chapter 14 - weight loss Flashcards
research shows that children near school age respond more to _______
external influences and learn to bypass internal fullness cues
when is eating in response to boredom or stress learned
between age 5 and 9
triggers for overeating
more food set before us
smell or see appetizing food
boredom or stress
how can paents disrupt natural flow of feeding
putting pressur eon children to eat more or less at meals
underweight children who are coerced to eat tend to back away from food while childrens trsticted in diet to lose weight are prone to overeat
“thrifty” gene
help ancestors survive occasional shortages of food
work against us bc food is now abundantly plentiful year around
poor appetite regulation and those who have easil stimulated capacity to store body fat
modern facotrs that result in obesity
sedentary desk jobs
remote controls
elevators
cars
escalatores
time and energy-saving gadgets
24 hour available food
higher fast food and soft drink consumption
reduced freuqency of fmily meals and icnreased [ortion iszes
tv
video games
computers
smartphones
little physical activity
what gland controls hunger
hypothalamusw
what is leptin
recieves signal from fat and intestines to make body feel full so eating will stop
what is ghrelin
released from stomach and singal hypothalamus that its to eat
what are components of enery out
basal metabolic rate
physical acitvity
thermic effect of food
what are factors that affect BMR
age, height, growth cycle, body composition
temperature, fasting undereating, hypothyroidism
___% of US adults report they engage in regulare leisuze time physical acitivt (150 min per week of light-to-moderate activity)
31
bmr percent breakdown
resting energy expenditure: 50-65%
physical acitivty: 25-50%
thermic effect of food: 10%
___% of adults report no leizure physical acitvty
40
only ___% of audlts obtain 30 min of mod or greater intesinty physical acitivty at least 5 days a week when physical acitivty measured by device that detects movement
3-5
adults consume ___ more cal a day in 2010 compared to 1970
450
____ of the population has eating pattern low in veg and fruits
3/4
obesity rates _______ in adults and ____ in children and adolescents from 1980-2000
adults: doubled
children: tripled
rate of obesity in these demographcis increased
men
boys
african american
hispanic women
family in poverty
adults obesity and overwieght
34.9% obese
68.6% obese or overweight
chidlren obese and overeight
16.9% obese
31.8% overweight or obese
definition of obesity
excess fat accumulation udner skin and around organs in body
subcutaneous fat
lower body (pea shape)
visceral fat
badominal area (apple)
higher health risk such as CV disease, T2D, breast cancer risk, and gallbladder disease
bmi ranges
below 18.5 = underweight
18.5-24.9 = healthy weight
25-29.9 = overweight
30 or higher = obese
bmi limits
overwestimate body fat in athletes and muscular buuld
underestimate body fat in older person and others who lost muscle
Hamwi formula
men: 5ft at 106 and add/ subtract 6 lb for every inch above or below 5ft for medium frame man (small frame, deduct 10% and large fram add 10%)
women: 5ft at 100lb (add or subtract 5lb for every inch above or below 5ft) (small frame deduct 10% and for large add 10%)
wrist measurement for medium frame women and man
women - 6 in
man - 7 in
obesity inflammatory condition
inflamation turned on body from increaxing visceral or abdominal fat = cascade of cronic disease
being overweight and obese increase risk for
Coronary heart disease
insulin resistance and T2D
cancers (endometrial, breast, and colon)
hypertension (high bp)
dyslipidemia (high total cholesterol)
stroke
liver and gallbladder disease
sleep apnea and respiratory problesm
osteoarthritis
gynecological problems
low self esteem and negative body image
obese indv pay ___% moer in healthcare costs than normal-weight indv
42
cost of overweight and obesity in US is estimated at $______ per year
270 billion
what is more important to long-term survival, level of fitness or level of obesity?
level of fitness
methods for body fat assessment
skin fold measurement and bioelectrical impedance analysis (BIA) machiens or scales
x=ray analusis (DEXA scan)
water dispalcment methods
error rate for at home fat percentage machiens (BIA)
8%
diet industry worth
60 billion
safe weight loss numbrt
1-2lb a weekh
decrease cal how much to lose weight healthily?
