Nutrition Module 3

• the perception of how we view our bodies
• often shaped by outside influences- family, peers, clothing designers/stores, media
• for many (esp women) body image, weight and shape are linked to self esteem
• there is no ideal body image, what really matters is how healthy we are

• by genetics- determine your size
• by actions and other external influences

influence what you wear or body size based on who you hang out with

an upper end store (ie Niemann Marcus) will make their clothes have smaller sizes because if an older richer woman comes in an can fit into a size 10 there where she's a 12 at other places, she is likely to shop there again

• portrays what an ideal male and female body looks like
• there isnt a real ideal body

• is unattainable for the majority of the population
• you really have to be born with that body type- thin long legs broad shoulders
• also, those models are a combination of edited best features of many people
• airbrushing, touchups done to hide flaws
• this combining of different women happens in actresses in movies too

• history has shown that it has changed over the years
• 60s: Marylin Monroe- curvy
• but today- she would be considered plus size
• but message is clear- thin is desireable by the media
• however, the population is becoming heavier
• 1980- 5% men 5% women obese, today over 30% us is obese

• being overweight used to be linked with socioeconomic status and western nations
• health problem is now global in nations where a western diet is popular- you see fast food everywhere now

• has a direct correlation to an increase in disease, cardiovascular disease, hypertension, cancer, stroke, and type 2 diabetes
• numerous health agencies are investigating how to address this growing weight issue
• prevent weight gain by maintaining a healthy weight in the first place

• energy intake being equal to the number of calories burned through basic body functions plus exercise
• calories ingested=calories burned

• more calories are consumed than burned per day
• overtime leads to weight gain

• calorie intake is less than the number of calories expended
• this is not desirable
• may occur if an illness or trauma happened that would negatively affect appetite and intake
• weight loss will occur
• a person may require huge amounts of energy for healing (ie someone who suffered a major burn) this could put them in neg energy balance.

• 3500kcal
• we need to eat 3500 extra calories to gain a pound
• by consuming an extra 500 calories daily, you could gain one pound per week

• fat is stored in adipose cells
• there are 2 stages that occur in the development of fat cells

• hyperplasia: during periods of growth like adolescence or pregnancy we have an increasing number of fat cells. we're growing/developing and putting down additional fat cells
• hypertrophy: during adulthood, we may still continue to develop cells (although we dont want to) but more likely the size of the cells will increase. the increasing of fat cells is hypertrophy

• Yes
• growth periods
• pregnancy
• childhood
• adolescence 
• any time of growth spurt

but for an adult, usually excess calories equal increased body fat

• our sole source of energy intake is from food and beverage
• energy yields: carb & protein 4kcal/g, fat 9kcal/g, alcohol 7kcal/g

• for most there is no problem finding food
• vending machines, fast food restaurants and convenience items in grocery stores make it easier than ever to find something to eat
• these things are high in fat, calories and sodium

• 14g fat
• 35g carbs
• 4g protein
• 280 total calories that we now need to expend to stay in energy balance

• intentional and naturally occuring
• we can burn energy in the form of: basal metabolism, physical activity, the thermic effect of food and thermogenesis (the two major components of energy expenditure are basal metabolic rate and physical activity) a combination of all of these determine or daily calories burned
• we can probably affect physical activity the most, followed by changes to alter our bmr

• the number of calories used by the body while in a fasting state
• males require 1kcal/kg/hr 
• females require .9kcal/kg/hr to support the function of carious body organs and to stay alive 
• BMR varies per person based on a number of factors

• gender: males have a higher BMR
• lean body mass: someone with muscle will burn more calories at rest more efficiently
• body size: larger mass burns more calories
• temperature
• age: as we increase in age, BMR declines
• nervous system activity
• caffeine: a stimulant that can increase BMR
• smoking: increases BMR (if quit you will gain weight often but it should adjust)
• pregnancy (BMR higher in pregnancy)
• if you dont take in enough calories, you will actually slow down your BMR

