Weight, Energy, and HAES PDF

Weight, Energy Science & Health at Every Size Understand the characteristics of healthful body weight Nutrition science ○ macronutrients contain calories that the body uses for energy carbohydrates fat protein ○ micronutrie...

Weight, Energy Science & Health at Every Size Understand the characteristics of healthful body weight Nutrition science ○ macronutrients contain calories that the body uses for energy carbohydrates fat protein ○ micronutrients iron vitamin A vitamin D helps the body absorb calcium, fight infection, and move muscles vitamin E vitamin K helps with blood clotting and bone health food quality ○ different types of foods contain different nutrient levels, some foods may benefit, some food may not chronic disease ○ overconsumption of poor quality nutrients can contribute to chronic disease states Know the three components that contribute to total energy expenditure (Basal Metabolic Rate, Thermic Effect of Food and physical activity) What influences each of these? What percentage of each is used by the body? BMR-Basal Metabolic Rate ○ represents the rate at which the body expends energy to sustain basic life processes, respiration, heartbeat, blood circulation, etc.. 60-75% of total energy expenditure more lean tissue increases your BMR BMR decreases with age, 3-5% per decade after age 30 ○ factors affecting BMR  increase BMR higher lean body mass greater height younger age elevated levels of thyroid hormones stress, fever, illness male gender pregnancy and lactation certain drugs ○ stimulants ○ caffeine ○ tobacco decrease BMR lower lean body mass lower height older age depressed levels of thyroid hormones starvation, fasting, or very low calorie diets female gender due to decreased lean tissue Thermic Effect of Food ○ represents the increase in energy expenditure associated with the body’s processing of food digestion absorption transport metabolism storage of energy from ingested food 10% of TEE smallest % of energy expenditure Physical Activity- energy expenditure ○ Exercise Activity Thermogenesis this is the calories we burn in physical activity ○ Non Exercise Activity Thermogenesis this is the calories we burn in daily movement including walking, standing, household activities, fidgeting, remaining postural, etc..  ○ energy expenditure is the most variable of components and the only component that is easily altered ○ account for 15-30 % of TEE ○ can be considerably less in an inactive person and considerably more in an active person ○ Total Energy Expenditure What is BMI? What data points are measured in BMI? What are the limitations of BMI as an evaluation method for body weight (you will not need to calculate BMI) BMI- Body Mass Index ○ expresses the ratio of a person’s weight to the square of his or her height ○ BMI= weight in kilograms/ height m2 underweight is defined as BMI ○ 25 obesity is defined as BMI ○ >30 BMI values below 18.5 or above 30 are associated with risks of health problems BMI has flaws ○ results are distorted in people with high muscle mass (athlete) ○ less reliable for older people certain ethnic groups What tools are used to measure body composition? Body composition ○ measurement of body fat and lean body mass not a measurement of BMI ○ Can be measured underwater weighing skinfold measurements bioelectrical impedance analysis  dual energy X-ray absorptiometry (DEXA) gold standard Bod Pod gold standard Know the fat distribution pattern associated with risk of chronic disease. What are its limitations and why? -What might be a better tool than fat distribution patterns to assess health risk? Fat distribution pattern ○ measured by waist to hip ratio and waist circumference ○ disease risk is associated with a waist to hip ratio of higher than 0.90 in men and 0.80 in women body shape fat distribution ○ apple shaped fat patterning- mid body increased risk of chronic diseases type 2 diabetes heart disease hypertension ○ pear shaped fat patterning-lower body some studies show less risk of chronic diseases ○ Body shape comparisons don’t indicate health risks Liver fat is better indicator Insulin resistance, cholesterol abnormalities, and cardiovascular problems ○ Fatty liver is more reliable indicator of health risk Identify factors that contribute to maintenance of body weight; gaining or losing weight Energy intake versus energy expenditure genetic factors composition of the diet metabolic factors physiologic factors cultural and economic factors social factors emotional factors How do our genes impact weight? Body shape and size has a strong influence genetic component more than 127 genes are associated with body weight twin studies in response to overfeeding or energy restriction have shown that some twin pairs lost weight or gained weight more easily than others genetic factors are estimated to account for 40-90% of the population variation in BMI Define the common genetic factor theories as discussed in lecture and explain how they impact weight (FTO gene, set point theory, thrifty gene theory) FTO gene ○ fat mass and obesity-associated gene ○ we now have isolated several genes that are associated with obesity Set point theory ○ proposes that each person’s weight stays within a small range Thrifty gene theory ○ proposes that a gene or genes causes people to be energetically thrifty What hormones impact hunger? What is its role in weight? Hormones play a strong role in weight and metabolism ○ hormones are chemical messengers that affect many processes including growth and development sexual function and reproduction mood metabolism ○ numerous hormones play a role in weight TSH Insulin suppresses hunger insulin resistance can lead to increased feeling of hunger  increased fat storage Sex hormones Cortisol Leptin satiety (Fullness) hormone when it is high you experience fullness and stop eating produced in our fat cells as body fat decreases leptin is reduced so appetite increases as body fat level increases leptin levels increase so appetite is reduced leptin keeps hunger and weight in