Nutrition A Functional Approach

Canadian 3rd Edition Thompson

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 CHAPTER
Achieving and Maintaining a
11 Healthful Body Weight
and In Depth: Obesity

Chapter Summary
A healthful body weight is one that is appropriate for age and physical development, pro-
motes healthful blood lipids and glucose, can be achieved and sustained without constant
dieting, promotes good eating habits, and allows for regular physical activity. Overweight
occurs when there is a moderate amount of excess body fat, and obesity occurs when excess
body fat adversely affects health. Morbid obesity occurs when body weight exceeds 100% of
normal. Body mass index, body composition, the waist-to-hip ratio, and waist circumference
are tools that can help to evaluate the health of a particular body weight.
We lose or gain weight based on changes in our energy intake, the food we eat, and our
energy expenditure. The three components of energy expenditure are basal metabolic rate
(BMR), the thermic effect of food, and the energy cost of physical activity. Many factors
affect the ability to lose or gain weight. Genetic background, childhood weight, physiologic
and social factors, and diet composition all influence our adult body weight. Fad diets rarely
result in long-term maintenance of weight loss. Diet plans that restrict intake of certain mac-
ronutrients can result in weight loss, but some have unhealthful side effects. A sound weight
loss plan involves a gradual reduction in energy intake, incorporating physical activity into
each day, and modifying behaviour where appropriate.
Underweight is having too little body fat to maintain health. Eating more and performing
resistance training and aerobic exercise can achieve healthful weight gain. Obesity and mor-
bid obesity are associated with an increased risk for many diseases and for premature death.
Treatment includes low-energy, low-fat diets and regular physical activity. Weight-loss pre-
scription medications and/or weight-loss surgery may be appropriate in some cases.

Chapter Objectives
After reading this chapter, your students will be able to:
1. Define what is meant by a healthful weight.
2. Define the terms underweight, overweight, obesity, and the three classes of obesity.
3. List at least three methods that can be used to assess your body composition or risk for
overweight.
4. Identify and discuss the three components of energy expenditure.
5. List and describe at least two theories that link genetic influences to control of body
weight.
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 6. Discuss at least two societal factors that influence our body weight.
7. Develop an action plan for healthful weight loss.

Chapter Outline
I. How Can You Evaluate Your Body Weight?
A. A healthful body weight can be defined by the following:
1. appropriate for one’s age and physical development
2. can be achieved and sustained without severely curtailing food intake or constantly
dieting
3. compatible with normal blood pressure, lipid levels, and glucose tolerance
4. based upon genetic background and family history of body shape and weight
5. promotes good eating habits and allows for participation in regular physical activity
6. acceptable to the individual
B. Determine your body mass index (BMI).
1. Body mass index (BMI) is a commonly used index representing the ratio of a person’s
body weight to the square of his or her height.
2. Why is BMI important?
a. BMI less than 18.5 kg/m2 is considered underweight.
b. BMI between 18.5 and 24.9 kg/m2 is considered normal weight.
c. BMI between 25 and 29.9 kg/m2 indicates a person is overweight.
d. BMI of 30 or greater is consistent with obesity.
e. BMI between 50 and 59.9 kg/m2 is considered super obesity.
f. BMI of 60.0kg/m2 and over is considered extreme obesity.
g. BMI values outside the normal weight range, either higher or lower, increase risk
of premature death.
h. You Do the Math: Calculating Your Body Mass Index.
3. There are limitations to the BMI.
a. BMI does not tell us how much of a person's body mass is composed of fat or
where the excess fat is stored.
b. BMI does not accurately assess muscle mass or bone mass.
c. Age affects BMI.
d. Physical and metabolic differences between people of different ethnic backgrounds
are not reflected in BMI.
e. BMI is of limited value for people with a disproportionately high muscle mass.
C. Measure your body composition.
1. Body composition measurements assess the amount of body fat and lean body mass
possessed by an individual.
D. Assess your fat distribution patterns.
1. The waist-to-hip ratio can determine the type of fat patterning.
2. Waist circumference can determine the type of fat patterning.

