside a chamber surrounded by water Heat is given off as food is burned The increase in water temperature indicates the amount of energy in the food

MACRONUTRIENTS AND FAT STORAGE

Most fat is stored directly into adipose tissue Body has unlimited ability to store fat (as fat) Limited CHO can be stored as glycogen Most CHO is used as a energy source Excessive CHO will be converted into fat (for storage)

Macronutrients and Fat Storage

Protein is primarily used for tissue synthesis Adults generally consume more protein than needed for tissue synthesis Some protein will be converted into fat (for storage)

MACRONUTRIENTS AND FAT STORAGE

Body prefers to use CHO as energy source Only excess intake of CHO and protein will be turned into fat Fat will remain as fat for storage Physical activity encourages the burning of dietary fat

ENERGY IN vs ENERGY OUT

Basal Metabolism
Dietary Intake Physical Activity Thermic Effect of food

BASAL METABOLISM
The minimum energy expended to keep a resting, awake body alive ~60-70% of the total energy needs Includes energy needed for maintaining a heartbeat, respiration, body temperature Amount of energy needed varies between individuals

INFLUENCES ON BASAL METABOLISM

Body surface area (weight, height) Gender Body temperature Thyroid hormone Age Kcal intake Pregnancy Use of caffeine and tobacco

PHYSICAL ACTIVITY
Increases energy expenditure beyond BMR Varies widely among individuals More activity, more energy burned Lack of activity is the major cause of obesity

THERMIC EFFECT OF FOOD

Energy used to digest, absorb, and metabolize food nutrients Sales tax of total energy consumed ~5-10% above the total energy consumed TEF is higher for CHO and protein than fat Less energy is used to transfer dietary fat into adipose stores

NONEXERCISE ACTIVITY THERMOGENESIS

Nonvoluntary physical activity triggered by overeating Fidgeting Over eating increases sympathetic nervous system activity Resists weight gain

MEASUREMENT OF BODYS ENERGY NEEDS

Direct calorimetry
Measures heat output from the body using an insulated chamber Expensive and complex

Indirect calorimetry
Measures the amount of oxygen a person uses A relationship exists between the bodys use of energy and oxygen

HARRIS-BENEDICT EQUATION FOR THE BODYS ENERGY NEEDS

ESTIMATES RESTING ENERGY needs Considers height, weight, age, and gender For men:
66.5 + 13.8x(kg) + 5x(cm) - 6.8x(age in yr.)

For women:
655.1 + 9.6x(kg) + 1.8x(cm) - 4.7x(age in yr.)

SAMPLE CALCULATIONS
Man: 21 yr., 510 (171 cm), 155# (70 kg) 66.5 + 13.8x(70kg) + 5x(171cm) - 6.8x(21) = 1745 kcal/day Woman: 21 yr., 510 (171 cm), 155# (70kg) 655.1 + 9.6x(70kg) + 1.8x(171cm) 4.7x(21)= 1536 kcal/day

ESTIMATED ENERGY REQUIREMENT (EER)

FOR MEN EER =662 - (9.53 x AGE) + PA x (15.91 x WEIGHT + 539.6 x HEIGHT )
FOR WOMEN EER = 354 (6.91 x AGE) + PA x (9.36 x WEIGHT + 726 x HEIGHT)

WHY DO YOU EAT?

Hunger
Physiological (internal) drive to eat Controlled by internal body

Appetite
Psychological (external) drive to eat Often in the absence of hunger e.g., seeing/smelling fresh baked chocolate chip cookies

WHY WE EAT
Appetite is affected by a variety of external forces Combination of internal and external signals drive us to eat Not a perfect system; desire to eat can be overwhelming

SATIETY REGULATOR
The hypothalamus
When feeding cells are stimulated, they signal you to eat When satiety cells are stimulated, they signal you to stop eating

Sympathetic nervous system

When activity increases, it signals you to stop eating When activity decreases, it signals you to eat

Influences of Satiety

Influences of Satiety

WHAT IS A HEALTHY BODY WEIGHT?

Based on how you feel, weight history, fat distribution, family history of obesityrelated disease, current health status, and lifestyle Current height/weight standards only provide guides

BODY MASS INDEX (BMI)

The preferred weight-for-height standard Calculation:

Body wt (in kg) [Ht (in m)]2

OR

Body wt (in lbs) x 703.1 [Ht (in inches)]2

Health risks increase when BMI is > 25

ESTIMATION OF HEALTHY WEIGHT

For men:

106 pounds for the first 5 feet

add 6 pounds per each inch over five feet A man who is 510 should weigh 166 lbs.

For women:

100 pounds for the first 5 feet

add 5 pounds per each inch over five feet A women who is 510 should weigh 150 lbs.

OBESITY
Excessive amount of body fat
Women with > 30-35% body fat Men with > 25% body fat

Increased risk for health problems Are usually overweight Measurements using calipers

ESTIMATION OF BODY FAT

Underwater weighing (Fig. 13-5)
Most accurate Fat is less dense than lean tissue Fat floats

ESTIMATION OF BODY FAT

Bioelectrical impedance
Low-energy current to the body that measures the resistance of electrical flow Fat is resistant to electrical flow; the more the resistance, the more body fat you have

X-ray photon absorptiometry

An X-ray body scan that allows for the determination of body fat

Infrared light
Assess the interaction of fat and protein in the arm muscle

BODY FAT DISTRIBUTION

Upper-body (android) obesity--Apple shape Associated with more heart disease, HTN, Type II Diabetes Abdominal fat is released right into the liver Fat affects livers ability to clear insulin and lipoprotein Encouraged by testosterone and excessive alcohol intake Defined as waist to hip ratio of >1.0 in men and >0.8 in women

