Chapter 9 – BMI, Obesity & Weight Management 1. How prevalent is obesity/overweight in the United States? The last 50 years? a. About 2/3 of U.S. adults are overweight or obese; 1/3 of US children overweight or obese b. 50 years later, 69% of US adults are overweight/ obese; 17% of children are obese 2. Be ablIf you want to learn more check out ∙ God represents the authority - this idea has shaped our Western World ∙ Who enforces this authority?
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e to define BMI, what it correlates to, interpretation and drawbacks of BMI a. Definition: measure of body fat based on weight and height; weight a. (lbs*703)/in2 b. Does it always correlates with body fatness and disease risk? a. No c. How do you interpret the BMI values? a. Underweight = <18.5 b. Normal = 18.5-24.9 (lowest risk of death c. Overweight = 25-29.9 d. Obese = >30 e. Morbid obesity = >35 d. Drawbacks a. Fails to indicate HOW MUCH of a person’s weight is fat and WHERE that fat is located 3. What’re the three methods used to assess body fat? a. Waist circumference i. Indicates visceral fatness and health risks ii. Above a certain girth, disease risks increase b. Skin fold test c. Radiographic techniques i. Ex: Dual energy X-ray absorptiometry 4. What is the average body composition of men and women? a. Men i. 45% muscle ii. 25% organs iii. 15% fat iv. 15% bones b. Women i. 36% muscle ii. 24% organs iii. 27% fat iv. 13% bones c. Men % fat i. 12-20% ‘normal’ ii. 5-10% for athletes d. Women % fat i. 20-30% ‘normal’ ii. 15-20% in athletes5. What affect body fat distribution? a. Age/gender i. Men have apple profile ii. Women have pear profile b. Moderate alcohol intake c. Higher levels of physical activity 6. What is visceral adipose fat? a. Fat collected within central abdominal area of the body poses greater risk of major chronic diseases than does subcutaneous fat of the abdomen, thighs, hips and legs b. Central obesity elevates the risk of death from all causes 7. Characteristics of fat cells (adipocytes) a. # of cells increases during teen years b. Cells never go away, but empty and re-fill i. Once too full, they divide and inc in # 8. Why excessive body fat increases the risk of chronic disease? a. Adipose tissue releases hormones adipokines. i. They help to regulate inflammatory processes and energy metabolism in the tissues. b. In obesity, the balance of adipokines is shifted that favor both tissue inflammation and insulin resistance. i. This contributes to the chronic diseases 9. What are some problems with obesity? a. Health: Higher risk for lots of chronic diseases and inflammation b. Social: Judgement and stereotyped by appearance, being lazy c. Psychological: feelings of rejections, shame, depression, failure 10. What is body’s energy balance? Where is this energy found? a. Change in energy = energy in – energy out i. Energy in = from foods and beverages ii. Energy out = basal metabolism, thermic effect of food and exercise 11. Define BMR and its factors, EER and thermic effect of food. a. BMR (basal metabolic rate) = amount of energy used daily while at rest i. Factors that affect the BMR (39 Chp 14) 1. Age; every decade decays 5% 2. Height; taller people spend more time 3. Growth; younger people uses more energy 4. Body composition 5. Stress/Fever 6. Environmental temps 7. Fasting/starvation 8. Malnutrition 9. Thyroxine; under production of this inc BMR + more production inc BMRb. EER (estimated energy requirements) i. Front page of textbook c. Thermic effect of food = caloric cost of digesting and processing different macronutrients in your diet 12. What are the components of energy expenditure? a. 50-65 BMR b. 25-50% exercise c. 5-10% thermic effects of food 13. How does the body tolerate rapid weight loss VS moderate weight loss? a. Gradual weight loss is preferred b. Rapid weight loss i. Fasting 1. Deprives tissue of nutrients 