Energy Values of

Foods & Nutrients;

Obesity; Rules for
Achieving Desirable
Weight
 Energy
• The capacity to do work
• Exist in various forms, each of which may be
converted into any other forms; heat, light, motion,
sound and electricity being form of energy.
• To measure the amount of energy in any of its forms, it
is ordinarily converted to heat energy and expressed
in calories(kcal).
• Kilocalorie is defined as the amount of heat required to
raise the temperature of 1 kilogram (kg) (2.2lb) of
water 1 degree Celsius.
• The accepted SI unit of energy is the joule.
• 1 kcal = 4.18 kilojoules (kJ)
 Four Basic Forms of Energy
• Chemical – for synthesis of new compound
• Mechanical – for muscle contraction
• Electrical – for brain and nerve activity
• Thermal – for regulation of body temperature
– Human are inefficient energy users because they can
convert only 25% of chemical energy from the food
they eat into mechanical energy (walking, typing)
 Energy Needs of the Body
( 3 Factors)
• Basal metabolism
• Energy for physical activity
• Specific dynamic action (SDA) – a small
amount of additional energy expended
during digestion and absorption of
carbohydrates. Proteins and fats in the
gastrointestinal tract.
 Basal Metabolism
• Is the minimum amount of energy required to
maintain vital functions in an organism at complete
rest, measured by the basal metabolic rate in a
fasting individual who is awake and resting in a
comfortably warm environment.
• Basal Metabolic Rate (BMR) – is the rate at which
energy is used by an organism at complete rest,
measured in humans by the heat given off per unit
time, and expressed as the calories released per
kilogram of body weight or per square meter of body
surface per hour.
 Basal Metabolic Rate
• Higher in young people
• It increases for some months after birth, then
decreases through adolescence
• The basal metabolism of healthy men requires
about 1600 to 1800 kcal daily while for women is
about 1200 to 1450 kcal.
 Factors that can Increase the
BMR
• Muscular development
• Body temperature
• Pregnancy
• Lactation
 Physical Activity
• Muscular activity affects both energy expenditure and
heat production
• Energy expenditure increases with muscular activity
• Maintenance Activity: sitting most of the day, about 2
hours of moving about slowly or standing.
• Light Activity: typing, teaching, shopwork, laboratory
work, some walking.
• Moderate Activity: walking, housework, gardening,
carpentry, cycling, tennis.
• Strenuous Activity: pick-and-shovel work, swimming,
basketball, running
 Specific Dynamic Action of
Food
• Is the term used to describe the expenditure of
calories during the digestion and absorption of food.
• Studies have shown that the heat increment, or
thermogenic response, necessary to digest and
absorb fat is 2%, for carbohydrate is 6%, and for
protein-rich foods is about 12%.
• In general, the specific dynamic effect of diet is
calculated to contribute approximately 10% of the
consumed calories.
Body Composition
The Spectrum of Body Size, Shape and
Composition
We All Change in Many Ways
What are the different ways
to look at human body
composition?
 Medical (health)

 Anthropological

 Performance

 Appearance
Why is knowledge of body
composition so important?
 Health and Disease
 Performance
 Appearance
 Longevity
 What Is Body Composition?
• Body composition = the body’s relative amounts of
fat mass and fat-free mass (bone, water, muscle,
connective and organ tissues, teeth)
• Essential fat = crucial for normal body functioning
– 3–5% of total body weight in males
– 8–12% of total body weight in females
• Nonessential fat = adipose tissue
Typical Body Composition
prepared by: R. Escudero
 Obesity
And its Associated Risk Factors
 Overview of Various Body
Composition Assessment Methods
Overview of Various Body Composition Assessment Methods
(cont.)
 Obesity
An Overview
• Overweight and obesity are both chronic
conditions that are the result of an
energy imbalance over a period of time.

• The cause of this energy imbalance can

be due to a combination of several
different factors and varies from one
person to another.

