Nutrition & You

Sixth Edition

Chapter 10 Lecture
Weight Management and
Energy Balance

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Learning Outcomes for Chapter 10
10.1 Explain the concept of a healthy weight, and differentiate between the
conditions of underweight, overweight, and obesity.
10.2 Explain how to determine if you are at a healthy weight.
10.3 Discuss energy balance, what determines your daily energy needs, and
the effects of energy imbalance.
10.4 Identify factors that affect body weight.
10.5 Explain how to lose weight healthfully.
10.6 Identify two strategies that help foster healthy weight maintenance.
10.7 Describe how to gain weight healthfully.
10.8 Define body image and identify factors that influence it and ways to
enhance it.
10.9 Define disordered eating and discuss the warning signs and treatment
options for eating disorders.

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What Is a Healthy Weight, and Why Is
Maintaining It Important? (1 of 3)
• Healthy weight: body weight relative to height that does
not increase the risk of developing weight-related health
problems or diseases
– Weight management: maintaining weight within a
healthy range
– Overweight: 10 to 15 pounds more than healthy
weight
▪ More than 70 percent of Americans are overweight
– Obesity: 25 to 40 pounds more than healthy weight
▪ Over 40 percent of Americans are obese

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What Is a Healthy Weight, and Why Is
Maintaining It Important? (2 of 3)
• Being overweight increases risk of:
– Hypertension and stroke
– Heart disease
– Gallbladder disease
– Type 2 diabetes
– Osteoarthritis
– Some cancers
– Sleep apnea
• Losing 5 to 10 percent of body weight can produce health
benefits
– Lower blood pressure, cholesterol, and glucose
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What Is a Healthy Weight, and Why Is
Maintaining It Important? (3 of 3)
• Underweight: weighing too little for your height
– May be caused by excessive calorie restriction and/or
physical activity, underlying medical condition,
emotional stress
– Increases risk for osteoporosis
– Risks for:
▪ Young adults: nutrient deficiencies, electrolyte
imbalance, low energy levels, decreased
concentration
▪ Older adults: low body protein and fat stores,
depressed immune system, medical complications

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How Do You Know If You’re at a Healthy
Weight? (1 of 2)
• BMI measurements can provide a general guideline:

▪ BMI is overweight: modest increase in risk of

dying from diseases
▪
is obese: 50 to 100 percent higher risk of dying
prematurely compared to healthy weight
▪ < 18.5 is underweight; can also be unhealthy
– May not be accurate for everyone
– Does not directly measure % body fat

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Figure 10.1 What's Your BMI?

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How Do You Know If You’re at a Healthy
Weight? (2 of 2)
• Measure your body fat and its location
– Average healthy adult male: 2 to 24 percent of weight is
body fat
– Average healthy female: 10 to 30 percent body fat
• Techniques to measure body fat include skinfold thickness
measurements and bioelectrical impedance
• Central obesity (excess visceral fat) v s subcutaneous
er us

fat, increases risk of heart disease, diabetes, hypertension

– Measure waist circumference

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Figure 10.2 Visceral and Subcutaneous
Fat Storage in the Body

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Table 10.1 Ways to Measure Percentage
of Body Fat (1 of 3)
Skinfold Thickness Measurements
How It Is Done: Calipers are used to measure the thickness of fat that is
located just under the skin in the arm, in the back, on the upper thigh, and
in the waist area. From these measurements, percent body fat can be
determined.
Cost: $
Margin of error 3–4%

Bioelectrical Impedance
How It Is Done: An electric current flows through the body and its
resistance is measured. Lean tissue is highly conductive and less
resistant than fat mass. Based on the current flow, the volume of lean
tissue can be estimated. From this information, the percentage of
body fat can be determined.
Cost: $
Margin of error 3–4%

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Table 10.1 Ways to Measure Percentage
of Body Fat (2 of 3)
Dual-Energy X-Ray Absorptiometry (DXA)
How It Is Done: An X-ray is used to measure bone, fat, and lean tissue.
The type of tissue that the X-ray passes through will absorb different
amounts of energy. The amount of energy lost will allow the percentage
of body fat to be determined.
Cost: $$$
Margin of error 1–4%

Underwater Weighing
How It Is Done: A person is weighed on land and also suspended in a
water tank. This is done to determine the density of the body. Fat is less
dense and weighs less than muscle mass and will be reflected as such
when the person is weighed in the water. The difference of a person’s
weight in water and on land is then used to calculate the percentage of
body fat.
Cost: $$
Margin of error 2–3%

