Weight Management
1
Energy Balance & Weight Management
Lecture Recordings Supporting Documents
u Consequences of Obesity (previous u Energy Expenditure
week) u Basic concepts
u Section 1: Strategies for the
prevention & treatment of obesity u including T-7-Measuring
Energy Expenditure
u Section 2: Regulation of food intake
u T-8-Assessing Body
u Section 3: Weight throughout the Composition
lifecycle
u Exercise
u Including T-10 –Case Studies
u Characteristics of exercise programs
u T-11 –Focus on Eating Disorders
u Metabolism during exercise
u Including T-9: Interval Training
2
Canadians live in an obesogenic
environment
u Sedentary
u Easy to overeat
Tension between:
u Individual choices
u External Environment
3
Opposite of an obesogenic
environment: leptogenic
environment
4
Strategies for reducing obesity
u Individual choice: u Environment changes to support
u Individual must have access to the
individual choice:
“tools” needed to improve lifestyle u Food industry and restaurants
u Small cumulative changes can add up u More nutritious foods; smaller portion
sizes; transparency about nutrition
content
u Recreational facilities in the
community
u Safe opportunities for physical
activity
Make the healthy choice u Schools and businesses
the easy choice. u Improved food quality
u Opportunities for physical activity
during the work/school day
5
u New clinical practice guidelines
from Obesity Canada
u Released Spring 2020
u Replaces guidelines of 2007
described in textbook
u Focus on the individual rather than
changing the environment
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df
https://www.cmaj.ca/content/cmaj/
192/31/E875.full.pdf
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http://obesitycanada.ca/wp- 10
content/uploads/2020/10/191707-guide-2-at.pdf
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BMI = body weight(kg)
/height (m2)
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https://obesitycanada.ca/guidelines/assessment/
BMI should be
measured in
combination
with waist
circumference.
15
http://obesitycanada.ca/wp-content/uploads/2020/09/6-Obesity-Assessment-v5-with-links.pdf
Consequences
Sleep apnea
Osteoarthritis
Gastroesophageal reflux
Type 2 Diabetes
Hyperlipemia
Hypertension
CVD
Endrocrine disorders
Cancer
16
Potential root causes:
§ Eating patterns
§ Physical activity
§ Screen time
§ Internalized weight bias
§ Patient values and goals
§ Mood and anxiety disorders
§ Physical, sexual, psychological
abuse
§ Substance abuse and addiction Consequences
§ Medications Sleep apnea
§ Endocrine disorders Osteoarthritis
§ Sleep disorders Gastroesophageal reflux
§ Socioeconomic status Type 2 Diabetes
§ Food Insecurity Hyperlipemia
Hypertension
CVD
Causes and consequences of obesity may become barriers
Endrocrine disorders
to succeeful management of obesity.
Cancer
17
Consider the values and goals of the
patient
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20
Suggested dietary patterns
u Canada’s Food Guide
u Mediterranean Diet
u Vegetarian Diet
u Portfolio Diet
u DASH
u others
21
Recommended Weight Loss to Address
other Health Issues
u Obesity + Prediabetes
u 5-7% of body weight
u Obesity + Type-2-Diabetes
u 7-15% of body weight
u Purpose of weight loss: Reduce risk of progression from pre-diabetes to type-
2-diabetes or to slow the development of complications from type-2-diabetes
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23
24
Characteristics of a healthy diet:
A healthy dietary pattern
Reasonable weight loss
Physical Activity
Flexible
No costly supplements
Promotes beneficial behavior change
Scientifically sound
25
26
27
Reduce the energy density (kcal/g) of the
food
How much a food induces fullness or satiety depends more on how much
that food fills the stomach than how many calories it contains.
28
Don’t drink your calories!!
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30
Dietary Reference Intakes:
Definitions of activity levels
SEDENTARY: LOW ACTIVE:
Activities of daily Walking 30 minutes
living; less than 30 at 6.5 km per hour
min of intentional every day
exercise/day
+ 135 to165 kcal
ACTIVE: VERY ACTIVE:
Walking 1 hour 45 Walking 4 hours 15
minutes at 6.5 km minutes at 6.5 km
per hour every day per hour every day
+ 470 to 580 kcal + 1145 to 1405 kcal
31
Achieving and maintaining a healthy body
weight: Cognitive Behavioural Therapy
u ABCs of behavior:
u (1): Antecedents or cues that lead
to the behaviours
u (2): the behaviour itself
u (3): consequence
Fig 7.27
32
Weight Loss Drugs and Surgery:
Orlistat and fat digestion
33
Weight loss drug- liraglutide
u Drug has two uses
u Prescribed to people with type-2-diabetes
u Stimulates the secretion of insulin to help control blood glucose
u Also found to suppress appetite
u Now prescribed to people with BMI > 30 to help promote weight loss or BMI >
27 with comorbidity e.g. controlled hypertension, type-2-diabetes,
dyslipidemia
34
Weight loss-Combination of drugs
u Naltrexone (an anti-addiction drug)-bupropion (anti-depressant)
u For use for individuals with BMI > 30 or BMI > 27 with comorbidity e.g.
