NCM 211 NUTRITION AND DIET THERAPY (LECTURE)

Father Saturnino Urios University

Prepared by: REANNE MAE C. ABRERA SN
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❖ INSUFFICIENTLY PHYSICALLY ACTIVE

OVERWEIGHT AND OBESITY
➢ Doing less than 60 minutes of moderate to vigorous intensity physical activity per
❖ Conditions in which body fat stores are enlarged to an extent which impairs health.
day.
❖ NORMAL WEIGHT
❖ PREVALENCE OF CHRONIC ENERGY DEFICIENCY AMONG ADULTS 20 YEARS OLD AND
➢ Average/desired/standard weight for height, age and sex;
OLDER
➢ BMI 18.5 to 24.9
➢ 8.0%
❖ OVERWEIGHT
❖ PREVALENCE OF OVERWEIGHT AND OBESITY AMONG ADULTS 20 YEARS OLD AND
➢ Weight 10% to 20% above average;
OLDER
➢ BMI 25 to 29
➢ 37.2%
❖ OBESITY
❖ The Philippines has shown limited progress toward achieving the diet-related
➢ Excessive body fat, with weight 20% above average;
non-communicable disease (NCD) targets. The country has shown no progress toward
➢ BMI is greater than 30
achieving the target for obesity.
EPIDEMIOLOGY
PATHOGENESIS OF OBESITY
❖ 11.6% of 10 to 19 year old adolescents are overweight and obese.
❖ “Obesity is not a single disease, but a heterogenous group of disorders each of which is
❖ Overweight more than doubled since 2003 with the prevalence registered at 4.9%
manifested by excess fat.”
❖ Proportion of insufficiently physically active adolescents among 10 to 17 year olds.
❖ FAT CELL THEORY
➢ 75.1% male
➢ Obesity develops when the size of fat cells increases; natural drive to regain any
➢ 84.4% female
weight lost.
❖ SET-POINT THEORY
 ➢ It proposes that the body tends to maintain a certain weight by means of its own 4. As addiction to food
internal controls. ❖ CULTURAL FACTORS
➢ OBESITY = POSITIVE ENERGY IMBALANCE ➢ Some cultures may find overweight as the epitome of beauty; ideal of strength
■ Poor diet and inactivity appears to be the leading factors. and power; food choices promote gain in weight.
❖ IMPAIRMENT OF APPETITE-MODULATING HORMONES ❖ MEDICATIONS
➢ GLP 1 – delay gastric emptying, decrease hunger, and promote weight loss ➢ Psychotrophic agents, antidepressants, narcoleptics, minor tranquilizers, and
➢ Oxyntomodulin – reduces food intake and increases energy expenditure beta-adrenergic agents including propranolol.
➢ PYY – reduces food intake ❖ METABOLIC DISEASES
➢ Ghrelin – active in the hunger center of the brain ➢ Hypothyroidism – rarely; decreases BMR (basal metabolic rate).
➢ Neuropeptide Y
HEALTH RISKS OF OBESITY
❖ HEREDITARY
❖ IMPAIRED INSULIN SENSITIVITY AND DIABETES MELLITUS TYPE 2
➢ No obese parents – 10% probability
➢ Sensitivty of cells to insulin is significantly reduced.
➢ One obese parent – 40%
❖ CORONARY HEART DISEASE
➢ Both parents are obese – 80%
➢ Strongly related to HPN (hypertension), CVA (cerebrovascular accident), coronary
❖ EMOTIONAL FACTORS
thrombosis, and CHF (congestive heart failure).
➢ People resort to overeating to alleviate tension, anxiety, worry, or frustration
❖ CANCER
➢ Making eating a weapon against failure and disappointment
➢ Breast cancer is common in obese post menopausal women; increases risk of
➢ Study of eating habits among overweight Americans shown:
certain cancers
■ Women tend to binge when lonely or depressed.
❖ OSTEOARTHRITIS
■ Men overeat in social occasions when happy, excited, encouraged to eat,
➢ Degenerative diseases of weight-bearing joints
or depressed.
❖ GALLSTONES
➢ CATEGORIES OF OVEREATING
➢ Higher output of cholesterol in bile
1. Response to non-specific emotional tensions
❖ REPRODUCTIVE DISORDERS
2. As a substitute gratification
3. Symptom of underlying emotional stress
 ➢ Excessive body fatness is associated with menstrual dysfunction, disorders of
fertility and childbirth; neural tube defects
❖ OBSTRUCTIVE SLEEP APNEA
➢ Sleep apnea and sleep-disorder breathing
❖ EMOTIONAL AND PSYCHOSOCIAL
➢ Depression and eating disorders; adults-social discrimination, social isolation,
peer problems, low self-esteem