• 60%-70%
• as we age, it declines by 1-2% per decade
• if no change in diet or activity level occurs from one decade to the next, a slow weight gain will result
• This is why people in their 40s and 50s may have indicated they have weight gain

• accounts for 15-40% of our energy expenditure
• a number of factors (body size, fitness level, and the actual activity) determine how many calories are expended
• low physical activity leads to weight gain
• previous generations expended many more calories than we do today bc their jobs were more physically demanding
• we must choose to be active in a sedentary world

• accounts for approximately 10% of expended calories
• this is the energy used for digestion and absorption of food
• larger meals and meals higher in protein result in a higher TEF

• the ability to regulate body temperature and activities such as fidgeting, maintaining body posture and shivering
• the amount of energy burned through thermogenesis is very small

• scientists have begun to study the link between brown adipose tissue and weight maitenance
• brown adipose tissue is found in infants below the collar bone and this type burns calories more efficiently
• most adults have little brown fat (mostly white fat), but lean adults have been found to have higher levels than their heavier counterparts
• could this help with being overwieght?

• direct calorimetry
• indirect calorimetry

• not used often
• very expensive
• inconvenient/complex
• a subject is placed into a chamber overnight. the chamber is insulated with a thin layer of water and when the subject gets up in the morning they can measure the amount of energy that they gave off and from there they can determine how many calories that person needs to maintain their current weight

2 ways: monitor and equation

a facility will have equipment and the subject goes onto a bike machine and they hook them up to monitors that measure they amount of oxygen the person takes in and co2 they put out as they peddle to determine the amount of energy expended

• estimated energy requirement  (EER) formula
• based on gender age height weight and physical activity
• the calories used for basal metabolism are part of the equation
• men and women have different formulas published on the food and nutrition board

EER= 662-(9.53*AGE)+Phys act (15.91*weight + 539.6*height)

EER= 354- (6.91*Age) + phys act (9.36*weight + 726*height

• 1kg=2.2lbs
• 1m= 39.4in

• sedentary, no exercise: 1.00
• low activity- exercises equivelent of walking 2-3 miles/day at 3-4mph : 1.11
• active- exercises the equivalent of walking 7 miles/day: 1.25
• very active- exercises the equivelant of walking 17 miles/day: 1.48

• sedentary, no exercise: 1.00
• low activity- exercises equivelent of walking 2-3 miles/day at 3-4mph : 1.12
• active- exercises the equivalent of walking 7 miles/day: 1.27
• very active- exercises the equivelant of walking 17 miles/day: 1.45

2155.1 calories is her estimated # cal required per day to maintain her current weight

• ideal or desirable
• no longer used, now we use healthy weight
• used when referring to weight based on a person's height

• published by insurance companies 
• provieded an estimate of the appropriate weight to your height
• were used to link weight and longevity
• these tables were used for the general population but didnt take into accound individual differences. they were also based on statistics from people who bought life insurance. once the weights were found there was no follow up to see if those people were actually healthier or if they had other factors such as smoking

• weight history
• family health history (someone your same age with a history of heart disease may require a lower weight to be healthy)
• where the weight is distributed in the body
• current weight
• current activity status

the # on the scale is just a guideline, to be healthy and fit is the goal

BMI as an indicator of healthy weight

• body mass index
• = weight (kg)/ height^2 (meters)
• can be used to measure healthy weight, under weight, overweight and obesity in the general pop, but isnt accurate for certain types of people

• children
• teens
• pregnant women
• breast feeding women
• short stature adults
• very muscular individuals
• elderly

kids and preg have their own bmi charts

• less than 18.5: underweight
• 18.5-25: healthy weight
• 25-30: overweight
• 30+: obese