controlled hypertension, type-2-diabetes, dyslipidemia
35
Weight Loss Drugs and Surgery:
Gastric Bypass
Reduced stomach size
Less absorption of food
because part of small
intestine is bypassed
Complications
-micronutrient deficiencies –
supplementation required
-”dumping syndrome”
-food enters small intestine
too rapidly and causes serious
symptoms (nausea, diarrhea,
etc)
-meals must be small and
eaten slowly
36
Weight Loss Drugs and Surgery:
Measha Brueggergosman
37
Why is weight loss so difficult?
u What percentage of people who u “In the current environment,
attempt weight loss fail? people who are not devoting
substantial conscious effort to
managing body weight are probably
gaining weight.” Peters 2002
90%
38
Section 2: Food intake regulation
u Adaptations to protect us from starvation
u Leptogenic environment
39
Mechanism for Regulating Body Weight
Hunger Satiety
u Internal signals that stimulate u Feeling of fullness and satisfaction
someone to acquire and consume caused by food consumption, that
food eliminates the desire to eat
u Experienced after a meal-
determines when next meal will
occur
Satiation:
Feeling of fullness that develops during a meal
Determines when a meal will end 40
Regulation of Energy Balance
Genetic differences in the regulation of
u Food intake
u Energy expenditure
u Fat metabolism
u Parents & children, siblings, twins, more similar in their
body characteristics than unrelated persons
u Weight management is easier for some than others
41
Regulation of Energy Balance
u Set-point theory
u Genetically pre-determined body weight that tends
to be defended
u Afterweight loss people tend to return to their pre-weight
loss weight
High & unhealthy Healthy weight
weight To
To Low & Unhealthy
Healthy weight weight
42
Hormones
Short term regulation Long term regulation of % body fat
u Gut peptides: u Leptin
There are many
u Ghrelin gut peptides u Regulation of food intake
u GLP-1 u Regulation of energy expenditure
u Influence food intake at meals and
between meals.
u Gut peptides may differ in
effectiveness between lean and
obese persons
43
Regulation of Energy Balance
Short Term: Meal-to-Meal intake
Stimulate hunger Suppresses hunger
u Ghrelin u GLP-1
u Hormone secreted by the u Hormone secreted in the small intestine
stomach u also stimulates the release of insulin
u Levels in the blood rise before a
meal, stimulating hunger
u Levels in blood decline after a
meal, reducing hunger
44
Difference in effect of ghrelin in lean
and obese subjects
Lean vs Obese:
Lean
-In obese individuals
ghrelin levels do not
Obese decline as much as in
lean individuals after
the start of a meal;
Meal
this may result in
English et al. J Clin Endocrinol Metab. 2002 Jun;87(6):2984.
prolonged eating at a
meal.
45
Meal-to-Meal intake
u Lean vs Obese:
u GLP-1 levels tend to be lower in obese than lean
individuals. This may increase the length of a meal.
u Drugs that mimic GLP-1 or prevent its degradation are
used in the treatment of both type-2-diabetes and
obesity.
u Promotes weight loss
u E.g. Liraglutide
46
Regulation of Energy Balance: Long Term:
Figure 7.22: Leptin Regulation
Leptin
u Hormone secreted into the blood by adipose
tissue
u Leptin levels are directly proportional to the
amount of adipose tissue
u Acts on the hypothalamus of the brain to
regulate food intake
u The more fat the more leptin secreted
u The presence of leptin (i.e. the presence of fat
tissue) reduces food intake
u The absence of leptin (i.e. absence of fat
tissue) stimulates hunger
47
Long-term regulation: leptin
u Lean vs Obese u What happens to leptin levels
during weight loss?
u Leptin levels are higher in obese
than lean individuals.
u The absence of leptin is a stronger u What happens to leptin resistance
signal to promote hunger than the during weight loss?
presence of leptin is to suppress
hunger.
u What effect do these changes in
u This insensitivity to the “stop
leptin levels and leptin sensitivity
eating” signal of leptin is called
have on food intake?
leptin resistance.
48
Regulation of Energy Balance
u Adaptive Thermogenesis
u Maintains set-point
uOvereating à increase in energy
expenditure
uUndereating à conservation of energy
u May increase or decrease energy expenditure
up to 250 kcal
uIndividual variation
49
Adaptive Thermogenesis
u Lean vs Obese u Lean vs Obese
u Increase in basal metabolism, in
u Decline in basal metabolism, in response to weight gain, is less
response to weight loss, is more pronounced in obese compared to
pronounced in obese compared lean individuals.
than lean individuals.
u Obese individuals conserve
u Lean individuals expend energy
energy more effectively
more readily.
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The Minnesota Starvation Study
A participant before the experiment (left) and after the semi-
starvation (right).
