Weight Management and Body Composition

Weight Management and Eating Disorders

• Body weight is the sum of bone, muscle, organs, body fluids, and adipose tissue.
• Body weight components are subject to change due to growth, reproductive status, exercise variations, and aging effects.
• Constant body weight is maintained through neural, hormonal, and chemical mechanisms which balance energy intake and expenditure within precise limits.
• Abnormalities in these mechanisms lead to significant weight fluctuations, like overweight and obesity.

Body Weight Components

• Body weight comprised of Fat mass and fat-free mass (FFM).
• FFM can be interchanged with lean body mass (LBM).
• LBM is the body part that is free of adipose tissue including the water, skeletal muscles, bone, and small amounts of essential fat.
• LBM is higher in men, increases with exercise, but lower in older adults.
• Water accounts is around 60-65% of body weight, and is the most variable part of LBM.

Regulation of Food Intake and Body Weight

• Food intake and body weight are regulated by long term and short term regulations.
• Short-term regulations are associated primarily with factors governing appetite, hunger, and satiety.
• Long-term regulations utilize a feedback mechanism where a signal from the adipose mass is released when the normal body composition is disturbed.
• Adipocytokines are proteins released into the bloodstream by adipose cells which act as signaling molecules; leptin is an example, inhibiting appetite and increasing energy expenditure.
• In obesity, there is a decreased sensitivity to leptin resulting in an inability to detect satiety despite high energy stores.

Weight Imbalance: Obesity and Overweight

• Obesity and overweight are a result of an imbalance between physical activity and food consumed.
• In the last four decades, obesity rates have increased, with the environment being a factor, despite the "gene pool" remaining relatively unchanged.

Prevalence of Obesity

• WHO states that obesity has become a worldwide health problem which can lead to a variety of conditions and diseases.
• Saudi Arabia is the world's 15th most obese country, with an overall obesity rate of 33.7% in the year 2022. Furthermore, it has been projected to reach 59.5%.
• Trends show that the obesity rate continues to increase; Saudi women have a higher obesity rate than men.
• According to the Saudi Arabia National Health Information Survey of 2019, 20.2% of adults are obese and 38.2% are overweight.
• In Saudi Arabia, research indicates that obesity is significantly high among different age groups and occupations, at different locations in the country, and among both males and females.

Obesity - Etiology, Risks, and Management

• Obesity has complex etiology.
• Factors such as genetics, physiological, environmental, social, and psychological factors all affect obesity.
• Although genes increase the vulnerability to obesity, other determinants play a role.
• Dietary and activity patterns are the primary contributor to weight problems in industrial societies, overeating and physical inactivity are major factors
• Overeating consists of excessive energy intake demonstrated by large portion sizes like "supersize", eating restaurant food - especially fast food - that is often high in far, and increased energy-rich, nutrient-poor foods.
• Physical inactivity stems from an environment that encourages it and a sedentary nature which is a factor in the growing problem of obesity and chronic diseases in Saudi society; fewer people are exercising and more time is spent on low-energy activities.
• It's been discovered that sleep deprivation can also alter hormone levels that regulate hunger.
• Obesity is directly linked to mortality and a range of health risks: diabetes, heart disease, gallbladder disease, hypertension, hyperlipidemia, sleep apnea, non-alcoholic fatty liver, kidney stones, and some cancers.
• Chronic diseases worsen as the degree of obesity increases.
• Successful weight-loss strategies include reasonable goals, moderate losses, and small changes.
• Obesity treatment goals should emphasize weight management rather than weight loss, by achieving the best possible weight for overall health.
• Obese individuals can potentially improve their health in the short term, by losing small amount of weight (5-10% initial body weight) as it can reduce the severity of obesity-associated comorbidities.
• The NIH's dietary recommendations promote about 1 to 2 lb calorie deficits each week.
• This rate of loss should continue for about 6 months, leading to a reduction of 10% of body weight, after that, weightloss should be changed to weight maintenance to avoid failure.
• After this initial phase, additional weight loss may be considered; final weight goals should be individualized and chosen realistically, with reduction of body fat as the focus.

Lifestyle Modifications for Obesity

• Behavior modification is the cornerstone of obesity intervention, focusing on changing behaviors to increase energy expenditure and decrease energy intake.
  • Strategies include:
    • Social support with family and friends.
    • Setting easy-to-achieve short-term goals (like increasing minutes of walking everyday.)
    • Self-monitoring through food and activity records.
    • Stimuli control by shopping only when not hungry.
    • Stress management through meditation and yoga.
    • Confronting barriers via problem-solving steps.
• Education and dietary modification can assist with weight-loss to include a lifestyle modification and nutritionally balanced dietary regimen with exercise.
  • Nutrition education can be achieved through using meal planning, nutrition facts, pyramid, portion sizes, food groups, calorie content of different foods, energy density, etc.
  • Meal planning and choosing foods can be simplified with The Traffic Light System or The Exchange System.