• Individual behaviors, environmental

factors, and genetics all contribute to
the complexity of the obesity epidemic.
 Overweight and Obesity
• The most important consideration in evaluating
body weight and composition is the proportion of
total body weight that is fat (percent body fat)
• Overweight = total body weight above a
recommended range for good health
• Obesity = severely overweight and overfat;
characterized by excessive accumulation of
body fat
 Energy Imbalance
What is it?

• Energy balance can be compared to a

Weight Gain
scale.
Calories Consumed >
Calories Used
• An energy imbalance arises when the
Weight Loss number of calories consumed is not
equal to the number of calories used
Calories Consumed < by the body.
Calories Used

No Weight Change • Weight gain usually involves the

combination of consuming too many
Calories Consumed =
calories and not expending enough
Calories Used
through physical activity.
 Energy Imbalance
Effects in the Body

• Excess energy is stored in fat cells, which enlarge

or multiply.

• Enlargement of fat cells is known as hypertrophy,

whereas
multiplication of fat cells is known as hyperplasia.

• With time, excesses in energy storage lead to

obesity.

Fat cells
2009
J La State Med Soc .2005; 156 (1): S42-49.
Fat Cell Enlargement
Hypertrophy

• Enlarged fat cells produce the

clinical problems
associated with obesity, due to
the following:

– The weight or mass of the extra

fat
– The increased secretion of free
fatty acids and peptides from
enlarged fat cells.
 Weight Classifications
A Review
• Body mass index (BMI) is a
mathematical ratio which is calculated With a BMI You are
as weight (kg)/ height squared of: considered:
(m2). It is used to describe
an individuals relative weight for Below 18.5 Underweight
height, and is significantly correlated
with total body fat
content. BMI is intended for those 20
18.5 - 24.9 Healthy Weight
years of age and older.
25.0 - Overweight
29.9
30 or Obese
higher
 Mortality and Morbidity
Associated with Obesity

• The effects of excess weight on mortality and morbidity

have been recognized for more than 2,000 years. It was
Hippocrates who recognized that “sudden death is more
common in those who are naturally fat than in the lean.”

• Today, obesity is increasing rapidly. Research shows that

many factors related to obesity influence mortality and
morbidity.
 Mortality
Weight, Fat Distribution, and Activity
• The following factors have been shown to increase
mortality in individuals:

– Excess body weight

– Regional fat distribution
– Weight gain patterns
– Sedentary Lifestyle
 Mortality
Excess Body Weight

• Mortality associated with excess body

weight increases as the degree of obesity
and overweight increases.

• It is estimated that 280,000 to 325,000

deaths a year can be attributed to obesity
in the United States, more than 80% of
these deaths occur among individuals with
a BMI greater than 30 kg/m2.
 Mortality
Regional Fat Distribution

Android
• Regional fat distribution can contribute to mortality. Gynoid
• This was first noted in the beginning of the 20 century.
th

• Obese individuals with an android (or apple) distribution of body fat

are at a greater risk for diabetes and heart disease than were those
with a gynoid distribution (pear).
• Android fat distribution results in higher free fatty acid levels, higher
glucose and insulin levels and reduced HDL levels. It also results in
higher blood pressure and inflammatory markers.
Mortality
Weight Gain

• In addition to overweight and central

fatness, the amount of weight gain after
ages 18 to 20 also predicts mortality.

• The Nurses’ Health Study and the

Health Professionals Follow-up Study
showed that a marked increase
in mortality from heart disease is
associated with increasing
degrees of weight gain.
 Mortality
Sedentary Lifestyle
• Sedentary lifestyle is another important
component in the relationship of excess
mortality to obesity.
• A sedentary lifestyle increases the risk of
death at all levels of BMI.
• Unfit men in the BMI range of less than 25
kg/m2 had a significantly higher risk than
men with a high level of
cardiovascular fitness.
• Obese men with a high level of fitness had
risks of death that were not
different from fit men with normal body fat.
 Morbidity
Associated with Obesity

• Overweight affects several

diseases, although its degree of
contribution varies from one
disease to another.