2. Overeating at times 3. Death ii. Body adjustments 1. Slows metabolism to save energy 2. Sacrifices lean tissue iii. Ketosis 1. Break down of fat molecules 2. Imbalances acid-base balance of blood ???? excessive mineral loss in urine 14. How does the body’s metabolism adjust in fasting/feasting? a. What are the sources of energy in fasting? a. Fasting i. glycogen ???? glucose ii. fat???? fatty acids ???? ketone bodies b. Feasting i. Carbs ????glucose ii. Fat???? fatty acids iii. Protein ???? amino acids c. During fasting, brain and nervous system uses ketone bodies as energy i. RBC only use glucose ii. Ketones can pass barrier and support brain iii. If you don’t eat carbs ???? uses proteins in muscle ???? glucose b. What happens with excess of macronutrients (carbs, proteins, fats) in the body? a. Weight gain c. How is the energy stored in a fed state? a. Glycogen in muscles b. Glycogen in liver to help with blood vessels 15. How do you achieve and maintain healthy body weight? a. Eating patterns b. Exercisec. Behavior modification d. Achievable goals e. Keep records f. Safe weight loss i. ½-2lbs per week; no more than 2lbs/week ii. 10% body weight / 6months iii. 1 lb = 3500 kcals 16. What are the best food strategies for weight loss? a. Identify calorie excesses b. Eat low energy density food (cals/grams) c. Choose nutritious foods d. Drink water e. Eat small portions 17. How to maintain healthy weight? a. Exercise with a friend or group b. Support groups c. Healthy diet choices Chapter 11, Controversy 8 – Dietary risk factors and disease 1. Explain the differences and characteristics of Chronic VS infectious disease a. Differences i. Cause 1. Infectious: Caused by bacteria, viruses, parasites and other microbes that can be transmitted from one person to another through air, water or food; by contact 2. Chronic: genetic, prior/current diseases, lifestyle ii. Duration 1. Infectious: slow or fast; depends on strain; many are resistant to antibiotics 2. Chronic: slow progression, long duration b. Examples i. Infections: influenza, malaria, TB, strep ii. Chronic: heart disease, hypertension, cancer, stroke, diabetes, obesity 2. What are the top 10 leading causes of death in the US? a. Heart disease b. Cancers c. Chronic lung diseases d. Strokes e. Accidents f. Alzheimer’s g. Diabetes mellitus h. Kidney diseases i. Pneumonia and influenza j. Suicide 3. How do micronutrient deficiencies impair the immune system? a. Impairs immune tissues first (cells can dec, leaving body vulnerable) i. Vit A = maintains healthy skin; cellular replication, antibody production. Anti-inflammatory response ii. Vit D = regulates immune cell responses iii. Vit C & E & selenium = protective against oxidative damage iv. Vit B6 and Zinc= maintains effective immune response v. Vit B12 ad folic acid = assist in cellular replication and antibody production 4. What’s the difference between acute inflammation and chronic inflammation? a. Inflammation = WBCs release oxidative products that kill microbes and heals wounds b. Chronic inflammation = i. long term inflammation ii. attacks healthy tissue 1. inflamed tissue produces free radicals, blood clotting factors and bioactive chemicals iii. root of many illnesses 1. heart disease 2. cancers 3. Alzheimer’s 4. Arthritis 5. What is oxidative stress and its causes? a. Imbalance between production of free radicals and ability for the body to counter (detoxify) their effects 6. What is the concept of risk factors? Give examples of risk factors for chronic diseases. a. They show correlation w/the disease and occur in clusters; may affect several diseases b. Risk factors put us at an increased risk for a disease, but does not necessarily cause it c. EXAMPLES i. Genetic ii. Nutrition iii. Environmental iv. Behavioral 7. How can a person estimate his/her risk? How can you reduce the risk? a. Estimation i. Search family’s medical history 1. Alcoholism 