Energy Balance &

Weight Management
Dr. Hadi Riyadi

 Dept. Gizi Masyarakat, FEMA, Institut

Pertanian Bogor
 2016
 Weight Management

 Obesity has doubled since 1960

 At current rates, all American adults

will be overweight by 2030
Figure 1. Obesity among adults, 2012 or nearest year
 TWELVE SPECIFIC HEALTH RISKS OF
EXCESSIVE BODY FAT

1. Abnormal plasma lipid and lipoprotein levels

2. Endometrial, breast, prostate, and colon cancers
3. Enormous psychological burden and social
stigmatization and discrimination
4. Gallbladder disease
5. Hypertension, stroke, and deep vein thrombosis
6. Impaired cardiac function from increased
mechanical work and autonomic and left
ventricular dysfunction
7. Increased insulin resistance in children and adults
and type 2 diabetes (80% of these patients are
overweight)
 TWELVE SPECIFIC HEALTH RISKS OF
EXCESSIVE BODY FAT

8. Menstrual irregularities
9. Osteoarthritis, degenerative joint disease,
and gout
10. Problems receiving anesthetics during
surgery
11. Renal disease
12. Sleep apnea, mechanical ventilatory
constraints (particularly in exercise), and
pulmonary disease from impaired function
because of added eff ort to move the
chest wall
 Tools: Measuring obesity
 The Mirror!
 Body Mass Index—
(BMI)
 Goal--18.5-24.9
 Body Fat %
 ≤ 25% men, 30%
women
 Waist Circumference
 ≤90 men, 80
women Asia
 Waist/ Hip Ratio
 ≤0.90 men, 0.80
women
 Blood analysis
 the strength-to-weight ratio is a
critical factor in sport.
 To improve the strength-to-weight
ratio or the body profile, athletes
typically resort to what amounts to a
weight-loss strategy by increasing
activity, reducing energy intake, or
doing both.
 healthy body weight
 A healthy body weight is a weight that is
associated with health and longevity.
 It is a weight at which the risk of illness
and death is lowest.
 What a healthy weight is for you depends
not only on how much you weigh, but also
on your body composition.
 Body composition refers to the proportion
of your body that is fat versus lean tissue.
Miller IL. 2010. Weight Management for Triathletes
the World Triathlon Corporation (WTC) consisting of a 2.4-mile (3.86 km) swim, a 112-
mile (180.25 km) bicycle ride and a marathon 26.2-mile (42.2 km) run
Miller IL. 2010. Weight Management for Triathletes
Miller IL. 2010. Weight Management for Triathletes
The Warm up—Why Make Dietary
Change Where’s the Evidence?

Diet and Disease

Connection Reduces incidence of:

 Obesity
 Heart Disease/
Hypertension
 Type II Diabetes
 Cancer
 Arthritis
 Sleep apnea
 Joint pain
 AMD-- Age-Related
Macular Degeneration
 Reduces Stress
Diet and Stress
connection Improves:
 Severity of stress
i.e. Fight, flight &
freeze
 Maintains health
while dealing with
stress
 Reduces stress
related depression
and disordered
eating
 Speeds stress
recovery
Improves Sports Performance
& Overall wellness
Diet contributes to
Diet Enhances Sport
Overall Wellness &
Performance
Longevity
Nutrient Density
 Energy Balance
• Energy In and Energy Out
– Input = Food and Calories
– Output = Metabolism (BMR) and Physical
Activity
• Balance
– Weight Maintenance
– Weight Increase
– Weight Loss
18
 Components of Energy
Output
We Need Energy for:
• Basal Metabolism (55-75%)
– BMR = Basal Metabolic Rate
• Physical Activity (20-40%)
• Metabolizing Food (5-15%)

19
Moderate physical activities
include:
Walking
briskly Gardening/
(about yard work
3½ Hiking
miles
per
hour)

Weight training
Golf (walking
(general light workout)
and carrying clubs)

Bicycling (less than

Dancing 10 miles per hour) 20
 Vigorous physical activities
include:
Heavy yard work,
such as chopping wood
Running,
jogging
Swimming (5 miles
(freestyle
per hour)
laps)
Walking
very fast
(4½ miles
Bicycling (more per hour)
than 10 miles
Basketball per hour) Aerobics
Weight lifting
(competitive)
(vigorous effort) 21
 Input & 650
Output
50
270
50 Dressing/ 100 210

Example
Washing Sitting in Class
Walking to
Eating Breakfast 20 min.
Campus
180 min. 25
20 min.