• Additionally, the risk of developing

a disease often differs by ethnic
group, and by gender within a
given ethnic group.
 Morbidity
Associated with Obesity
Individuals who are obese are at a greater risk of
• Obstructive sleepdeveloping:
apnea • Endometrial, prostate
• Osteoarthritis and breast cancers
• Cardiovascular • Complications of
disorders pregnancy
• Gastrointestinal • Menstrual irregularities
disorders
• Psychological disorders
• Metabolic disorders
Cardiovascular Disorders
Associated with Obesity
Obese individuals are at a greater risk of developing these
cardiovascular disorders:

Hypertension
Stroke
Coronary Artery Disease
Hypertension
• Hypertension (HTN) is the term for high
blood pressure.
• Hypertension is identified when a blood
pressure is sustained at ≥140/90 mmHg.
• High blood pressure is referred to as the
“silent killer,” since there are usually no
symptoms with HTN.
• Some individuals find out that they have
high blood pressure when they have
trouble with their heart, brain, or kidneys.

2009
NHLBI
 Hypertension
The Dangers
Failure to find and treat HTN is serious, as untreated
HTN can cause:
– The heart to get larger, which may lead to heart failure.
– Small bulges (aneurysms) to form in blood vessels.
– Blood vessels in the kidney to narrow, which may lead to kidney
failure.
– Arteries in the body to harden faster, especially those in the
heart, brain, kidneys, and legs. This can cause a heart attack,
stroke, kidney failure, or can lead to amputation of part of the
extremities.
– Blood vessels in the eye to burst or bleed. This may cause
vision changes and can result in blindness.
 Hypertension

• Blood pressure is often increased in overweight

individuals.
• Estimates suggest that control of overweight
would eliminate 48% of the hypertension in
Caucasians and 28% in African Americans.
• Overweight and hypertension interact with cardiac
function, leading to thickening of the
ventricular wall and larger
heart volume, and thus to a
greater likelihood of cardiac failure.
 Hypertension
Prevalence in the Overweight
35
32. Age-adjusted
30 7 prevalence of
25 27. 27. hypertension in
0 7 overweight U.S.
Prevalence of HTN

22. adults
20 1 BMI < 25
15 BMI > 25 & < 27
14. 15.
9 2 BMI > 27 & <30
10

0
Males Females
Stroke
• Normally, blood containing oxygen
and nutrients is delivered to the
brain, and carbon dioxide and
cellular wastes are removed.
• A stroke occurs when the blood
supply to part of the brain is
suddenly interrupted by a blocked
vessel or when a blood vessel in
the brain bursts.
• Once their supply of oxygen and
nutrients from the blood is cut off
to the brain cells, they die.
 Stroke
The symptoms of a stroke
include:

• Sudden numbness or weakness, especially on one side of the body

• Sudden confusion or trouble speaking or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble with walking, dizziness, or loss of balance or
coordination
• Sudden severe headache with no known cause
 Stroke
• There are two forms of stroke: ischemic and hemorrhagic.
• Ischemic stroke occurs when an artery to the brain is blocked.
• Overweight and obesity increase the risk for ischemic stroke in
men and women.
• With increasing BMI, the risk of ischemic stroke increases
progressively and is doubled in those with a BMI greater than
30 kg/m2 when compared to those having a BMI of less than 25
kg/m2.
• Hemorrhagic strokes occur when a blood vessel in the brain
erupts.
• Overweight and obesity do not increase the risk for
hemorrhagic strokes.
 Coronary Artery Disease
• Coronary artery disease (CAD) is a type of atherosclerosis that
occurs when the arteries supplying blood to the heart muscle
(coronary arteries) become hardened and narrowed.
• This hardening and narrowing is caused by plaque buildup.
• As the plaque increases in size, the insides of the coronary
arteries get narrower, and eventually, blood flow to the heart
muscle is reduced.
• This is critical because blood carries much-needed oxygen to the
heart.
 Coronary Arteries
Blood Flow
Angina
This is the chest pain or discomfort
• When the heart muscle that occurs when the heart is not
is not receiving the getting enough blood.
amount of oxygen that
it needs, one of two Heart attack
things can happen: This is what happens when a blood
clot develops at the site of the
plaque in a coronary artery.
– Angina The result is a sudden blockage,
– Heart Attack which may block all or most of the
blood supply to the heart muscle.
Because cells in the heart muscle
begin to die when they are not
receiving adequate amount of
oxygen, permanent damage to the
 Coronary Artery Disease

• Over time, CAD can Heart Failure

weaken the heart In this condition, the heart
muscle and can’t pump blood effectively to
the rest of the body. Heart
contribute to:
failure does not mean that the
heart has stopped nor does it
– Heart Failure mean that it is about to. It
means that the heart is failing
– Arrhythmias to pump blood the way that it
should.

