Energy Balance &

Weight Management
Dr. Hadi Riyadi

Dept. Gizi Masyarakat, FEMA, Institut

Pertanian Bogor
2015

Weight Management

Obesity has doubled since 1960

At current rates, all American adults

will be overweight by 2030

TWELVE SPECIFIC HEALTH RISKS OF

EXCESSIVE BODY FAT
1.
2.
3.
4.
5.
6.
7.

Abnormal plasma lipid and lipoprotein levels

Endometrial, breast, prostate, and colon cancers
Enormous psychological burden and social
stigmatization and discrimination
Gallbladder disease
Hypertension, stroke, and deep vein thrombosis
Impaired cardiac function from increased mechanical
work and autonomic and left ventricular dysfunction
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
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
8.

Use Your Information!

Tools:

The Mirror!
Body Mass Index(BMI)

Goal--18.5-24.9

Body Fat %
25% men, 30%
women
Waist Circumference
40 men, 35 women
Waist/ Hip Ratio
0.90 men, 0.80 women
Blood analysis

Miller IL. 2010. Weight Management for Triathletes

theWorld Triathlon Corporation(WTC) consisting of a 2.4-mile (3.86km)swim, a 112-mile
(180.25km)bicycle rideand amarathon26.2-mile (42.2km)run

 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.

BMI of Miss America Pageant Winners

SOURCE: Rubinstein, S., and B. Caballero. 2000. Is Miss America an undernourished role model? Journal of American Medical Association 283(21): 1569.
Used with permission from the American Medical Association.

Miller IL. 2010. Weight Management for Triathletes

Miller IL. 2010. Weight Management for Triathletes

The Warm upWhy Make Dietary

Change Wheres 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 Enhances Sport
Performance

Diet contributes to Overall

Wellness & Longevity

Nutrient Density

Energy
How we generate Energy from Food
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
BMR = Basal Metabolic Rate

Physical Activity
Metabolizing Food

19

Balance food calories

with physical activity level

20

21

Moderate physical activities

include:
Walking
briskly
(about
3
miles
per
hour)

Gardening/
yard work
Hiking

Golf (walking
and carrying clubs)

Dancing

Weight training
(general light workout)

Bicycling (less than

10 miles per hour)

23

Vigorous physical activities

include:
Heavy yard work,
such as chopping wood
Running,
jogging
(5 miles
per hour)

Swimming
(freestyle
laps)

Basketball
(competitive)

Bicycling (more
than 10 miles
per hour)

Walking
very fast
(4 miles
per hour)
Aerobics
Weight lifting
(vigorous effort)
24

Energy Balance

25

Input &
Output
Example
A day in the
life
Intake:
3,400 kcal
Output:
3,005 kcal
IMBALANCE:
395 kcal

650

50

270

100
Dressing/
50
Washing
Sitting in Class
Walking
to
Eating Breakfast 20 min.
180 min.
Campus
20 min.
20 min.
250
25

150
Walking on
Campus
30 min.

Snack
10 min.

Lirary/Study
180 min.

1200

280
At the Gym
40 min.

395

100

75

Walking Home
Eating Dinner
20 min.
30 min.

105

180

210
25
Coffee Break
10 min.

700
75

200

Walking to-from
Eating Lunch Campus
30 min.
30 min.

65
Check email
30 min.

390
50

Hanging out
490 Undress/Shower 260
with Date
Eating Snack
30 min
Emailing/Texting 120 min
20 min
Studying
Sleep 71/2
120 min
hours

55
Driving to-from
Date
30 min.

400
Dancing
40 min.

26

Calories and Energy

Balance NOT Higher
order math
Calories IN = Calories OUT
Weight
Calories IN > Calories OUT
Weight
Calories IN < Calories OUT
Weight

Maintain
GAIN
LOSE

To maintain a desirable weight, energy

intakes should not exceed energy needs. 27

28

Energy Balance
Negative energy balance
achieved via:
Decreased caloric intake
Increased caloric output
Combination of the above*

29

Its 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

30

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

31

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 and Science in Sports and Exercise. 25
(1): 71-80.

32

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
33

How much exercise to

offset breakfast?
125 pound (45kg woman)

Bagel with Cream Cheese

Coffee with Cream

309 Calories

32 Minutes Running a
10 Minute/Mile
2

Dunkin Donuts Muffin

490 Calories

25 Minutes Swimming Laps

25 Minutes Cycling @ 15 mi/hr
34

How much exercise to

cancel out lunch?

