Chapter

7
Energy Balance
and
Weight Control

Copyright 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.
Energy Balance and
Weight Control
Estimated 1 billion people worldwide are
overweight or obese
Westernized diets (high-fat, high-sugar)
increasing in popularity
Excess weight increases likelihood of many
health problems
Government agencies, food industry, health
professionals, communities, addressing weight
problem in North America
7.1 Energy Balance
1. What are the main components of energy balance?
2. How is the energy content of food determined and
expressed?
3. What are the four main purposes for which the body uses
energy? Approximately how much does each component
contribute to overall energy use by the body?
Energy Balance

68.8% of North American adults are overweight

34% of total population is obese
Signals for reevaluation of diet and lifestyle:
10 pounds of weight gain
2-inch increase in waist circumference
2009-2010 National Health
and Nutrition Examination
Survey

Results suggest a slowing or leveling off of obesity and BMI

trends
NHANES study identified slight downward trend in
energy/calorie intake
No quick cure for overweight, despite some of the
advertisements
Takes hard work and commitment
Obesity Trends in the
U.S.
 Energy Balance

Energy balance
energy intake, in form of food and beverages, matches energy expended,
primarily through basal metabolism and physical activity
Positive and Negative
Energy Balance

Positive energy balance

energy intake is greater than energy expended, generally
resulting in weight gain
Negative energy balance
energy intake is less than energy expended, resulting in weight
loss
1 lb. weight loss = 3300 kcal
Using 3500 kcal is more simple to use
Energy Intake

Energy needs met by food intake

represented by number of calories eaten each
day
Average adult is 8 pounds heavier than just 10 years ago
cheap cost
availability of palatable food in vending
machines
drive-up windows
social gatherings
fast-food restaurants
supersized portions
Estimating kcal Content in
Food
Bomb Calorimeter
measures calorie content
by burning dried portion of
food. Burning food raises
temperature of water
surrounding chamber
holding food
Energy Intake vs.
Expenditure
Energy Output

Body uses energy for three general purposes:

1. Basal metabolism
2. Physical activity
3. Digestion, absorption, processing of ingested nutrients
Small amount for adaptive thermogenesis (shivering,
fidgeting in response to cold)
Basal Metabolism
Minimal amount of calories body uses to
support itself in a fasting state when resting
and awake in warm, quiet environment
~60-75% of total energy needs
Includes energy needed for maintaining
heartbeat, respiration, body temperature
Amount of energy needed for basal
metabolism varies between individuals
Approximately 1 kcal/minute
Resting Metabolism (RMR), person is not
fasting, slightly higher than BMR
BMR Sample Calculation

2.2 pounds per kilogram

130 lbs 2.2 lbs/kilograms = 59 kg per hr
BMR per day
53 kcal/hr X 24 hrs = 1272 kcal
 Factors That Influence
Basal Metabolism

Body surface area (weight, Stress, norepinephrine

height) Age
Lean body mass Calorie intake
Gender Pregnancy
Body temperature Use of caffeine and tobacco
Thyroid hormone
Energy for Physical
Activity

Increases energy expenditure,

by as much as 15% to 35%
More activity, more energy
burned
Lack of activity is a major
cause of obesity
 Thermic Effect of Food
(TEF)

Energy used to digest, absorb, and metabolize food nutrients

Tax of total energy consumed
~5-10% above the total calories consumed
TEF is highest for protein, then carbohydrate, then fat

Celery is a negative
calorie food
Adaptive Thermogenesis

Nonvoluntary physical activity

Triggered by overeating
Fidgeting and shivering
Maintenance of muscle tone
Maintenance of posture
Adaptive Thermogenesis

Overeating
Increases sympathetic nervous system activity
Resists weight gain
Brown Adipose Tissue
Participates in thermogenesis
Brown Fat
7.2 Determination
of Energy
Use by the Body
1. What methods can be used to measure energy use by the body?
2. Estimated Energy Requirement can be calculated based on which five factors?
 Direct and Indirect
Calorimetry

Direct calorimetry, insulated chamber

Measures body heat output
Expensive and complex
Indirect calorimetry
Measures the amount of oxygen consumed
Oxygen consumed is
related to energy expended
Estimates of Energy
Needs

EER = Estimated Energy Requirement

AGE = age in years
PA = Physical Activity Estimate (see following table)
WT = weight in kilograms (pounds 2.2)
HT = height in meters (inches 39.4)
Estimates of Energy
Needs

EER for Men 19 years and older:

EER= 662-(9.53 x AGE) + PA x (15.91 x WT +

539.6 x HT)
EER for Women 19 years and older:

EER= 354- (6.91 x AGE) + PA x (9.36 x WT +

726 x HT)
7.3 Assessing
Healthy
Body Weight
1.

