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					HNU 200   Section 4: Healthy Body Weights
4.1. EVALUATING
BODY WEIGHT
HNU 200 Section 4: Healthy Body Weights
What is this?
Healthy Body Weight
   Appropriate for age, physical development
   Can achieve and sustain without severely restricting
    food intake or constantly dieting
   Is acceptable to you
   Based upon your genetic background and family
    history of body weight and shape
   Promotes good eating habits and allows physical
    activity
Healthy Body Weight
   Underweight: having too little body fat to maintain
    health.

   Overweight: having a moderate amount of excess
    body fat.

   Obesity: having an excess of body fat that
    adversely affects health
Evaluating Body Weight
   A person’s actual weight is not the only factor to
    consider.
   Determining if a person’s body weight is healthy
    should include:
     Determining  the Body Mass Index (BMI)
     Measuring body composition

     Assessing the pattern of fat distribution
Body Mass Index

 Indicator of wt in relation to ht
 Used to identify levels of health risk

 Calculated by dividing wt by square of ht

 BMI = wt (kg)

         ht (m2)
 www.hc-sc.gc.ca/
Evaluating Body Weight




                         11-8
Evaluating Body Weight

   Limitations of the Body Mass Index (BMI):
     Do not get an indication of distribution of body fat
     Does not reflect history
     The BMI is not appropriate for those who are:
       Muscular  adults
       Naturally lean adults
       < 18 yrs old
       Pregnant or nursing
       >65 yrs old
       In certain ethnic and racial groups
BMI: Interpretation


  Classification   BMI           Risk of Developing
                   Category      Health Problems
  Underweight      < 18.5        Increased
  Normal weight    18.5 – 24.9   Least
  Overweight       25 – 29.9     Increased
  Obese class 1    30 – 34.9     High
  Obese class 2    35 – 39.9     Very high
  Obese class 3    ≥ 40          Extremely high
Calculation of BMI

 Ex: 70 kg man, 6 feet tall
 Step 1: convert inches to meters

   6 feet = 72 inches
   2.54 cm/1 inch
   72 x 2.54 = 183 cm = 1.83 m
                   2
 Step 2: wt/ht (m )

   = 70/(1.832)
   BMI = 20.4 (normal weight range)
Body Composition

   Body Composition
     Measurement of body fat and lean muscle mass

     Can be measured by

       Underwater weighing
       Skinfold measurements
       Bioelectric impedance analysis
Body Composition
   Underwater weighing
     Submerged    in
       water
     Exhale

     Weight taken

     2-3% margin of

       error
     Fast: at least 8 hrs

     No activity:

       previous 12 hrs
Body Composition
   Skinfold measurements:
     Pinch skin at different places with calipers
     Can’t be use with obese

      people
     3-4%    margin of error
Body Composition
   Bioelectrical Impedance Analysis:
     Sends  low level of electrical current through body
     Water = good conductor

     Fat = poor conductor

     Fast: 4 hrs

     No exercise: previous 12 hrs

     No alcohol: within 48 hrs of test

     Not good measure if retaining water

     Margin of error: 3-4%
     Body Composition




Source: Kasch Exercise Physiology Lab. (ND). Body composition: bioelectrical impedance analysis. Retrieved Sept 29, 2009,
from http://www-rohan.sdsu.edu/~ens304l/bia.htm
Body Composition

 Percentage of body weight as fat:
 General recommendations:

   Men: 15%
   Women: 20%



   Athletes:
     Male: 5 – 10%
     Female: 15 – 20%
Body Composition
Body Fat Distribution

 May be more imp than fat itself
 Central obesity or upper body fat:

     Excess   fat stored around trunk of body (apple vs. pear
      shape)
   Linked with increased risk heart disease, stroke,
    diabetes, hypertension
Body Fat Distribution

                  Waist circumferance:
                  Men: >40”
                  Women: >35”

                  Waist to hip ratio:
                  Men: >1
                  Women: >0.8
Health Risk      Classifications 3