Turkey Sandwich
12 oz. Soda
1 oz. Potato Chips

125 pound (45kg woman)

585 Calories

9 Miles Walking Briskly

@13 min/mile

2 Slices of Cheese Pizza

366 Calories

1 Hour of Downhill Skiing

35

Composition of Weight Loss w/

Food Restriction & EXERCISE*

Daily
0.23 kg
0.18 kg
Weight 0.82 kg
Loss
1000 kcals/day & 2.5 hrs. of exercise/day*

36

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

38

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.

39

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 bodys energy
reserves to the brain, which in turn releases neuropeptides that
influence energy intake and/or energy expenditure. If this longterm system functions effectively, body weight remains somewhat
stable over time.

40

41

42

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)
43

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

44

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
(5 to 10% below initial weight)

200

Actual weight
Weight (pounds)

180

Disappointing weight
Acceptable weight

160

Happy weight
140

Dream weight
Suggested healthy
weight range

120

100

Time (year)

49

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

50

Energy Balance
~ 3500 kcals = 1 # body fat
to lose 1# / wk --> -3500 kcals / wk
(-500 kcals / day)
Safe rate for wt loss: - 2
lbs/week; 10% body wt/6 months

51

Weight-Loss Strategies
Energy Intake
Physical Activity
Behavioral Changes

52

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

53

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

54

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
56

Physical Activity
Choose activities that you enjoy and
are willing to do regularly
Low to moderate intensity for longer
duration is recommended
Daily routines

57

Physical Activity
Be physically active every day
Reduce the risk
of chronic
disease
Prevent gradual
weight gain
Sustain weight
loss

30 minutes / day
60 minutes / day
6090 minutes /
day

Endurance exercise
Strength training

Exercise guidelines and sample prescription plan for

maximizing energy expenditure and long-term weight control

59

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)

60

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 812 weeks.

Be patient!
1.Be Realistic.
2.Set goals based on a
pattern that will keep you
healthy.
3.Change slowly, but
steadily.

63

64

65

66

67

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

69

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

70

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.

71

Table 8-3
Page 262

72

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

73

Features of a Sound Program

Foods high in CHO, low fat
Exercise
Who is the promoter?

74

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 activityexercise 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

76

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

77

Miller IL. 2010. Weight Management for Triathletes

78

Survey of Weight Loss Related Supplements

79

Survey of Weight Loss Related Supplements

80

In-text Figure
Page 296

The key to good health is to combine sensible

eating with regular exercise.

81

Other Recommendations
Nutrition Recommendations from the World
Health Organization (WHO)
Energy: Sufficient to support normal growth,
physical activity, and body weight (BMI 2022).
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

Salt: Upper limit of 6 grams per day

82

Dietary Guidelines for

Americans 2010

Maintain calorie balance over time to achieve and sustain

a healthy weight
Focus on consuming nutrient-dense foods and beverages
Physical activity
Focus on fruits.
Vary your veggies
Get your calcium-rich foods
Make half your grains whole.
Go lean with protein.
Know the limits on fats, salt, and sugars

83

The Challenge of Dietary

Guidelines
People vary in the amount of a given
nutrient they need.
The challenge of the DRI is to
determine the best amount to
recommend for everybody.
Lifestyle diseases: conditions that may
be aggravated by modern lifestyles
that include too little exercise, poor
diets, and excessive drinking and
smoking. Lifestyle diseases are also
referred to as diseases of affluence.
84

Tools for Diet Planning

85

86

MyPyramid
Design
Make smart choices
from every food
group
Find balance between
food and physical
activity
Focuses on nutrientrich foods in sensible
portion sizes

87

MyPyramid Key Components

Activity

Regular physical
activity and reduced
sedentary activities

Variety

Moderation

Consume less of solid

fats and added sugars
Consume more of
nutrient-rich foods

Eat foods from all

groups and
subgroups

Personalization

Identifies
proportions of
foods that should
make a healthful
diet

Gradual improvement

Proportionality

One size does not fit all

Customize your plan at
www.MyPyramid.gov
Take small steps to
improve diet and lifestyle
everyday
Visit www.smallstep.gov
88

Using The Power

of the Pyramid
Step 1: Estimate
your daily energy
needs
Step 2: Build your
daily eating plan
Step 3: Let the
pyramid guide your
food choices
89

http://vm.cfsan.fda.gov/~dms/foodlab.html

Food Label

90

Making Better Food Choices

690 calories
24 g fat
8 g saturated fat

1,350 calories
43 g fat

Dont supersize
Think grilled, not fried
Avoid all-you-can-eat
restaurants
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, 2010. 7th
Edition, Washington, DC: U.S. Government Printing Office,
December 2010

95