• good for gen pop but not outliers
• doesnt take into account the amount of muscle vs fat in the body- muscular people must use caution
• a diagnosis of overweight or obese must look at body fat %, fat distribution,  and health problems associated with excess body fat

• men: 8%-24%
• women: 21%-35%

levels greater than these upper limits are indicators of obesity

females require higher fat percentage for reproduction

• underwater weighing
• bioelectrical impedance
• dual energy xray absorptiometry (DEXA)
• anthropometrics

• very accurate, but uncommon
• an individual is weighed on a scale and then again underwater
• the difference between these two measurements is used to estimate total body volume and the percentage of lean muscle and body fat can be calculated

• based on the principle that water will conduct electricity and fat will resist electricity
• muscle is mostly water 
• they connect electrodes to your body and send a low energy electric current throughout (its painless)
• the more resistant that occurs, the higher the body fat %

• Dual Energy Xray Absorptiometry 
• the most accurate measure of body fat composition as well as bone mass
• an instrument that emits small doses of radiation determines the amount of fat, lean tissue, and bone in an individual
• very accurate by very expensive and rarely used

• use a caliper (looks like tongs) to measure the amount of fat just under the layer of skin at 3 or 4 different points on the body. from this fat % can be calculated
• skin fold measuring is quick and accurate if trained
• use other anthropometrics (measuring weight, height, waist and hip circumference)
• many home scales now have electrodes to calculate fat water and muscle

where in the body its distributed

• upper body or lower body
• where it is can impact your health

• fat is stored in the abdominal area
• commonly referred to as the apple shape
• ie potbellied man
• aka android obesity
• linked to high testosterone, alcohol, smoking, or diet high in refined carbs
• seen in older men

• fat is stored in the hips and thighs
• pear shape- seen in women
• aka gynoid obesity
• small waist but fat hips/butt/thighs

• location of fat is directly related to health risks
• upper body fat storage in abdominal tissues interferes with the livers ability to use insulin
• the fat cells also lead to insulin resistance and produce substances that increase blood clotting, constriction of blood vessels, and inflammation
• therefore upper body fat storage leads to increased risk of hypertension, heart disease and type 1 diabetes
• womens fat around the hips and thighs is less likely to cause health issues but after menopause a shift in hormones results in an increased risk of upper body obesity then a womens risk goes up too

• mostly genetics- twins seperated at birth and still had similar weight and fat distribution despite different nurture
• environment and genes are important but genes are more important
• genes account for 70% of an individual's body weight- we inherit certain body types

• if a child has normal weight parents they have a 10% chance of being obese
• if 1 parent is obese their chance is 40%
• if both parents obese their chance is 80%

• we may inherit a thrifty metabolism- this was helpful in older times but can be detrimental now
• a thrifty metabolism makes you likely to use fewer calories to maintain body functions and you can store fat easily- makes you prone to gain weight
• usually if you have a thrifty metabolism you have a lower bmr too

• another theory to support the role of genetics in weight
• there is evidence that each of us has a genetically predetermined body weight and that the body will resist change. this set weight is not difficult to maintain

• they fed ppl large amounts of calories in a controlled environment (the patients didnt know they were eating extra, they were given meals that had them eat up to 4,000 calories/day)
• the people of course gained weight, but afte the calories were decreased to what is appropriate for that individual, their weight returned to the set point

• it may be true when we are younger, but as we age it becomes easier for us to gain than lose weight, and the setpoint may change
• this process is related to many hormones and enzymes
• bc of this, now it may be okay for older people to be a bit heavier

• leptin 
• fat cell development

scientists are looking to see what high levels of leptin do and how we can use that info for weight loss

• once a fat cell is formed it is always goin to be there and our body is predisposed to want to fill those fat cells
• for someone heavy they have X number of fat cells and they always will, but they can shrink them and therefore lose weight
• sex age race and ethnicity play key roles in body composition