51
The Minnesota Starvation Study
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Section 3:Weight management and physical
activity through the life cycle.
How do body weight concerns vary
throughout the lifecycle?
53
Ch 14: Nutrition during pregnancy and
lactation
Ch 15: Nutrition from Infancy to
Adolescence
C16: Nutrition and Aging: The Adult Years
54
The Physiology of Pregnancy
Weight Gain During
Pregnancy
u Most of the weight gain during
pregnancy is lost at birth
u Maternal fat stores are required to
fuel lactation
u There are risks to mother and baby
of too little or too much weight
gain
55
The Physiology of Pregnancy
u Weight loss is not recommended
during pregnancy
u For overweight or obese women:
u Weight loss should occur before
pregnancy
u Weight gain should be kept to a
minimum during pregnancy
u Most Canadian women are gaining
more weight than they should
during their pregnancy.
56
The nutritional needs of pregnancy
u For normal weight women:
u Additional energy needs during
pregnancy:
u 350-450 kcal in the last two
trimesters
u Pregnancy: three trimesters
u 1st: first 13 weeks
u 2nd: 14-26 weeks
u 3rd: 27-40 weeks
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The Physiology of Pregnancy
What does
this graph say
about the
relationship
between
maternal
weight gain
and
birthweight?
Too little or
too much
weight gain
puts the baby
at risk
58
Fetal & Maternal environment:
Early programming: Development origins of
disease and health (DoHAD)
u Poor fetal environment à
u Low birth weight babies à
u Thrifty genotype or epigenotype à
u Causes people to expend less energy than other people and therefore gain
weight when food is plentiful
u Genotype: affects gene function: mutations or polymorphism = changes in DNA
sequences
u Epigenotype- silencing (or switching off) of genes by methylation of DNA
u Adult obesity
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1944 Dutch Famine
Compared to
Siblings not exposed to
In utereo famine exposure famine
u Increased risk of
u Obesity
u Atherogenic lipid profile
u Hypertension
u Coronary heart disease Smoking during pregnancy
u Impaired glucose tolerance has the same effect.
60
Exposure to high levels of insulin
in utero
Compared to
Siblings born after mother Siblings born before mother
developed diabetes developed diabetes
Adolescent BMI: 24.6 vs 20.9
Increased concentration of amniotic fluid insulin
associated with:
•Obesity
•Impaired glucose tolerance
•Poorer intellectual and psychomotor development
Source: Silverman and others. 1998. Diabetes Care 21: B142-B149
61
Possible Risk Factors for Adult Obesity
that may occur in Infancy
u Increased birth weight
u Reduced breastfeeding
u Recommendation:
u Exclusive breastfeeding for 6 months (Week 4 Short topics)
u then introduction of solid foods
u Increased weight gain during the first weeks of life
u Reduced sleep duration
62
Nutritional Needs of Infancy: Assessing
infant growth
Weight and
height is
measured in
percentiles
Length for
50 percentile
age = average
High
percentile à
greater than
the average
Weight for age weight
63
BMI-for-age: boys and girls
Obese > 97
percentile
Overweight: 85-97
percentile
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Childhood Obesity
u Environmental factors:
u Fast food
u Screen time
u Physical inactivity
66
Critical Thinking:
Parental Influences on Childhood Eating Habits
(section 15.3 pg 699)
What is the
main message
of this graph?
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Required Textbook Reading
u Chapter 15: Chapter Opener & Case Study Outcome
u Pg 677 & 715
u Felicia: age 13 to 15
u What are the features of a successful program of weight management for
childhood and adolescent obesity?
Gradual approach that takes
advantage of adolescent growth
70
Required Reading:
Focus on Eating Disorders (after ch 15 pg. 720-740)
u Most eating disorders are
diagnosed during adolescence
u Women are most affected, but
men are catching up
u Contributing factor: Unrealistic
female body ideal
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Required Textbook Reading:
Focus on Eating Disorders (after ch15) pg. 720-740
u Be sure you can describe and distinguish between the following:
u Anorexia nervosa
u Binge eating disorder
u Bulimia nervosa
u Binge/purge cycle
u Diabulimia
u Bigorexia
u Describe the components of the female athlete triad.
u What are the goals of Canadian Eating Disorders Strategy ? What are the 6 pillars
of the Canadian Eating Disorders Strategy?
u In addition to the text, read:
Fig F7.6 (pg 727); F7.8 (pg 730); F7.9 (pg 731); F7.12 (pg 735)
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GI Joe: 1964 1975 1994
Evolving ideals of
male body image as
seen through action
toys.
Source: Pope and others. 1999. Int J Eating Disorders.
26(1):65-72.
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Luke Skywalker and Hans Solo : 1977 1997
Nutrition and Aging: The Adult Years
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Life expectancy in Canada (section 16.1)
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Causes and consequences of
malnutrition
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Physical activity guidelines for older adults
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