### Chapter 8

```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)
REE = 66 + 13.7W + 5.0H – 6.8A
REE = 655 + 9.6W + 1.8H – 4.7A
Abbreviated method to estimate REE
REE = W in kg  1.0 kcal/kg  24 hr/day
REE = W in kg  0.9 kcal/kg  24 hr/day
Estimated Energy Requirements (EER) for Adults
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
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.
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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
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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
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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
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.
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
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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?
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:
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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
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?
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
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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?
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
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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
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