• Over years weve witnessed change as modern appliances have made our lives easier
• our jobs dont involve manual labor anymore
• housework isnt done by hand
• as lifestyle has become more sedentary our waistlines have become thicker

• socioeconomic status (more $ may mean going out to eat more or fattier cuts of meat)
• frients and family (hanging out with fat people can make you fat, order 1st at restaurants to avoid)
• cultural/ethnic influences
• availability of high fat foods
• excessive TV viewing
• lack of sleep (get at least 6-7)
• emotional eating
• stress
• fast food
• quitting smoking

• it is global and growing
• theres growing evidence that our kids are heavier than ever
• if things dont change, healthcare costs will soar
• we need a public health plan for kids and adolescents
• health conditions related to obesity are becoming more prevelant

• kids less than 2YO: 10%
• Teens: 18%
• men: 73%
• women: 64%

• isnt easy
• the focus for adults should be a slow weight loss with decreased calorie intake, adequate nutrient intake, and increased physical activity
• once weight loss is acheived the long term goal should be weight management

• control of calories
• physical activity
• behavior modification

• this is a lifestyle change, not a diet
• chang our dietary intake and our activities of daily living
• think in terms of something you can change for the rest of your life

• there isnt a magic diet
• diet is a nasty word that has a negative connotation
• makes you think of starving and things you cant eat
• diet indicates short term goals, it cant be sustainesd and is often a failure long term

• 1-2 lbs per week
• by losing weight slowly over time you are much more likely to be successful in weight loss and maitenance

• females: no less than 1200 calories
• males: no less than 1500 cal
• if you go less than these it is very difficult to meet your nutrient needs and you will also screw yourself because you will slow your BMR and not lose weight

• read labels: comparing labels on similar food products can help you make wise food choices in terms of serving size, # cal per serving, and amount of fat per serving
• keeping food records: ppl who record what they eat are more successful in weight loss and maitenance. if you are writing it down youre more likely to think twice and be aware of what your eating when youre eating why your eating , portions and how you feel when you eat
• portion sizes: we tend to overestimate our portion sizes. limit drinks loaded with sugar and drink low/nocal drinks.

• today, the bigger the better
• restaurants increased portion sizes, fast food and convenience stores increased the drink sizes

• drinks pack a large number of calories with no satiety
• drinks: 22 oz, 32 oz, 44oz
• 5g of sugar= 1 teaspoon
• 22oz= 15 tsp
• 32oz= 22 tsp
• 44oz= 30tsp

portion size is the amount we choose to eat, while a serving size is the measured amount for one serving. it is a specific measurement of food that is recommended to help the consumer make wise food choices

• 20 years ago, the average bagel was 3in in diameter and provided 140 cal
• today, a bagel is 6in in diameter and provides 350 cal, an extra 210 calories
• in order to burn the extra 210 cal a 130lb person would need to rake leaves for 50min
• at home, use measuring cups and a scale to control portions since they are hard to visualize

• food manufacturers have started to manipulate products and labels. many products are now "low fat" or "fat free"
• read nutrition facts and ingredients bc low fat doesnt mean healthy
• the low fat may have the same number of calories. also, fat gives taste sot hey may add extra sugar or salt to make up for that.
• thinking a product is low in fat may also cause you to eat more of it, even if its not healthy

• being physically active does more than just burn calories
• even if you dont lose wieght, there are many benefits to being active
• decreases stress (stress causes weight gain)
• increases mood
• increases productivity (feeling sluggish? move for 10min and youll be more productive)
• maintains bone health (prevents bone loss and lowers osteoperosis risk)
• increases lean muscle mass allowing us to burn cal more efficiently even at rest

• 60-90 min of exercise a day
• 10,000 steps/day
• it used to be thought you have to exercise all at one time for benefits, not true, small increments gives you the same benefits as long as it adds up
• you can be flexible with varing activities
• you need cardio for your heart and also resistance activity and stretching
• do little things, instead of emailing go walk otver to someones desk 
• resistance activities tone you, you may not lose weight but your clothes will fit differently

certain behaviors prevent us from reducing our weight loss goals and defining what they are and learning how to manage them will make you more successful with weight loss and management

