Energy Balance, Weight, & Health - Chapter 9 Flashcards
Weight and Health
- Many different shapes and sizes
- Health problems with overweight and underweight
- Several problems with focusing just on weight
- Body composition most related to health
Energy Balance
- Balance occurs when energy in = energy out
- Part 1: Energy intake: foods, beverages
Defining Food Intake Regulation
- Hunger:
- Appetite:
- Satiation:
- Satiety:
Hunger
Physiological need to eat, sensation that demands relief
Appetite
Psychological desire to eat, learned motivation
Satiation
Perception of fullness that build throughout meal
Satiety
Perception of fullness that lingers after meal (inhibits eating until next meal)
Estimating Energy Needs
- Quick and easy estimation of energy needs:
- Males:
- Body weight in kg x 24 = kcal/day - Females:
- Body weight in kg x 22 = kcal/day
- Males:
Food Intake Regulation: Inside the Body
- Hormones:
- E.g. Leptin:
- Appetite suppressing
hormone produced in fat
cells
- Operates on feedback
mechanism
- E.g. Leptin:
What are some external cues that can lead to overeating?
- Wide variety of delectable foods
- Human sensations or emotions
- Time of day
- Stress
What food-related factors can lead to overeating?
- Pricing (cheap food options)
- Availability of food
- Advertising that promotes food consumption
How does physical inactivity relate to energy storage?
Lack of physical activity reduces energy expenditure, leading to excess energy being stored as fat.
Energy Balance
Part 2: Energy Expenditure
Energy Expenditure
- 50-65%: BMR (basal metabolic rate: all activities to sustain life)
- 25-50%: voluntary activity (not included in BMR)
- 5-10%: thermic effect of food (increased metabolism for ~5 hours after eating a meal) (not included in BMR)
Factors That Affect BMR
- Age
- Height
- Growth
- Body Composition
- Fever, stress
- Environmental temperature
- Fasting, Starvation, Malnutrition
- Thyroxin
What is anthropometry in assessing body composition?
It is the measurement of body size and proportions, such as waist circumference.
- Fat fold or skin fold using calipers
What are the healthy waist circumference values for males and females?
- Males: Less than 102 cm (40 inches)
- Females: Less than 88 cm (35 inches)
What is central obesity, and why is it significant?
- Central obesity (android or apple-shaped body) refers to fat accumulation in the upper body.
- It is associated with a higher risk of death from all causes compared to lower-body fat distribution.
What is the difference between android and gynecoid obesity?
- Android obesity:
- Upper body fat, “apple-shaped”; higher health risks.
- Gynecoid obesity:
- Lower body fat, “pear-shaped”; lower risk of health complications.
What does density refer to in assessing body composition?
Lean tissue is denser than fat.
What is underwater weighing used for in body composition assessment?
To determine body volume and density.
What principle does bioelectrical impedance analysis (BIA) rely on?
Lean tissue and water conduct electrical current, helping to estimate body composition.
Which method measures body composition using density?
Underwater weighing.
Which body composition method uses conductivity as its principle?
Bioelectrical impedance analysis (BIA).
What radiographic method is used to assess body composition?
Dual-energy X-ray absorptiometry (DEXA).
What does DEXA measure in assessing body composition?
Total body fatness, fat distribution, and bone density.
What does BMI stand for?
Body Mass Index
For which age group is BMI commonly used?
Adults over 20 years.
What is the formula for calculating BMI?
Weight in kilograms divided by height in meters squared BMI= weight (kg)/height (m)2
BMI & Weight Status Category
- < 18.5
- Underweight
- 18.5 - 24.9
- Healthy weight
- 25 - 29.9
- Overweight
- 30 - 34.9
- Obese class 1
- 35 - 39.9
- Obese class 2
- > 40
- Obese class 3
How does all-cause mortality relate to BMI?
It increases at very low and very high BMI levels.
What happens to mortality risk when moving from overweight to normal weight?
There is not much change in risk.
What happens to mortality risk when moving from obese to normal weight?
There is a significant decrease in risk.
Why is BMI commonly used to measure health?
Because it provides a quick and simple estimate of body weight relative to height.
Why might BMI not be the best measure of health?
It can misclassify people in larger bodies as “not healthy” and people in smaller bodies as “healthy,” even if their actual health status does not match these classifications.
What is a limitation of BMI in assessing health?
It does not account for factors like muscle mass, fat distribution, or overall fitness.
