Weight Management - PDF

Overweight and Obesity Obesity, worldwide, affects 1.9 billion adults and 41 million children younger than age 5 In Saudi Arabia (2018): – Prevalence of obesity (BMI ≥ 30): 24.1% in men; 33.5% in women Increasing rates of obesity in countries around the world reflect a global food...

Overweight and Obesity Obesity, worldwide, affects 1.9 billion adults and 41 million children younger than age 5 In Saudi Arabia (2018): – Prevalence of obesity (BMI ≥ 30): 24.1% in men; 33.5% in women Increasing rates of obesity in countries around the world reflect a global food system that delivers an abundance of energy-dense, processed, affordable, and effectively marketed products Obesity in children of Saudi Arabia As per MOH the percentage of children who suffer from overweight and obesity in the Kingdom in 2012 was: Children under five: 15% are overweight. 6% suffer from obesity. Children five years and older: 23% are overweight. 9.3% suffer from obesity  Overweight and Obesity Overweight is when one’s BMI exceeds: a) 20 b) 23 c) 25 d) 30  Fat Cell Development Fat is stored in adipose tissue. The number and size of fat cells increases when energy balance is positive. As fat cells enlarge, it stimulate cell proliferation, meaning the number of cells increases. If energy balance becomes negative, the number of fat cells remains the same. – People with extra fat cells tend to regain lost weight rapidly Ectopic fat disrupts normal metabolism and contributes to disease.(Which organs?) – fat that accumulates outside of adipose tissue  Fat Cell Metabolism Lipoprotein lipase (LPL) removes triglycerides from the blood for storage in both adipose tissue and muscle cells. Obese people have more LPL activity in their fat cells, compared to lean people. – makes fat storage especially efficient – modest excesses in energy intake have a more dramatic impact on obese people than on lean people. Women have higher LPL levels in the breasts, thighs, and hips. Men have higher LPL levels in abdominal fat cells. After weight loss, LPL activity in adipose tissue increases. – people who lose weight regain it easily  Types of fat: 1- White adipose tissue stores fat for other cells to use for energy. 2- Brown adipose tissue releases stored energy as heat defending against cold and preventing obesity. important in newborn infants and in animals exposed to cold weather brown fat activity declines with age and with obesity – overweight and obese individuals have less brown fat activity than others 3- Brite adipocytes: white fat cells with brown fat cell characteristics; also called beige adipocytes – Contain active uncoupling proteins – more abundant than brown fat cells in adults – Physical activity triggers browning (transformation of white fat cells into brite fat cells)  Set-Point Theory After weight losses, the body adjusts its metabolism to favor weight regain – The decrease in the metabolic rate after weight loss is greater than would be expected based on body composition alone. Causes of Overweight and Obesity 1- Genetics and Epigenetic 2- Environment A- Genetics and Epigenetics Genes interact with diet and activity patterns that lead to obesity. They also play a role in metabolic pathways that influence energy balance and satiety. Environmental factors like diet and physical activity influence gene expression. – Epigenetics video – You cannot change the genome you inherit, but you can influence the epigenome Genetics may determine a person’s susceptibility to obesity  Obesity Gene Gene named ob – Where? expressed primarily in the adipose tissue – Codes for the protein leptin Satiety hormone Acts as a hormone in hypothalamus Promotes negative energy balance and a decrease in body weight and fatness  Suppresses appetite  Increases energy expenditure  leptin levels increase as body fat increases.  Leptin sensitivity decreases (leptin resistance)  Why not given in form of pills? Leptin injections reduce body weight in animals and humans – Rare genetic deficiency of leptin or receptor mutation in humans  Ghrelin A hormone secreted by the stomach cells – Hunger hormone – Acts on the hypothalamus – Increases appetite – Promotes positive energy balance and an increase in body weight and fatness. – Two main factors play role in ghrelin: 1- Psychological mindset : influences ghrelin’s response to a meal 2- Sleep Lack of sleep increases ghrelin and decreases leptin  B- Environment Obesity reflects interaction between genes and the environment – Obesogenic environments circumstances that we encounter daily that push us toward fatness B1- Overeating – Past and present eating and activity patterns influence current body weight – Food availability – Portion sizes  Restaurant food  B2- Physical Inactivity Modern technology has replaced physical activity – watching television, playing video games, and using the computer Sedentary activities contribute to weight gain in several ways – require little energy beyond the resting metabolic rate – replace time spent in more vigorous activities – watching television influences food purchases and correlates with between-meal snacking on the high- kcalorie, solid fat and added sugars foods and beverages most heavily advertised  Physical Inactivity People must be physically active if they are to eat enough food to deliver all the nutrients they need without unhealthy weight gain to prevent weight gain, the DRI suggests an accumulation of 60 minutes of moderately intense physical activities every day in addition to the less intense activities of daily living  Consequences Most obese people do not successfully lose weight and maintain the loss, in which it has different consequences: 1- Social consequences – Discrimination in Jobs, school, and social situations. – Judged by appearance more than character. – negatively stereotyped as lazy and lacking in self- control. – Discrimination can exacerbate overeating 2- Psychological problems – Embarrassment, rejection, shame, depression  3- Health Risks Weight loss is recommended for people who are obese (BMI =30) and for those who are overweight (BMI 25 to 29.9) with one or more of the following obesity related risk factors: – Hypertension – Fatty liver disease – Abnormal blood lipids – Diabetes or prediabetes – Sleep apnea  Dangerous Interventions 1- Diet books and weight- loss programs – Ineffective – unsubstantiated claims and deceptive testimonials 2- Fad diets – popular eating plans that promise quick weight loss severely limit certain foods or overemphasize others for example, never eat potatoes