A day in the
20 min.
Coffee Break
10 min.
250
life…
700
150 25 395 200
Walking on Lirary/Study
75
Walking to-from
Snack 180 min. Eating Lunch Campus
Campus
Intake: 30 min.
10 min. 30 min. 30 min.
3,400 kcal
280 1200 65
100 55
Output: At the Gym
40 min.
75 Check email
Walking Home
3,005 kcal 20 min. Eating Dinner 30 min. Driving to-from
Date
30 min.
30 min.
IMBALANCE:
395 kcal 180 390 400
105 50
Hanging out
490 Undress/Shower 260
Dancing
with Date 40 min.
30 min Eating Snack
Emailing/Texting 120 min 20 min
Sleep 71/2 Studying 22
hours 120 min
 Calories and Energy
Balance – NOT Higher
order math
Calories IN = Calories OUT Maintain
Weight
Calories IN > Calories OUT GAIN
Weight
Calories IN < Calories OUT LOSE
Weight
To maintain a desirable weight, energy
intakes should not exceed energy needs. 23
 Energy Balance
• Negative energy balance
achieved via:
– Decreased caloric intake
– Increased caloric output
– Combination of the above*

25
 It’s all about Calorie
Balance
• If you eat more calories than your
body uses, they will be stored as fat
• One pound of body fat is equal to
3,500 kcal
– In theory, losing one pound requires a
deficit of 3,500 calories
Eating 500 fewer calories per day - or
expending 500 more calories - would
result in losing one pound per week
26
 Weight Management
• To maintain body weight in a healthy
range, balance calories from foods
and beverages with calories
expended
• To prevent gradual weight gain over
time, make small decreases in food
and beverage calories and increase
physical activity

27
 Energy Expenditure
• Calorie expenditure depends on:
– Weight of person
– Type of activity
• Length of activity
• Speed of activity
• Metabolic rate

From: Ainsworth, BE, et. al. 1993. Compendium of physical activities:

classification of energy costs of human physical activities. Medicine 28
and Science in Sports and Exercise. 25 (1): 71-80.
 REPEAT: Calorie Balance
Simple Math
No Loss or gain of weight occurs when:
Number of Calories Consumed
EQUALS Number of Calories
Expended
1 POUND = 3500 Calories
If you eat 500 calories MORE than you expend, every
day for an entire week, you WILL gain 1 pound

29
 How much exercise to
offset breakfast?
Bagel with Cream Cheese
1 125 pound (45kg woman)

= 309 Calories
Coffee with Cream
32 Minutes Running a
10 Minute/Mile

2
= 490 Calories
Dunkin Donuts Muffin
25 Minutes Swimming Laps
25 Minutes Cycling @ 15 mi/hr

30
 How much exercise to
cancel out lunch?
Turkey Sandwich 125 pound (45kg woman)
1
12 oz. Soda
= 585 Calories

1 oz. Potato Chips 9 Miles Walking Briskly

@13 min/mile

366 Calories
2 2 Slices of Cheese Pizza
1 Hour of Downhill Skiing

31
 Composition of Weight Loss w/
Food Restriction & EXERCISE*
100%
90%
80%
70%
60% Water
50% Protein
40% Fat
30%
20%
10%
0%
Days 1-3 Days 11-13 Days 21-24
Daily
Weight 0.82 kg 0.23 kg 0.18 kg
32
Loss 1000 kcals/day & 2.5 hrs. of exercise/day*
 Factors Contributing to
Excess Body Fat
 Genetic factors
 Physiological factors
 Metabolic rate
 Hormones

