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Chapter 14

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© 2012 McGraw-Hill Higher Education. All rights reserved.
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Weight Management
 National Institutes of Health
 68% of American adults are overweight
 More than 33.8% of American adults are
obese
 In 2007-2008, 32.3% of adult men and 35.5%
of adult women were obese

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Figure 11.1 Obesity prevalence by age and

sex, of American adults, 2007-2008

Weight Management © 2012 McGraw-Hill Higher Education. All rights reserved.

Basic Concepts of Weight Management 4

 Body Composition
 Fat-free mass and body fat
○ Fat-free mass: bone, water, muscle, connective tissue, organ
tissues, and teeth
 Body Fat
 Essential fat: necessary for body to function
○ 3-5% of total fat in men, 8-12% in women
 Fat Storage
 Adipose tissue: connective tissue in which fat is stored
 Subcutaneous fat: Located under the skin
 Visceral Fat (intra-abdominal fat): Located around major organs
 Factors Affecting Body Composition
 Genetically determined number of fat cells
 Cells can increase or decrease in size depending on
○ Age
○ Sex
○ Metabolism
○ Diet
○ Activity level
 1 pound of fat = 3500 calories
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Energy Balance
 Energy balance is key to keeping a
healthy ratio of fat and fat-free mass
 You take in energy (calories)
 You use up energy (calories)
 Energy in = energy out, you maintain
your current weight
 Energy in > energy out, you gain
weight
 Energy in < energy out, you lose
weight
Weight Management © 2012 McGraw-Hill Higher Education. All rights reserved.
Figure 11.2 The energy balance 6

equation

Weight Management © 2012 McGraw-Hill Higher Education. All rights reserved.

Evaluating Body Weight and Body 7

Composition
 Overweight: Total body weight above
recommended range for good health
 Obesity: A more serious degree of overweight
 Body Mass Index (BMI)
 Based on the concept that weight should be proportional
to height
 Does not distinguish between fat weight and fat-free
weight
 Pros?
 Cons?

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Body Composition Analysis

 Most accurate and direct way to determine
percent body fat
 Hydrostatic (underwater) weighing and Bod
Pod
 Skinfold measurements
 Thickness of fat under the skin
 Electrical impedance analysis
 Electricity prefers fat-free tissue

Weight Management © 2012 McGraw-Hill Higher Education. All rights reserved.

Figure 11.3 Body mass index 9

(BMI)

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Excess Body Fat and Wellness
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 The health risks of excess body fat

 Reduces life expectancy by 10-20 years
 Associated with: Unhealthy cholesterol and
triglyceride levels, impaired heart function, and
death from cardiovascular disease
 Other health factors: hypertension, cancer,
impaired immune function, gallbladder and kidney
disease, skin problems, impotence, sleep and
breathing disorders, back pain, arthritis, bone and
joint disorders
 Strong association with diabetes mellitus: a
disease that disrupts normal metabolism

Weight Management
© 2012 McGraw-Hill Higher Education. All rights reserved.
Body Fat Distribution and Health
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 Apple shape- typical in men

 Pear shape- typical in women
 Assessed by measuring waist circumference
 Total waist measurement of more than 40 inches for
men and 35 inches for women is associated with
increased risk of disease
 Large waist circumference can be a marker for
increased risk of diabetes, high blood pressure, and
CVD, even in people with a BMI in the normal range

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Body Image
 Collective picture of the body as seen
through the mind’s eye
 Perceptions
 Images
 Thoughts
 Attitudes
 Emotions

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Problems Associated with Very Low
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Levels of Body Fat

 Very low body fat is less than 8-12% for
women and less than 3-5% for men
 Extreme leanness has been linked to
problems with
 Reproductive disorders
 Circulatory disorders
 Immune system disorders
 Female Athlete Triad
1. Abnormal eating patterns
2. Amenorrhea
3. Decreased bone density

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Factors Contributing To Excess 14

Body Fat
 Genetic Factors
 25% to 40% of an individual’s body fat
 The tendency to develop weight is inherited,
what you do does matter
 Physiological Factors
 Metabolism
○ Resting metabolic rate (RMR): the energy
required to maintain vital body functions while
the body is at rest

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Lifestyle Factors
 Eating
 Physical activity
 Psychosocial factors
 Emotions
○ Distraction from difficult feelings
○ Helps regulate emotions
○ Coping strategies
 Socioeconomic status
 Family and culture

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Adopting A Healthy Lifestyle For
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Successful Weight Management