Waist           Normal       Overweight   Obese Class 1
Circumference
Males: <40”     Least Risk   Increased    High Risk
Females: <35”                Risk
Males: >40”     Increased    High Risk    Very High Risk
Females: >35”   Risk
Strengths and Limits of Tools
4.2. WEIGHT RELATED
HEALTH ISSUES
HNU 200 Section 4: Healthy Body Weights
Underweight Health Concerns

   Underweight
     BMI below 18.5

     Can be just as unhealthy as overweight

     Undernutrition

     Osteoporosis

     Infertility

     Impaired immune system

     1998-99 National Population Health Survey: 9%
      Canadians are underweight2
                                            11-24
Overweight Health Concerns

   Overweight
     BMI between 25 and 29.9

     Increases the risks of high blood pressure, heart
      disease, type 2 diabetes, sleep disorders,
      osteoarthritis, gallstones, certain cancers
     Can lead to obesity

   Overweight: 36% Canadians10


                                                11-25
Obesity Health Concerns

   Obesity
     Obesity: BMI over 30
       Class I obesity is BMI 30 – 34.99
       Class II obesity is BMI 35 – 39.99
       Class obesity is BMI > 40.0
     6 of the 10 leading causes of death in Canada
      are associated with obesity
     Risks for those health problems seen in
      overweight
     Obesity: 23% Canadians10                11-26
Health Concerns in Canada

 Top 10 leading causes of death in Canada,
  2004-2005
 #1. Cancer

 #2. Heart disease

 #3. Stroke

 #6. Diabetes
Health Concerns in NS

 1st in Canada for deaths from cancer
 2
   nd for deaths due to diabetes and circulatory

  problems
 Cardiovascular disease (heart disease, stroke
  and atherosclerosis): 36% of all deaths
 Cancer: 30% of all deaths
References for 4.1 and 4.2
1.   Anderson, H. (2000). Obesity: genetics or environment? Retrieved
     Sept 30, 3009, from
     http://www.sugar.ca/english/pdf/carbohydratenews/CarboNews
     2000.pdf
2.   Che, J. (2002). Underweight Canadians. Canadian Social Trends.
     Statistics Canada Catalogue No. 11-008.
3.   Chung, W.K., & Leibel, R.L. (2008). Considerations regarding the
     genetics of obesity. Obesity, 16 (S3), s33-s39.
4.   Health Canada. (2003). Canadian guidelines for body weight
     classification in adults. Ottawa: ON.
5.   Kapoor, R. (2005). Environmental factors of obesity: food portions
     and patterns. Retrieved Sept 30, 2009, from
     http://www.moreaboutmilk.com/downloads/educators_pdf/05/NF
     FHEFeb05.pdf
References for 4.1 and 4.2
6.   MIT Medical, Centre for Health Promotion and Wellness. (ND). Set point
     theory. Retrieved Sept 29, 2009, from
     http://medweb.mit.edu/pdf/set_point_theory.pdf Orpana, H.M.,
     Berthelot, J.M., Kaplan, M.S., Feeny, D.H., McFarland, B., & Ross, N.A.
     (2009). BMI and mortality: results from a national longitudinal study of
     Canadian adults. Obesity, doi: 10.1038/oby.2009.191
7.   Phytila, H. (2007). Thrifty gene. Retrieved Sept 29, 2009, from
     http://www.genomicseducation.ca/informationArticles/health/thrifty_gen
     e.asp
8.   R&D Systems. (1997). Leptin. Retrieved Sept 29, 2009, from
     http://www.rndsystems.com/mini_review_detail_objectname_MR97_Lepti
     n.aspx
9.   Tjepkema, M. (2005). Adult obesity in Canada: measured height and
     weight. Report No. 82-620-MWE. Retrieved Sept 30, 2009, from
     http://www.statcan.gc.ca/pub/82-620-m/2005001/pdf/4224906-
     eng.pdf
Body Fat
   Adipose tissue: connective tissues made of
    adipocytes (fat cells)
   White adipose: most common form
   Brown adipose: found in small mammals and babies
    (most disappears in humans)
Types of Body Fat
               Subcutaneous:
               • just under skin
               •Not associated with as
               many health risks
               •Seen in pear shape
               •~50% body fat