Arrhythmias
Arrhytmias are changes in the
normal beating rhythm of the
heart. They can be either
2009 faster or slower than normal.
 Coronary Artery Disease
• Obesity is associated with an increased risk for CAD.
• Abdominal fat distribution is believed to be related as well.
• Data from the Nurses Health Study illustrated that women in
the lowest BMI but highest waist-to-hip circumference ratio
had a greater risk of heart attack than those in the
highest BMI but lowest waist-to-hip circumference ratio.
• Regional fat distribution appears to have a greater effect on
CAD risk than BMI alone.

2009
Gastrointestinal Disorders
Associated with Obesity
Obese individuals are at greater risk of developing these
gastrointestinal disorders:

Colon Cancer
Gall stones
 Colon Cancer
• Colorectal cancer is a term used to refer to cancer
that develops in the colon or the rectum.

• The colon (a.k.a. the large intestine) is about 5 feet

long and its role in the digestive system is to continue
to absorb water and mineral nutrients from food.
Once this process of absorption is complete, waste
matter (feces) remains.

• The rectum is the final 6 inches of the digestive

system. Feces are passed from the large intestine to
the rectum, to exit the body through the anus.
 Colon Cancer
• Colorectal cancer is the second leading cause of cancer-
related deaths in the U.S.
• It is estimated to cause about 55,170 deaths during 2006.
 Colon Cancer
Findings Relating to Obesity

• Colon cancer has been shown to

occur more frequently in people
who are obese than in people who
are of a healthy weight.

• An increased risk of colon cancer

has been consistently reported for
men with high BMIs.

• Women with high BMI are not at

increased risk of colon cancer.
There is evidence that abdominal obesity
may be important in colon cancer risk.
 Gallbladder Disease
• Cholelithiasis is the primary hepatobiliary pathology
associated with overweight.
• Cholelithiasis is a condition characterized by the presence
or formation of gallstones in the gallbladder or bile ducts.
• Normally, a balance of bile salts, lecithin, and cholesterol
keep gallstones from forming. However, if there are
abnormally high levels of bile salts or, more commonly,
cholesterol, then stones can form.
 Gallstones
Findings Related to Obesity
• Obesity appears to be associated with the development of
gallstones.
• More cholesterol is produced at higher body fat levels.
• Approximately 20 mg of additional cholesterol is
synthesized for each kg of extra body fat.
• High cholesterol concentrations relative to bile acids and
phospholipids in bile increase the likelihood of
precipitation of cholesterol gallstones in the gallbladder.
 Gallstones
Findings Related to Obesity

• In the Nurses’ Health Study, when compared to those having a

BMI of 24 or less,
– Women with a BMI > 30 kg/m2 had a 2-fold increased risk for
symptomatic gallstones.
– Women with a BMI > 45 kg/m2 had a 7-fold increased risk for
symptomatic gallstones.

• The relative increased risk of symptomatic gallstone

development with increasing BMI appears to be less for men
than for women.
 Gallstones
Findings Related to Obesity
• Ironically, weight loss leads to an increased risk
of gallstones-- because of the increased flux of
cholesterol through the biliary system.

• Diets with moderate levels of fat that trigger

gallbladder contraction and subsequent
emptying of the cholesterol content may reduce
the risk of gallstone formation.

• Bile acid supplementation can be used to lower

ones risk for gallstone formation.
 Metabolic Disorders
Associated with Obesity
Obese individuals are at greater risk of developing these
metabolic disorders:

Diabetes Mellitus
Dyslipidemia
Liver Disease
 Diabetes Mellitus

• Type 2 diabetes mellitus (DM) is strongly associated with

overweight and obesity in both genders and in
all ethnic groups.