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Table 10.1 Ways to Measure Percentage
of Body Fat (3 of 3)
Air Displacement Using a Bodpod

How It Is Done: A person’s body volume is determined by measuring air

displacement from a chamber. The person sits in a special chamber
(called the BodPod), and the air displacement in the chamber is
measured. From this measurement, the percentage of body fat can be
estimated.
Cost: $$$
Margin of error 2–3%

$ = very affordable
$$ = less affordable
$$$ = expensive

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Figure 10.3 Waist Measurement
Higher health risk:
• Woman > 35 inches
• Man > 40 inches

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Figure 10.4 How at Risk Are You?

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What Is Energy Balance, and What
Determines Energy Needs? (1 of 3)
• Energy balance is calories in versus calories out
– Positive energy balance: more calories consumed than
expended (leads to fat storage, weight gain)
▪ Energy excess
– Negative energy balance: more calories expended than
consumed (leads to weight loss)
▪ Energy deficit
• Energy needs are different for everyone
– Energy needs comprise:
▪ Basal metabolism
▪ Thermic effect of food
▪ Physical activities
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Figure 10.5 Energy Balance and
Imbalances

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Figure 10.6 The Three Components of
Energy Needs

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What Is Energy Balance, and What
Determines Energy Needs? (2 of 3)
• Your basal metabaolic rate (BMR) is the minimum amount
of energy you need to function
– Amount needed to meet basic physiological needs,
keep you alive
– Makes up about 60 percent of total energy needs
– Many factors affect BMR, chiefly lean body mass
• The thermic effect of food affects your energy needs
– Amount of calories expended to digest, absorb, and
process food (about 10 percent of calories in food
eaten)

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Table 10.2 Factors That Affect Your
Basal Metabolic Rate (1 of 2)
Factor Explanation
Lean body mass Lean body mass, which is mostly muscle mass, is more metabolically active than fat tissue, so
more calories are needed to maintain it. Athletes who have a large percentage of lean body mass
due to their increased muscle mass will have a higher BMR than individuals who aren’t athletic.
Age For adults, BMR declines about 1 to 2 percent per decade after the early adult years, but it
increases by 15 percent during pregnancy. For children, BMR increases during times of rapid
growth such as infancy and adolescence.
Sex Females typically have less lean body mass and a higher percentage of body fat than males. This
results in females having up to a 10 percent lower BMR. They also tend to have a smaller body
size.
Body size Larger individuals will have a higher BMR due to increased surface area compared with smaller
individuals. More surface area means more heat lost from the body, which causes the metabolic
rate to increase to maintain the body’s temperature.
Genes Research suggests that genes may affect BMR, as individuals within families have similar
metabolic rates.

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Table 10.2 Factors That Affect Your
Basal Metabolic Rate (2 of 2)
Factor Explanation
Stress Hormones such as epinephrine, which are released during emotional stress, increase BMR.
Physiological stress on the body caused by injury, fever, burns, and infections also causes the
release of hormones that raise BMR. Heat lost from the body through wounds, as well as the
response of the immune system during infection, increase BMR.
Hormones An increase in thyroid hormone increases BMR, whereas too little of this hormone lowers BMR.
Hormone fluctuations during a woman’s menstrual cycle lower BMR during the phase before
ovulation.
Starvation Both starvation and fasting for more than about 48 hours lower BMR.

Environmental Being very cold or very hot can increase BMR, but the change is minimal if you make adjustments
temperature in your clothing or in the temperature of your surroundings.
Caffeine Caffeine can raise BMR, but only slightly, when consumed regularly in moderate amounts.

Drugs Nicotine may increase BMR.* Drugs such as amphetamines and ephedrine increase BMR.

*Note: Smoking is not a weight-management strategy. Some people may think that replacing snacks with cigarettes helps
them stay slim, but the health risks associated with smoking, such as lung cancer, heart disease, and stroke, make it a
foolish habit. Anyone concerned about weight gain when quitting smoking can minimize the chances of this with exercise
(plus, you’ll be able to run farther and faster with your cleaner lungs!).