2. Cancer 3. Diabetes 4. CVD 5. Hypertension 6. Liver disease7. Osteoporosis ii. Laboratory tests b. Reducing risk i. Get physical evaluation from your PCP ii. Know family history iii. Evaluate diet iv. Reduce/eliminate modifiable risk factors 1. Dietary 2. Physical activity 3. Smoking, alcohol 4. stress 8. What is the incidence of CVD in the US? a. Kills 1 million Americans per year b. More than 82 million men and women suffer from some form of CVD c. CVD s the leading cause of death among women d. More than 42 million US women have CVD 9. What causes atherosclerosis? What are the contributors to atherosclerosis? a. Hardening because of build of plaques ???? pumps blood harder ???? inc BP i. Deposits of plaque along walls of arteries, hardening of the arteries ii. Everyone has signs; advanced disease b. Plaque formation (inflammation????macrophages????mineralization) i. LDL particles oxidized ???? no longer metabolized by liver???? accumulate in branches of arteries ???? pro inflammatory action starts (WBCs)???? macrophages become foam cells ???? mineralization inc hardening the plaques c. Results i. Plaque ruptures ii. Blood clots 1. Thrombus 2. Embolus 3. Omega-3 fatty acids (raw material for hormones [eicosanoids]); pro/anti-inflammatory that fight plaque formation iii. BP – Aneurysm 10. What are the modifiable/non-modifiable risk factors for CVD? a. Nonmodifiable i. Age, gender, genetic inheritance b. Modifiable i. Diet, smoking, certain diseases and physical inactivity ii. LDL.HDL cholesterols 1. Higher the LDL????greater risk a. Most atherogenic lipoproteins iii. High blood triglycerides 11. Define metabolic syndrome and know the health risks a. A cluster of health risks that increase your risk of heart diseases i. low blood HDL cholesterol, ii. high blood pressure, iii. elevated fasting blood glucose (insulin resistance) iv. central obesity v. high blood TAGs b. Central obesity and insulin resistance are thought to be primary factors 12. What are the recommendations for reducing CVD risk? a. Estimate heart diseases risk b. Lifestyle changes i. Inc physical activity ii. Lose weight iii. Implement dietary changes iv. Reduce exposure to tobacco smoke 13. What kind of diet can reduce the CVD risk? a. Diet to reduce CVD risk i. Reduce fat intake; moderation 1. Sat and trans fats 2. Replace w/unsat ii. Limit refined starches and added sugars iii. Eat fruits, vegetable and whole grains iv. Diet rich in omega-3 fatty acids v. Other dietary factors 14. What is hypertension? What is the normal BP? What is BP based on? What are the risk factors for hypertension? Effects of nutrition/lifestyle on hypertension? What is DASH diet? a. Hypertension = higher than normal BP b. Normal BP = 120/80 i. Systolic (120) = pressure during contraction ii. Diastolic (80) = pressure during relaxation c. BP is based on: i. Cardiac output = BP from contractions ii. Peripheral resistance = resistance blood encounters in the small arteries iii. BP inc when either cardiac output or peripheral resistance increases d. Risk factors i. Age (2/3 adults older than 65 have hypertension) ii. Genetics (African Americans higher prevalence) iii. Obesity (60% people w/hypertension are obese)iv. Salt intake v. Alcohol vi. Diet vii. Exercise e. Effects of nutrition i. Nutrition 1. Lowers BP (K, Ca, Mg) 2. Reduces inflammation 3. Lowers LDL cholesterol ii. Lifestyle 1. Decreases stress hormones 2. Redistributed water and eases transit of blood through small arteries f. DASH diet i. Diet rich in fruits, veggies and low-fat milk products w/reduced sat fat intake 15. How does cancer form? a. In genes by mutation b. DNA damaged by carcinogen i. Cellular repair or self-destruction ii. Immune system (well-nourished person destroys damaged cells) c. Cell loses ability to self-destruct i. Replicates uncontrollably d. Mass of abnormal tissue i. Benign (encapsulated tumor) ii. Malignant (metastasis, replicates