 Lifestyle factors
 Eating
 Physical activity
 Psychological factors
“Apple” and “Pear” Body Shapes Compared

34
Regulation of energy balance
• Short-term regulation
The short-term regulation of energy
balance involves the control of food
intake from meal to meal.
We eat in response to hunger, which
is the physiological drive to consume
food. We stop eating when we
experience satiety, the feeling of
fullness and satisfaction that follows
food intake. 35
Regulation of energy balance
• Long-term regulation
In addition to short-term regulation of food
intake, the body also regulates energy intake on a
longterm basis.
Short-term regulators of energy balance affect
the size and timing of individual meals. If a
change in food intake is sustained over a long
period, however, it can affect long-term energy
balance and, hence, body weight and fatness.
Long-term regulatory signals communicate the
body’s energy reserves to the brain, which in turn
releases neuropeptides that influence energy
intake and/or energy expenditure. If this long-
term system functions effectively, body weight 36
remains somewhat stable over time.
37
38
These obese mice have a defect in the gene that codes for leptin. Without
leptin, they become extremely obese. In a Rockefeller University study by
Dr. Jeffrey Friedman, the mouse on the right received leptin treatments for
four and a half weeks and then weighed in at about 35 grams; the mouse
on the left did not have any treatment and was weighed at about 67 grams.
(Normal mice starting the study weighed about 24 grams)

39
Caballero B, Allen L, and Prentice A. 2013 Encyclopedia of Human Nutrition
40
 A small reduction in the percentage of FFM lost is observed if exercise is
included with the dietetic intervention. Thus, for example, in a
woman losing 15 kg, exercise would reduce her FFM loss from
3.6 kg (24%) to 3.0 kg (20%). Similar but quantitatively greater
benefits are seen in men: For a 15-kg weight loss, exercise
reduced FFM loss from 3.6 kg (24%) to 2.5 kg (17%).

Caballero B, Allen L, and Prentice A. 2013 Encyclopedia of Human Nutrition

Caballero B, Allen L, and Prentice A. 2013 Encyclopedia of Human Nutrition
Definition of successful weight loss maintenance
• There is no universally accepted definition of successful
weight loss maintenance.
• One definition, proposed in the ‘‘Clinical Guidelines on the
Identification, Evaluation, and Treatment of Overweight and
Obesity in Adults,’’ developed by an expert panel convened
by the National Obesity Education Initiative of the National
Heart, Lung, and Blood Institute (NHLBI), in cooperation with
the National Institute of Diabetes and Digestive and Kidney
Diseases in 1995, is that successful weight loss
maintenance is a weight regain of <3 kg (6.6 lb) in 2 years,
following a 10% reduction in body weight.
• The criterion of 10% weight loss is recommended because
weight losses of this magnitude have been shown to have
positive health consequences.
• The definition assumes that the weight loss is intentional.
Weight Cycling
 Reasonable Weight Goals and Expectations Compared
220

Reasonable goal weight

200 (5 to 10% below initial weight)

Actual weight
180
Disappointing weight
Weight (pounds)

Acceptable weight
160
Happy weight

140 Dream weight

Suggested healthy
120 weight range

100

0 1 45
Time (year)
So What Does Work?
• Reasonable treatments: small
changes, moderate losses,
reasonable goals.
• 1 –2 lbs/wk recommended;
moderate loss can improve
health; 5-10% of body wt
• Set specific, realistic, forgiving
goals; unreasonable goals
sabotage efforts
46
 Energy Balance
• ~ 3500 kcals = 1 # body fat
• to lose 1# / wk --> -3500 kcals / wk
(-500 kcals / day)
• Safe rate for wt loss: ½ - 2
lbs/week; 10% body wt/6 months