• The risk for Type 2 DM increases with the degree and duration
of overweight in individuals.

• The risk for Type 2 DM also increases in individuals with a

more central distribution of body fat
(abdominal).
 Obesity and Type 2 DM
In the United States

Among people
15% diagnosed with Type
2 diabetes,
BMI <25 55 percent have a
BMI >25 or BMI <30 BMI ≥ 30 (classified
55% 30%
BMI >30 as obese),
30 percent have a
BMI ≥
25 or ≤30
(classified as
overweight), and
only 15 percent
have a BMI ≤ 25
(classified as normal
weight).
 Diabetes Mellitus
Findings Related to Obesity
• The Nurses’ Health Study demonstrated the curvilinear relationship
between increasing BMI and the risk of diabetes in women:
– Women with a BMI below 22 kg/m2 had the lowest risk of DM
– At a BMI of 35 kg/m2, the relative risk of DM increased 40-fold or 4,000%

• The Health Professionals Follow-up Study demonstrated a similar

relationship between increasing BMI and the risk of diabetes in men:
– Men with a BMI below 24 kg/m2 had the lowest risk of DM
– At a BMI of 35 kg/m2, the relative risk of DM increased 60-fold or 6,000%
 Diabetes Mellitus
Findings Relating to Weightloss
• Weight loss reduces the risk of developing
diabetes.

• In the Health Professionals Follow-up

Study, a weight loss of 5-11 kg decreased
the relative risk for developing
diabetes by nearly 50%.

• Type 2 DM was almost nonexistent with a

weight loss of more than 20 kg (44 lbs) or
in those with a BMI below 20.
Dyslipidemia
• Dyslipidemia is defined
as abnormal
concentration of lipids or
lipoproteins in the blood.

• As BMI increases, there

is an increased risk for
heart disease.

• This is because a
positive correlation
between BMI and
triglyceride (TG) levels
has been demonstrated.
 Dyslipidemia
Findings Related to Obesity

HDL
• An inverse relationship between HDL cholesterol and BMI has
been noted.
• This relationship may be more important than the relationship
between BMI & TG levels.
• Low level of HDL carries more relative risk for developing heart
disease than do elevated triglyceride levels.
• Central fat distribution also plays an important role in lipid
abnormalities.
• Excessive body fat in the abdominal region leads to increased
circulating triglyceride levels.
 Liver Disease
• Nonalcoholic fatty liver disease (NAFLD) is the term
given to describe a collection of liver abnormalities
that are associated with obesity.

• In a cross-sectional analysis of liver biopsies of

obese patients, it was found that the prevalence of
steatosis, steatohepatitis, and cirrhosis were
approximately 75%, 20%, and 2% respectively.
 Liver Disease
Fatty Liver
• Steatosis is the term for “fatty liver” and it
is not actually a disease, but rather a
pathological finding.

• Most cases of fatty liver are due to obesity.

• Other causes of fatty liver include:

– Diabetes
– Certain drugs
– Intestinal bypass operations
– Starvation
– Protein malnutrition
– Alcoholism
 Liver Disease
Fatty Liver

• A gradual weight reduction can

help to reduce the enlargement
of the liver due to fat, and it can
normalize the associated liver
test abnormalities.

• It is important to limit the

amount of alcohol consumed in
the diet. Alcohol can decrease
the rate of metabolism and
secretion of fat in the liver.
Importance of a Healthy Liver
The liver is the largest organ in the body and it plays a vital
role in performing many complex
functions
– The 300 billion cells that
of the liver are essential
control for life:
a process known as metabolism. During
metabolism, the liver breaks down nutrients into usable products. These
products are then delivered to the rest of the body through the bloodstream.

– The liver also metabolizes toxins into byproducts that can be safely eliminated.