Copyright © 2014 Pearson Canada Inc. CHAPTER 11 Achieving and Maintaining a Healthful Body Weight 103
 II. What Makes Us Gain and Lose Weight?
A. We gain or lose weight when our energy intake and expenditure are out of balance.
1. Energy balance occurs when energy intake = energy expenditure.
2. Energy intake is the food we eat each day.
3. Energy expenditure includes more than just physical activity.
a. Basal metabolic rate (BMR) is energy output at rest.
4. The primary determinant of BMR is the amount of lean body mass.
a. The thermic effect of food (TEF) is the energy expended to process food.
b. The energy cost of physical activity is highly variable.
5. You Do the Math: Calculating BMR and Total Daily Energy Needs.
B. Genetic factors affect body weight.
1. The thrifty gene theory suggests that some people possess a gene (or genes) that
causes them to be energetically thrifty.
2. The set-point theory suggests that our bodies are designed to maintain weight within a
narrow range, or “set point.”
C. Physiologic factors influence body weight.
1. Hunger is our innate, physiologic need to eat.
2. Satiety is the state in which we no longer desire to eat.
3. Several proteins influence body weight.
a. Leptin is a hormone produced by adipose cells that reduces food intake and causes a
decrease in body weight and body fat.
b. Ghrelin is a hormone produced in the stomach that plays a role in appetite
regulation.
c. Peptide YY (PYY) is a protein produced in the gastrointestinal tract that decreases
appetite and inhibits food intake.
d. Uncoupling proteins uncouple certain steps in ATP production, producing heat
instead of ATP.
1. UCP1 is found in brown adipose tissue.
2. UCP2 and UCP3 are found in various other body tissues and are important to en-
ergy expenditure and weight gain.
4. Various other physiologic factors are known to increase satiety and include the
following:
a. the hormones serotonin and cholecystokinin (CCK)
b. an increase in blood glucose levels
c. stomach expansion
d. nutrient absorption from the small intestine
5. Physiologic factors that can decrease satiety include the following:
a. beta-endorphins
b. neuropeptide Y
c. decreased glucose levels
E. Cultural and economic factors affect food choices and body weight.
1. Both cultural and economic factors can contribute to obesity.

104 INSTRUCTOR RESOURCE MANUAL, NUTRITION: A FUNCTIONAL APPROACH, 3Ce Copyright © 2014 Pearson Canada Inc.
 2. The customs of many cultures put food at the center of celebrations of festivals and
holidays, and overeating is tacitly encouraged.
3. Cultural influences on food intake are cultural factors that promote inactivity.
F. Psychological and social factors influence behaviour and body weight.
1. Appetite can be experienced in the absence of hunger.
2. Social factors can encourage people to overeat.
a. Easy access to food encourages overeating.
3. Some social factors promote inactivity.
a. Food preparation time has decreased with technology.
b. Entertainment choices decrease activity levels.
4. Social pressures can promote underweight.

III. How Can You Achieve and Maintain a Healthful Body Weight?
A. Healthful weight change involves the following three primary strategies:
1. gradual changes in energy intake;
2. incorporation of regular and appropriate physical activity;
3. application of behaviour modification techniques.
B. If you decide to follow a popular diet plan, choose one based on the three strategies
(gradual reductions in energy intake, increased physical activity, strategies for modifying
your eating and activity-related behaviour).
1. Avoid fad diets.
2. Diets focusing on macronutrient composition may or may not work for you.
a. High-carbohydrate, moderate-fat, moderate-protein diets are effective in decreasing
body weight.
3. These diets are nutritionally adequate if food choices follow the guidelines of
Eating Well with Canada's Food Guide.
a. Low-carbohydrate, high-fat, high-protein diets appear to be effective in decreasing
body weight.
4. These diets are controversial based on limited evidence regarding long-term compli-
ance, potential health risks, and side effects.
a. Low-fat and very-low-fat diets appear to be effective in decreasing body weight.
5. These diets are low in some nutrients and require supplementation.
C. If you decide to design your own diet plan, include the three strategies.
1. Set realistic goals.
2. Eat smaller portions of lower-fat foods.
a. Quick Tips: Controlling Portion Sizes.
3. Participate in regular physical activity.
a. Quick Tips: Overcoming Barriers to Physical Activity.
4. Quick Tips: Modifying Your Behaviours Related to Food.
5. Hot Topic: Using Dietary Supplements to Lose Weight—Should You Consider It?

