Chapter 9 Energy Balance and Weight Management: Finding Your Equilibrium Important Math Calculations Harris-Benedict equations (W = weight in kg, H = height in cm, and A = age in years) For adult males: REE = 66 + 13.7W + 5.0H – 6.8A For adult females: REE = 655 + 9.6W + 1.8H – 4.7A Abbreviated method to estimate REE For adult males: REE = W in kg 1.0 kcal/kg 24 hr/day For adult females: REE = W in kg 0.9 kcal/kg 24 hr/day Estimated Energy Requirements (EER) for Adults For adult males: EER = 662 – 9.53 Age [yr] + PA (15.91 Weight [kg] + 539.6 Height [m]) PA = 1.0 Sedentary 1.11 Low active 1.25 Active 1.48 Very active For adult females: EER = 354 – 6.91 Age [yr] + PA 3 [9.36 Weight [kg] = 726 Height [m]) PA = 1.0 Sedentary 1.12 Low active 1.27 Active 1.45 Very active Body mass index (BMI) 2 BMI = W in kg/H in m 2 BMI = W in lbs/H in m 704.5 Chapter Outline I. Energy In. *Energy balance is the relationship between energy intake and energy output. The energy content in food can be measured directly using a bomb calorimeter, or estimated using the factors 4 kilocalories per gram for carbohydrate and protein, 9 kilocalories per gram for fat, and 7 kilocalories per gram for alcohol. A. Regulation of food intake (Figure 9.3). *Food intake is regulated by hunger, satiation, satiety, and appetite, which are influenced by complex factors. Hunger is the physiological need to eat. Satiation is the feeling of fullness that leads to termination of a meal. Satiety is the feeling of satisfaction and lack of hunger that determines the interval until the next meal. Appetite is a desire to eat that is influenced by external factors such as flavors and smells and environmental and cultural factors. 1. Hunger, satiation, and satiety (Figure 9.3) 2. Appetite B. Control by committee. *Gastrointestinal stimulation, circulating nutrients, neurotransmitters, and hormones signal the brain to regulate food intake. © 2014 Jones & Bartlett Learning, LLC, an Ascend Learning Company 1. Diet composition 2. Sensory properties 3. Portion size (Table 9.1) 4. Environmental and social factors 5. Emotional factors 6. Gastrointestinal sensations 7. Neurological and hormonal factors Key terms: energy intake, energy output, energy equilibrium, positive energy balance, negative energy balance, energy balance, bomb calorimeter, hunger, satiation, satiety, appetite, hypothalamus, neuroendocrine, arcuate nucleus, alpha-melanocyte stimulating hormone, cocaine and amphetamine-regulated transcript, neuropeptide Y, agouti-related protein, melanocorin 4 receptor, leptin, anoreyigenic, ghrelin, oreyigenic, peptide YY II. Energy Out: Fuel Uses A. Major components of energy expenditure (Figure 9.5). *The major components of energy expenditure are resting energy expenditure, the thermic effect of food, and energy for physical activity. 1. Energy expenditure at rest a. Factors affecting RMR (Figure 9.2). *Body composition, age, sex, genetics, and hormonal activity affect the amount of energy used for resting metabolism. 2. Energy expenditure for physical activity (Table 9.3). *The energy cost of physical activity is affected by the person’s size and the intensity and duration of the activity. 3. Energy expenditure to process food B. The measurement of energy expenditure 1. A brief history of calorimetry. *Calorimetry is the measurement of energy use, either directly by measuring heat production, or indirectly by determining oxygen intake and carbon dioxide production. 2. Direct and indirect calorimetry (Figure 9.7) 3. Doubly labeled water (Figure 9.8) C. Estimating total energy expenditure (Table 9.4) D. DRIs for energy: Estimated Energy Requirements (Table 9.5) Key terms: total energy expenditure, basal energy expenditure, resting energy expenditure, basal metabolic rate, resting metabolic rate, lean body mass, nonexercise activity thermogenesis, thermic effect of food, calorimetry, calorimeter, direct calorimetry, indirect calorimetry, doubly labeled water, isotopes, Harris-Benedict equation III. Body Composition: Understanding Fatness and Weight. *Body composition—relative amounts of fat and lean body mass—has a major influence on energy expenditure and risk of chronic disease. A. Assessing body weight B. Assessing body fatness 1. Densitometry and underwater weighing 2. Densitometry and air displacement 3. Dual energy x-ray absorptiometry © 2014 Jones & Bartlett Learning, LLC, an Ascend Learning Company 4. Isotope dilution 5. Skinfold thickness 6. Bioelectrical impedance analysis 7. Computed tomography and magnetic resonance imaging 8. Near-infrared interactance C. Body fat distribution (Figure 9.15) Key terms: body composition, body mass index (BMI), Quetelet index, densitometry, underwater weighing, hydrostatic weighing, BodPod, dual energy x-ray absorptiometry (DEXA), total body water, bioelectrical impedance analysis (BIA), computed tomography (CT), magnetic resonance imaging (MRI), near-infrared interactance, body fat distribution, gynoid obesity, android obesity, waist circumference IV. Weight Management. *Abandoning unrealistic ideas of thinness and accepting body weight and shape are important elements in weight management. A. The perception of weight B. What goals should I set? *Long-term weight management includes a balanced diet of moderately restricted caloric intake, adequate exercise, cognitive-behavioral strategies for changing habits and behavior patterns, and attention to balancing self-acceptance, and the desire for change. C. Adopting a healthy weight-management lifestyle D. Diet and eating habits 1. Total calories 2. Crash diets don’t work 3. Balancing energy sources: fat 4. Balancing energy sources: carbohydrates 5. Balancing energy sources: protein 6. Eating habits E. Physical activity. *Physical activity improves fitness and helps achieve the negative energy balance needed for weight reduction. F. Thinking and emotions 1. Stress management 2. Balancing acceptance and change (Figure 9.8) G. Weight-management approaches 1. Self-help books and manuals 2. Meal replacements 3. Self-help groups 4. Commercial programs 5. Professional private counselors 6. Antiobesity prescription drugs 7. Over-the-counter drugs and dietary supplements 8. Surgery. *Surgical approaches to weight control should be considered only as a last resort for the morbidly obese. Key terms: weight management, metabolic fitness, positive self-talk, negative self-talk, ABC model of behavior, very-low-calorie diet, morbid obesity © 2014 Jones & Bartlett Learning, LLC, an Ascend Learning Company V. Underweight. *If the cause is not hereditary, being underweight can pose health problems. Gaining weight can be difficult for people who are underweight. A. Causes and assessment B. Weight-gain strategies What About Bobbie? Another day’s intake is presented in this chapter with a notation that Bobbie has gained 10 pounds in her freshman year. Dietary changes to lessen her caloric intake by 500 calories are included. Based on Bobbie’s height and weight, have the students calculate her REE and her BMI. Is she consuming enough kilocalories to sustain her REE and what is her risk for an obesity-related disease as based on her BMI? Classroom Activities ACTIVITY 1: WHAT IS THE DIFFERENCE BETWEEN HUNGER AND APPETITE? This activity can be completed for both large and small classes to help students identify the differences between the psychological desire to eat and the physiological need to eat. Instructors should first have the students identify the terms that match each of these definitions. These definitions can be placed on overhead transparencies or on worksheets. 1. __________ The internal, physiological drive to find and consume food. This is often experienced as negative sensations, often manifesting as an uneasy or painful sensation. 2. __________ The effects of a food or meal that delays subsequent intake. Feeling of satisfaction and fullness following eating that quells the desire to eat. 3. __________ Feeling of satisfaction and fullness that terminates a meal. 4. __________ A psychological desire to eat that is related to the pleasant sensations often associated with food. ANSWERS 1. hunger 2. satiety 3. satiation 4. appetite After the students identify what each term relating to the regulation of food intake means, they will read the following scenarios and decide which regulator the individual is experiencing. 1. Neil comes home from school at 2:00 P.M. after eating lunch. He must study for three final exams. He goes into the kitchen, opens up the refrigerator door and just stares at the food. He decides to make himself a sandwich. appetite 2. Melissa is a consultant for a beauty company and has back to back appointments planned all day. At 3:00 P.M. Melissa realizes she has not eaten and feels a pain in her stomach. hunger © 2014 Jones & Bartlett Learning, LLC, an Ascend Learning Company 3. Barney walks into a restaurant with an empty stomach. He orders appetizers, a main entree, and anticipates ordering a dessert. After finishing the appetizer and half of his entree, Barney notes that he is feeling fairly comfortable with his food consumption and decides to get a box for the rest of his entree and skip dessert. satiation 4. Blake has