2.
How is the body mass index determined?

What are the BMI, body fat percentage, and waist circumference values for men and
women that are associated with increased risk of health problems related to being
overweight?

3. What are five methods by which body fat content can be estimated?

4. Obesity leads to an increased risk of which diseases?

What Is a Healthy
Body Weight?

Current height/weight standards

Weight associated with health and longevity
May not be the healthiest weight for individual
Should be determined with physician guidance
Healthy Weight Based On

Not a mathematical calculation

Personal and family weight history, fat distribution patterns,
family history of weight-related disease, current health status
Indicators Weight Is Not
Healthy

Hypertension
Elevated LDL-cholesterol
Family history of obesity, cardiovascular disease, or certain
forms of cancer (e.g., uterus, colon)
Pattern of upper-body fat distribution
Elevated blood glucose
A Healthy Body Weight

What is the lowest weight maintained for at least a year?

What weight was maintained without constantly feeling
hungry?
Establish a personal healthy weight
Body Mass Index (BMI)
Body mass index is
calculated as
body weight (in kilograms)
height2 (in meters)

Or

weight (pounds) X 703

height2 (inches)
BMI Categories
Height / Weight Table
Estimating Body Fat Content
and Diagnosing Obesity
Medical experts: dont rely on body
weight, also use percent body fat
Acceptable amount of body fat
Women, 16% to 30%
Men, 11% to 20%
Obesity
Women over 37%
Men over 24%
Increased risk for health problems
Are usually truly overweight
 Estimation of Body Fat

Underwater
weighing
Very accurate
Fat is less dense than lean
tissue
Fat floats
 Estimation of Body Fat

Air displacement
Determines the body
volume and air
displaced in a sealed
chamber
Body density = Body
wt/body volume
% Body fat =
(495/body density) -
450
Skinfold Measurements
 Estimation of Body Fat

Bioelectrical impedance
Low-energy current that measures the
resistance of electrical flow
Fat is resistant to electrical flow; the
more the resistance, the more body fat
 Estimation of Body Fat

DEXA (dual x-ray

photon
absorptiometry)
X-ray body scan that
allows for the
determination of body
fat
Most accurate but
expensive
Using Body Fat
Distribution
to Further Evaluate
Upper-body obesity, Apple shape
Obesity
Called abdominal or central obesity, common in
men
Associated with
Insulin resistance, fatty liver
Cardiovascular disease, hypertension, type 2
diabetes
Testosterone and excessive alcohol
Abdominal fat is released into the liver and
promotes inflammation in the body
Defined as
Waist measurement of > 40 for men
Waist measurement of >35 for women
Using Body Fat
Distribution
to Further Evaluate
Obesity
Lower-body obesity, typical female pattern
gynecoid or gynoid)
Small abdomen, much larger buttocks and thighs, give a pear
like appearance
Post menopause, estrogen falls, raises risk of chronic
disease
Body Fat Distribution
7.4 Why Some
People
Are Obese
Nature Versus
Nurture
1.
2.
Explain how body weight is influenced by nature.
What role does nurture play in determining body weight?
How Does Nature
Contribute to Obesity?

Identical twins
When raised apart still
have similar weights
Genes
Affect metabolic rate, fuel
use, brain chemistry, body shape
Account for up to 70% of weight differences
Thrifty metabolism gene
More fat storage to protect against famine
 Set-Point Theory
Weight is regulated by the body, hypothalamus
Genetically predetermined body weight
Body resists weight change
Leptin can assist in weight regulation
Over fat are resistant to increase leptin from body fat
Reduction in calorie intake results in lower
metabolic rate
Ability to shift the set-point weight?
Commit to healthy lifestyle best approach
 Opponents of
Set-Point Theory

Weight does not remain constant

Different environments can alter weight
People settle into a particular weight based on current
circumstances
 Does Nurture Have a
Role?