• Chain breaking
• Stimulus control
• Cognitive Restructuring
• Contingency Management
• Self Monitoring

• discovering what ties connect 2 or more behaviors that encourage overeating and breaking those ties
• ie- if you sit down to watch TV and eat snacks, to chain break, you can say youll only eat in the kitchen and youve broken the chain linking eating and watching TV

• a way to avoid temptation
• ie 0 if you eat when your bored dont buy convenience foods that you like to eat at these times, or limit yourself to 1 piece of chocolate per day

• changing your frame of mind regarding food
• ie- rather than turning to food when your stressed, turn to exercise
• if after exercising you are still hungry, you can eat something small, but this new thinking and exercise will help you not to eat out of habit

preparing for situations that can trigger overeating like a party or donuts at the office

• keeping a diary
• this keeps you accountable and lets you know why, when, how, where and how you feel when eating

• many cant keep it off
• this is where behavior modification comes in to help you long term
• in addition to changing behavior, social support is also important (family, friends, social programs and professional help)

• family and friends
• hospitals, community colleges and restaurants
• cooperative extension programs
• professional help
• weight loss programs

• can have a positive or negative impact
• if you eat around your fat friends youre more likely to get fat
• make sure they understand your goal to keep it off and that you seek their encouragement and support

• can provide healthy cooking classes
• can be general healthy cooking classes or cooking related to a specific disease
• heart disease, cook with low salt
• diabetes, low concentrated sweets

ie strength training classes

• physicians
• exercise physiologists
• registered dieticians (can be available at grocery stores to help you make wise choices)

• TOPS (take off pounds sensibly)
• Jenny Craig
• Weight Watchers
• Nutrisystem

these people may look into medical procedures including medication, surgery and/or prescribed low cal diet

bmi over 30 or over 27 with other health problems

• amphetamines
• appetite reduction drugs
• fat absorption inhibitors

• stimulate the CNS (which helps you burn calories)
• you feel on a high, have lots of extra energy
• only for short term use
• people can develop a dependency on these or abuse them, so doctors try to avoid them, and if they do recommend them, its not for long

• meridia is one of the best known ones of these, it is approved by the FDA
• reduces hunger sensations
• helpful for people who eat fairly healthy but eat more than they should

• Orlastat is a well known one (aka zenecal)
• prescription only
• there is also a low dose form called Alli that is over the counter. you can start this to see how it works and if you get bad side effects
• this inhibits glucolipase enzyme from digesting fat
• appx 1/3 of your dietary fat is not absorbed and it is passed with the feces
• side effects include gas, bloating diarrhea, so if someone doesnt cut back on the amount of fat in their diet in addition, they will be very uncomfortable

• in addition to meds, this may also be perscribed by a physician
• diet low in carbs and high in protein
• diet may be as low as 800 cal a day

• a last resort to lose weight
• bariatrics: the branch of medicine that deals with obesity and interventions that can be used to help a person lose weight
• there are 2 forms of bariatric surgery

• Gastric Banding
• Gastroplasty (Aka Gatric Bypass)
• Both are proven successful but need to be ordered and donw by a physician and behavior modification techniques are recommended for both

• A restrictive procedure, the opening from the esophagus to the stomach is restricted using a gastric band- it forms a small pouch int he stomach. That band can then be inflated or deflated to help control the amount of food that a person can consume and still be comfortable
• if they eat too much at one time, it will cause upper GI issues (ie heartburn) to help restrict the amount they eat

• stomach stapling- you are reducing the stomach capacity and you end up bypassing a small portion of the duodenum
• the stomach is decreased in size so it can only hold 30 mL or the volume of an egg. 
• for the majority of people who get this lose 50% of the weight over the next year
• people start to feel full quickly and cant overeat or they will experience abdominal symptoms and vomitting