IV. What About Underweight?

A. Underweight occurs when a person has too little body fat to maintain health.
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 1. A BMI of less than 18.5 kg/m2 is considered underweight.
2. Being underweight increases risk for infections and illness.
3. Safe and effective weight gain can be achieved by eating frequent meals containing
healthy energy-dense foods.

V. Nutrition Debate: Is Bariatric Surgery Appropriate for Adolescents?

A. There are many different terms and definitions for severe obesity.
1. However, in children and adolescents, BMI is classified using a growth chart that
looks at BMI for age.
B. Some researchers suggest that bariatric surgery should be considered when lifestyle and
pharmacotherapy have not been successful.
C. Bariatric surgery has the potential to decrease morbidity and health costs by decreasing
the risk factors for related chronic diseases.
1. With early intervention, in certain adolescents there is the potential to prevent lifelong
chronic disease.
2. Surgery may also prevent teasing and bullying.
D. Opponents to surgery say there is not enough evidence about the effectiveness to support
the risks associated with surgery.
1. Risks depend on the type of surgery.
2. There is no evidence to date that shows that bariatric surgery reduces early mortality.
3. Few randomized control trials have been done in adolescents to determine the long-
term effectiveness of surgery and the long-term effects and risks are unknown.
4. Some pediatricians feel that surgery that causes malabsorption will interfere with
growth.
E. There are 2 main types of bariatric surgery tried on adolescents:
1. Roux-En-Y gastric bypass.
2. Gastric banding.
F. The Canadian Obesity Network released clinical obesity practice guidelines in 2006.
1. They recommended that bariatric surgery in adolescents be limited to exceptional
cases, and only be carried out by exceptional teams: this recommendation was based
on anecdotal evidence.
G. Guidelines and criteria for bariatric surgery in adolescence have also been suggested by
researchers; however, there does not seem to be consensus between regulating bodies as
of yet.
H. There are several contraindications to bariatric surgery.
I. Research is required on the compliance of adolescents to dietary recommendations post-
surgery.

VI. In Depth: Obesity

A. Why is obesity harmful?
1. Obesity is linked to many chronic diseases and complications.
2. Abdominal obesity is one of five risk factors collectively referred to as the metabolic
syndrome.
B. Why do people become obese?

106 INSTRUCTOR RESOURCE MANUAL, NUTRITION: A FUNCTIONAL APPROACH, 3Ce Copyright © 2014 Pearson Canada Inc.
 1. Genetic and physiologic factors influence obesity risk.
2. Childhood overweight and obesity are linked to adult obesity.
a. Health data demonstrate that obese children are already showing signs of chronic
disease while they are young.
b. Three critical periods in childhood that can increase the risk of obesity in adulthood
are
1. gestation and early infancy
2. the period of weight gain that occurs between 5 and 7 years of age
3. adolescence (or puberty)
3. Social factors appear to influence obesity risk.
4. Physical factors can contribute to obesity.
C. Does obesity respond to treatment?
1. Lifestyle changes can help.
a. A low-energy diet and regular physical activity are the first line of defence in treat-
ing obesity.
b. Counselling and support groups can help people maintain dietary and activity
changes.
2. Weight loss can be enhanced with prescribed medications.
a. Prescription drugs typically act as appetite suppressants and may increase satiety.
b. Prescription weight-loss medications are not for everyone.
c. Over-the-counter substances for weight loss are used, but can be abused.
3. Surgery can be used to treat obesity.
a. Gastric bypass Roux-En-Y surgery (RYGB) involves attaching the lower part of
the small intestine to the stomach.
b. Laparoscopic Adjustable Gastric Banding (LAGB) is a relatively new procedure
which reduces the capacity of the stomach with an adjustable band.
c. Vertical banded gastroplasty involves partitioning a small section of the stomach.
d. Laparoscopic Sleeve Gastrectomy (LSG) is used in Ontario, only if RYGB is not
feasible.
e. Surgery is considered a last resort for morbidly obese people.
f. About one-third to one-half of those who received obesity surgery lose significant
amounts of weight and keep it off for at least 5 years.
g. Liposuction is a cosmetic procedure not recommended to treat obesity or morbid
obesity.