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What Is Energy Balance, and What
Determines Energy Needs? (3 of 3)
• Physical activity will increase your energy needs
– Energy expended by sedentary people = less than half
of BMR
– Very active athletes can expend twice BMR
▪ Exercise causes small increase in energy
expenditure after activity has stopped
• Calculating your energy needs:
– Estimated energy requirement (EER): daily energy
needed to maintain a healthy body weight based on
age, gender, height, weight, activity level

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Self-Assessment (1 of 2)
What's Your Estimated Energy Requirement (EER)?
Calculating your EER is a two-step process.
1. First, complete the information below.
a. My age is fill in the blank.
b. My physical activity during the day based on the chart below is
Physical Activity Male Female
Sedentary (no exercise) 1.00 1.00
Low active (walks about 2 miles daily at 3 mph) 1.11 1.12
Active (walks about 7 miles daily at 3–4 mph) 1.25 1.27
Very active (walks about 17 miles daily at 3–4 mph) 1.48 1.45

c. My weight in pounds is fill in the blank divided by 2.2 = fill in the blank k g . ilo rams

d. My height in inches is fill in the blank divided by 39.4 = fill in the blank meters.
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Self-Assessment (2 of 2)
What's Your Estimated Energy Requirement (EER)?
2. Using your answers from each part of step 1, complete the following
calculation based on your gender and age.
Males, 19+ years old, use this calculation.

Females, 19+ years old, use this calculation:

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Energy Imbalances over Time Can Lead
to Changes in Body Weight (1 of 2)
• Reducing calories can lead to weight loss
– Stored glycogen and fat are used as fuel sources
▪ Amino acids from body protein breakdown can be
used to make glucose
▪ Prolonged fast depletes all liver glycogen
▪ Ketone bodies generated from incomplete
breakdown of fat
▪ Fat stores and about one-third of lean tissue mass
depleted in about 60 days

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Energy Imbalances over Time Can Lead
to Changes in Body Weight (2 of 2)
• Excess calories can lead to weight gain
– Excess calories are stored as fat, regardless of source
▪ Limited capacity to store glucose as glycogen
▪ Can't store extra protein
▪ Unlimited capacity to store fat
– Body contains about 35 billion fat cells, which
can expand

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What Factors Are Likely to Affect Body
Weight? (1 of 6)
• Factors in weight management are complex and include:
what and how often you eat
• Hunger and appetite affect what you eat
– Appetite is psychological desire for food
– Hunger is physiological need for food; subsides as
feeling of satiation sets in
▪ Satiety determines length of time between eating
episodes

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What Factors Are Likely to Affect Body
Weight? (2 of 6)
• Physiological mechanisms help regulate hunger
– Many hormones play a role:
▪ Ghrelin: produced in stomach when empty; increases hunger
▪ When fat stores increase, leptin in fat tissue signals brain to
decrease hunger and food intake.
▪ Cholecystokinin: released when stomach is distended,
increasing feelings of satiation, decreasing hunger
– Protein, fatty acids, and monosaccharides in small intestine
stimulate feedback to brain to decrease hunger
• Many people override feedback mechanisms, resulting in energy
imbalance

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Figure 10.7 The Social-Ecological Model
of Health

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Figure 10.8 Your Brain Controls Hunger
and Satiation
Two regions of the brain—the ventromedial nucleus and the lateral hypothalamus—control
eating behaviors in response to hormones released from the stomach, pancreas, small
intestine, fat cells, and the hypothalamus. The ventromedial nucleus responds to hormones to
stimulate satiety. Hunger is triggered by hormones that stimulate the lateral hypothalamus.

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What Factors Are Likely to Affect Body
Weight? (3 of 6)
• Genetics partially determines body weight
– Risk of becoming obese doubles if parents are
overweight, triples if obese, five times greater if
severely obese
– Confirmed by studies of identical twins separated at
birth

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What Factors Are Likely to Affect Body
Weight? (4 of 6)
• Genetic differences in level or function of hormones,
such as high ghrelin or low leptin levels, increase
obesity
– Many obese have adequate leptin, but brain has
developed resistance to it
• Genetic differences in nonexercise-associated
thermogenesis (NEAT): energy expenditure in
nonexercise movements, such as fidgeting, standing,
chewing gum
• "Set point" theory holds that body opposes weight loss
and works to maintain a set weight

