Nutrition and weight loss principles Flashcards
The cornerstone of treatment for overweight and obese individuals is ____
lifestyle modification
Commonly, the three major components of a successful obesity treatment program are:
Physical activity
Nutritional programming
Exercise programming
Increased Risk for Obesity-Related Diseases With Higher Body Mass Index
arthritis
heart disease
diabetes (type 2)
gallstones
hypertension
stroke
Increased risk of chronic illness and disease with high %BF levels:
Greater than 32% in women
Greater than 25% in men
Desirable Body Fat Percentage
Lower Limits:
12% in women
> A range of 12% to 17% body fat is necessary for normal menstrual function
> Lower levels can lead to amenorrhea
3% in men = for vital body function
BMI is calculated as the ratio of one’s weight to height:
BMI = Weight (kg)/Height2 (m)
Uses of BMI in the Clinical Setting:
Approximate degree of body fat
Baseline measure against which progress can be compared
Provides potential health-risk factors
Starting point for discussion about the relationship between body fat and chronic disease
Body Fat Percentage Based on BMI
Men average:
20-39 yrs = 8-18%
40-59 yrs = 11-21%
60-79 yrs = 13-24%
Women average:
20-39 yrs = 21-32%
40-59 yrs = 23-33%
60-79 yrs = 24-35%
Limitations of BMI
BMI fails to consider the body’s proportional distribution of body fat and lean tissue
False positives = body builder
False negatives = frail stature
BMI is not a measure of body composition (i.e., percentage of body fat) per se but merely a calculated ratio using height and weight
Body Composition Models
Two-component, whole-body model
1) Fat mass (FM)
2) Free fat mass = body mass – FM = FFM
73.8% water
19.4% protein
6.8% mineral
Organs, bone, muscle…..
Hydrostatic Weighing
Assumed proportions and their respective densities can be used to convert an individual’s total body density (Db) into his or her relative %BF
Calculate fat free weight
Need to know persons % body fat
100% - % body fat= fat free weight
Useful for weight loss planning
Goal weight=fat-free weight
(1−goal % fat)
Example:
Female college student has 30% body fat and weighs 142 lbs. She wants to be at the low end of the healthy range, so her goal is 20% fat
100%-30%=70% fat free (current % fat)
70% x 142 lbs= 99.4 fat-free weight (current)
Goal of 20% body fat= 99.4/1-.20= 124 lbs (goal weight)
Using Caloric Information to Affect Weight
To change weight by 1 pound (0.45 kg), caloric intake must be decreased or increased by ___
3,500 calories
Reduce caloric intake by 250 calories per day and increase daily expenditure (through physical activity) by 250 calories
500 calorie deficit x 7 days = 3500 calories per week or 1 pound
Double for 2 pounds per week:
Weight-loss rate of 1 to 2 pounds per week
Diet and nutrition are key components of primary, secondary, and tertiary prevention of many conditions managed by physical therapists
It is within the professional scope of the physical therapist practice to screen for and provide information on diet and nutritional issues to patients, clients, and the community
This includes appropriate consultation or co-management with or referrals to a registered dietitian when seeking the expert opinion of another provider with specialized knowledge or skills, or to obtain services for
Dietary Guidelines for Americans- Department of Health and Human Services and the U.S. Department of Agriculture
Follow a healthy eating pattern across the lifespan
Focus on variety, nutrient density, and amount
Limit calories from added sugars and saturated fats and reduce sodium intake
Shift to healthier food and beverage choices
Support healthy eating patterns for all
Follow a healthy eating pattern across the lifespan. All food and beverages choices matter
Choose a healthy eating pattern at an appropriate calorie level to help achieve and maintain a healthy body weight, support nutrient adequacy, and reduce the risk of chronic disease
Focus on variety, nutrient density, and amount
To meet nutrient needs within calorie limits, choose a variety of nutrient-dense foods across and within all food groups in recommended amounts
Limit calories from added sugars and saturated fats and reduce sodium intake
Consume an eating pattern low in added sugars, saturated fats, and sodium
Cut back on foods and beverages higher in these components to amounts that fit within healthy eating patterns
Shift to healthier food and beverage choices
Choose nutrient-dense foods and beverages across and within all food groups in place of less healthy choices
Consider cultural and personal preferences to make these shifts easier to accomplish and maintain
Support healthy eating patterns for all
Everyone has a role in helping to create and support healthy eating patterns in multiple settings and support healthy eating patterns in multiple settings nationwide, from home to school to work to communities
Healthy eating patterns includes
Variety of vegetables: dark green, red and orange, legumes (beans and peas), starchy, and other
Fruits: especially whole fruits
Grains: at least half of which are whole grains: Oats are a great option!