 Diet and eating habits
 Total calories
○ MyPyramid suggestions- varies!
○ Best approach for weight loss is combining an increase of
exercise with moderate calorie restriction
 Portion Sizes
 Energy (Calorie) Density
 Eating Habits
 Small, frequent meals
 Set rules to govern your food choices
 Eat in moderation

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Physical Activity and Exercise

 Increasing physical activity is a better
approach to losing weight than cutting
food intake
 Regular physical activity:
 Protects against weight gain
 Maintains weight loss
 Improves quality of life

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Thinking and Emotions

 Low self-esteem
 “Ideal self”
 “Self-talk” can either be self-deprecating
or motivating
 Realistic beliefs and goals

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Coping Strategies
 Appropriate coping strategies help you deal
with the stresses of life and help with
weight management
 Overeating is not an appropriate coping
strategy
 Use food appropriately
 To fuel life activities
 Foster growth
 Bring pleasure
 Find new coping strategies
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Approaches to Overcoming A Weight 20

Problem
 Doing it yourself
○ Lose 0.5-2.0 pounds per week
○ Initial weight loss occurs from fluid loss
○ Smaller, mostly fat, losses later in the diet are better than
initial larger, mostly fluid, losses
○ Reasonable weight loss: 8-10% of body weight over 6
months
 Dietary supplements and diet aids
○ Formula drinks and food bars
○ Herbal supplements
○ Other supplements

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Weight-Loss Programs
 Noncommercial weight-loss programs
 TOPS (Take Off Pounds Sensibly)
 OA (Overeaters Anonymous)
 Commercial weight-loss programs
 Clinical weight-loss programs

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Prescription Drugs
 Appetite suppressants
 All prescription weight-loss drugs have
potential side effects
 Recommended only for people who have
been unable to lose weight with nondrug
options or who have a BMI over 30

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Surgery 23

 Treatment of last resort

 Only for severely obese
 5.7% of American adults qualify as
severely, or morbidly, obese
 NIH recommends gastric bypass for
individuals with a BMI of 40 or higher

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Body Image
 Severe body image problems
 Body dysmorphic disorder (BDD)
○ Affects about 2% of Americans
○ Usually begins before age 18
 Muscle dysmorphia
 Acceptance and change
 Knowing what is a healthy lifestyle change

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Eating Disorders
 Problems with body weight and weight
control
 Characterized by severe disturbances in
body image, eating patterns, and eating-
related behaviors
 Disordered eating affects an estimated 10
million American females and 1 million
males
 About 90% of eating disorders begin during
adolescence. Some begin as young as 8

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Anorexia Nervosa
 Failure to eat enough food to maintain a reasonable
body weight
 Affects 3 million people – 95% are female
 Characteristics of anorexia nervosa
 Fear of gaining weight
 Distorted body image
 Compulsive behaviors and rituals
 Excessive exercise
 Health risks of anorexia nervosa
 Loss of menstruation
 Intolerance to cold
 Low blood pressure and heart rate
 Dry skin covered by fine body hair
 Hands and feet may swell and take on a blue tinge
 Variety of medical complications – electrolyte imbalance, heart
failure, cardiac arrest
 Depression and suicide

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Bulimia Nervosa
 Recurring episodes of binge eating followed by purging
 Begins in adolescence or young adulthood
 Characteristics of bulimia nervosa
○ Rapidly consumes food, then purges
○ Done in secret
○ After a binge, individual feels ashamed, disgusted and physically and
emotional drained
 Health risks of bulimia nervosa
○ Erodes tooth enamel
○ Deficient calorie intake
○ Liver and kidney damage
○ Cardiac arrhythmia
○ Chronic hoarseness
○ Esophageal tearing
○ Rupture of the stomach
○ Increased depression
○ Disturbances in cognitive functioning

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Other Eating Disorders

 Binge-Eating
 Similar to bulimia, except no purging
behavior
 Likely to be obese
 Increased health risks
 Higher rates of depression and anxiety
 Borderline Disordered Eating
 Have some symptoms of eating disorders
but do not meet full diagnostic criteria for
eating disorder

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Treating Eating Disorders

 Combination of psychotherapy and medical management
 Individual or group therapy
 Address problematic eating behaviors, misuse of food, and
managing emotions
 Anorexia Nervosa
○ Averting a medical crisis by restoring adequate body weight
○ Psychological aspects
 Bulimia Nervosa
○ Stabilizing eating patterns
○ Identifying and changing patterns of thinking
○ Improving coping skills
 Binge-Eating
○ Similar treatment protocol as bulimia nervosa

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Chapter 11

© 2012 McGraw-Hill Higher Education. All rights reserved.