47
Weight-Loss Strategies
• Energy Intake
• Physical Activity
• Behavioral Changes

48
 Weight-Loss Strategies
Energy Intake
• Be realistic about Energy Intake
– 300-500 kcals/day reduction for BMI
between 27 – 35
– 500-1000 kcals/day reduction for BMI
>35
– Smaller portions
– Include foods of lower energy density,
higher in fiber, lower in fat
– Watch empty kcals from alcohol and
sugar 49
 Weight-Loss Strategies
Energy Intake
• Consuming a low-calorie, low-fat diet
• Reducing the energy density
(kilocalories/gram weight of food) of
the diet Over 1 year, the condition
that reduced fat and consumed water-rich foods
had a lower energy density, reported less hunger,
and lost more weight (7.9 kg vs. 6.4 kg) than the
condition that reduced fat only.
• Having a highly structured diet
50
Caballero B, Allen L, and Prentice A. 2013 Encyclopedia of Human Nutrition
Weight – Loss Strategies
Physical Activity
• Greater amounts of physical activity,
greater weight loss occurs
• Increases metabolic rate with daily
vigorous activity
• May decrease body fat and increase
lean body mass
• May help curb appetite
• Can reduce stress, improve self-
esteem
52
 Physical Activity
• Choose activities that you enjoy and
are willing to do regularly
• Low to moderate intensity for longer
duration is recommended
• Daily routines

53
 Physical Activity
• Be physically active every day
Reduce the risk of
30 minutes / day
chronic disease

Prevent gradual
60 minutes / day
weight gain

Sustain weight loss 60–90 minutes / day

• Endurance exercise
• Strength training
 Exercise guidelines and sample prescription plan for
maximizing energy expenditure and long-term weight control

55
Weight – Loss Strategies
Behavioral Changes
• Identify behaviors; food records helpful
• Learn alternative ways to deal with stress
• Self-monitoring of weight
• Change behaviors with realistic goals
– Changing behaviors
– Do not grocery shop while hungry
– Eat slowly
• Support groups
• Reward success (but not with food)
56
Top reasons for making dietary change :

• Improve overall health (69%)

• Lose weight (62%)
• Because of specific health condition
(37%)
• To maintain weight (19%)
• Other (4%)

International Food Information Council Foundation

(IFIC) Food and Health Survey 2006
Start with Lifestyle Changes
Behavior change become
cognitive adaptation in 8-
12 weeks.
Be patient!

1.Be Realistic.
2.Set goals based on a
pattern that will keep you
healthy.
3.Change slowly, but
steadily.
59
60
61
62
Caballero B, Allen L, and Prentice A. 2013 Encyclopedia of Human Nutrition
 Weight Maintenance
• Vigorous exercise and careful eating
plans are key
• Frequent self-monitoring is
recommended
• More attention needed on weight
maintenance

64
 Prevention
• Eat regular meals and limit snacking
• Drink water in place of high-kcal
beverages
• Select sensible portion sizes
• Limit daily energy intake to energy
expended
• Limit sedentary activities; be
physically active

65
Why is Weight Loss Maintenance
Difficult?
• Long-term weight loss maintenance may be
difficult due to a combination of
physiological, environmental, and
psychological factors.
• Proposed physiological factors
contributing to weight regain include
reduced resting metabolic rate and insulin
and leptin resistance.
• Environmental factors may affect energy
balance by promoting increased intake
and/or reduced energy expenditure,
causing weight regain to occur. 66
Table 8-3
Page 262

67
 Features of a Sound
Program
• Food program that you can follow for
life
• Foods that provide adequate
nutrition
• Foods that you choose/like
• Weight loss 1-2 #/ week
• Regular meals