Environmental factors influence weight

Learned eating habits
Activity factor (or lack of)
Poverty and obesity
Female obesity is rooted in childhood obesity
Male obesity appears after age 30
 Nature and Nurture

Obesity is nurture allowing nature to express itself

Location of fat is influenced by genetics
Child of obese parents is especially at risk
Increased physical activity and moderate calorie intake can
promote healthy weight
7.5 Treatment of
Overweight
and Obesity
1. What are the characteristics of an appropriate weight-loss program?
2. What are the Dietary Guidelines related to Balancing Calories to Manage Weight?
Treatment of
Overweight and Obesity
Obesity is a chronic disease

Treatment requires long-term

lifestyle changes
Dieters are misdirected

More concerned about weight

loss than healthy lifestyle
Unrealistic weight expectations
Emphasis on healthy, active living
 Losing Body Fat

Cannot consist of rapid weight loss

Calorie deficit needed to lose adipose tissue
Weight loss of 1 lb. (3300 kcal) per week
Combination of reduced calorie intake, and increase physical activity
Combination to equal 500 calories per day
Goal to spare loss of lean body tissue
 What to Look for in a
Sound Weight-loss Plan
Seek advice from a Registered Dietitian
Interactive tools
www.ChooseMyPlate.gov
1. Control calorie intake
2. Increased physical activity

150 to 300 minutes of moderate-

intensity aerobic per week
3. Need for lifelong change, behavior modification to maintain healthy
weight
Recommendations from Dietary
Guidelines for Americans 2010

Balancing calories to manage weight

Prevent obesity through improved eating and physical activity
behaviors
Control total calorie intake
Increase physical activity
Maintain calorie balance during each life stage
Weight Loss in
Perspective

Must be directed to all age groups

Need to focus on children and adolescents
Adult focus directed at:
weight maintenance
healthy dietary choices
increasing physical activity
Weight-Loss Triad Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

3 2

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7.6 Control of Calorie
IntakeThe Main Key
to Weight Loss and
Weight Maintenance
1. How are hormones involved in hunger control?
2. What are calorie creep and the weight-loss plateau and how can they lead to weight gain?
Control of Calorie Intake

Average caloric need per day

Female: 1800 to 2400 calories per
day
Male: 2200 to 300 calories per day
Higher for more active people
Sedentary society
Requires less calories
Control of Calorie Intake

Low-fat, high-fiber approaches

Most successful in long-term studies
No diet has a metabolic
advantage
Read and use food labels
Keep a food log (portion size
awareness)
Controlling Hunger

Challenge to regulate hunger and eat less calories

Separate true hunger from habit and emotion
Hormone ghrelin, empty stomach signals brain you are hungry
Nerves in stomach signal brain you are full
Takes up to 20 minutes
Suggestions to
Relieve Hunger

High fiber snack

Glass of water
Lean protein, nuts, low fat dairy, soy, lean meat, fish,
chicken
Slow down eating
 Conquering the
Weight-Loss Plateau

Healthy weight-loss takes time

Normal to be erratic
Early weight loss includes fluid and fat
May be increasing muscle mass
1 to 2 pounds per week for long-term
Track diet to determine if old food habits returning
Reduce calories, increase activity intensity
7.7 Regular Physical
ActivityA Second
Key to Weight Loss
and Especially
Important
1. What should dietersfor Later
remember
physical activity as part of their
about

Weight
weight lossMaintenance
plan?
 Regular Physical Activity

Important for weight maintenance

Promotes steady weight loss
Expends 100-300 kcal while controlling calories
Boosts self-esteem
Add weight resistance,
strength training
Increase lean body mass
Increase fat use
Increase bone health
Increase metabolic rate
7.8 Behavior
ModificationA
Third Strategy for
Weight Loss and
1. What behavior modification steps are

Management
helpful in changing problem eating
behaviors to increase weight-loss success?
2. How does mindful eating help control
hunger while dieting?
2010 Dietary Guidelines

Focus on total number of calories consumed

Monitor food intake
When eating out, choose smaller portions or lower-calorie
options
Prepare, serve, and consume smaller portions of foods and
beverages, especially
those high in calories
Eat a nutrient-dense breakfast
Limit screen time
Mindful Eating

Why do I eat?
How do I eat?
When do I want to eat?
How much do I eat?
What do I eat?
Where does the energy go?
From book, Eat What You Love, Love What You Eat by
Michelle May
Other Behavior
Modification Strategies

Chain-breaking
Stimulus control
Cognitive restructuring
Contingency management
Self-monitoring
Chain-Breaking

Breaking the link between

two behaviors
Snacking while watching television

Links can lead to excessive

intake
Stimulus Control

Altering the environment

Minimize the stimuli for eating
Remove foods from sight
Putting you in charge of
temptations
Cognitive Restructuring

Changing your frame of mind

regarding eating
Replacing eating due to stress with going for a walk with a friend
Contingency
Management

Forming a plan of action to

respond to a situation
What to do at a party when food is easily available

Rehearsing appropriate
responses before the situation
arises
Self-Monitoring

Tracking foods eaten and

conditions affecting eating
Understanding your eating
habits
Relapse Prevention

Need to plan for lapses, dont overreact

Take charge immediately
Continue to practice newly learned behavior
Dont allow lapse to collapse effort
Requires motivation, movement, and monitoring
Social Support Aids
Behavioral Change