BODY FAT DISTRIBUTION

BODY FAT DISTRIBUTION

Lower-body (gynecoid) obesity--Pear shape Encouraged by estrogen and progesterone After menopause, upper-body obesity appears Less health risk than upper-body obesity

OVERWEIGHT AND OBESITY

Underweight = BMI < 18.5 Healthy weight = BMI 18.5-24.9 Overweight = BMI 25-29.9 Obese = BMI 30-39.9 Severely obese = BMI >40

JUVENILE-ONSET OBESITY
Develops in infancy or childhood Increase in the number of adipose cells Adipose cells have long life span and need to store fat Makes it difficult to loose the fat (weight loss)

ADULT-ONSET OBESITY
Develops in adulthood Fewer (number of) adipose cells These adipose cells are larger (stores excess amount of fat) If weight gain continues, the number of adipose cells can increase

CAUSES OF OBESITY
Nature debate Identical twins raised apart have similar weights Genetics account for ~40% of weight differences Genes affect metabolic rate, fuel use, brain chemistry Thrifty metabolism gene allows for more fat storage to protect against famine

CAUSES OF OBESITY
Nurture debate Environmental factors influence weight Learned eating habits Activity factor (or lack of) Poverty and obesity Female obesity is rooted in childhood obesity Male obesity appears after age 30

NATURE AND NURTURE

Obesity is nurture allowing nature to express itself Location of fat is influenced by genetics A child with no obese parents has a 10% chance of becoming obese A child with 1 obese parent has a 40% chance A child with 2 obese parents has a 80% chance

NATURE VS. NURTURE

Those at risk for obesity will face a lifelong struggle with weight Gene does not control destiny Increased physical activity, moderate intake can promote healthy weight

WHY DIETS DONT WORK

Obesity is a chronic disease
Treatment requires long-term lifestyle changes

Dieters are misdirected

More concerned about weight loss than healthy lifestyle Unrealistic weight expectations

WHY DIETS DONT WORK

Body defends itself against weight loss Thyroid hormone concentrations (BMR) drop during weight loss and make it more difficult to lose weight Activity of lipoprotein lipase increases making it more efficient at taking up fat for storage

WHY DIETS DONT WORK

Weight cycling (yo-yo dieting) Typically weight loss is not maintained Weight lost consists of fat and lean tissue Weight gained after weight loss is primarily adipose tissue Weight gained is usually more than weight lost Associated with upper body fat deposition

WHY DIETS DONT WORK

Weight gain in adulthood Weight gain is common from ages 25-44 BMR decreases with age Inactive lifestyle Changes in body composition Fluid is usually the first weight lost Loss in lean body tissue means lowering the BMR Very little fat is lost during weight loss

LIFESTYLE VS. WEIGHT LOSS

Prevention of obesity is easier than curing Balance energy in(take) with energy out(put) Focus on improving food habits Focus on increase physical activities

WHAT IT TAKES TO LOSE A POUND

Body fat contains 3500 kcal per pound Fat storage (body fat plus supporting lean tissues) contains 2700 kcal per pound Must have an energy deficit of 2700-3500 kcal to lose a pound per week

DO THE MATH
To lose one pound, you must create a deficit of 2700-3500 kcal So to lose a pound in 1 week (7 days), try cutting back on your kcal intake and increase physical activity so that you create a deficit of 400-500 kcal per day

- 500 kcal x 7 days = - 3500 kcal = 1 pound of weight loss

day

week

in 1 week

SOUND WEIGHT LOSS PROGRAM

Slow & steady weight loss Adapted to individuals habits and tastes Contains enough kcal to minimize hunger and fatigue Contains common foods Fit into any social situation See a physician before starting

CUTTING BACK
Control calorie intake by being aware of kcal and fat content of foods Fat Free does not mean Calories Free (or All You Can Eat) Read food labels Estimate kcal using the exchange system Keep a food diary

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

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

CHAIN-BREAKING
Breaking the link between two behaviors These links can lead to excessive intake

Snacking while watching T.V.

STIMULUS CONTROL
Alternating the environment to minimize the stimuli for eating Puts you in charge of temptations

COGNITIVE RESTRUCTURING
Changing your frame of mind regarding eating Replace eating due to stress with walking

CONTINGENCY MANAGEMENT
Forming a plan of action in response to a situation Rehearse in advance appropriate responses to pressure of eating at parties

SELF-MONITORING
Tracking foods eaten and conditions affecting eating Helps you understand your eating habits

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

DIETING CAN BE HAZARDOUS TO YOUR HEALTH

Weight regained consists of a higher percentage of body fat than before Less healthy than before dieting Weight loss diet should not be considered unless you are committed and motivated

Diet Drugs
Amphetamine (Phenteramine)
Prolongs the activity of epinephrine and norepinephrine in the brain Decreases appetite Not recommended for long term use

Sibutramine (Meridia)
Enhances norepinephrine and serotonin activity Decreases appetite(eat less) Not recommended for people with HTN

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 Dumping syndrome

GASTROPLASTY

UNDERWEIGHT IS ALSO A PROBLEM

15-25% below healthy weight or BMI of <18.5 Associated with increased deaths, menstrual dysfunction, pregnancy complications, slow recovery from illness/surgery Causes are the same as for obesity but in the opposite route

TREATMENT FOR UNDERWEIGHT

Intake of energy-dense foods (energy input) Encourage meals and snacks Reduce activity (energy output) To gain a pound you need a total excess intake of 2700-3500 kcal