What lifestyle changes did John and Linda make to improve their health? (But Do I Need to Lose Weight?)
They gave up soda and started walking together for 30 minutes in the evening instead of watching TV.
What were the health outcomes for John and Linda after their lifestyle changes?(But Do I Need to Lose Weight?)
John lost 10 pounds in 2 months, but Linda’s weight did not change.
Does weight loss alone determine health improvements? (But Do I Need to Lose Weight?)
No, health improvements can occur through better habits like regular exercise and dietary changes, regardless of weight change.
Is John healthier than Linda because he lost weight? (But Do I Need to Lose Weight?)
Not necessarily—both may have improved their health through lifestyle changes, even if Linda’s weight didn’t change.
What factors affect weight?
- Genetics
- Age
- Hormones
- Some Medications
- Some Medical Conditions
- Family habits and culture
- Social Determinants of Health
- Many others
Determinants of Health (Definition)
A broad range of personal, social, economic, and environmental factors that
determine individual and
population health
Core Determinants of Health
- Income and social status
- Employment and working conditions
- Education and literacy
- Childhood experiences
- Physical Environments
- Social supports and coping skills
- Healthy behaviors
- Access to health services
- Biology and genetic endowment
- Gender
- Culture
- Race / Racism
Health inequalities
Differences in the health status of individuals and
groups
Health inequity
- Health inequalities that are unfair or unjust and
modifiable- Example:
- Canadians who live in remote or northern regions do not have the same access to nutritious foods such as fresh fruits and vegetables as other Canadians
- Example:
Do I Need to Lose Weight?
- Diets don’t work and can be harmful; many will report weight regain after dieting
- Dieting results in:
- Lower metabolism; we store fat more easily from eating fewer calories
- Increased hunger and food cravings
- Decreased attention span, fatigue, irritability
- Decreased muscle mass
- Poor nutritional intake
- Feeling “obsessed” or fixated on food
- Feelings of failure; reduced self-esteem
- Consumer’s Corner: Fad Diets
Weight Cycling (Increases)
- Mortality / risk of death
- Risk of coronary heart disease, heart attack and stroke
- Risk of type 2 diabetes
- Risk of some types of cancer
- Risk of osteoporotic fractures
- Blood pressure
- Likelihood of over-eating in stressful situations (Polivy, 1996)
- Weight independent of BMI and age
- Inflammation
- Likelihood of binge eating
- Emotional distress
Weight Cycling (Decreases)
- Immune function
- Metabolic rate
- Physical activity (secondary to fatigue, lack of energy, etc.)
- Muscle mass
- Self-esteem
Weight Inclusivity Approaches
- Eat well (eating enough, variety)
- Be active
- Good sleep
- Stress management
- Quit smoking
- Have fun (social connection)
- See your doctor
“I want to lose weight,”
what are they seeking?
- To improve their habits
- Manage a disease or condition
- Feel better (emotionally or physically)
- Build resilience and self-compassion Health is
not perfect
If I don’t lose weight, why
bother with self-care?
- More energy
- Improved stress management
- Better sleep
- Improved digestion
- Good role modeling
for others - Reduced fatty liver
- Lower blood sugar,
cholesterol & blood
pressure - Prevention of
diabetes, heart
attack, stroke - Longer life and
better quality of life
Weight Inclusive Approaches (Part 2)
- Moving towards meaningful change:
- Desires: What do you want to do?
- Abilities: How confident are you?
- Reasons: Why does it matter to you?
- Need: What do you need (resources) in order to act?
What are the two competing viewpoints on weight in North American culture and healthcare?
- Weight Normative
- Weight Inclusive
Food Feature
Promoting Weight-Neutral Approaches to Obesity and
Reducing Weight Stigma
Weight Normative
- People are expected to be one size (dominant group defines)
- Goal is to attain the size defined as worthy/ideal
- If some people must maintain restriction/hunger to maintain lower weight, that is prescribed
- If some people need to organize their lives around maintaining weight
suppression, that is prescribed
Weight Inclusive
- People are expected to be a range of sizes (recognition that dominant group is not “standard” for humans)
- Goal is to accommodate the needs of people of all sizes
- No one is expected to be hungry and all sizes are prescribed adequate nutrition
- No one is expected to sacrifice major quality of life activities in order to organize themselves around weight suppression
Weight Normative (Definition)
- People who differ from normative size have a “disease” i.e., require
explanation - Fat tissue/weight is the focus of change and presumed to be the
most powerful factor for better health
Weight Inclusive (Definition)
- Eventual body size might be the outcome of processes that can be normal or not, but no body size alone is inherently healthy or unhealthy
- How people are treated and
determinants of health are the focus of change and presumed to be the most power factors
How is thinness perceived in sociocultural contexts?