Key Terms
basal metabolic rate
(BMR) (374)
body composition (371)
body mass index (BMI)
(366)
brown adipose tissue
(381)
Copyright © 2014 Pearson Canada Inc.
energy cost of physical activity obesity (367)
(376) overweight (367)
energy expenditure (373) peptide YY (PYY) (380)
energy intake (373) set-point theory (378)
ghrelin (380) thermic effect of food (TEF)
leptin (380) (375)
metabolic syndrome (396) thrifty gene theory (378)
multifactorial disease (396) underweight (367)
CHAPTER 11 Achieving and Maintaining a Healthful Body Weight 107
In-Class Discussion Questions
1. Discuss the factors that may contribute to an individual being overweight.
2. What are the strengths and limitations of the BMI? How should these factors affect inter-
pretation of this value?
3. Discuss the difference between being overweight and being obese. Can an individual be
healthy and overweight? Explain.
4. Discuss factors that are used to determine optimal weight. Which of these factors are
based on valid criteria? Which of these factors are based on invalid criteria?
5. Using examples from this chapter, discuss what specific traits an individual with a “high
metabolism” that “never gains weight” might exhibit.
6. Discuss aspects of your daily routine that promote inactivity. How can these be modified
to increase your activity level?
7. Make a list of chronic diseases that are linked to obesity. How many students know peo-
ple with these chronic diseases? How often is the condition associated with obesity?
8. Explain what is meant by the term “metabolic syndrome.” What are the health conse-
quences of this condition?
9. Discuss strategies for losing weight, as well as aggressive treatments for obesity. Be spe-
cific. Do you think aggressive treatments are appropriate? If so, when do you think they
should be pursued?

In-Class Activities
1. Bring several tape measures to class. Have students measure their waist (at the level of
their natural waist) and hip (at the maximal width of the buttocks) circumference. Ask
them to do the following:
a. calculate their waist-to-hip ratio.
b. compare their waist-to-hip ratio to recommended measurements.
c. interpret their results.
2. If calipers are available, perform skinfold measurements.
3. Have students work in groups to obtain a copy of a currently popular weight-loss diet and
evaluate it. Use guidelines in the chapter to help students recognize fad diets.
4. Have students calculate their BMI. To do this they must convert their height to meters
(divide height in inches by 39.3) and their weight to kilograms (divide weight in pounds
by 2.2). They can then calculate BMI using the formula: BMI = kg/m2. Ask students to
interpret their BMI with regard to health risks. The BMI data for the class can be graphed
as an additional activity.
5. Ask students to keep a journal for 1 to 3 days with observations in their daily life that
may contribute to weight gain and/or weight loss. In class, students can share their obser-
vations and discuss possible changes that can help maintain a healthy weight.
Some examples of conditions to note might include the following:
presence or absence of sidewalks

Copyright © 2012 Pearson Education, Inc. CHAPTER 11 Achieving and Maintaining a Healthful Body Weight 108
 presence or absence of bicycle lanes
parks or other open space in their area
cost of foods in the grocery store
presence or absence of fast food restaurants
availability of healthy food at their school or workplace

MyDiet Analysis Activity

6. Using the nutritional assessment previously completed, students should note the
following:
a. How many calories do you consume daily?
b. How does this caloric intake compare to recommendations?
c. What three foods that you consume contain the highest number of calories? How
many calories are in each food?
d. What changes can you make in your diet to more closely meet caloric
recommendations?

Nutrition Debate Activity

7. Instruct students to research bariatric surgery methods, and to come to class prepared to
discuss the advantages and disadvantages of this drastic measure for weight loss. Divide
students into groups to discuss their opinions about bariatric surgery.