500 to 1000 cal a day
for very obese indv what is safe body weight
1$ body weight weekely
healthy diets
therapeutci lifestyle changes from NIH
Ornish diet
medetarian diet
DASH (Dietart approach to stop hypertension) from NIH
eat highly nutritious fruits, veg, high-fiber grains, heart-healhy proteins such as seafood, beans, v lean poultry, low-fat diary, nuts, seeds, and small amt of oil
hand size for food porition
v lean protien in palm of one palm
highe rfiber grain or healthy starchy veg/ starchy bean disk fit in other palm
fil rest of plate w nonstarchy veg in form of salass, soiupls, and steam or lightly sauteed veg (brocolli, spunach, tomatoes, green beans, cucumbers, mushrooms, carrots, cbbage, peeppers, summer squash (suzcchini lettuce) and onion
serving of friut, milk, and healthy fat
popular diets
Mayo Clinic Diet
volumetric diet
weight watchers
the biggest loser diets
count cal or fat grams
weigh and measure foods
pros and cons of low carb (<100g/day; Atkins, South Beach, Protein Power)
Pros: Rapid intial wt loss, low circulating glucose, drop in lipds
cons: most initail weight loss is water; poor stamin and ketosis; atkins high in unhealthy fat; high protein taxes kidnets; no higher wt loss compared to low fat; artificial sweetener; hard to followe
extremelt low fat (<20% cal from fat; T-factor, Pritikins, Ornish)
pro: wide variety of wholesome foods allowed at normal portions; reduced risk of heart disease and cancer
cons: satiety and palatability may be of concern; decreased absopriton of fat-siltuion vitamins abd nuberaks
novel diets promotng certain nturients, foods, or combinations
pros: may promote rapid wt loss
cons: nutritionally inadequate; doesnt promote permanent change in food habits or body weight
paleo - hunter, gather diet
pros: makes you feel full, good wt loss and control of blodod sugar and bp
cons: low in calcium, vitmain D, b-vitamins, possbilty folate; expensive bc high meat, poultry, and seafood intake; nutritious food off limits such as legumes whole grains and dairy
fit for life
pros: encourages veg
cons: teaches food combining and diet low in calcium, zinc, iron, vitamin B12 and D
enter the zone
pros: six small eating session = steady supply of energy
cons: low in fiber, marginal in some nutrients, portrays some high-gylcemic foods as dangerous even if they may have merit nutritionally
very low cal (<800 cal/day) or formula (optifast, mdifast, cambridge)
pros: quick wt loss, eliminate behavior cues and food decision
con: low cal diet can be dangerous if not monitored; doesnt foster long term behavior changepre
premeasured (jenny craig, nutrisystem)
pro: get safe and effective; eliminate decision making abt eating
con: expensive; clients may have trouble transition to home-cooked meals
plateu period
weight doesnt decrease further
yo=yo effect
swings in binging and dieting
motivational interviewing
evidence -based conversational counseling style to help ppl plan for and begin the process of changing
express empathy
rolling w resistance (reflect w clients resistance)
develop discrepancny (help client understand how deeply held vales are different than current behavior)
support self-efficiacy (biuld confidence that change is possible)
bheavior patterns that influence energy balance
skipping breakfast
eating in front of tv
late night snacking
lack of adeqate sleep
being too rushed to exercise
eating to help manage stress or difficult emotons
behavioral straegies for wt loss
- specific realistic goals to address changes in eating and exercise
- establish new routines
- record of food intake and amt of physical activity
- include emotions surrounding eating patterns + hunger and satiety levels
- change surroundings to avoid overeating (avoid eating in front of tv, pantry of healthy foods, balance poritons of food to work)
- reward success in a non-food way
- support from healthcare provider, friend, or spouse
- weight only once a weak (measure w tape measure if scared of tape)
exercise benefits
loers risk of chronic disease + help improve bp
strenghtens lungs and help them to work more efficiently
builds and strehtnens muscles and keeps joint in hood conditions