• extensive counseling is required
• patient's history is examined, health risks are looked at 
• they want to ensure the person truly is a candidate
• the person must be aware of the risks
• bypass is very costly and additional surgeries are needed after weight loss to remove excess skin
• person must be willing to make lifestyle changes, adding exercise and changing dietary habits to maintain the loss

• clots
• bleeding
• hernias
• infection
• nutrient deficiency
• increased risk of death

• can also be a cause for concern
• less than an 18.5BMI
• gaining weight can be as difficult as losing it

• genetics (small frame size)
• disease- cancer, endocrine disease or kidney disease
• gi disorder- ibs or crohns (nutrients not absorbed)
• AIDS
• eating disorder and excessive exercise

• increase calories
• exercise to gain muscle mass
• behavior modification
• eat several healthy snacks a day (this is called grazing)
• milkshakes with protein powder
• limit fluids to decrease satiety
• increase healthy fats

• will lead to periods stopping which can have long term effects including loss of bone mass (puts young women at risk for fractures), weakened immune system (increased complication after surgery, slow wound healing, etc)
• if low body weight is due to genetics and the person is otherwise healthy, there is little need to worry

everywhere- tv, magazines, newspaper, radio, celebs, grocery store

• a healthy diet includes all foods in moderation, the fad diet often emphasizes one food group
• you can lose weight on a fad diet, but is it the diet? or just eating less calories?

• promote quick weight loss: while true you may shed the weight quickly, it is likely water weight not fat weight youre losing
• endorsements: use celebrities or actors who impersonate medical professionals to sell it
• limited food selections: you are often encouraged to avoid 1 or more food groups
• cost: can be expensive and require expensive nutrient supplements
• claim to cure all: not only do they claim weight loss but also more energy, better sex life, decreased stress 
• leave out other parts: do not recognize the role of exercise and behavior modification

• many women do this ie oprah winfrey
• diet, lose weight, eat more, gain weight, become upset and diet again
• fad diets like this set the individual up for this cycle of failure
• women who yoyo diet have greater health risks than just overweight women
• this cycle can also lead to feelings of guild and lower self esteem

• moderate calorie restriction
• carb or protein focused
• low fat
• novelty diet

• limits calories to 1200-1800 cal/day
• if the plan includes a variety of foods from all groups and encourages exercise it can be a good diet
• examples: weight watchers, jenny craig, diety for dummies, dr. phils ultimate weight solution

• most of these have a severe carb restriction which causes the body to turn to protein and stored glycogen for energy.
• This can lead to weight loss but also ketosis, headaches, constipation and muscle cramps
• weight lost is water weight
• failure usually occurs due to boredom with the diet
• examples: atkins, south beach, nutrisystem
• recently there has been more emphasis on glycemic load. carbs are limited but emphasis is placed on low glycemic index foods such as whole grains, fruits and veggies and limiting high glycemic index foods. Its not a perfect diet but its more reasonable to follow and long term success has been acheived (ie new glucose resolution and the GI diet)

• eliminates animal protein sources and oils
• focuses on fruits, grains and veggies
• can be a very helpful way of eating but with fat restricted to less than 20% of daily cal intake this can get tedious and repetative
• this approach can result in improvement in cholesterol and blood pressure improvement
• examples include the Ornish or Pritikin diets, T factor diet and Eat More Weigh Less

• focuses on gimmicks, they promote certain foods or types of foods as having special weight loss qualities
• theres no scientific evidence to back it up
• ie: cabbage soup diet, beverly hills diet, cookie diet
• weight loss in this diet is from lack of calories but not the recommended foods and tend to gain the weight back long term

are not nutritionally balanced and may lead to malnutrition longterm. If you want to lose weight dont fall for gimmicks. You shoud acheive a healthy weight slowly