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What Factors Are Likely to Affect Body
Weight? (5 of 6)
• Environmental factors can increase appetite and decrease
physical activity
• Environment of cheap and easily obtainable energy-dense
foods stimulates appetite
– Gene-environment interaction: increases risk of
obesity in some people
• We eat out more and cook less
– 32 percent of calories come from ready-to-eat foods
prepared outside of home
– Frequent dining out associated with higher BMI

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What Factors Are Likely to Affect Body
Weight? (6 of 6)
• We eat more (and more)
– Increased availability of food-service establishments
and access to large variety of foods, larger portions
encourage people to eat more
• We sit more and move less
– Americans are eating about 375 calories/day more
than in 1970
– Labor-saving devices at work and home, sedentary
leisure activities ("screen time") result in decreased
energy expenditure

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Figure 10.9 Role of Eating and Physical
Activity Patterns in Weight Gain

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How Can You Lose Weight
Healthfully? (1 of 4)
• National Institutes of Health: overweight individuals should
aim to lose about 10 percent of body weight over 6-month
period
– For example, 180-pound person should lose 18 pounds/6
months = 3 pounds/month, pounds/week
– To lose 1 pound of body fat, need 3,500-calorie deficit
▪ For a weight loss of to 1 pounds/week, need to
decrease daily calories by 250 to 500 calories
• Fad diets promise dramatic results but may carry risks

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How Can You Lose Weight
Healthfully? (2 of 4)
• Successful long-term weight loss requires changes in diet,
physical activity, behavior
• Eat smart, because calories count: add satiation to low-
calorie meals by including higher-volume foods
– Eat more vegetables, fruits, and fiber
– Include some protein and fat in your meals
▪ Protein increases satiety most
▪ Fat slows movement of food from stomach into
intestines
▪ Choose lean meat, skinless chicken, fish, nuts,
unsaturated oils

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Figure 10.10 Three Pieces of the
Long-Term Weight-Loss Puzzle

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Table 10.3 The Energy Density of
Foods (1 of 2)
The Energy Density of Foods

Low
These foods provide 0.7 to 1.5 calories per gram
and are high in water and fiber. Examples include
most vegetables and fruits—tomatoes, cantaloupe,
strawberries, broccoli, cauliflower— as well as
broth-based soups, fat-free yogurt, and cottage
cheese.

Medium
These foods have 1.5 to 4 calories per gram and
contain less water. They include bagels, hard
cooked eggs, dried fruits, lean sirloin steak,
hummus, whole wheat bread, and part skim
mozzarella cheese.

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Table 10.3 The Energy Density of
Foods (2 of 2)

High
These foods provide 4 to 9 calories per gram,
are low in moisture, and include chips, cookies,
crackers, cakes, pastries, butter, oil, and bacon.

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Figure 10.11 The Volume of Food You
Eat Affects Satiety

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How Can You Lose Weight
Healthfully? (3 of 4)
• Use MyPlate as a weight-loss guide
– High volume of fruits, vegetables, whole grains, some
lean protein, modest amounts of fat
– Diet should contain variety of foods from all food groups
▪ Replace higher-calorie foods with lower-calorie
options from each food group
– For example, replace full-fat dairy with nonfat
products
– Replace sodas with water

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How Can You Lose Weight
Healthfully? (4 of 4)
• Move to lose
– 45 minutes/day of moderate-intensity activities can
prevent becoming overweight and aid in weight loss
▪ 10,000 steps/day can reduce risk of becoming
overweight
• Break bad habits
– Behavior modification: change behaviors that
contribute to weight gain or impede weight loss
▪ Techniques include keeping food log, controlling
environmental cues that trigger eating, managing
stress

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Table 10.4 Calories Used during
Activities
Approximate Approximate
Moderate Physical Calories/Hour for Vigorous Physical Calories/Hour for
Activity a 154-pounds Person* Activity a 154-pounds Person*
Hiking 370 Running/jogging (5 m p h ) iles er our 590

Light gardening/yard work 330 Bicycling (>10 m p h )iles er our 590

Dancing 330 Swimming (slow freestyle 510

laps)
Golf (walking and carrying 330 Aerobics 480
clubs)
Bicycling (<10 m p h ) iles er our 290 Walking (4.5 m p h )
iles er our 460

Walking (3.5 m p h )
iles er our 280 Heavy yard work 440
(chopping wood)
Weightlifting (general light 220 Weightlifting (vigorous 440
workout) effort)
Stretching 180 Basketball (vigorous) 440

*Note: Calories burned per hour will be higher for persons who weigh more than 154 pound s (70 k g ) and lower for ilo ram

persons who weigh less.