fast) 16. Risk factors for cancer. How diet can affect cancer? a. Risk factors i. Genetic or microbial infections ii. Lifestyle and environmental exposure iii. Energy intake 1. Reduce calorie intake ????cancer rate falls iv. Obesity 1. Obese women have higher levels of circulating estrogen – breast cancer risk v. Avoidance of hormone replacement therapy 1. May reduce breast cancer vi. Physical activity vii. Alcohol viii. Fat and fatty acids b. Diet effects i. Red meat 1. Nitrates added to keep meat red???? become carcinogenic 2. Cooking at high temps form carcinogens 3. Smoking, grilling the same effect ii. Minimize carcinogen formation 1. Roast or bake meats in oven 2. Wrap food in foil when grilling 3. Take care not to burn foods 4. Marinate meats before cooking iii. Increase in your diet 1. Fiber rich foods 2. Folate and antioxidant vitamins 3. Ca and vit D 4. Iron 5. Whole foods and phytochemicals iv. Dash diet: preventive medicine 1. Fruits and veggies a. More matters 2. Make only a few dietary changes at a time Chapter 9 – Eating Disorders 1. What are eating disorders? Incidence? a. Serious mental illnesses characterized by severe disturbances in eating and exercise behavior and potentially can be life threatening b. Incidence i. About 5 million people in US suffer from anorexia and bulimia nervosa ii. More than 8 million suffer from binge eating; 3 million men iii. Has steadily increased since the 50s 2. Possible causes and health consequences of underweight a. Signs i. Lethargy – no energy ii. Depression iii. Loss of muscle bulk iv. Loose, elastic skin b. Causes i. Malnutrition ii. Smoking habits iii. Substance abuse iv. Illness v. Eating disorders c. Health risks i. Inability to preserve lean tissue during a wasting diseases (cancer, digestive disorder)ii. Women: menstrual irregularities and infertility iii. Osteoporosis and bone fracture iv. Nutrient deficiencies are common v. Immune response is diminished 3. What causes eating disorders? a. Psychological (depression, low self-esteem, obsessive-compulsive disorder) b. Biological (genetic factors) c. Cultural d. Society’s influence i. Many causes to eating disorders 1. Pressure for thinness a. Distorted body image: normal healthy body as to fat b. These behaviors are nonexistent in cultures where body leanness is not central to self-worth ii. Media messages 1. Miss America beauty pageant: thinner women over years have won 2. Magazines and media convey message that to be happy, beautiful and desirable, one must first be thin 4. Know the types of eating disorders a. Anorexia Nervosa i. Characteristics 1. Can’t recognize condition 2. Insists on being too fat 3. Stop menstruating 4. Moody 5. Chronically depressed 6. Blames external circumstances 7. Physical exhaustion 8. Insomnia ii. Physical perils: 1. same damage as classic severe malnutrition: growth ceases, osteoporosis, anemia, heart and kidney failure, damage to body and death iii. Treatment 1. Needs a multidisciplinary approach that addresses 2 areas of concern a. Restoring weight b. Psychological processes2. Teams of physicians, nurses, psychiatrists, psychotherapists and dietitians involved 3. When starvation leads to sever underweight (<75% of ideal body weight) patient needs hospitalization b. Bulimia Nervosa i. Characteristics 1. More prevalent than anorexia nervosa 2. Obsessed by thoughts of food 3. Kept in secret, but aware of illness 4. Frequent binges and compensations (at least 2x a week for 3 months) 5. Sense of lack of control during episodes 6. Emotional insecurity ii. Cycle 1. Tension ????craving????binge eating????purging????shame/disgust????strict diet???? tension iii. Physical and psychological perils 1. Fluid and electrolyte imbalances ???? death from heart and kidney failure 2. Vomiting -????irritation and infection of pharynx, esophagus and salivary glands; erosion of teeth and dental cavities 3. Correlation