may slow bone loss
increases energy levels and bilds self confidence
helps in relaxation and coping skills by reducing stress and possibly lessenign depression solid sleep havbits
boost immunity
how much activity necessary
good health and reduce risk of disease - 30 min of mod physical activity daily
maintain body weight - 60 min mod to vigourous
weight loss - 60-90 min daily mod activity
break exercise into 15 min increments
who are prescirption weight loss drugs for
BMI above 30
BMI above 27 w associated sieases (hypertension, T2D, dyslipidemia)
appetite suppressants aproved for only short use
reevalulate every.3 monthsm
Orlistat
Xenical (prescription)/ Alli (OTC)
lipase inhibitor that prevents absorption of fat from food in body
side effects: gassiness, oily bowel movement, bowel-related changes, liver malfunction, yellow skin or eyes, itching, loss of appetite
modest reuslts
Lorcaserin
Belviq
acts on receptors in brain that promote feeligns of fullness, encouraging users to eat less
cant be used w SSRIs
sid effects = drowsiness, headche, and constipiation
when combined w diet and exercise, users lost 3-3.7% moreP
Phentermine + Topiramate
sold under name Qsymia
phentermine - stimulate that decreases appetite
Topiramate: antis-eziure and migrain drug thatalso decrease appetiet due to feeling of early satiety
women of child-bearing age must use birh contorl due to issues w possible birth defects
lost on avg 9% of ody weiht
Bupropion + Naltrexone
Contrave
targets brain’s hypothalamus
controls hunger and brain circuity involving reward activity incuding eating
initially rejected bc risk of long-term effects on heart and CV system
black box warning (increased risk of suicidal thoughts)
42% lost at leazt 5% body weight
Liraglutide
sold under Saxenda
black box warning as animal studies sow it cuases thyroid tumrs
62% of uers lost 5% or more of body weight
adjustable gastric band (AGB) surgery
smal lbracelet-like band is placed around top of stomach to rstrict size of opening from throat to stomach, reducing food intake (size of opening cotrolled via balloon)
Roux-en-Y gastric bypass (RYGB)
food intake limited as surgeous create small pouch for stomach
pouch (size of walmut) connect diff pat of intestine (bypass the stomach and duodenum) therby changing the way food is absorbed
Vertical sleeve gastrectomy (VSG)
newer proceudre
remove much of stomach in vertical fashion allowing only tubular sleeve shaped stomach that empties into duodenum
bc so much stomach rremoved there is less ghrelin which reduces hunger more than banded gastroplasty
Biliopancreatic diversion w duodenal switch (BPD-D)
done 6-18 month after sleeve surgery (staged approach)
rerout sleeve from much of small itnestine and diverting bile and gastric juices to change digestion and absorption
whio is bariatric surgery an option for
BMI > 40
BMI > 35 w serious health problem (linked to obesity - T2D, heart diesae, severe sleep apenea)
gastric band for pt w BMI ? 30 w at least one other condition linked to obesity
before bariatric surgery
clients must show proof they tried traditional methods of weight loss and failed
psych eval to determine if proper candiate and can respond well to wt loss and change in body image
require clients to demonstrate full understanind of undertakng and motivation to follow extensive food, exercise, and medical guidance
side effects to bariatric suergery
bleeding
infection
leaks from site where intestines are sewn together
diarrhea
blood clots in legs that can move to lungs and heart
nutrient deficienct - vitamin B12, iron, vitamin D, and folate
(200% of daily value of nutrient given in multi vitamin along w sufficient calcium a d vitamin D; B12 fiven sublinguily)
dumping sydrnome - cramping after higher-fat, higher-sugar foods
lactose intolerance, hair loss, taste changes
15% complication rate
after bariatic surgery
1 oz size stomach pounc htath takes 6-8 weeks to health
begin high protein liquid diet for 2-3 weeks then trnsition to soft-solid protein for another 4-6 weeks
then soft, moist whole foods
musust comsume fliuds spereatel y from meals and take 30-60 kin to eat