               Visceral:
               •around internal organs
               •Most strongly related to
               health risks (type 2
               diabetes)
               •Seen in apple shape
Fat and our Health
   Stores energy: releases fatty acids when energy
    needed
   Helps stabilize levels of glucose and lipid
   Secretes protein factors that have various roles
Role of Fat in Health
   Fat tissue = endocrine
   Leptin: hormone, will talk about later
   Adiponectin: hormone, influence cells response to
    insulin
   Immune system: makes cytokines that can increase
    risk CVD – cause low level inflammation and
    promote insulin resistance of adipocytes
   Angiotensinogen: helps regulate blood pressure
   Secretes proteins that play a role in blood clotting
Role of Fat in Health
   Factors can lead to metabolic syndrome:
            resistance
     Insulin

     High blood sugar

     Excess abdominal fat

     High blood cholesterol

     High blood pressure

   Risk factor for heart disease and stroke
Visceral Fat and our Health
   Why is visceral fat more imp?
   Theory:
     Located  near portal vein
     Carries blood from intestines to liver

     Visceral fat releases substances including free
      fatty acids portal vein  liver  affects
      production of blood lipids
Liver

Stomach

SI

LI
Measures of Body Fat
   Underwater weighing:
     Converts   total body density into estimate of % body
      fat
     Considered by many to be best measurement

     Based on the different densities of adipose tissue and
      other body tissues in water
     Often used as standard reference for evaluating
      accuracy of other methods
Body Fat Measurements
   Skinfold: subcutaneous
   BIA: fat mass, fat free mass, total body bone free
    lean mass, level of visceral fat
     BIA:just estimations
     Uses equations to predict amounts of fat according to
      flow of current
   Imaging: can see visceral fat
     MRI (Magnetic Resonance Imaging)
     DXA (Dual X-Ray Absorptiometry)

     CT (computed tomography)
Subcutaneous

               visceral
Accuracy of Measurements

 Daniel, J.A., Sizer, P.S., & Latman, N.S. (2005).
  Evaluation of body composition methods for
  accuracy. Biomedical Instrumentation and
  Techology, 39(5), 397-405.
 121 participants

 Used underwater weighing as standard

 Compared UWW to other methods
Accuracy of Measurements
   Skinfold thickness:
     Used   four different equations for each participant
   Waist circumference:
     Used   3 different protocols
   BIA:
     used   2 different instruments
Accuracy of Measurements
   Results:
        tended to overestimate lower %BF
     All

     Underestimated higher %BF

   Conclusions:
     Skinfold and waist circumference: do not appear to be
      accurate on samples that show a wide variation of
      characteristics
     Whole body BIA: appeared to be most accurate

     Takes gender and age into consideration

     Small differences between genders
References
   Bosy-Westphal, A., et al. (2008). Accuracy of bioelectrical impedence
    consumer devices for measurement of body composition in comparison to
    whole body magnetic resonance imaging and dual x-ray absorptiometry.
    Obesity Facts, 1, 319-324.
   Daniel, J.A., Sizer, P.S., & Latman, N.S. (2005). Evaluation of body
    composition methods for accuracy. Biomedical Instrumentation and Techology,
    39(5), 397-405.
   Harvard Health Publications. (2006). Abdominal fat and what to do about
    it. Retrieved Oct 1, 2009, from
    http://www.health.harvard.edu/newsweek/Abdominal-fat-and-what-to-
    do-about-it.htm
   Trayhurn, P., & Beattie, J.H. (2001). Physiological role of adipose tissue:
    white adipose tissue as an endocrine and secretory organ. Proceedings of
    The Nutrition Society, 60(3), 329-339.
TLA
TLA
   Ellen is a 21 YO student who is 5’4 and weighs 120
    lbs. The majority of her days are spent studying and
    working a part-time job as a cashier. Twice a week
    she goes to the gym where she spends an hour doing
    cardio exercises and some weight training. After
    completing a three day food diary, it was determined
    that she ate an average of 45 grams of fat, 241
    grams CHO, and 32 grams protein a day.
TLA