balance when working properly leptin resistance ○ the body’s inability to properly respond to leptin plays a role in overeating and obesity ○ causes high stress poor sleep overeating high insulin and triglycerides processed foods, sugar, and HFCS toxins yo-yo dieting too little or too much exercise excessive snacking Ghrelin hunger hormone produced by the stomach and duodenum secretions increases between meals when the stomach is empty high levels of ghrelin make us feel hungry returns to normal after eating How do economic and social & cultural factors impact weight? Cultural and economic factors ○ Cultural customs and beliefs ○ changes in work and leisure activity levels ○ cultural norms related to body size ○ lack of health literacy ○ food environment ○ lack of access to affordable, healthful foods Social Factors ○ expectations of family and friends ○ holiday foods, fast foods, and serving sizes ○ television and other sedentary activities ○ work responsibilities ○ media images and social pressures to achieve unrealistic weight goals ○ feelings/emotions ○ trauma addiction, body image issues, chronic dieting, disconnection from the body, inability to feel body cues ○ social factors can override physical hunger/ satiety impacting weight What are the most common approaches to weight loss? Calorie reduction ○ aka “dieting” ○ most common approach to weight loss ○ often focused on limiting calories and may or may not focus on nutrient quality ○ examples keto atkins jenny craig  weight watchers vegan low fat paleo south beach Fad Diets ○ claims rapid weight loss ○ eliminates or severely restricts entire food groups/categories of food ○ requires the purchase of a product ○ involves restrictive calorie counting and/or counting of macronutrients ○ claims to new discovery, secret, or undiagnosed illness ○ may be promoted by a celebrity/ doctor ○ few people stick with fad diets long enough to harm themselves ○ results tend to be short term Pharmacotherapy ○ use of prescription medication to aid in weight loss ○ recommended for people with BMI >30 ○ recommended for people with BMI >27 with comorbid conditions ○ people with waist circumference >35 inches women and 40 inches men are also candidates for pharmacotherapy if comorbidities are present ○ FDA approved Alli Phentermine GPL-1 Wegovy Ozempic Contrave Surgery ○ Bariatric Surgery What are the most common outcomes of diets? Dieters usually lose weight in the short term 6-12 months long term 2-5 years that vast majority of dieters gain the weight back  estimates are 95% of people who diet gain back all or more weight within 5 years researchers determined that most would be better off not going on diet at all Why do people have a hard time keeping weight off in the long run? What mechanisms within the body interfere with people's ability to keep weight off long term? Calorie deprivation leads to changes in hormones, metabolism and cognitive functions that make it difficult to enact the behaviors needed to keep weight off Recognize characteristics of fad diets Claim new discovery, secret, or undiagnosed illness Claim rapid weight loss Eliminates or restricts certain food groups Requires the purchase of specific products may be promoted by celebrity or doctor Identify types of bariatric surgery Surgery to reduce the capacity of the stomach or creating malabsorption of nutrients ○ sleeve gastrectomy staple the stomach and cause malabsorption ○ gastric bypass most restrictive and most complications where you reroute stomach to smaller section ○ gastric sleeve most flexible and least amount of death risk of a band over certain part of the stomach Which are restrictive and which lead to malabsorption Sleeve gastrectomy and gastric bypass are restrictive Can lead to malabsorption What is weight cycling? What are its impacts on the body? Attempts to lose weight typically result in weight cycling a decrease in weight followed by an increase in weight Is more common among obese individuals Results in increased inflammation which in turn increases the risk of many “obesity associated diseases Linked to ○ cardiovascular disease ○ stroke ○ diabetes ○ altered immune function may be as or more dangerous than obesity What are long term diet implications? Gain back the weight in the long run ○ results in increased inflammation leads to increase risk of “obesity associated” What is HAES and what are the principles of the HAES theory Health at Every Size supports people in adopting health habits for the sake of healthy and well being rather than weight control ○ encourages eating in flexible manner that is pleasurable and satiates hunger and appetite find joy in one’s own body and becoming more physically vital accepting and respecting natural diversity of body sizes and shapes  ○ research shows that weight loss programs aren’t effective and cause harm focus on what increases health and longevity targeting people for intervention ○ reduce stigma against people of size; stigma can contribute to health risks What is weight stigma? How does weight stigma impact patients in the healthcare setting? Internalized negative attitudes about weight, increases the risk of ○ hypertension ○ diabetes ○ hyperlipidemia ○ metabolic syndrome ○ eating disorders ○ depression In healthcare ○ larger bodied people may not be able to get the healthcare they need because practitioners may be more focused on influencing their patients to lose weight they don’t focus on addressing their current concerns due to blaming weight ○ patients may feel shame and embarrassment about their weight ○ they may avoid regular medical care due to weight stigma, worsening their health conditions What does a HAES approach look like in a health care setting? Practitioners don’t weigh patients unless medically necessary may not calculate BMI don’t advocate for weight loss interventions ○ creating healthier patterns around food ○ promoting movement ○ treating specific health concerns ○ a do no harm approach ○ discussing behaviors vs body size ○ compassionate and respectful care for all