barietric pt daily diet after 6087 week healing period
64oz fluid
protein at 60-80g via soft, chopped, or ground meat, fish or poultry, or other protein source (intoleranct to red meat)
- three sevings of fruit and veg (difficulty w raw forms)
- three sevings of whoel grain (1/2 c is one serving) (some may have difficulties w rice, pasta, or doughy breads)
- overall focus is low-fat, low-sugar, high-rptoein
when is wt los surgery considered successulf
50% excess wt loss and loss is sustained up to 5 years
bariatrci sugery cost
20k to 25k
baloon procuedre for weight loss
temporary implanted balloon device
endoscopically two-conencted ballons are insertedinto stomch and filled w saline
cause full sensatio nwhen only small amt is eating = weight loss
device is allowed to stay in stomch for 6 months then removed
another one is balloon in a pill w tiny cathether attached which is swalloed and saline is pumped to fill baloon (naturally passes thorugh GI tract over time)
—-% of diets fail
95
approx __% of overweight indv find success in long term wt loss when defined as losing at least 10% of intian body weight
20
___% of obse indv are successful at 1 year wt loss maintenance
29.7
solid habits by those who mainted sigfniciant weight loss
78% eat breakfast daily
75% eight themselves at least once a week
62% watch less than 10 hours of tv per week
90% exercise on vg about 1 hour a day
1 in __ chuldren in america are overweight or obese
3
overweight adolescents have ___ change of being overweight or obese adults, increasing to ___% if at leat one parent is overweight or boese
70
80
in AA nd hispanic communities nearly ___% of children are overweih or obese
40
average media time per.US children is ___ hr a day
7.5
bmi percentiles for obesity
btw 85 and 95 pecentile overweight
95th percentil is obese
contributors to overweight and obesity
- skip breakfast
- low fruit and veg intake
- sweetned beverage intake
- excess media time (esp TV in bedroom)
- low physical activity level (sedentary behavior)
- not eating meals together as family
- parnental restirctoin of palatable foods
strateies for childgood weight loss
- provide reliable meals and snacks at table w no food handouts at other times
- model slow, midnful eatings w chidlren being allowed to trust themselves to eat til stisfied
- prepare fresh andbalanced meals w small amounts of treats several tumes a week to prevnet feeling deprived
- consider fiber and nutrient desnitry are esp important for kids experiecning insulin resistance
- plan fun home based activies and encouarge partciapting in sporting activites
- understand need for parental limits on media time = more activity
- healthy habit hcanges are faimly affair
popular programs to improve fitness and health while hatlgin weight gain in cihldren
CATCH program (child and adolescent trial for Cardiovascular health)
LEAP (lifestyle education for activity program)
Project SPARK (Sports, play, and active recreation for KIDS)
youth porogramming at local YMCAs
bariatric surgery for v obese youth
extreme obesity w BMI > 40
adult height (13 yo for girls, 15 yo for boys)
serious health problems linked to weight (T2D, seep apnea)
candidates emotional stabiltiy and his or her willingness to follow through w lifestyle changes
gastric bypass surgery
adjusted gastric banding not approved for those under age 18
how is robert wood honson foundation reversing childgood obesity
- ensure all food and beverages served in school meet or exceed dietary guidleins for americans
- increase access to high-quality and affordable food through new or improved grocery stores and healthier corner stores
- increase time intesnity and duration pf physical tivity during school day and in after-school programs
- increae pysical acitivty by imrpvoing built environment in communities
- using pricing stategies to promote purhcase of healthier food
- reduce youth exposre to marketing of unhealth foods
what causes underweight
anorexia
depression
cancer
tissue wasting
poor absorption of nutrients
infection
excessive activity
hyperthyroidism
faliure to thrive from illness, issues related to swallowing and digestion, lack of feeding support, or imbalanced diet, genetics