or pasta, or eat cabbage soup daily  Dangerous Interventions 3- Weight-loss products – Herbal and dietary supplements  consumers cannot assume that an herbal product or dietary supplement is safe or effective just because it is available on the market  Do not need FDA approval  Not tested for safety or efficacy  Often contain undeclared ingredients  serious consequences such as seizures and heart attacks 4- Other gimmicks – Hot baths to speed up metabolism dehydration  Weight-Loss Strategies Successful treatment includes – Healthy eating, physical activity, supportive environment, and psychosocial support (1st line therapy) Reasonable rate of weight loss – 0.25 to 1 Kg/ week – 5 to 10 percent of body weight over 6 months  More beneficial and sustainable than rapid losses – Modest losses improve disease related factors Improv blood glucose lower blood pressure and blood lipids – Daily healthy eating and activity yields success  Eating Patterns No single food plan is magical, and no specific food must be included or avoided in a weight- management program. Consider foods that you like or can learn to like, that are available, and that are within your means Creating a healthful eating pattern is the first step  Eating Patterns Be Realistic about Energy Intake – Rapid weight loss usually means excessive loss of lean tissue, a lower BMR, and rapid weight regains to follow – A deficit of 500 to 750 kcal /day is reasonable and recommended by increasing activity and reducing food intake This rate of weight loss supports fat loss while retaining lean tissue – In general, weight-loss diets need to provide 1200 to 1500 kcal/d for women 1500 to 1800 kcal/d for men  Eating Patterns Lower Energy Density – Can mean increasing quantity of food eaten Water – increase fullness, reduce hunger, and consequently reduce energy intake  Eating Patterns Focus on plant-based foods – Lower energy, higher nutrients and fiber Choose fats sensibly – Energy density and satiation Select carbohydrates carefully – Limit added sugar and sugary beverages – Caution artificial sweetener use Watch for empty kcalories – Fat, sugar, and alcohol  Eating Patterns – Breakfast frequency is inversely associated with obesity and its associated risk factors people who regularly eat breakfast have a lower BMI, blood pressure, and blood lipids than those who tend to skip breakfast Emphasize Nutritional Adequacy – difficult to achieve on fewer than 1200 kcal/d Eat Small Portions – feeling satisfied, not stuffed Slow Down – Eat for pleasure chewing thoroughly reduces amount eaten before satiety hormones “kick in”  Physical Activity Support weight management – Physical activity recommendation 200 to 300 min/ moderately intense physical activity /week in addition to activities of daily living – Advantages of diet and physical activity:  Lose more fat, reduce abdominal obesity  Retain more muscle  Regain less weight  Strength and balance Psychological Benefits of Activity 1- helps reduce stress 2- Self-esteem Choose activities: – Enjoyable – 60 minutes/day of moderate intensity  2000 kcalories per week  Benefit weight management  Energy-expending daily activities Spot reducing: – Specific exercises do not influence the site of adipose tissue loss  Activity Energy Expenditure kcalorie expenditure: – Influenced by body weight, intensity, and duration – Greater energy deficit = greater fat loss kcalorie allowance: – physical activity increases kcalories requirements Metabolism: – Speeds up with activity – Metabolic rate increases due to increased lean tissue  Successful Weight Loss 1. People who consistently Answer: 1. Exercise are more successful at weight 2. a) similar maintenance than people who b) Prevention begins early don’t. Explanation: 2. Preventing weight gain is Forming beneficial eating and activity habits early is easier easier than weight loss. than breaking poor habits later. a) The strategies for both are. b) One major difference is:  Benefits of Physical Activity 1. Changes in body Answer: result from exercise. Body 1. Composition; fat; lean decreases. mass 2. Appetite is suppressed after exercise. Exercise increases, even without doesn’t cause overeating. Exercise can help inhibit weight loss. inappropriate appetite caused by boredom or 2. Explain the effect exercise has anxiety. on appetite.  Behavior and Attitude Behavior modification – Adopt positive, matter- of-fact attitude Healthy eating and activity should be incorporated into daily routines Become aware of behaviors – Keep record Change behaviors – Shopping when hungry – Eating while watching TV  Cognitive Skills Successful behavior changes depend on – Problem solving and cognitive restructuring  Replace negative thoughts – Other health behaviors Personal attitude – Understand personal relationship with food – Identify triggers that prompt overeating  Problem solve to change response Support groups  Drug Treatment for Obesity Strategies for weight reduction depend on: – Degree of obesity and risk of disease Drugs can provide meaningful weight loss – Part of a long-term, comprehensive plan FDA approval – Mandate: “Benefits must exceed risks” Orlistat (Xenical) – Inhibits pancreatic lipase activity in the GI tract, thus blocking digestion and absorption of dietary fat and limiting energy intake Side effects: GI cramping, diarrhea, gas, frequent bowel movements, reduced absorption of fat-soluble vitamins; rare cases of liver injury Surgical Treatments for Obesity Surgery for obesity could be an option for people with all of the following conditions: – Unable to achieve adequate weight loss with diet and exercise – BMI ≥ 40 or BMI ≥ 35 with obesity-related health problems (such as diabetes or hypertension) – No medical or psychological contraindications – Understanding of risks and strong motivation to comply with post-surgery treatment plan Surgical Treatments for Obesity Surgeries decrease stomach size, it therefore limits food intake. Bariatric surgery changes hormone production. Long-term safety and effectiveness depend largely on compliance with dietary instructions. Deficiencies in vitamins and minerals are common Gastric Surgery Used in the Treatment of Severe Obesity  Weight-Gain Strategies Diet planning strategies: Adequacy and balance Select energy-dense foods and extra snacks – milk shakes instead of fat-free milk Regular Meals Daily – eat at least three healthy meals every day Large Portions Exercising to Build Muscles – strength training primarily, and increase energy intake to support that exercise Liquid supplements for illness