unit 8: weight management Flashcards
fat free mass
body’s non fat tissues: bone, water, muscle, connective tissue, organ tissues, teeth
3 types body fat
subcutaneous fat, visceral fat, ectopic fat
subcutaneous fat
fat located just beneath the skin
-protective for a variety of diseases
-represents the normal physiological buffer for excess energy intake
-80% of body fat in subcutaneous area
visceral fat
-embedded within the mesentery (tissue that connects the intestines to the back of the abdominal wall) surrounding the abdominal organs
-excess linked to cardiovascular and a host of other diseases
-accounts for 10-20% of total fat in men and 5-8% of fat in women
-increases in age
ectopic fat
located on or within organs: liver, heart, brain
-increases the risk for metabolic syndrome, heart disease and stroke
energy balance
- energy in = energy out to maintain current weight
-taking in more calories than burning (positive energy balance)
-taking in fewer calories than burning (negative energy balance (lose stored fat + weight)
-energy in (food cals), energy out (PE: 20-30%, food digestion: +- 10%, resting metabolism: 65-70%)
height weight charts
-list a range of ideal or recommended body weights associated w/ lowest morality of a particular sex, age, and height)
-highly inaccurate for some ppl as it provides only an indirect measure of body fat
BMI
-useful for classifying the health risks of body weight
-weight should be proportional to height
-frequently use BMI in conjunction w/ waist circumference in studies that examine health risks associated w/ body weight
-doesn’t distinguish fat/fat free weight
-not useful in tracking changes in body comp- muscle mass and loss of fat
18.5-24.9 = normal
25-29.9 = overweight
30-34.9 = obese class I
35-39.99 = obese class II
40+ = class III obese
less than 18.5 = underweight
17.5 or lower = anorexia nervosa
hydrostatic weighing
- a person is submerged and weighed underwater
-% body fat can be calculated from body density
-muscle has higher density and fat is lower density than water
-more fat = float and weight less under water
-lean= sink and weigh more underwater
bod pod
like hydro static weighting but uses air
-person sits in a chamber and computerized pressure sensors determine the amount of air displaced by the person’s body –> can calculate body composition
skinfold measurements
measures the thickness of fat under the skin
-taken at several sites and plugged into formulas that calculate body fat percentages
-accuracy is highly dependent on expertise of practitioner
circumference measures
waist circumference and waist to hip ratio measures abdominal obesity and predict health risk
- waist cir of greater than 40 in for men or greater than 35 in for women is increased risk for chronic disease for most adults
-waist to hip above 0.94 for young men and 0.82 for young women is associated w/ increased risk of heart disease and diabetes
electrical impedance analysis
-electrodes are attached to body and a harmless electrical current is transmitted from electrode to electrode
-conduction favours fat free tissues over fat tissues where it is calculated by computer (% and measurements of current)
scanning procedures
-expensive equipment
-CT, MRI, dual energy X ray absorptiometry (DEXA), dual photon absorptiometry, infrared reactance (Futrex 1100) and total body electrical conductivity (TOBEC)
smart scales
-easy to use
-not as accurate for body composition than body weight
-helps with self monitoring at home
health risks of excess body fat
-increased mortality and reduces lifespan by 20 years
-associated w/ unhealthy cholesterol and triglyceride lvls, impaired heart function and death from cardiovascular disease
- hypertension, cancer, impaired immune function, gallbladder and kidney diseases, skin problems, impotence, sleep and eating disorders, back pain, joint pain, arthritis
-psychosocial disorders, depression, low self esteem, body dissatisfaction, weight bias, stigma, bullying
-DIABETES (type 2) –> kidney failure, nerve dmg, circulation problems, amputations, retinal dmg, and blindness, increased rates of heart attack, stroke, and hypertension
5A’s of management
ASK for permission to discuss weight and explore readiness
ASSESS obesity-related risks and root causes of obesity
ADVISE on health risks and treatment options
AGREE on health outcomes and behav goals
ASSIST in accessing appropriate resources and providers
distribution of body fat
-fat in abdominal areas: men and postmenopausal women
-premenopausal women –> hips, buttocks, and thighs
-risk of abdominal area: high blood psi, type 2 diabetes, early onset heart disease, stroke, certain types of cancer and death
-reason is bc abdominal fat is more easily mobilized and sent into bloodstream
-abdominal obesity and any 2 other risk factors associated w/ cardiovascular health put an individ at risk for metabolic syndrome
body image
- the collective picture of the body as seen through the minds eye, consisting of perceptions, images, thoughts, attitudes, and emotions
-negative: dissatisfaction w/ body in general or some parts