Thinness is historically associated with goodness and social power, reflecting fat-phobic values.
How are individuals in larger bodies treated?
They often face overt and covert poor treatment due to weight bias.
How can weight stigma in health interventions affect individuals?
It can create body-related shame and stress, leading to healthcare avoidance, particularly in women.
What is the cycle caused by weight stigma in healthcare?
Weight stigma → body-related shame → healthcare stress → avoidance
Weight inclusivity
Accept and respect weight diversity
Health Enhancement
Improve and equalize access to information and services, and personal
practices that improve human well-being
Respectful care
Acknowledge our biases and work to end weight discrimination, weight stigma, and weight bias
Controversy 9: Disordered Eating and Eating Disorders
- Do you spend most of your day thinking about food and your body?
- Avoid meals, restrict certain foods, binge eat, or purge after eating?
- Feel guilty or out of control when eating?
- Think that life will only be good if an ideal weight is achieved?
- If you answer yes to any combination of these, you may have an eating disorder or be exhibiting disordered eating behaviours
Controversy 9: Disordered Eating and Eating Disorders ( Physical Signs and Symptoms)
- May vary
- People who have eating disorders come in all shapes and sizes
- Many have been dismissed because they appear to “look fine”
- Don’t underestimate an eating disorder simply
because of someone’s body size or shape
- Eating disorders affect people of all genders
and all ages - It is the behaviours, thoughts, and feelings
that dictate the severity of the eating disorder
Controversy 9: Disordered Eating and Eating Disorders (People with eating disorders may exhibit some of these behaviours)
- Eat very little
- Only eat certain foods or have many “food rules”
- Eat much larger than average amounts of food in a short amount of time
- Eliminate certain foods or entire food groups
- See foods as ‘good’ or ‘bad’ or ‘healthy’ or ‘unhealthy’
- Eat only in private, or alone
- Vomit or use laxatives to get rid of food and lessen
anxiety about eating or weight gain - Buy foods just for a binge
- Think about food constantly, including planning what to eat or not eat
- Extreme or compulsive exercise
Controversy 9: Disordered Eating and Eating Disorders (People with eating disorders may exhibit some of these behaviours - part 2)
- Ask for opinions from other people about their size (“Do
you think I’m fat?”) or eating habits (“Did I eat too much?”) - Spend more time in private
- Exercise alone
- Stop doing activities or avoiding social gatherings if food is involved
- Avoid situations where others might see their body,
like swimming or changing clothes in a communal change area - Exercise even when they are sick, hurt, or very tired
- Exercise or eat at atypical times like in the middle of the night when others are sleeping
Controversy 9: Disordered Eating and Eating Disorders (People with eating disorders may believe)
- Eating food they consider ‘bad’ will make them gain weight immediately
- Missing a workout will immediately change the
shape or size of their body - Life would be different if they had the ‘right body’
- Thinness or fitness is extremely important, no
matter what their actual body size - Their behaviour is normal or healthy; others may feel the opposite – that they are ‘crazy’ or ‘messed up’
Controversy 9: Disordered Eating and Eating Disorders (At-risk Population)
- Athletes: e.g., weight-dependent sports
- Female athlete triad: disordered eating,
amenorrhea, osteoporosis - Seen in sports where weight is important (dancing, gymnastics, figure skating)
- Males can also experience (e.g., wrestling)
- Female athlete triad: disordered eating,
Controversy 9: Disordered
Eating and Eating Disorders (What are key characteristics of anorexia nervosa?)
- Obsession with thinness and intense fear of weight gain.
- Eating very little, resisting hunger, and seeing their bodies as larger than they are.
- May have ritualistic eating or exercising behaviors.
Controversy 9: Disordered
Eating and Eating Disorders (What are common behaviors of people with anorexia nervosa?)
- Think about food or plan meals constantly but avoid eating.
- Cook for others but don’t eat what they make.
- Exercise excessively, even when sick or tired.
- Avoid food-related gatherings, eat alone, and conceal weight loss with layers or baggy clothes.
- Frequently weigh or measure themselves, hide the severity of their behaviors, and cut out specific foods or food groups.
