Energy Balance, Weight Control and Eating Disorders Part 2 of 2

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Energy Balance, Weight Control and Eating
DisordersPart 2 of 2

• Chapter 10

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Learning Outcomes

• Describe the different methods to measure body
  composition.
• Describe the programs available to treat
  overweight and obesity.
• Discuss the characteristics of fad diets.
• Be able to evaluate whether weight loss programs
  are safe and likely to result in long- term
  weight loss.

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Learning Outcomes

• Describe the treatments that are available for
  more severe obesity.
• Describe the causes of, effects of, typical
  persons affected by, and treatment for anorexia
  nervosa, bulimia nervosa, and binge-eating
  disorder
• Explain methods for reducing the development of
  eating disorders, including the use of early
  warning signs to identify early cases.

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Treatment Pyramid
Surgery
BMI
Pharmacotherapy
Lifestyle Modification
Diet
Physical Activity
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Do diets work at weight loss?
DIET WEIGHT LOSS COST
Weight Watchers 5 in 6 months 167
VLCD 15-20 in 6 months 1700-2100
Internet-based 1 in 6 months 65 (per 3 months)
The average weight loss for high quality, state
of the art weight loss diets is 10 in 6 months.
Tsai and Wadden. Ann Intern Med 2005.
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Fad diets

• Encourage rapid weight loss
• Lean tissue and water loss occur
• Does not encourage behavior change
• Weight loss is usually regained
• Low carbohydrate diets
• Novelty diets
• Quick fad diets

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Treatment of Overweight and Obesity

• 3 Key Components to Sound Weight Loss
• Control of energy intake
• Fewer kilocalories
• Low energy density diet
• Physical activity
• Control of behavior problems
• Behavior modification techniques

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Control of Problem Behaviors Chain Breaking
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Control of Problem Behaviors Stimulus Control

• What about your environment may be driving you to
  eat more or make poor choices?
• Where?
• What?
• Why?

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Control of Problem Behaviors Cognitive
Restructuring

• Changing ones frame of mind about eating
• Making excuses or justifying unhealthy habits
• Being very negative or hard on yourself

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Control of Problem Behaviors Self Monitoring

• Tracking food intake, physical activity, and body
  weight
• Tracking emotions related to eating

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Will they keep the weight off?
DIET LONG TERM WT LOSS LONG TERM ATTRITION RATE
Weight Watchers 3.2 at 2 y 27 at 2 yr
VLCD 7.3 at 3.4 yr 42 at 3.4 yr
Internet 1.1 at 1 yr 34 at 1 yr
Tsai and Wadden. Ann Intern Med 2005.
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Why is it so hard to maintain weight loss?Is it
even possible?
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Weight Maintenance

• When you restrict calories for weight loss your
  body responds by reducing energy expenditure
  lower than one would expect for the new weight
  and body composition.
• Restricting calories also alters expression of
  hormones which increase hunger.
• EXERCISE can help prevent the above things from
  happening

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Successful Weight Management Lessons from The
National Weight Control Registry

• Registry members have lost an average of 66
  pounds and kept it off for 5.5 years
• 90 exercise, on average, about 1 hour per day.
• 62 watch less than 10 hours of TV per week.
• 78 eat breakfast every day.
• 75 weigh them self at least once a week.

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Case Study RK and the freshman 40

• 19 yo female
• 65 inches, 180 lbs, BMI 30
• Wt history weighed 140 (BMI 23.3) in HS. Also
  played soccer and ran track.
• Lifestyle Stopped playing sports, lives in
  dorm, busy schedule.
• Goal 120 lbs

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Step 1 Set realistic goals

• Substitute healthy weight for ideal or dream
  weight
• Loss of 10 of body weight (18 lbs or 162)
• 1-2 pounds per week (will take 9-18 weeks)
• Long term goal should be weight maintenance

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Assess Expectations Weight Goals

• Dream Weight
• A weight you would choose if you could weigh
  whatever
• Happy Weight
• A weight that is not as ideal but would be happy
  to achieve
• Acceptable Weight
• A weight you would not be particularly happy
  with, could accept
• Disappointed Weight
• Less than current weight, but could not view as
  successful in any way