between addictive nature of binge eating and drug abuse iv. Treatment 1. Structured eating and exercise plan 2. Steady maintenance of weight 3. Consistently eating enough food to satisfy hunger (at least 1600 cal/day) c. Binge eating disorder i. Associated w/3+ of the following 1. Eating much more rapidly 2. Eating until feeling uncomfortably full 3. Eating large amounts of food when not physically hungry 4. Eating alone bc of embarrassment of quantity of food 5. Feeling disgusted w/oneself, depressed or guilty ii. Characteristics 1. Uncontrolled eating, kept in secret 2. Depression and other psychological problems 3. Awareness that eating pattern is abnormal 4. W/o compensatory behavior5. Responds more rapidly to treatment Chapter 12 – Food Safety 1. What are the FDA’s 6 main concerns about food safety? a. Microbial foodborne illness b. Natural toxins in foods c. Residues in food i. Environmental contamination ii. Pesticide residues iii. Animal drugs d. Nutrients in food e. Intentionally approved food additives f. Genetically modified foods 2. How do microbes in food cause illness in the body? a. Infection i. Salmonella bacteria or hepatitis viruses b. Intoxication i. Enterotoxins ???? act on mucous membranes ii. Neurotoxins ???? act on cells of the nervous system iii. The most common cause of food intoxication is the Staphylococcus aureus bacterium 1. they are heat-resistant and remain hazardous even after cooked iv. The deadliest is Clostridium botulinum 1. are heat-sensitive and can be destroyed by boiling 3. Main symptoms of foodborne illnesses (FBI)? a. Bloody stools b. Dehydration c. Diarrhea d. Fever e. Headache w/muscle stiffness and fever f. Numbness, weakness and tingling g. Rapid HR, fainting/dizziness h. Severe cramps 4. How does the food get contaminated? What foods are most at risk? How do we reduce contamination? a. Contamination i. Meat – during slaughter 1. Microbes in animals’ guts (E. coli) ii. Fruit & veggies– contamination of water/soil 1. Animal manure or human sewage run off can contaminate irrigation water or soil iii. Oysters, fish can be grown in bacteria contaminated water iv. Salmonella – infects hen’s ovary v. Transfer microbes from hand to foodvi. Cross contamination between ready to eat food and un-cooked food b. Foods at risk i. Foods high in moisture and nutrients and chopped or ground are especially favorable hosts for microbial growth ii. Meat, ground meats, stuffed poultry iii. Undercooked eggs accounts for about 30% of U.S. Salmonella infections iv. Unpasteurized raw milk and raw milk products v. Seafood, filter-feeding shellfish (oysters, clams, mussels) vi. Raw produce, vegetable sprouts c. Reduce contamination i. Farm (workers trained what method to grow food)???? processing (workers trained how to prevent contamination – clean machine) ???? transportation (proper temp)???? retail (keep eye on cleanliness and temp)???? table (properly cooked and stored) 5. What are the most dangerous bacteria causing FBI? a. E. coli i. Found in intestines of healthy cattle ii. Shiga toxin 1. E. coli O157:H7 iii. Sources 1. Contaminated meat during slaughter 2. Contaminated water 3. Diarrheal stools iv. Effects 1. Severe bloody diarrhea and ab cramps, dehydration 2. Acute kidney failure in children 3. 6. What are the precautions you need to take to avoid FBI? a. In a grocery store a. Freshness dates (expiration, sell by, consume by) b. Inspect seal, wrappers, buttons, bulging, leakage, soiling, punctures c. Nerve buy dented cans d. Frozen foods should be completely frozen e. Buy fresh eggs and not cracked ones b. The four practices for individuals. a. Clean i. Keep hands clean ii. Wash fresh fruits and veggies iii. Keep kitchen clean b. Separatei. Keep meats away from other foods ii. Avoid cross contamination c. Cook i. Make sure it’s cooked + storing methods after cooking ii. Below 40 and above 140 is safe bc microbes can grow; in