problems associated w/ very low lvls of body fat
- reproductive, circulatory, immune system disorders (8-12% for women) and 3-5% for men
-muscle wasting, fatigue, dangerous eating disorders
-female athlete triad: abnormal eating patterns, lack of menstrual periods, decreased bone density
factors contributing to excess body fat
-genetic, physiological, lifestyle, psychosocial factors
nutrigenomics (genetics)
study of how nutrients and genes interact and how genetic variations can cause ppl to respond differently to nutrients in food
-40-70% heritability in children
-50+ genes associated w/ obesity
- if both parents have obesity, children have 80% risk
-one parent, 40% risk
-must be balanced with environmental factors
–> TENDENCY is inherited but expression is affected by environment and behav
physiological factors
metabolism: sum of vital processes by which food energy and nutrients are made available to and used by the body
-resting metabolic rate (RMR): energy required to maintain vital body functions (heart rate, body temp, blood psi at rest)
-counts for 65-70% of daily energy expenditure
-energy required to digest food accounts for additional +- 10% of daily energy expenditure
-20-30% is expended through physical activity
-heredity and behav affect metabolic rate as well as weight loss/gain
-higher rmr burns more cals at rest and can take in more cals without gaining weight
-losing weight decreases RMR and energy required and reverse happens when weight is gained
-exercise has positive effect –> increase RMR and increase muscle mass–? higher metabolic rate, burns cals, raises total energy energy expenditure
hormones
-leptin (bodys fat cells) lets brain know how big or small the body’s fat stores are which lets brain regulate appetite and metabolic rate accordingly
-ghrelin: released by stomach, responsible for increasing appetite
fat cells
more visceral and ectopic fat = greater chances of developing insulin resistance, metabolic syndrome, type 2 diabetes, heart disease
-metabolically active
subcutaneous fat carries little or no health risk. lies under skin and tends to be soft and flabby
-lower body (gynoid obesity) –> hips, upper thighs and buttocks “pears”
-visceral + ectopic –> upper body “apples” (android obesity)
-apples bad and pears good
lifestyle factors
-increased eating (cal intake, high sugar, high fat, high cal, big portion, fast food, low in nutrients), decreased physical activity (cut PE and recess, technology, increased sedentariness, sleep (short sleep, increased snacking and overall energy intake)
obesogenic environment
promotes overconsumption of cals and discourages physical activity
-food and activity are influenced by socio economy status, religion and culture and geographic location
-ppl w/ few opp for physical activity/ healthy lifestyle dont have the same options as some do in more enriched environments
-vending machines, consession stands, sports areas promotes unhealthy processed foods at minimal cost and full convenience and higher pref for younger age and thus making unhealthy lifestyle choices
-endocrine disrupting chemicals ( EDCs) disrupt the bodys control over fat production and energy balance, and increase one’s susceptibility to diseases such as obesity and diabetes
–> diethylstilbestrol, bisohenol, phthalates, organotins, obesogens found in manufactured products (cosmetics, plastics, lubricants, champoos, pesticides, and paints
-
how to curb neg influence of obesogenic environment
-cal count on menus
-banned hydrogenated oils
-changing food pricing to promote healthful options
-limiting advertising of unhealthy foods targeting children
-fund strats to promote physical activity by creating more walkable communities, parks, and recreational facilities
diet
daily food choices
health halo effect
when we overestimate how healthy an item is based on a single claim such as being organic, fat-free, or low in cals. we overconsume the item and often feel less guilty doing so bc we perceive it to be good for us
energy density
the number of cals per gram of food
how to reduce energy density
-eat fruit w/ breakfast and for desert
-add extra veggies to sandwiches casseroles, stir fry dishes, pizza, pasta dishes, and fajitas
-start meals w/ a bowl of broth-based soup and includes a green salad or fruit salad
-snack on fresh fruits and vegetables rather than crackers, chips, or other energy-dense snack foods
- limit energy dense foods (fried, high in added sugars)
5 key principles for obesity management
-it is a chronic disease that requires long-term management
-management is more than just reducing #’s on a scale- its about improving overall health and well being over the long term
-an important part of obesity management is identifying and addressing root causes for weight gain and removing road blocks
-every individ defines success differently
-work towards your “best” weight
-recommended diet should be safe and balanced, include all food groups and meet the daily recommended intakes (DRI’s) for all nutrients. reg physical activity and exercise should be strongly encouraged
BDD
-body dysmorphic disorder