ASSESSMENT AND ESTIMATION OF OBESITY

❖ DESIRABLE/IDEAL BODY WEIGHT

➢ NDAP METHOD
■ Males: 5 feet = 112 lbs
■ Females: 5 feet = 106 lbs
➢ For every inch increment above or below 5 feet, add or subtract 4lbs
➢ Overweight: 10% to 20% above average weight
➢ Obese: 20% or greater above average weight
 ○ Android – “apple-shape” common among men; deposits around the
BODY MASS INDEX
upper waist and upper abdomen.
❖ BMI = Weight (kg) / Height (m^2)
❖ WAIST-HIP RATIO (WHP)
CLASSIFCATION BMI (kg/m^2) RISK OF CO-MORBIDITIES ➢ Men: < 1.0
➢ Women: < 0.8
Undeweight < 1 8.5 Low
❖ WAIST CIRCUMFERENCE
Normal 18.5 – 24.9 Average ➢ Men: < 35
➢ Women: < 32
Overweight > 25
❖ BODY COMPOSITION

Pre-obese 25 – 29.9 Increased ➢ Overweight Individual – 150lbs

➢ Muscle Man – 150lbs
Obese Class I 30 – 34.9 Moderate
❖ MEASUREMENT OF SUBCUTANEOUS FAT

Obese Class II 35 – 39.9 Severe ➢ Skinfold thickness with the use of calipers
➢ Sites: Triceps, subscapular, abdominal, hip, pectoral and calf areas
Obese Class III > 40.0 Very Severe ➢ May be representative of the percentage of body fat
■ Water Displacement/Underwater Weighing
■ Bimetric Impedance
DISTRIBUTION OF BODY FAT
■ Neutron Activation Analysis
❖ TYPES OF OBESITY
■ Computed Tomography (CT)
1. Excess body mass or percentage fat
■ Ultrasound
2. Excess abdominal visceral fat
■ Total Body Water
3. Excess subcutaneous truncal-abdominal fat (android)
4. Excess gluteofemoral fat (gynoid/gynecoid)
○ Gynoid – “pear-shape”; common among women; heavier fat deposits
aroudn the buttocks and thighs; lower risks
 DIETARY TREATMENT OF OBESITY TOTAL ENERGY

❖ “For the diet to be effective, one must have a GENUINE DESIRE TO LOSE WEIGHT.” ❖ Macronutrients (CHO, CHON, and Fat) provide energy; PFV of 4 kcal/g, 4kcal/g, and
❖ Three (3) important goals necessary in obesity management: 9kcal/g respectively.
1. To help the patient achieve (if possible) a weight in the desirable range ❖ Promote negative energy balance to use up stored energy.
2. To help the patient remain at this target weight indefinitely; and ❖ NDAP FORMULA
3. If necessary, try to restore the patient’s self-esteem.
ACTIVITY LEVEL MALE FEMALE
❖ Characteristics of a satisfactory dietary program:
(kcal/kg) (kcal/g)
1. Fits the framework of family food habits and eating patterns
2. Nutritionally adequate In bed but mobile/Sedentary 35 30