Have social support

Encouragement from friends,
family, and professionals
Long-term help from
professional
Support groups
 Societal Efforts to
Reduce Obesity

Improvement takes effort from many

sectors
2010 Dietary Guidelines
1. Ensure all Americans have access to nutritious foods, opportunities for
physical activity
2. Facilitate individual behavior change through environmental strategies
that make it easier for individuals to make healthier choices
3. Set stage for lifelong healthy eating, physical activity, and weight
management behaviors
7.9 Professional
Help for Weight
Loss
1. What are the surgical options for obese people who have failed to lose weight with other weight-loss strategies?
2. How restrictive is a very-low-calorie diet plan? Why is monitoring by a qualified health professional important?
Medications for Weight
Loss

Candidates BMI of 30 or more,

or 27 to 29.9 with weight-related
health conditions
Amphetamine (Phenteramine)
Prolongs the activity of epinephrine
and norepinephrine in the brain
Decreases appetite
Not recommended for long-term
use (dependency)
Medications for Weight
Loss

Sibutramine (Meridia)
Removed from market in 2010
Increases heart attacks and strokes
Enhances norepinephrine and serotonin activity
Decreases appetite
 Orlistat (Xenical)
Inhibits (lipase) fat digestion
Reduces absorption of fat by 30% in the
small intestine
Dietary fat is deposited in the feces,
with resulting side effects
Must still control fat intake
Malabsorption of fat-soluble
vitamins
Supplement needed at bedtime
alli is a low dose of Orlistat, available OTC
Orlistat (Xenical)
Treatment of Severe
Obesity

BMI greater than or equal to 40

or weighing at least 100 pounds or more
or twice healthy body weight
Very-low-calorie diet (VLCD)
known also as protein-sparing modified fast (PSMF)
diet allows person 400 to 800 kcal per day, often in liquid form
120 to 480 kcal is carbohydrate, the rest mostly high quality
protein
 Bariatric Surgery

Bariatrics
Medical specialty focusing on treatment of obesity
Only considered for severe obesity
Adjustable gastric banding
Procedure in which opening from esophagus to stomach is reduced by
a hollow gastric band
Gastroplasty
Gastric bypass surgery performed on stomach to limit volume to ~30
milliliters
Referred to as stomach stapling
Sleeve gastrectomy
Surgical reduction of stomach by about 75%
Also known as the gastric sleeve
 Risks of Bariatric Surgery

Death and early to late postoperative complications

Bleeding, blood clots, hernias, severe infection
Risk of death as high as 2 percent
Cost: $18,000 to $35,000 for bypass
Banding: $17,000 to $30,000
Further costs to remove stretched skin
 Lipectomy

Removing problem local fat deposits

Suctioning out fat through thin tube
Risk of infection, skin depressions, blood clots
May result in 4 to 8 pounds
Costs $1800 per site, range $2600 to $9000
7.10 Treatment of
Underweight
1. How is underweight defined and what are some of its primary causes?

2. What are the components necessary to gain weight as muscle and not as fat?
 Underweight

Body mass index below 18.5

cutoff less precise than for obesity
condition less studied
Caused by variety of factors
cancer, infectious disease, digestive tract disorders, excessive dieting
or physical activity
Associated with increased death rate
Sometimes requires medical intervention
Treatment for
Underweight

Intake of energy and nutrient dense

foods (energy input)
Encourage regular meals and snacks
Reduce activity (energy
output)
Increase portion size
Strength training
Gaining Weight as
Muscle, Not Fat

Combination of diet and strength training needed to gain

weight as muscle
Strength training slows muscle loss of aging
Assistance from qualified fitness trainer
Protein serving before and after lifting
Some carbohydrate assist protein absorption
Lean varieties of protein best
Nutrition and Your
Health
Popular DietsCause for Concern
 How to Recognize an
Unreliable Diet
1. Promote quick weight loss
2. Limited food selections
3. Use of testimonials
4. Billed as cure-alls
5. Recommend expensive supplements
6. No permanent lifestyle changes
advocated
7. Critical, skeptical of the scientific
community
8. Claim no need to exercise
Types of Popular Diets

High-protein, low carbohydrate approaches

Carbohydrate focused diets
Low-fat approaches
Novelty diets
Meal replacements
 Quackery Is Characteristic
of
Many Popular Diets

People taking advantage of others

Some dont realize they are promoting quackery
Gimmicks come, go, and return again
Check consumer resources for help in identifying fraudulent
products, services