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Weight Expectations
Defined Weights Reduction Dream 38 Happy
31 Acceptable 25 Disappointed 17
After 48 weeks of treatment, 47 of patients did
not achieve even a disappointed weight.
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Step 2 Assess diet
Time Food Kcal 8am Large coffee w/skim
milk and splenda protein bar
(220) 1pm Tuna salad wrap (700) 3pm
Diet coke and bag of Baked Lays (200) 7pm 3
cups pasta with red sauce (650) 10pm 1 slice
pizza (300) 2070
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Step 3 Determine energy needs

• Estimated calorie needs for RK 1913
  Calories/day
• Cut 500 calories/day to cut 3500 calories/week
  1 pound loss/week
• New calorie goal 1413 (not less than 1200
  calories/week)

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Step 4 Make new plan- can use Food Guide
website http//www.choosemyplate.gov/
Food group Amount Tips
Grains 5 oz 3 oz whole grain
Vegetables 2.0 cups VARIETY
Fruit 1.5 cups VARIETY
Dairy 3 cups Low fat
Protein 4 oz Lean
Oils 3 tsp Monounsaturated
Discretionary 100 calories Limit empty calories
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Step 4 Make new plan
Time Food Kcal 8am Small latte w/skim
milk high fiber bar and banana (180) 1pm
Tuna SW on whole wheat w/lite mayo w/ cup of
veg soup (400) 3pm Water and
yogurt (130) 7pm 1 cup ww pasta, 2 cup veg,
2 oz chix (400) 10pm Sundae from
McD (330) 1440
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Fast forward 20 years

• Every January RK tried a new fad diet that
  produced a 10 lb loss followed quickly by a 15 lb
  gain.
• She now weighs 280 lbs (BMI 46.6) and has type 2
  diabetes. She needs knee replacement surgery but
  because of other health conditions her Dr. tells
  her to lose weight first.

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Treatment Pyramid
Surgery
BMI
Pharmacotherapy
Lifestyle Modification
Diet
Physical Activity
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Drug treatment

• Subutramine or Meridia
• Reduces hunger by changing some of the signals in
  the brain (hypothalamus)
• Phentermine
• Also reduces hunger by changing some of the
  signals in the brain (hypothalamus) and raises
  basal metabolic rate
• Orlistat, Zenical, or Alli
• Blocks fat absorption by inhibiting lipoprotein
  lipase
• Other
• Anti depressant and anti seizure medications that
  reduce hunger

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Indications for Weight Loss Surgery

• 1. BMI gt 35 in association with major medical
  complications of obesity
• OR
• BMI gt 40
• 2. Failure of other approaches to long-term
  weight loss

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Roux en Y Gastric Bypass

• Small stomach pouch
• Alteration of food pathway
• Causes decreased hunger, increased fullness
• Average weight loss is 30 of initial weight

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Adjustable Gastric Banding

• Small stomach pouch
• Requires regular adjustments and greater dietary
  monitoring
• Average weight loss is 20 of initial weight
• No change in food pathway

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Eating Disorders

• Anorexia Nervosa

• Bulimia Nervosa

• Denial of appetite poor body image

• Binge followed by purge

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Who?
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Eating Disorders Otherwise not Specified (EDOS)

• Broad category to include partial symptoms of
  anorexia or bulimia
• Examples
• Meets all criteria for anorexia nervosa but
  continues to menstruate OR whose weight is in
  normal range
• Meets all criteria for bulimia nervosa but binges
  less than twice/week OR does not binge OR spits
  out food

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Eating Disorders Treatment

• AN

• BN

• Nutrition
• Gradual weight gain
• Help choose healthy food
• Psychological
• Body image
• Coping skills (control)

• Nutrition
• Emphasis on regular meal patterns
• Self monitor
• Psychological
• Coping skills
• All or nothing thinking

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Eating disorders Prevention

• Recognizing whats normal and what is a red flag
• Treating any physical and emotional problems
  early
• Setting up children for positive body image,
  tolerance for all body types

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Almost everyone in Marys family is overweight or
obese. She is worried about this as well.
Should she be?Is there anything she can do to
avoid excess weight gain?
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Ed does his project for Human Nutrition. His
weight is stable, but according to the dietary
analysis he is consuming much less than he should
be.Why might this happen?Should he increase
his calories?