classes all day and does not have time to eat until 2:30 P.M. When he goes home for supper, the family eats around 5:00 P.M.; however, Blake chooses to put his meal in a microwave dish and eat when he feels more hungry. satiation 5. Sherry only gets to go to her grandmother’s house twice a year. She can’t wait for those times because she gets to eat her favorite cherry pie made especially for her, compliments of her grandmother. Even when Sherry has finished a big meal and feels full, she eats a piece of cherry pie. appetite ACTIVITY 2: IS “NUTRITION IN A CAN” AN EFFECTIVE MEANS FOR WEIGHT LOSS? The following assignment can be completed for small and large classrooms. However, the debate is best completed with a smaller class. I have included my point distribution and how I grade the paper, but both can be done in various ways and to the liking of the instructor/professor. Mandating that a paper be written before the debate assures that students do the research and are prepared to debate the information providing factual information. The day of the debate, students will number off 1-2-1-2. All of the 1s can represent the pro side of the topic and all of the 2s can represent the con side of the topic. The instructor can pretend to be a lay consumer who is mediating the debate. She can introduce the debate identifying that she is uneducated on the topic being presented and so she has invited a group of medical professionals (students) to discuss the topic at hand. She will ask a question and open the floor to one of the sides. Once the side has spoken the other side can respond. The instructor decides when the question is closed for discussion and then moves onto the next question. The questions can include: 1. Is “nutrition in a can” an effective way to help a person lose weight? 2. Are there advantages/disadvantages to using “nutrition in a can”? 3. Does “nutrition in a can” encourage behavior modification in diet and lifestyle? 4. The label on the can has plenty of numbers under the % Daily Value. This means there are many nutrients so this product must be healthy for an individual, right? 5. Is there an ingredient in the “nutrition in a can” that helps an individual lose weight? 6. Is it true that these products are only used for weight loss? 7. Is “nutrition in a can” an effective long-term weight loss practice? After the debate, the instructor can address the questions that were asked and highlight the following points: © 2014 Jones & Bartlett Learning, LLC, an Ascend Learning Company 1. “Nutrition in a can” appears to be a simple plan and gives individuals a starting point in losing weight. The plan might include the following: Just replace one to two meals with nutrition in a can. However, the individual would simply be cutting calories by doing this. 2. Convenient, but expensive 3. Monotonous 4. Does not promote MyPyramid with behavior modification regarding diet. 5. Get more fiber and phytochemicals by consuming a variety of foods. 6. There is not a special ingredient in “nutrition in a can” that helps a person lose weight. It is simply the reduction of kilocalories. 7. People tend to forget that food should be consumed as nourishment and start the habit of focusing on food as kilocalories. Slim-Fast® becomes a way to manipulate food and kilocalories rather than focusing on eating an overall healthy and balanced diet and enjoying it! 8. An individual may feel hungry much of the time. 9. “Nutrition in the can” is not only used for weight loss, but also for individuals who want to gain weight. In addition, some of the “nutrition in a can” can be used as tube feedings for those who are unable to receive adequate nutrition by mouth. 10. Gives an individual a false sense of security about his or her nourishment. 11. These liquids can be used to supplement the diet, but should not be used as a consistent replacement for meals with the intention to lose weight. However, for individuals who skip breakfast and find “nutrition in a can” convenient, something is better than nothing in providing fuel for the body and brain in the morning. The following are the instructions given to students: Writing Assignment 40 points You will need to research the assigned case study and help Renee make a decision about her nutritional dilemma. You will then write a paper using three different sources, two of which can be your text and an Internet site. This paper will be graded on writing ability (15 points), content (15 points), and the proper use of the APA reference format (10 points). The paper should be at least two pages, excluding the reference