– The liver also produces many important substances, such as: albumin, bile,
cholesterol, clotting factors, globin, and immune factors.
 Other Disorders
Associated with Obesity
Obese individuals are at greater risk of developing these
metabolic disorders:
Obstructive sleep apnea
Osteoarthritis
Endometrial, prostate, and breast
cancers
Complications of pregnancy
Menstrual irregularities
Psychological disorders
 Obstructive Sleep Apnea
• Obstructive sleep apnea is caused by repetitive upper airway
obstruction during sleep as a result of narrowing of the
respiratory passages.
• Patients having the disorder are most often overweight with
associated peripharyngeal infiltration of fat and/or increased size
of the soft palate and tongue.
Obstructive Sleep Apnea
• Common complaints are loud snoring,
disrupted sleep, and excessive
daytime sleepiness.
• Individuals with sleep apnea suffer from
fragmented sleep and may develop
cardiovascular abnormalities because of
the repetitive cycles of snoring, airway
collapse, and arousal.
• Because many individuals are not aware of
heavy snoring and nocturnal arousals,
obstructive sleep apnea may remain
undiagnosed.
 Obstructive Sleep Apnea
Findings Relating to Obesity
• Obstructive sleep apnea affects around 4% of middle-aged
adults.
• Individuals having a BMI of at least 30 are at greatest risk
for sleep apnea.
• Weight loss has been shown to improve the symptoms
relating to sleep apnea.
 Osteoarthritis
• Osteoarthritis (OA) is the most common type of arthritis
• 40 million Americans currently have osteoarthritis.
• It is a degenerative disease which frequently leads to
chronic pain and disability.
• For individuals over the age of 65, it is the most disabling
disease.
• Currently, only the symptoms of OA can be treated; there
is no cure.
 Osteoarthritis
Findings Relating to Obesity
• The incidence of OA is significantly increased in
overweight individuals.

• OA that develops in the knees and ankles is

probably directly related to the trauma associated
with the degree of excess body weight.

• Osteoarthritis in other non-weight bearing joints

suggests that there must be some component of
the overweight syndrome responsible for
Areas of the
altering cartilage and bone metabolism, body most
independent of the actual stresses of body weight commonly
on joints. affected by
OA
 Cancer
Findings Relating to Obesity
• Overweight and obesity are associated with an
increased risk of:
esophageal, gallbladder, pancreatic, cervical,
breast, uterine, renal, and prostate cancers.

• Obesity and physical inactivity may account for

25 to 30 percent of several major cancers,
including--- colon, breast (postmenopausal),
endometrial, kidney, and cancer of the
esophagus.
 Endocrine Changes
• There are various endocrine changes associated with
overweight.
• Changes in the reproductive system are among the most
common.
• Irregular menses and frequent anovular cycles are
common.
• Rates of fertility may also be reduced.
 Endocrine Changes
Associated with Obesity

Common hormonal abnormalities associated with obesity

• Increased cortisol production

• Insulin resistance
• Decreased sex hormone-binding globulin in women
• Decreased progesterone levels in women
• Decreased testosterone levels in men
• Decreased growth hormone production
 Psychological Disorders
Associations with Obesity

• Obesity is associated with an impaired quality

of life.
• Higher BMI values are associated with greater
adverse effects.
• When compared to obese men, obese women
appear to be at a greater risk for
psychological dysfunction.
• This may be due to the societal pressure on
women to be thin.
 Psychological Disorders
Weight Loss
• Intentional weight loss has been
consistently associated with
improved quality of life.

• Severely obese patients who lost

43 kg through gastric bypass
demonstrated improved quality
of life scores to such an extent
that their post-weight loss
scores were equal to or even
better than population norms.
 In Conclusion
The following conditions have been found to be
associated with obesity:
• Diabetes mellitus
• Hypertension
• Gallbladder Disease • Psychosocial Function
• Liver Disease
• Obstructive Sleep
• Cancer Apnea
• Coronary Artery Disease
• Osteoarthritis
• Cerebrovascular disease
(stroke)
• Endocrine Changes These diseases have been
found to be associated with
increased fat mass
These diseases have been
found to be associated with
increased metabolic activity
(secretion) of fat cells in