68
Features of a Sound Program
• Foods high in CHO, low fat
• Exercise
• Who is the promoter?

69
 Creating an Individual
Weight-Management Plan
1. Assess your motivation and commitment
2. Set reasonable goals
3. Assess your current energy balance
• To lose one pound, you must create a negative energy balance of 3500
calories
• To lose 1/2 pound per week requires a negative daily energy balance
of 250 calories
• To lose 2 pounds per week requires a negative daily energy balance
of 1000 calories
• Energy balance is affected by food intake and energy output
4. Increase your level of physical activity—exercise habits are critical for long-
term success
5. Make changes in your diet and eating habits (explain that eating habits is not
just what you eat, but how, where, when, and why you eat)
6. Put your plan into action
• Write daily
• Get others to help
• Think positively
71
Caballero B, Allen L, and Prentice A. 2013 Encyclopedia of Human Nutrition
72
 73
Miller IL. 2010. Weight Management for Triathletes
Survey of Weight Loss Related Supplements

74
Survey of Weight Loss Related Supplements

75
In-text Figure
Page 296

The key to good health is to combine sensible 76

eating with regular exercise.
 Other Recommendations
Nutrition Recommendations from the World
Health Organization (WHO)…
• Energy: Sufficient to support normal growth,
physical activity, and body weight (BMI 20–
22).
• Total fat: 15 to 30% of total energy
– Saturated fatty acids: 0 to 10% of total energy
– Polyunsaturated fatty acids: 3 to 7% of total energy
• Dietary cholesterol: 0 to 300 milligrams per
day
• Total carbohydrate: 55 to 70% of total energy
– Complex carbohydrates: 55 to 75% of total energy
– Dietary fiber: 27 to 40 grams per day
– Refined sugars: 0 to 10% of total energy
• Protein: 10 to 15% of total energy
77
• Salt: Upper limit of 6 grams per day
Dietary Guidelines for American 2015-2020

Five Overarching Guidelines

1. Follow a healthy eating pattern across the lifespan
2. Focus on variety, nutrient density, and amount
3. Limit calories from added sugars and saturated fats
and reduce sodium intake
4. Shift to healthier food and beverage choices while
considering cultural and personal preferences
5. Support healthy eating patterns for all
Dietary Guidelines for American 2015-2020

I. Follow a Healthy Eating Pattern Across the Lifespan

• Consume a healthy eating pattern that accounts for all
foods and beverages within an appropriate calorie level

• All food and beverage choices matter; eating pattern is

the totality of all foods and beverages consumed

• An individual’s nutritional needs should be met primarily

from whole foods rather than supplements
• Eating patterns reflect
socio-cultural, personal, and
economical preferences
 Dietary Guidelines for American 2015-2020

II. Focus on Variety, Nutrient Density, and Amount of Food

• To meet nutrient needs within calorie limits, variety is key

• Select variety of nutrient-dense foods across and within all

food groups

• Nutrient density refers to the ratio of nutrients to caloric

contribution of a food
Dietary Guidelines for American 2015-2020

III. Limit Calories from Added Sugars and Saturated

Fats and Reduce Sodium Intake
• Foods and beverages containing high amounts of the
following should be limited to quantities that fall within
the range of a healthy eating pattern.

 Added sugars,

 Saturated fats, and

 Sodium
Dietary Guidelines for American 2015-2020

IV. Shift to Healthier Food and Beverage Choices, While

Considering Cultural and Personal Preferences
• Shift eating patterns to include more vegetables, fruits,
and fat-free or low-fat dairy products
• Shift from solid fats to foods naturally containing oils
• Increase the variety of nutrient-dense protein food choices
and make half of all grains consumed whole grains
• Small shifts in food choices accumulated over a meal,
day, or week can make a large difference
• Consider cultural and personal preferences to make
shifts easier to maintain.
Dietary Guidelines for American 2015-2020

V. Support Healthy Eating Patterns for All

• Make healthy lifestyle choices at home, work, school,

and out in the community

• The food and physical activity choices an individual

makes are influenced by the Social-Ecological Model

• Improved eating and physical activity behaviors

sustained by considering changes at all levels of the
Social-Ecological Model
Dietary Guidelines for American 2015-2020

Key Recommendations

I. Consume a healthy eating

pattern that accounts for all
foods and beverages within
an appropriate calorie level