Controversy 9: Disordered
Eating and Eating Disorders ( Anorexia Nervosa)
Anorexia has the highest death rate of any mental
illness. It rarely goes away without treatment. The
longer behaviours go untreated, the harder it can be to change
Controversy 9: Disordered
Eating and Eating Disorders (Health Consequences of Anorexia Nervosa)
- Heart failure
- Hair loss
- Dry skin
- Loss of menstrual
periods - Digestive issues (gas,
bloat, abdominal pain) - Weakness
- Dizziness
- Tiredness
- Growth of downy hair on
the body (lanugo)
Controversy 9: Disordered
Eating and Eating Disorders (Bulimia nervosa)
- People with bulimia nervosa:
- Will try to restrict their food intake in some way
- They then eat and feel extremely guilty, often eating much more than they intend to
- Out of control eating is called binge eating
- After a binge, people with bulimia try to get rid of the calories by vomiting, using laxatives, or exercising excessively
- Will try to restrict their food intake in some way
Controversy 9: Disordered
Eating and Eating Disorders (People with Bulimia often)
- Feel extremely guilty and ashamed of their behaviour
- Have histories of dieting
- Find that bingeing and purging helps calm them
- Feel intensely anxious if they have eaten and cannot
purge
Controversy 9: Disordered
Eating and Eating Disorders (People with Bulimia often - Part 2)
- Visit a bathroom after eating; they may run the water or take a shower so others don’t hear them vomiting
- Seem to prefer one washroom, like a basement
washroom with more privacy - Many people with bulimia hide their behaviour because
they fear being judged by others - Often do not appear outwardly ill so others may not notice their behaviour
Controversy 9: Disordered
Eating and Eating Disorders (Bulimia leads to Serious Health Problem)
- Heart and kidney problems
- Electrolyte imbalance
- Damage to the mouth, throat or teeth
- Gum problems
- Chest pain
- Muscle cramps
- Fatigue
- Laxative use can lead to dependence, as well as bowel
damage and dehydration
Controversy 9: Disordered
Eating and Eating Disorders (Binge Eating Disorder)
- Almost all people with binge eating disorder have a history of dieting
- They may have grown up in a larger body than considered desirable and felt pressure to be smaller
- After dieting for some time, the body’s natural response is to want food
Controversy 9: Disordered
Eating and Eating Disorders (Binge Eating Disorder - Part 2)
- For some, this leads to binge eating
- Dieting is not a solution, and in fact can make the
problem worse - It reinforces the shame people have about their bodies
Controversy 9: Disordered
Eating and Eating Disorders (People who binge)
- Eat a large amount of food in a short period of time
- May eat very quickly
- Feel very ashamed of their bodies
- May eat alone
- Often have weight cycling (weight has gone up and down over
time)
Controversy 9: Disordered
Eating and Eating Disorders (People who binge - Part 2)
- Usually feel very guilty and ashamed of binge eating
- Do not use vomiting, compulsive exercise, or laxatives to try to control their weight
- Feel out of control during binges
- May plan their binges, or it may feel more spontaneous, for example, eating dinner, having dessert, then feeling unable to stop eating
Controversy 9: Disordered
Eating and Eating Disorders ( Binge Eating Disorder - Part 2)
- Many people with binge eating disorder plan to diet through the day, then find themselves very hungry in the evening, and end up bingeing
- Can lead to shame and feeling like they have failed or lack control
- They may resolve to do better the following day
and plan to diet again - While some people with binge eating disorder
have large bodies, some do not - People may be surprised or may not believe them if they share that they binge eat
Controversy 9: Disordered
Eating and Eating Disorders (Treating Eating Disorders)
- First Seek support:
- Manitoba: http://eatingdisordersmanitoba.ca/
- Canada-wide: http://nedic.ca/
- Helpline open until 9pm EST daily
- Toll free: 1-866-633-4220
- It takes a team!
Controversy 9: Disordered
Eating and Eating Disorders (Treating Eating Disorders)
- Treatment is collaborative
- Recovery goals developed collaboratively with each client
- Help identify client’s values apart from the eating disorder, so they can challenge the problematic beliefs and behaviors that are interfering in living their life
Controversy 9: Disordered
Eating and Eating Disorders
(Treating Eating Disorders - Part 2)
- Treatment is individualized
- Team will work with the client towards their recovery goals
- Treatment is supportive
- Addresses physical, psychological, and emotional healing
- Supports behavioural changes, with the goal of unlearning behaviours that are no longer productive for the client