between is perfect environment for microbes d. Chill i. Refrigerate foods quickly 1. After shopping 2. Leftovers ii. Don’t over stud refrigerator 1. Smaller containers get chilled faster iii. Keep fridge below 40F iv. More than 2 hrs in room temp or above 90F ???? throw away v. Refrigerator doesn’t kill microbes, just slows growing process Phytonutrients/Dietary supplements 1. Define of phytochemicals. Their role in the body. a. Phytochemicals = Non-nutrient components found in minute amounts in plant foods b. Role in body i. Help protect plants from germs, fungi, bugs and other threats ii. Compounds that confer color, taste, aroma and texture of foods iii. Bioactive food components that interact w/metabolic processes in body iv. Interact w/each other in synergy 2. What are some important phytonutrients? a. Carotenoids i. Act as antioxidants ii. Alpha and beta carotene (yellow/orange foods), lycopene (red fruits and lowers prostate cancer), lutein (eye nutrient) iii. Sources: greens b. Flavonoids i. Helps prevent cancer (catechins), reduce inflammation (hesperidin) and CVD/lung problems (quercetin) ii. acts as antioxidant and limits damage to brain cells by oxidation c. Resveratrol i. Acts as an antioxidant and anti-inflammatory d. Phytoestrogens i. Can behave like estrogen and can block the effects of natural estrogen 3. Know some foods that have phytonutrients a. Blueberries = dec development of dementia, superfood for brain, b. Chocolate = rich in flavonoids (antioxidants) c. Flaxseed = rich in ligans and chemical that can be converted to phytoestrogens, helps relieve constipation and digestive stress d. Garlic = medical purposes, inhibit cancer development, oposses allergies 4. What are the reasons for taking supplements? a. Correct overt deficiencies b. Support increased nutrient needs i. Breastfeeding women have inc needs to support themselves and their babies ii. Small intestine disease causes inc needs due to absorption problems iii. Women who lose a lot of blood each month (iron deficiency) c. Improve nutrition status and prevent deficiencies i. Vegetarians who avoid certain food groups d. Reduce disease risk i. Inadequate intake of some nutrients linked to inc disease ii. But some studies show that taking supplements also inc risk 5. Who needs supplements? a. Nutrient deficiencies b. Very low energy diets (<1500 kcals/day) c. Strict vegetarians d. People w/allergies or intolerance e. Certain stages of lifecycle (pregnancy, breastfeeding, infants, elderly) f. Digestive system diseases that cause malabsorption g. Medications that interfere w/specific nutrients 6. Why do people stray away from supplements? a. Toxicity i. Foods rarely cause nutrient imbalances or toxicities but supplements can and do b. People self-medicate vs going to doctor c. Some supplements interfere w/medications i. Especially certain botanicals d. False sense of security i. Don’t eat veggies bc I have a multivitamin e. Supplement absorption may interfere w/other nutrients i. Fe and Ca compete for absorption ii. Taken in unnatural form ???? may not be absorbed f. Still being studied g. Waste of money 7. How dietary supplements are regulated? What is required on a DS label? a. Regulation i. Regulated under different set of rules by the FDA 1. Manufacturer must ensure product is safe for marketing 2. FDA is responsible for taking action against unsafe products ii. Dietary supplements don’t need to be approved by FDA 1. FDA has little supplements b. Label requirements i. Other Ingredients ii. Lot number iii. Expiration date iv. Contact information v. DSHEA disclaimer: vi. Units/container vii. Supplement Facts viii. Serving size ix. Amount per serving x. % Daily Value 8. How do you choose a supplement? a. Talk with your doctor, pharmacist and/or RD b. Look for USP label c. Choose a type d. Read labels e. Look for your target needs f. Look at the quality g. Avoid marketing traps