-extreme dissatisfaction of body image and develop disordered eating
-underrecognized and underdiagnosed
begins before age 18 but can occur in adulthood
-overly concerned w physical appearance, focusing on slight flaws that are not obv to others
-low self esteem
-related to ocd and leads to depression, social phobia, and suicide
muscle dysmorphia
-distorted body image
-exp by body builders and athletic ppl seeing themselves as small and out of shape when they are muscular
-may let obsessive bodybuilding interfere w work and relationships
-may also use steroids and other potentially dangerous muscle building drugs
eating disorder
a srs disturbance in eating patterns or eating related behav, characterized by a neg body image and concerns abt body weight or body fat
-anorexia, bulimia, binge-eating, other specified feeding or eating disorder (OSFED)
-central feature: dissatisfaction w/ body image and body weight
–> distorted thinking, perfectionistic beliefs, unreasonable demands for self control, excessive self-criticism
-heredity plays a role (more than 50% of risk) tendency of this expression is explained by home environment, cultural factors, how one views oneself, turning points in life (stresses)
anorexia nervosa
-characterized by the refusal to maintain body weight at a minimally healthy lvl and an intense fear of gaining weight or becoming fat; self starvation
-1% of north americans, 90% are female
-appears during puberty/late teenage years
characteristics:
-may binge and purge
-vigorous and prolonged exercise
-own diet is extreme but may view food with interest
-may hide or hoard food w/o eating it
-typically introverted, emotionally reserved and socially insecure
-entire sense of self esteem may be tied up in evaluation of body shape and weight
health risks:
-females stop menstruating, intolerant to cold, low blood psi and heart rate, dry skin, swelling of feet and hands and may take on a blue tinge
-body turns to its own organs for a desperate search for protein
-death can occur from heart failure caused by electrolyte imbalances
-1/10 die from starvation, cardiac arrest or other medical complications –> highest death rate for any psychiatric disorder
-33-50% have a comorbid mood disorder (depression), 20 % of fatalities have been suicides
bulimia nervosa
-recurrent episodes of binge eating and purging - overeating and then using behavs such as vomiting, laxatives, and excessive exercise to prevent weight gain
characteristics:
- binge: may rapidly eat thousands of calories
-feel as thought they have lost control and cannot stop or limit how much they eat (some occasionally; others do so many times every day)
- very uncomfortable around food but appear to eat normally
-food acts as an anesthetic and blocks all feelings and afterwards feel physically drained and emotionally spent
-stress may trigger binge/purge cycle (major life changes)
health risks of bulimia nervosa
- vomited stomach acids erode tooth enamel
-dmg to liver and kidneys due to repeated vomiting –> arrythmia
-chronic hoarseness and esophageal tearing w bleeding
-(rarely) rupture of stomach
- women: weight loss can cause menstrual problems
increased depression, excessive preoccupation w/ food and body image, disturbances in cog functioning
binge eating disorder
-lack of control over eating behav in general
characteristics:
-uncontrollable eating –> feelings of guilt and shame w/ weight gain
- eating more rapidly than normal , eating until uncomfortably full, eating when not hungry, and preferring to eat alone
-see rigid dieting as the only solution to their problem
-food is used as a means of coping w stress, conflict, other disorder
-begins in childhood
-disordered feelings w family and how they reward/punish w food
health risk
-obesity –> face all health risks of obesity
-higher rates of depression and anxiety
other patterns of disordered eating
-OSFED (other specified feeding or eating disorder)
- include individuals who did not meet explicit diagnostic criteria for anorexia nervosa or bulimia nervosa but still experienced a marked eating disorder.
-ex. atypical anorexia, bulimia limited duration, purging disorder, night eating syndrome
-avoidant restrictive food intake disorder (ARFID) selective eating disorder
–> similar to anorexia but dont share the same fears of body shape and weight
–> new dsm 5 diagnosis
-orthorexia: extremely obsessed with healthy eating that its dmging
-not in the dsm
-compulsive about checking ingredient lists and nutritional labels and exhibit an inability to eat anything not on their narrow list of foods that they have deemed “pure” or “acceptable”
treating eating disorders
- anorexia: averting a medical crisis by restoring body weight then address psychological aspects
-bulimia/ binge eating: stabilizing eating patterns then identifying and changing the patterns of thinking that led to disordered eating/improving coping skills then address depression and anxiety
-timely professional treatment
-combo of psychotherapy and medical management
- support or self help group
-hospitalization may be necessary
