Nutrition: Energy Balance and Weight Management – Flashcards

Age, gender, body composition, amount of food consumed and composition, activity level, lifestyle/ environment (nurture)

40-70%

-basal metabolic rate (BMR) -genes affect metabolic rate, fuel use, brain chemistry, body shape

-Leptin (reduces appetite) -Ghrelin (stimulates appetite)

Lower-body (gynecoid) obesity: Pear shape Encouraged by estrogen and progesterone After menopause, upper-body obesity appears Less health risk than upper-body obesity Upper-body (android) obesity: Apple shape Associated with more heart disease, HTN, Type II Diabetes Abdominal fat is released right into the liver Encouraged by testosterone and excessive alcohol intake Defined as waist measurement of > 40" for men and >35" for women

2. Rules of 5/6s: (m): 106# for 1st 5 feet + 6# for each inch after +/- 10% (range) (w): 100# for 1st 5 feet + 5# for each inch after +/- 10% (range) >20% IBW = mild health risk >40% IBW = moderate risk >100% IBW = severe risk

Body wt. (in kg)/ [Ht (in inches)]2 OR Body wt (in lbs) x 703.1 [Ht (in m)]2 / [Ht (in inches)]2 The preferred weight-for-height standard: Underweight = BMI 40 Health risks increase when BMI is > 25

Methods of measuring body fat distribution are an indication of health risk The greater the amount of weight/mass in the stomach area the greater the health risks 1. Waist : Hip ratio: (m): > .95 = increased health risk (w): > .8 = increased health risk 2. Waist Circumference: (W): > 35 = increased health risk (M): >40 = increased health risk

Healthy Standards: Men: 40 yo: 10-25% Women 40 yo: 25-38% High Risk: Men 22%; >40 yo: >25% Women: 35%; >40 yo: >38%

Social issues Insulin resistance/Type II diabetes Hypertension Heart disease Bone/joint disorders Cancer Osteoarthritis Gallstones Sleep disturbances Stroke Early death

"State in which energy intake, in the form of food and /or alcohol, matches the energy expended, primarily through basal metabolism and physical activity"

Energy intake > energy expended Results in weight gain

Energy intake < energy expended Results in weight loss

Weight = energy in - energy out

The minimum energy expended to keep a resting, awake body alive Accounts for ~50-70% of the total energy used daily Includes energy needed for maintaining a heartbeat, respiration, body temperature Amount of energy needed varies between individuals Approximately 0.9 kcal/kg/hr

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

Increases energy expenditure beyond BMR Varies widely among individuals Accounts for 25-50% of energy used daily More activity, more energy burned Lack of activity is the major cause of obesity

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

To maintain weight: energy in = energy out To lose weight: energy in energy out

Increase calorie intake To gain a pound you need a total excess intake of 2700-3500 kcal Increase kcal intake by 250-500 kcals/day Consume more energy-dense foods Increase number and size of meals and snacks Reduce activity (energy output) Increase muscle mass

1. Change energy out: Change BMR Increase muscle mass Increase activity to burn more kcals/day (see next slides) OR 2. Change energy in: To lose one pound, you must create a deficit of 2700-3500 kcal Decrease kcal intake by 500 kcals/day (that is a lot for some people) OR To lose a pound in 1 week (7 days): Reduce your kcal intake by 250 kcals (more moderate change) and increase physical activity by doing enough activity to burn an extra 250 kcals so that you create a deficit of 400-500 kcal per day

-diets do work -With any diet, an individual will lose weight . . . HOWEVER ?Where does weight loss come from? ? How long does weight loss last? Research Shows: The success of any diets is due to REDUCED CALORIE INTAKE not because you are or are not eating one thing or another. All weight loss programs are low calorie diets in disguise!!!!!

Rapid weight loss: Weight loss comes from: Reduced glycogen stores: glycogen used up to provide glucose for brain and red blood cells Water loss: water is stored with glycogen and as glycogen is used, water is excreted Lean body mass: once glycogen stores are depleted, the body needs another source of glucose for brain and red blood cells. Muscle mass is broken down and amino acids are used to make glucose Ketone production: from breakdown of lean body mass for energy Reduces BMR: Loss of lean body mass causes a decrease in BMR Low kcal intake causes BMR to slow down; the body recognizes it is not getting enough energy so it slows down, becoming much more efficient with the energy it does have

Enhances fat storage ability: Activity of lipoprotein lipase increases making it more efficient at taking up fat for storage Binging: Low kcal can lead to hunger which can cause binging and rebound dieting Can't be maintained in long run: Weight comes back when individual goes back to regular eating pattern

Higher in fat/saturated fat/increase risk for heart disease Lower in fiber, vitamins, minerals, phytochemicals/increase risk for cancer Nausea, fatigue, constipation Increase calcium excretion/ risk for osteoporosis Increase risk for gout/kidney stones Increase risk for dehydration

Loss of body fat, not lean body mass Realistic 5-10% weight loss Loss of 1-2# per week (1# = 3500 kcals) kcal: ;1200 kcals/day for women ;1500 kcals/day for men Protein: 1-2x RDA (15%) Fat: 20-25% of total kcals CHO: ; 100 grams/day 50-70% of total kcals ; 10% total kcals from simple sugar Variety: balance of all food groups Does not eliminate specific foods or food groups Not monotonous or depriving Ordinary, common, available foods; reasonable cost Includes EXERCISE/ACTIVITY Eat small frequent meals/don't skip breakfast Focus on life long changes, not temporary Lots of water

1. Calorie controlled 2. Low fat = 24% 3. Higher CHO = 56% 4. Breakfast 5. Self monitor (food diary) 6. Physical activity every day

Recommended for people ;30% above their healthy weight 700-800 kcal per day Low carbohydrates and high protein (1 gram for every pound of lean body mass) Causes ketosis Lose ~3-4 pounds a week Requires careful physician monitoring Health risks includes cardiac problems and gallstones

BMI ;30 BMI ;27 w/ co-morbid conditions Meridia/Redux Recalled: raises blood pressure, heart attack/stroke risk 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 Ephedra containing - banned

BMI ; 40 BMI ; 35 w/ co-morbid conditions Motivated/well informed 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 Still requires lifestyle change