3. Limited in calories
Light 40 35
4. Foods included are easily available, economic, and convenient
5. Provide effective motivation and suitable knowledge Moderate 45 40
6. Follow-up program included
Heavy 50
APPROPRIATE RATE OF WEIGHT LOSS
❖ Sedentary: secretary, clerk, typist, administrator, cashier, bank teller
❖ 0.5 – 1.0kg (1 – 2 lbs) per week
❖ Light: teacher, nurse, student, lab technician, housewife with madis
❖ Equivalent to reduction of 500kcal – 1000kcal per day from daily E° intake, respectively
❖ Moderate: housewife without maid, vendor, mechanic, jeepney, and car driver
MEDICAL HISTORY AND BASIC DATA ❖ Heavy: farmer, laborer, kargador, coal miner, fishermen, heavy equipment operator
❖ Multiply actual weight with corresponding activity level, deduct 500kcal to 1000kcal to
❖ Accompanying diseases
promote weight loss.
❖ Reasons as to noncompliance of previous diets (if applicable)
❖ Dietary Habits (food taboos, eating patterns, culture, etc.)
❖ CARBOHYDRATES
➢ 45% to 65% of total energy intake
➢ Emphasis on complex carbohydrates; 25 to 30g of fiber per day
❖ PROTEIN
➢ 10% to 20% of total energy intake unless contraindicated by the physician
➢ Emphasis on HBV proteins
❖ FATS
❖ VITAMINS AND MINERALS
➢ 20% to 35% of total energy intake
➢ Diet should contain necessary vitamins and minerals.
➢ Emphasis on MUFA (monounsaturated fatty acids), PUFA (polyunsaturated fatty
❖ FLUID
acids) rather than SFA (saturated fatty acids).
➢ Facilitates in the excretion of metabolic wastes.
➢ 1ml of water per 1kcal
❖ FOOD SELECTION
➢ “Eat smart”; choose foods that are low calorie, nutrient dense
❖ The FOOD EXCHANGE LIST is beneficial. ❖ Additional behavior modifications:
❖ COOKING METHODS 1. Weigh regularly, BUT do not weigh everyday
➢ Broiling, grilling, baking, roasting, poaching, or boiling are preferred 2. Don’t wait too long between meals
➢ Skimming fat from soups and meat disehs 3. Join support groups
➢ Trimming fat from meats 4. Eat slowly
➢ Limiting the addition of butter, cream, full cream, dairy products 5. Use a smaller plate
❖ EXERCISE 6. Treat yourself to other than food
➢ Aerobic Exercise (dancing, jogging, bicycling, power walking, etc.) 7. Anticipate PROBLEMS (e.g. BANQUET and HOLIDAYS). Undereat before and after.
➢ Such exercise: tone muscles, increases BMR (basal metabolic rate), lowers set 8. Save some calories for snacks.
point 9. Don’t punish yourself by eating.
❖ DAILY GUIDELIENS FOR EXERCISE: 10. If a binge occurs, don’t punish by continuing to binge.
➢ 30 minutes to prevent chronic diseases
FAD DIETS
➢ 60 to 90 minutes to prevent weight gain
❖ CRASH DIETS
➢ Over 90 minutes to maintain weight loss
➢ Intended to cause a very rapid rate of weight reduction.
➢ Children should get exercise or be active 60 minutes everyday
➢ Weight loss is caused by a loss of body water and lean muscle mass rather than
➢ Dieter must be aware of calories burned by specific exercise to prevent overeating
body fat.
after workout.
❖ ATKIN’S DIEAT
❖ SLEEP
➢ Phase 1 induces KETOSIS, restricts CHO to 20g
➢ Lack of sleep decreases BMR (basal metabolic rate).
➢ Phase 2 gradually increases CHO intake, emphasizes on complex CHO
➢ Sleep experts recommend at least 8 hours of sleep per day.
➢ Phase 3 maintains weight but controlled CHO
❖ BEHAVIOR MODIFICATION FOR WEIGHT LOSS
❖ ZONE DIET
➢ Fundamental behavior modification: development of a new and healthy eating
➢ 40% carbs, 30% protein, and 40% fats (sometimes called 40:30:30)
plan and an exercise program that can be used for over the long term
➢ A closer look at the Zone Diet shows that it is a low(er) carbohydrate diet – with a
➢ Hunger — physiological need for food
low calorie count – at times possibly too low
➢ Appetite — learned psychological reaction to food
❖ SOUTH BEACH DIET
PHARMACEUTICAL TREATMENT OF OBESITY
➢ The diet is becoming known as the “healthy” version of the Atkins diet.
❖ “Miracles are still short of supply.”
❖ CABBAGE SOUP DIET
❖ AMPHETAMINES (PEP PILLS)
❖ TAPEWORM DIET
➢ Central nervous system stimulants, weak appetite suppressant, does not
❖ LOW FAT DIET
promote weight loss.
❖ LOW CARBOHYDRATE DIET
➢ Increases heart rate, constricts blood vessels and open air passage ways;
❖ HOW TO IDENTIFY FAD DIETS
nervousness, insomnia; habit forming/addictive
➢ Recommendations that promise a quick fix.
➢ Phenylpropanolamine (PPA)
➢ Dire warnings of dangers from a single product or regimen.
❖ DIURETICS (WATER PILLS) AND LAXATIVES
➢ Claims that sound too good to be true.
➢ Weight loss relates to water elimination and not true fat tissue weight reduction.
➢ Simplistic conclusions drawn from a complex study.
➢ Causes dehydration, low BP (blood pressure), fluid and electrolyte balance; may
➢ Recommendations based on a single study or testimonials.
become habit-forming.
➢ Dramatic statements that are refuted by reputable scientific organizations.
❖ SIBUTRAMINE (MERIDIA™ AND REDUCTIL®)
➢ Lists of ‘good’ and ‘bad’ foods.
➢ Suppresses appetite; increases energy expenditure and satiety
➢ Recommendations made to help sell a product.
➢ AR: loss of appetite, constipation, dry mouth, insomnia, tachycardia, palpitations,
➢ Recommendations based on studies published without review by other
HPN (hypertension), vasodilation, dizziness, paresthesia, headache, anxiety,
researchers.
sweating, taste disturbances
➢ Recommendations from studies that ignore differences among individuals or
❖ ORLISTAT (XENICAL®)
groups.
➢ Inhibits the action of pancreatic lipase resulting in the excretion of about 30% of
➢ Eliminating one or more of the five food groups.
ingested fats
➢ Oily spotting, FLATUS WITH DISCHARGE, fecal urgency, fatty/oily stool, OILY
EVACUATION, increased defecation, fecal incontinence. Rarely, elevated
transaminase or alkaline phosphatase levels or hepatitis.
❖ THYROID PREPARATION
 SURGICAL TREATMENT OF OBESITY

❖ GASTRIC BYPASS
➢ Most of the stomach is stapled off, creating a pouch in the upper part.
➢ Pouch is attached directly to the jejunum.
❖ STOMACH BANDING
➢ Stomach is stapled but to a slightly lesser degree.
➢ Complication with surgeries: bleeding, infections, gastritis, gallstones; iron,
vitamin B12 and calcium deficiencies; DUMPING SYNDROME – nausea, vomiting,
diarrhea, bloating and dizziness

PRACTICE THE PRINCIPLE OF MOVABA

❖ MODERATION
❖ VARIETY
❖ BALANCE