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Examining the Evidence: Evaluating
Popular Diets
• Reduction of calories, not composition of diet, is key to
weight loss
• People who diligently adhere to diets lose the most weight
– High dropout rates for most extreme diets (Atkins and
Ornish diets)
• Beware of fad diet claims and hype:
– "It's carbs, not calories, that make you fat!"
– "Lose seven pounds in one week!"
– Celebrity-endorsed miracle weight-loss products
– "Natural" substances help lose weight without risk

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Distinguishing Among Popular Diets (1 of 2)
Weight-Loss
Dietary Approach Claim What You Eat Pros Cons Examples
Very low-calorie Severely 400 to 800 calories Quick weight loss of Fatigue, • Medifast
diet (VLCD) limiting calories per day; liquid 15%–20% in 12–16 hypotension, • Cabbage Soup
burns fat and meals containing weeks; improves headaches, • Cookie Diet
reduces body vitamins, glycemic control in dizziness, • Medically
weight electrolytes, type 2 diabetics, constipation, and supervised VLCD
minerals, and reduces gallstones in long-
essential fatty hypertension and term use; loss of
acids; high in Hyperlipidemia lean body tissue;
protein (up to 125 regain 50% of
g /day)
rams weight lost in one
year
Balanced, low- Moderate 1,200 to 1,800 Average weight loss Low adherence • Jenny Craig
calorie diet (LCD) reduction of calories per day; of 1 to 2 pounds per rates; some • Weight Watchers
calories balanced 45%– week; balances programs require • Nutrisystem
promotes 65% reduced food intake prepackaged • The Biggest Loser
weight loss at a carbohydrate,20% by portion sizes and foods
healthy rate –35% fat, and exercise, which
10%–35% protein; helps maintain lean
wide variety of body mass;
foods; portion incorporates
control behavior
modification

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Distinguishing Among Popular Diets (2 of 2)
Dietary Weight-Loss
Approach Claim What You Eat Pros Cons Examples
Restricted Insulin < 20% Hunger is controlled, Reduced • Dr. Atkins
carbohydrate, promotes fat carbohydrate, resulting in weight glycogen, loss of • South Beach
High protein/ high storage; low 55%–65% fat, loss; improved lean body tissue • Belly Fat Cure
fat glycemic foods 25%–30% protein; glycemic control; and electrolytes; • Wheat Belly Diet
are more excludes most may improve HDL fatigue, • Paleo Diet
satisfying, fruits, grains, and triglycerides headaches, • Keto Diet
which limits starchy dizziness, and
total food intake vegetables, and constipation;
legumes; allows nutritional
meat, limited dairy, deficiencies
and fats
High When fat is >65% Significant weight Low adherence • Ornish
carbohydrate, low restricted, fewer carbohydrate, loss due to low rates; limited food • Pritikin
fat calories are <20% fat, 10%– calorie intake; allows options; may have • Pasta Diet
consumed 20% protein; low- you to eat more poor nutrient
energy-dense absorption due to
plant foods: fruits, low fat intake and
vegetables, whole high fiber
grains; low or void
of animal foods;
limited nuts and
seeds

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Treating Obesity (1 of 2)
• BMI > 40 = extreme obesity
– High risk of heart disease, stroke, dying
– Requires aggressive weight-loss treatment, including
very-low-calorie diets, medications, and/or surgery
– Very-low-calorie diets (< 800 calories/day) are short
term and must be medically supervised
– Medications such as phentermine, liraglutide, Orlistat,
Belviq, and Qsymia can't replace a lower-calorie diet,
physical activity, and behavior modification.
▪ However, they impact appetite and help individuals
lose from 3 to 9 percent of their body weight when
combined with diet and exercise.
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Treating Obesity (2 of 2)
• Gastric bypass, gastric banding and sleeve gastrectomy
result in higher levels of satiety and lower levels of hunger
– Results in dramatic weight loss and reduction of
hypertension, diabetes, high blood cholesterol, and
sleep apnea
– Small risk of complications and death from surgery
– Deficiencies of certain vitamins and minerals
• Liposuction is performed for cosmetic reasons
– Fat may reappear; results are not permanent
– Complications such as infections, scars, swelling

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Figure 10.12 Surgeries for Extreme
Obesity