may have weaker immune systems, lower muscle mass, compromised bone stats, subtandard nutrition stores
<18.5 BMI (below 5th percentile on BMI)
treat underweight
high cal diet
1lb per week (500 extra cal a day, gain wt lowley, eat a bmit more w every meal and ack, extra vitamin or mineral supplement)
limit high volumic food s(too much bulk, fiber, or water) : salads, broth-based soups, raw veg, ultra-high fiber cereals, light or diet products made w artifical sweeteners, high consumption of water
tips to help w underweight
- eat frquently (5-6 meals per day) to avoid feelign full
- eat foods that are dense in nutrients and cal (nuts, seeds, dried fruit, egg, avo, yogurt) (limit heavy amounts of sugar or unhealthy fats)
- add healthy fat to food such as olive or canola oil or mayo (butter, whole milk, and cheese should be used w more discretion in those w cholesterol concerns)
- pack foods to eat when away from home
- check out high cal snacks like milk shakes, puddlings, dense foods like homeade peantus butter granola
- supplement drinkks to boost cal
- encourage parents of underwt childfen to provide support but not threaten bribe or force feed child
- nvestigate root cause of underweight status
athetles require what ercent of caloreis from carbohydrates
65%
light intensity requires how many grams of carbohydrates per kg
3-5
moderate intensity requires how many grams of carbohydrates per kg
5-7
high intensity requires how many grams of carbohydrates per kg
6-10
very high intensity requires how many grams of carbohydrates per kg
8-12
daily protein requirement for athletes
1.2-2 grams per kg
what percent of cal from protein for maximize muscle growth
15%
what body fat percentage should female athletes maintain
18-24
National Athletic Trainers’ Association (NATA) recommends water guidliens for training and competition athletes
- 2–3 hours before event, consume 17–20 ounces (500–600 mL) fluid * 10–20 minutes before event, consume 7–10 ounces (200–300 mL) fluid * every 10–20 minutes during event, consume 7–10 ounces (200–300 mL) fluid * within 2 hours following event, consume 20–24 ounces (600–700 mL) fluid for every one pound lost through sweat
side effects of anabolic steroid hormones
reason: A male sex hormone used to build strength and add muscle mass
Harmful Effects: Liver disorders, kidney disease, growth disorders, decreased level of HDLs (good cholesterol) and increased level of LDLs (bad cholesterol), high blood pressure, sexual problems, reproductive disorders (men—affects the production and functions of testosterone; women—growth of facial hair, baldness, menstrual irregularities, aggressiveness), unusual weight gain or loss, rashes or hives
side effect of arginine (nitric oxide)
An amino acid supplement used to increase blood flow, improve exercise efficiency, and enhance performance
If taken in excess, may experience headache, nausea, and weakness; other side effects related to allergic reactions include diarrhea and stomach cramps. Doses greater than 30 grams are toxic.
Bicarbonate of soda or soft drinks (soda loading)
Used to avoid muscle fatigue
A form of doping, no confirmed benefits for game performance
caffeine
A stimulant to the central nervous system used to increase endurance during strenuous exercise
May increase fluid losses; increases heart rate; can cause headaches, insomnia, and nervous irritability
carnitine
An amino acid supplement used to improve endurance
Can cause muscle cramps, muscle weakness, and loss of iron-containing muscle protein
human growth hormones
Used to build muscle and shorten recovery time
Thickening of bones, overgrowth of soft body tissues, possibility of grotesque body features
Pangamic acid (sometimes called vitamin B15)
Used to improve efficient use of oxygen in aerobic exercises
Ruled illegal by the Food and Drug Administration, unsafe for humansv
vitamin supplements
Used to feel better and provide a competitive edge
False promises, promotes “pill popping,” costs more than food sources, individual becomes less concerned about eating a nutritious diet
female athlete triad