Weight-Loss Treatment Strategies

• Strategies depend on health risk and the goals of the patient.
  • Treatment options include:
    • Increased physical activity, a low-calorie diet, and lifestyle.
    • Pharmacotherapy in addition to the above.
    • Lifestyle modification program, individually prescribed dietary regimen, physical activity, and a surgery.
    • Preventing weight gain via energy balance.
• The common weight reduction prescribed method is the balanced restricted-energy diet which should stay nutritionally adequate except for energy.
• Caloric deficit of 500 to 1000 kcal daily is needed in order to mobilize fat stores for energy needs.
• The energy level usually ranges from 1200-1800 kcal daily.
• Healthful eating should be emphasized and taught, with recommendations for increasing physical activity included. - CHO's compromise 50-55% of all calories, through whole grains, vegetables, fruits, and beans. - Proteins should compromise about 15-25% of calories. - Fat consumption shouldn't exceed 30% of total calories. - Foods that are high in fiber help to promote satiety. - High-sugar foods and unnecessary energy should be limited. - Artificial sweeteners may improve the taste for some. - Diets shouldn't exceed 1200 kcal for women, and 1800kcal for men unless vitamin/mineral supplements are consumed.
• Extreme energy restriction such as very-low diets only providing 200 to 800 kcal are classified as very low-calorie diets but should not be exceeded. - They are given for the purpose of promoting rapid weight loss in the short term. - Their adverse reactions/side effects are: fatigue, hair loss, nervousness, light-headedness,anemia, or constipation. - The NIH recommends against using VLCD for weight-loss therapy if not supplemented with minerals and vitamins. - They don't produce significant weight losses in the long term compared to LCD.

Fad Diets & Aggressive Treatment

• Fad diets produce a weight loss in a short time, can be used for a period of time to promote weight loss and have potentially serious adverse effects.
• Some fad diets include:
  • The Atkins Diet: it restricts CHO which induces ketosis, and can cause fatigue, kidney disease, worsening medical problems and even nausea with light headedness. Diets are high in fat which increase heart disease and cancers.
  • Eat type right for your blood: food groups/foods are excluded. It has no scientific data regarding blood type and food choices.
• An overweight person requires a need to only improve habits/ increase physical activity. Some with clinically severe obesity need aggressive treatment like surgery and drugs.
• Clinically Severe Obesity: BMI of 40+ or 35+ with medicine problems.

Pharmaceutical Interventions for Weight Loss

• Drugs help obese people lose weight when used as part of a comprehensive, long-term weight-loss program; weight regain commonly occurs with the discontinuation of drug therapy, with long-term use posing health risks.
  • Prescription drugs :
    • Sibutramine: it suppresses appetite, was used until 2010 was withdrawn from the market for increased cardiovascular events & strokes.
    • Orlistat: it prevents causes less fat (30 percent of fat and calories) to be absorbed into the gut, and its side effects cause diarrhea when eating fatty foods.
    • Qsymia: Phentermine helps short-term weight loss, and topiramate (an epilepsy and migraine medicine) triggers satiety.
    • Lorcaserin Hydrochloride (Belviq:) controls appetite and metabolism was approved by the FDA in 2012.
    • Contrave: combines bupropion with naltrexone and increases dopamine activity in the brain, and can help increase energy; potential side effects are vomiting, suicidal thoughts, insomnia, and nausea.
    • Liraglutide: Results from a clinical trial showed 49% participants treated with Saxenda lost at least 5% of their body weight
• The newest are - Ozempic: it enhances the way the body regulates levels and fat
  • Mounjaro: The reduces blood sugar levels

Surgical procedures for weight loss

• Bariatric surgery is treatment for morbid obese patients. It requires 40+ or 35+ BMI with comorbidities.
• Two classifications: restrictive surgeries (sleeve gastrectomy and gastric banding) and malapsorptive restrictive surgeries (gastric bypass).
• It causes the effects of reducing the amount of food that can be eaten as well as early satiety produced.
• For post-operative dietary interventions, the diet must gradually progress from clear liquid to reach a meal.
• attention has to placed on taking mineral supplements for adequate nutritional intake

Eating Disorders

• Eating disorders are a devastating psychiatric illness characterized by a persistent disturbance of eating habits or weight control behaviors resulting in significantly impaired physical health and psychosocial functioning.
• Females are more susceptible than males, especially dancers, models, or athletes.
• Types of eating disorders, their characteristics, and the appropriate medical nutrition therapy:
  • Anorexia Nervosa (AN) includes medical nutrition therapy to correct for biologic and psychological normalization, weight rehabilitation; treatment plan should target weight gain (2-3lb/week for hospitalized patients and .5-1lb/week for out patient). Calories should be (30-40kcal/kh/d) and promote a calorie increase as a way to progressively gain weight.
  • Bulimia Nervosa (BN) includes immediate goals to ensure there's a normal eating cycle
• Prognosis:
  • Relapse rates after weight restoration in AN are, roughly 50% can require hospitalization within a year.
  • Morality rates, eating disorders are among the highest psychiatric illnesses. Treatment studies can suggest short term can have a 50-70% success rate.