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How Can You Maintain Weight Loss?
• Weight cycling (repeated gain and loss of body weight) is
common result of fad diets
• Weight loss can be maintained if healthy habits used during
weight loss are maintained
– National Weight Control Registry
• New, lower weight requires fewer calories to maintain weight
– Physical activity can close the "energy gap," which is
easier than further reducing caloric intake
▪ estimated that the energy gap is about 8 calories per
pound of lost weight

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How Can You Gain Weight Healthfully?
• Gaining weight for the underweight is as challenging as
losing weight is for the overweight
• Need to add at least 500 calories to daily energy intake for
gain of 1 pound/week
– Choose more energy-dense but nutritious foods from
each food group
▪ For example, waffle instead of toast, coleslaw
instead of cabbage
– Eat more snacks during day to add more calories

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Figure 10.13 More- and Less-Energy-Dense
Food Choices, by Food Group

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What Is Disordered Eating, and What
Are the Warning Signs? (1 of 9)
• Disordered eating: abnormal and potentially harmful
eating behaviors that do not meet specific criteria for
eating disorders
• Eating disorders: psychological illnesses that involve
specific abnormal eating behaviors and other factors
– In United States, about 30 million people struggle with
eating disorders at some point in life
▪ Most are adolescent or young adult females, but
increasing among males, and across ethnic, racial
and gender identities.

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Table 10.5 Brief Summary of Diagnostic
Criteria for Eating Disorders Super 101 (1 of 2)
Eating Disorder Diagnostic Criteria
Anorexia Nervosa • Restriction of energy (caloric) intake relative to energy (calorie) requirements leading to a
significantly low body weight (less than minimally expected)
• Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight
gain
• Disturbance in the way one’s body weight or shape is experienced, undue influence of body
weight or shape on self-evaluation, or lack of recognition of the seriousness of low body weight.
Bulimia Nervosa • Recurrent episodes of binge eating, characterized by both:
– Eating large amounts of food in a discrete amount of time (a 2-hour period)
– A sense of lack of control over eating during the episode
• Recurrent inappropriate compensatory behavior (purging)
• Self-evaluation is unduly influenced by body shape and weight.
Binge Eating • Recurrent episodes of binge eating (binges have same characteristic criteria as in bulimia
Disorder nervosa)
• The binge eating episodes are associated with three (or more) of the following:
– Eating much more rapidly than usual
– Eating until uncomfortably full
– Eating large amounts of food when not physically hungry
– Eating alone because of feeling embarrassed by how much one is eating
– Feeling guilty, depressed, or disgusted with oneself afterward
• Marked distress regarding binge eating
• The binge eating is not associated with the recurrent use of compensatory behavior (for
example, purging) and does not occur exclusively during the course of anorexia nervosa or
bulimia nervosa.

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Table 10.5 Brief Summary of Diagnostic
Criteria for Eating Disorders Super 101 (2 of 2)
Eating Disorder Diagnostic Criteria
Avoidant/Restrictive • Persistent failure to meet appropriate nutritional or energy needs, associated with (one or more):
Food Intake Disorder significant weight loss, nutritional deficiency, interference with psychosocial functioning, and
(ARFID) reliance on enteral nutrition or nutrition supplements.

Blank

Other Specified
Feeding or Eating
Disorders (OSFED)

Atypical anorexia • Anorexia nervosa criteria are met except weight is within or above the expected range.
nervosa Purging • Recurrent purging behavior in the absence of binge eating.
disorder Night eating • Recurrent episodes of night eating, causing significant distress or impairment.
syndrome

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What Is Disordered Eating, and What
Are the Warning Signs? (2 of 9)
• No single factor causes eating disorders
• Sociocultural factors
– Desire/social pressure to be thin
• Genetic factors
– Eating disorders "run in families"
• Psychological factors
– Depression, anxiety, perfectionism, sense of control
contribute

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Figure 10.14 Factors That Contribute to
Eating Disorders

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What Is Disordered Eating, and What
Are the Warning Signs? (3 of 9)
• Anorexia nervosa results from severe calorie restriction
– Self-starvation and excessive weight loss
– Intense fear of being "fat"
– Distorted body image: see oneself as fat when
underweight
– Health consequences: electrolyte imbalance (low blood
potassium) can be fatal
– Other risks: decrease in heart rate and blood pressure,
lanugo (downy hair), osteoporosis