page. Case Study Renee wants to lose 10 pounds before the summer so she can fit into her bikini. She has seen the before and after pictures of individuals who have taken liquid nutritional supplements. Renee questions if “nutrition in a can,” such as Slim-Fast, is an effective means for permanent weight loss? Are these supplements only to be used for weight loss? Do they really work and should Renee lose her weight through this means? The first part of your paper should include your research findings about the case study topic. (Remember to refer to your book and notes on evaluating nutrition information when evaluating the validity of your research.) The last part of your paper should include your opinion, based on your research findings and class information, about the decision Renee should make and your overall thoughts on your topic. © 2014 Jones & Bartlett Learning, LLC, an Ascend Learning Company Debate 10 points The day of the debate you will be assigned to the pro or con side of your topic. You must then use the information you found in your research to defend the side you are assigned. Everyone must participate or points will be deducted from your grade. You may find it helpful to write down pros and cons for your topic before coming to class on the day of the debate. ACTIVITY 3: ENERGY BALANCE OR NOT? The following problems and questions can be presented as case studies to help students understand the concept of energy balance. These problems can also be used for group work. 1. John consumes 2,200 kilocalories on Monday, Wednesday, and Friday. Tuesday and Thursday he consumes 2,000 kilocalories. John tends to eat more on the weekend and consumes about 2,500 kilocalories on both Saturday and Sunday. John is extremely active and so his total energy expenditure for weight maintenance is quite high at 3,800 kilocalories. Is John in energy balance or is he gaining or losing weight? If so, how much? ANSWER 2,200 kcal 3 days = 2,000 kcal 2 days = 2,500 kcal 2 days = 6,600 kcal 4,000 kcal + 5,000 kcal 15,600 kcal/wk Per week John needs: 3,800 kcal 7 days = 26,600 kcal 15,600 – 26,600 kcal = –11,000 kcal John is lacking 11,000 kcalories in his diet to maintain weight. How many pounds lost per week is John losing? 11,000 kcal 3,500 kcal = 3.14 pounds John is not in energy balance. 2. Based on physical appearance, would a sumo wrestler be in energy balance? ANSWER: No. A sumo wrestler would be consuming more energy in than he is expending. 3. Maye is consuming 1,800 kilocalories a day. Her total weekly energy expenditure including voluntary activity, thermic effect of food, and basal metabolic rate equals 12,600 kilocalories. Is she in energy balance? Is she losing, gaining, or maintaining her weight? ANSWER: 1,800 kcal/day 7 days/wk = 12,600 kcal/wk consumed 12,600 kcal consumed 12,600 kcal expended = 0 © 2014 Jones & Bartlett Learning, LLC, an Ascend Learning Company Maye is consuming the same amount of kilocalories that she is expending, so she is in energy balance. Maye is maintaining her weight. 4. Which of the following would represent an individual in the latter stages of anorexia? Energy in = Energy out Energy in < Energy out Energy in > Energy out 5. Kay is a freshman in college. She recently went to a dietitian to seek help for her recent weight gain. Kay was unsure as to why she was gaining weight so quickly. Based on Kay’s dietary history of what she used to eat at home and what she currently eats at college, she is consuming an extra 600 kilocalories per day. How many pounds a week has Kay been gaining? ANSWER: 600 kcal/day 7 days/wk = 4,200 extra kcal/wk 4,200 kcal 3,500 kcal in a pound = 1.2 pounds per week Spotlight on Obesity: The Growing Epidemic Chapter Outline I. Factors in the Development of Obesity (Figure SO.4) A. Biological Factors 1. Fat Cell Development (Figure SO.5) 2. Sex and Age (Figure SO.6) 3. Race and Ethnicity (Figure SO.7) B. Social and Environmental Factors 1. Socioeconomic Status 2. Environment C. Lifestyle and Behavior Factors 1. How often do you eat out? 2. Our social network 3. Lack of physical activity 4. Psychological factors 5. Emotional eating Key Terms: hypercellular obesity, hypertrophic obesity, hyperplastic obesity, build environment, restrained eaters, binge eaters II. Childhood Overweight A. Let’s Move! (Figure SO.13) III. Health Risks of Overweight and Obesity (Table SO.2) A. Weight Cycling Key Terms: sleep apnea, weight cycling IV. Obesity Is a Preventable National Crisis © 2014 Jones & Bartlett Learning, LLC, an Ascend Learning Company
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