II. Meet the Physical Activity Guidelines

for Americans
Dietary Guidelines for American 2015-2020

Key Recommendation I: What Does a Healthy Eating

Pattern Consist Of?
• A variety of vegetables from all subgroups
 Including all fresh, frozen, dried, and canned
versions in cooked or raw form, dark greens, red
and orange, beans and peas, and starchy
vegetables

• Fruits, especially whole fruits

 Including fresh, canned, frozen, dried, and 100%
fruit juice, are essential to a healthy eating pattern
Dietary Guidelines for American 2015-2020

What Does a Healthy Eating Pattern Consist Of?

• Grains, at least half of which are whole grains

• Fat-free or low-fat dairy products

 Yogurt, cheese, milk, and/or fortified soy beverages
Dietary Guidelines for American 2015-2020

What Does a Healthy Eating Pattern Consist Of?

• A variety of protein sources
 Both animal and plant origin
 Sources include seafood, nuts, seeds, legumes,
lean meats and poultry, eggs, and soy products
• Oils
 Oils should replace solid fats rather
than being added to the diet
 Major source of essential fatty acids
and Vitamin E
Dietary Guidelines for American 2015-2020

What Does a Healthy Eating Pattern Limit?

• The intake of trans fats should be as low as possible

• Saturated fats should be limited to less than 10% of the

total daily caloric intake

• Consume less than 10% of calories per day from added

sugar

• Consume less than 2,300 milligrams per day of sodium

Dietary Guidelines for American 2015-2020

What Does a Healthy Eating Pattern Limit?

Quantitative Recommendations
Consume less than:
• 10 percent of calories per day from added sugars
• 10 percent of calories per day from saturated fats
• 2,300 milligrams (mg) per day of sodium
• If alcohol is consumed, do so in moderation
 Women: 1 drink per day
 Men: 2 drinks per day
Dietary Guidelines for American 2015-2020
Making Better Food Choices
690 calories
24 g fat Don’t supersize
8 g saturated fat
Think grilled, not fried
Avoid all-you-can-eat
1,350 calories restaurants
43 g fat “Just say no.”
13 g saturated fat

91
The Newest Food Guide Pyramid

• Balancing Calories ● Enjoy your food, but eat less. ● Avoid

oversized portions.
• Foods to Increase ● Make half your plate fruits and
vegetables. ● Make at least half your grains whole grains. ●
Switch to fat-free or low-fat (1%) milk.
• Foods to Reduce ● Compare sodium in foods like soup, bread,
and frozen meals ― and choose the foods with lower numbers. ●
Drink water instead of sugary drinks.

• Website: http://www.choosemyplate.gov/
– Includes interactive tools including a personalized daily food
plan and food tracker
When traveling in Oia,
Santorini (a Greek
Island), EAT,
DRINK, and BE
HAPPY, for
tomorrow you may
die.
If you make it home,
exercise often,
hard, and a long
time.
 References
• Maughan RJ. 2014. Sports nutrition : Encyclopaedia of sports
medicine volume XIX. John Wiley & Sons, West Sussex.
• Miller IL. 2010. Weight Management for Triathletes. Aachen :
Meyer & Meyer Sport.
• McArdle WD, Katch FI, Victor L. Katch VL. 2013. Sports and
exercise nutrition. 4th ed. Baltimore : Lippincott Williams & Wilkins.
• Smolin LA, Grosvenor MB. 2010. Nutrition and weight management.
Second Edition. New York : Chelsea House Publisher.
• Caballero B, Allen L, and Prentice A. 2013 Encyclopedia of Human
Nutrition. Elsevier
• U.S. Department of Agriculture and U.S. Department of Health and
Human Services. Dietary Guidelines for Americans, 2015. 8th Edition,
Washington, DC: U.S. Government Printing Office, May 2016
• Fink H and Mikesky AE. 2015. Practical Applications in Sports
Nutrition. Fourth Edition. Burlington, MA : Jones & Bartlett Learning.
95