Fat-free or low-fat dairy: milk, yogurt, cheese, and/or fortified soy beverages
Variety of protein foods: seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products
Oils: plant based, olive, peanut, coconut, palm, canola, soybean
Healthy eating patterns limits:
Saturated fats, trans fats, added sugars, and sodium = less than 10% of calories per day
If alcohol is consumed, it should be consumed in moderation—up to one drink per day for women and up to two drinks per day for men—and only by adults of legal drinking age
Three components of human daily energy expenditure:
> Basal metabolic rate
Thermic effect of food
Thermic effect of physical activity
Basal metabolic rate =
Amount of energy required for core, resting bodily functions without food
it accounts for about 60% to 75% of daily energy expenditure in a sedentary person
Thermic effect of food =
The energy required to digest, absorb, and store ingested food energy
it accounts for about 10% of daily energy expenditure in most people
Thermic effect of physical activity =
The energy required for physical activity
it represents between 15% to 30% of daily energy expenditure
Daily energy needs (caloric requirement) are determined by three factors:
1) Resting metabolic rate (RMR) between 60% and 75% of the total calories used daily
2) Thermogenesis (amount of calories needed to digest and absorb foods that are consumed
3) Activity energy expenditure – exercise + non-exercise activity thermogenesis (activity not sleeping, eating or sports like exercise)
Estimate RMR
men: = (10 x weight in kg) + (6.25 x height in cm) - (5 x age in years) + 5
women: = (10 x weight in kg) + (6.25 x height in cm) - (5 x age in years) - 161
BMR result may be multiplied by a factor that approximates an individual’s physical activity level (PAL) to estimate their total energy expenditure (TEE)
sedentary or light activity
> PAL = 1.53
> ex) office worker getting little or no exercise
active or moderately active
> PAL = 1.76
> ex) construction worker
vigorously active
> PAL = 2.25
> farmer
Weight loss =
reduce caloric intake by 250 calories per day and to increase daily expenditure (through physical activity) by 250 calories
This 500-calorie difference, when multiplied by 7, creates a weekly negative caloric balance that results in a loss of 1 lb
Most health organizations recommend a weight-loss rate of ___ per week
1 to 2 lb (0.45-0.91 kg)
To lose weight, data indicate that moderate-intensity exercise is the preferred level of exertion:
(~ 60% to 70% of maximal oxygen uptake and 11 to 13 on the ratings of perceived exertion scale (6–20 scale)
Programming exercise for overweight and obese clients must take into consideration ___
their unique needs
Exercise Guidelines:
Many individuals may be severely deconditioned and/or have orthopedic limitations
Establish a reduction in initial body weight of at least 5% to 10% over 3 to 6 months
Non-weight-bearing activities are encouraged = avoid orthopedic risk
Primary mode of exercise should be ___ with resistance exercise included ___ per week
aerobic activities
2-3 times
Initial emphasis of the exercise training should be on ___
duration and frequency
> keep intensity moderate and progressing gradually as tolerated
Frequency of training should be ___
5 to 7 days per week
Progressively accumulate 250 to 300 min/week (~2,000 kcal/week) of moderate-intensity exercise for weight loss and prevention of weight gain
Create a negative energy balance of 500 to 1,000 kcal/day (which is equivalent to a 0.5-1 kg loss of weight per week) This reduction should be combined with a reduction in dietary fat to <30% of total energy intake
Include the use of behavior-management techniques = relapse prevention
Exercise Programming for Overweight and Obese Clients:
Physical activity lasting <150 minutes/week has a minimal effect on weight loss
Physical activity lasting >150 minutes/week usually results in modest weight loss
Physical activity lasting between 225 and 420 minutes/week results in the greatest weight loss
Biomechanical Considerations for Cardiorespiratory Exercise
Combination of weight-bearing (such as walking and elliptical exercise if orthopedically tolerated) and nonweight-bearing (such as cycling and swimming) modes
Individual’s preferences and exercise history
Monitoring of muscle soreness
Identifying any orthopedic problems
Walking as initial exercise
High-quality fitness shoes
Resistance Training
> Increasing muscle mass elevates RMR
> Positive impact of maintaining, or increasing, fat-free body mass while encouraging the loss of fat body weight in a progressive-overload, resistance-training program
Biomechanical Considerations for Resistance Training
Seated exercises are good options
The seats on some exercise machines are not designed for large persons, which may limit the feasibility of using some strength-training equipment
An overweight person may have difficulty getting down to and up from the floor
Certain supine exercises may cause breathing difficulty for some obese clients (by inhibiting the passage of air)
Periodization
planned manipulation of training variables (load, sets, and repetitions) in order to maximize training adaptations and to prevent the onset of overtraining syndrome
Form or resistance training that may be defined as:
strategic implementation of specific training phases
Training phases are based upon increasing and decreasing volume =
reps times sets and intensity based on load or percentage of 1RM when designing a training program
Inverse relationship between intensity (how hard) and total repetitions
Percentage of maximal effort correlates inversely with training volume, implying that, as the intensity increases, the number of repetitions decreases proportionally
Aerobic exercise intensity can use HRR, max HR %, max aerobic capacity (VO2 max), or RPE
volume can be adjusted by duration of the session, as well as frequency of the sessions
Incorporate frequent CR workouts at low intensity for long duration
Include some CR workouts that are of higher intensity for a shorter period (one per week to minimize injury)
Cross train- use variety of exercise modes- minimizes fatigue and overuse of same ms but altering movement patterns
Vary work outs- change the stimulus