Web Resources
Main Chapter
www.eatrightontario.ca
Eat Right Ontario
Email or call a registered dietitian! Learn more about a Canadian service designed to help
you improve your health through nutritious eating.
www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php
Health Canada - Eating Well with Canada's Food Guide
See this site for information about Canada's Food Guide.
www.obesitynetwork.ca
Canadian Obesity Network
This is a network connecting researchers, health professionals, and 150 partner organizations
concerned about obesity issues in Canada.
www.cdc.gov/healthyweight/index.html
Centres for Disease Control and Prevention. Healthy Weight - It's Not a Diet, It's a Lifestyle!
This is an interactive site from the CDC for consumers who want to change their lifestyle to
achieve and maintain a healthy body weight.

Copyright © 2014 Pearson Canada Inc. CHAPTER 11 Achieving and Maintaining a Healthful Body Weight 109
 www.sneb.org
Society for Nutrition Education and Behavior
Click on Nutrition Resources and then Weight Realities Division Resource List for additional
resources related to positive attitudes about body image and healthful alternatives to dieting.
www.eatright.org
Academy of Nutrition and Dietetics (formerly the American Dietetic Association)
Go to this site to learn more about fad diets.
women.webmd.com/fad-diets
WebMD - Spotting Fad Diets
Visit this site to learn about the dangers of fad diets and how to identify them.

www.ftc.gov
Federal Trade Commission (US)
Go to Consumer Protection tab, click on Consumer Information and then choose Weight Loss
& Fitness under the Health category. Find out about how to avoid false weight loss claims.

www.eatracker.ca
Eat Tracker
This online tool by the Dietitians of Canada allows you to track your day's food intake and
activity expenditure and compare them with Health Canada's guidelines.

www2.niddk.nih.gov/HealthEducation/HealthNutrit
National Institute of Diabetes and Digestive and Kidney Diseases
Find out more about healthy weight loss.

hp2010.nhlbihin.net/portion/
National Institutes of Health Portion Distortion
Take the "Portion Distortion" quiz and find out how changing portion sizes influences body
weight.

www.nhlbisupport.com/bmi/
National Heart, Lung, and Blood Institute BMI calculator
Calculate your body mass index(BMI) on the internet.

In Depth: Obesity
www.oa.org
Overeaters Anonymous
Visit this site to learn about ways to reduce compulsive overeating.
www.nhlbi.nih.gov/health/dci/Diseases/obe/obe_treatments
National Heart, Lung, and Blood Institute Overweight and Obesity Site
Visit this site to find out more about various treatment options for overweight and obesity.
www.win.niddk.nih.gov
Weight Control Information Network
This site, from the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), offers information, brochures, tools, and even a newsletter on obesity, weight con-
trol, physical activity, and related nutritional issues.

110 INSTRUCTOR RESOURCE MANUAL, NUTRITION: A FUNCTIONAL APPROACH, 3Ce Copyright © 2014 Pearson Canada Inc.
Additional Information
1. For great research on fad diets, visit the University of Arkansas Cooperative Extension
Service at www.uaex.edu/depts/FCS/EFNEP/Lessons/Fad_Diets/fat_diets_fact_fallacy.pdf.

2. For an interesting look at various dieting approaches, visit the Oracle Think Quest Educa-
tion website at http://library.thinkquest.org/10aug-oracle-62/693261657/.

3. For extensive information regarding prescription medications for the treatment of obesity,
visit the Weight-Control Information Network at
http://win.niddk.nih.gov/publications/prescription.htm.

4. For additional information on prescription weight loss drugs and their pros and cons, visit
the Mayo Clinic at http://www.mayoclinic.com/health/weight-loss=drugs/WT00013.

5. For an article entitled, "Canada's diet pill market about to get heavier: Approval sought
for new weight-loss drug", visit
http://www.canada.com/health/Canada+diet+pill+market+about+heavier+Approval+sought+
weight+loss+drug/7037237/story.html.

6. For an article about prescription weight loss drugs and why some doctors are prescribing
them, visit
http://www.weightwatchers.ca/util/art/index_art.aspx?tabnum=1&art_id19751&sc=801.

7. Bariatric Surgery
There is an excellent research document about bariatric surgery, authored by Shahzeer Kar-
mali, MD, FRCSC, et al., that can be found at the Canadian Family Physician website at
http://www.cfp.ca/content/56/9/873.full.

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