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What Is Disordered Eating, and What
Are the Warning Signs? (4 of 9)
• Bulimia nervosa involves cycle of binge eating and purging
– Purging can include self-induced vomiting; excessive
exercising; strict dieting or fasting; abuse of diet pills,
laxatives, diuretics
▪ Vomiting can cause tears in esophagus, swollen
parotid glands, tooth decay, gum disease, broken
blood vessels in eyes
– Potentially fatal electrolyte imbalance can result

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What Is Disordered Eating, and What
Are the Warning Signs? (5 of 9)
• Binge eating disorder involves compulsive overeating
(without purging)
– Eat in secret, feelings of shame
– Health effects are those associated with obesity
▪ High blood pressure, cholesterol levels
▪ Risk of heart disease, type 2 diabetes, gallbladder
disease

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What Is Disordered Eating, and What
Are the Warning Signs? (6 of 9)
• Other disordered eating behaviors can be harmful
• Avoidant/Restrictive Food Intake Disorder (ARFID)
• Pica: desire to consume nonnutritive substances (clay, dirt, chalk)
– Can cause medical complications
• Other Specified Feeding or Eating Disorder (OSFED)
– Purging disorder
– Atypical Anorexia Nervosa
– Orthorexia: "healthy or righteous eating"
▪ Fixation on eating the "right" foods
– Night eating syndrome: combination eating, sleep, mood disorder
▪ Person consumes most calories after evening meal, wakes up
at night to eat

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What Is Disordered Eating, and What
Are the Warning Signs? (7 of 9)
• Body image is the thoughts and feelings an individual has about the
attractiveness of his/her body
• Strategies to help maintain a positive body image:
– Know and accept what determines your physical appearance
(genetics, age, etc.)
– Avoid comparing yourself to others
– Recognize that you are a whole person and not just individual
parts
– Respect yourself and others based on the qualities of character
and accomplishments, rather than appearance

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What Is Disordered Eating, and What
Are the Warning Signs? (8 of 9)
• There are some common signs of disordered eating
– Hair loss
– Significant/sudden weight changes
– Russell's sign: scar tissue on knuckles of fingers used
to induce vomiting (bulimia nervosa)
– Avoiding social situations where food is present
– Weighing often, obsessively counting calories
– Denial of problem

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Table 10.6 Warning Signs for Eating
Disorders and Disordered Eating (1 of 2)
Sign Explanation/Example

Significant weight loss or Refusal to accept and maintain body weight (even if it is within normal
weight fluctuations range) or weight gain or patterns of repeated weight loss and gain

Exercising excessively Often exercise daily for long periods of time to burn calories and
prevent weight gain. May skip work or class to exercise.
Preoccupation with food, Constantly worry about and talk about amount and type of food eaten.
weight, and diet May weigh themselves daily or several times per day. May be
vigilantly tracking daily food intake and calories burned.

Refusing to eat Will avoid food in order to lose weight or prevent weight gain. May
avoid only certain foods, “unhealthy” foods, processed foods, or foods
with added or natural sources of fats and sugars. Makes excuses to
avoid social situations that involve eating with others.

Secretive eating Prefers to (or will only) eat alone. May be binge eating and hiding food
wrappers, denies eating/ snacking, appears to be dieting.

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Table 10.6 Warning Signs for Eating
Disorders and Disordered Eating (2 of 2)
Sign Explanation/Example

Distorted body image Do not see themselves as they truly are. May comment on being fat
even if underweight.
Body dissatisfaction Harshly self-critical and not accepting or appreciating one’s body;
comparing self to others and commenting on others’ bodies.
Diet pill use or laxative use Evidence of pill bottles, boxes, or packaging

Changes in mood May become more withdrawn, depressed, or anxious, especially

around food.
Hair loss Hair becomes thinner and falls out in large quantities.

Oral health issues Cavities or gum disease caused by stomach acid from frequent
vomiting.

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What Is Disordered Eating, and What
Are the Warning Signs? (9 of 9)
• Eating disorders can be treated
• Multidisciplinary team approach is most effective
– Psychological, medical, and nutrition professionals
– Nutritional approaches include:
▪ Identifying binge triggers, safe and unsafe foods,
hunger and fullness cues using food journals
▪ Meal plans to ensure adequate calorie/nutrient
intake (anorexia nervosa) or to avoid overeating
(bulimia nervosa, binge eating disorder)
– Best treated in early stages; no "quick fix"

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