 1. What is her average total daily caloric
  intake?
 Fat: 45 gm x 9 Cal/gm = 405 Cal

 CHO: 241 gm x 4 Cal/gm = 964 Cal

 Protein: 32 gm x 4 Cal/gm = 128 Cal

 Total = 1497 Cal/day
TLA
   2. What percentage of calories comes from fat,
    CHO, and proteins?
   Fat: 405/1497 x 100 = 27%
   CHO: 964/1497 x 100 = 64%
   Protein: 128/1497 x 100 = 8.55% = ~9%
TLA
   3. Do these percentages fall within the ADMRs?
   Fat: 25 – 35%, falls within but could be less
   CHO: 45 – 65%, falls within but could be less
   Protein: 10 – 35%, does not fall within
TLA
   4. Based on these results, how many grams of fat, CHO, and
    protein would she have to consume to meet the lowest percent
    ADMRs?
   Fat: in order for her to get 25%:
   0.25 = X/1497 = 374.25 Cal from fat, 374.25 Cal/9
    Cal/gm = 41.58 gm fat (reduce by ~ 3 gm/day)
   CHO: in order to get 45%
   0.45 = x/1497 = 673.65 Cal from CHO, 673.65/4 Cal/gm
    = 168.4 gm CHO (reduce by ~ 73 gm/day)
   Protein: in order to get 10%
   0.10 = x/1497 = 149.7 Cal from protein, 149.7 Cal/4
    Cal/gm = 37.4 gm protein (increase by ~ 5 gm/day)
TLA
   5. What is her BMI?
   BMI = wt (kg)/ht (m2)
   Wt: 120 lbs/2.2 lbs/kg = 54.5 kg
   Ht: 5’4 = 64” x 2.54 cm/inch = 162.56 cm/100
    cm/m = 1.62 m
   BMI = 54.5/(1.622) = 54.5/2.62 = 20.8
TLA
   5. Classify her weight, according to her BMI.
   Underweight: <18.5
   Normal weight: 18.5 – 24.9
   Overweight: 25.0 – 29.9
   Obese: ≥ 30
TLA
   6. What is her estimated energy expenditure per day?
   BMR estimate: 0.9 Cal/kg/hr
       Convert lbs to kg: 120 lbs/2.2 lbs/kg = 54.5 kgs
       BMR/hour: 0.9 Cal x 54.5 kg = 49.05 Cal/hr = ~ 49 Cal/hr
       BMR/day: 49 Cal/hr x 24 hr/day = 1176 Cal/day
   Physical activity estimate: light – moderate (50%)
       0.5 x 1176 = 588 Cal
   Thermic effect of food: 10%
       0.10 x 1176 = 117.6 Cal
   Total estimated energy expenditure = 1882 Cal
TLA
   8. Does she lose more calories a day than she is currently
    consuming, according to her expenditure in number 6? At the
    current rate, what can you predict that will happen with her
    weight on a monthly basis (assuming 4.3 weeks in a month)?
   Caloric intake: 1497 Cal/day
   Estimate Energy Expenditure: 1882 Cal/day
   Deficit of: 385 Cal/day
   Deficit per week: 2695 Cal
   Deficit per month: 2695 x 4.3 = 11588.5
TLA

 Weight change: 3500 Cal/lb
 11588.5 Cal/3500 Cal/lb = 3.31 lbs

 If her activity and intake does not change it

  can be expected that she would lose around 3
  lbs a month.
4.3. WEIGHT
BALANCE
HNU 200 Section 4: Healthy Body Weights
Gaining or Losing Weight

   Whether a person gains or loses weight depends
    on:
     Energy  intake vs. energy expenditure
     Genetic factors

     Childhood weight

     Behavioral factors

     Social factors




                                              11-57
Energy Balance

   Energy balance
     Occurs when energy intake = energy expenditure
     Energy intake = Cal from food

     Energy expenditure = BMR, activity, TEF




                                               11-58
Biological Factors
   Genetics
   Gender
     Female:   more body fat for reproduction
   Ethnicity
     May   have genetic predisposition
   Period of life:
     Prenatal,   adolescents, pregnancy, menopause
Genetic Factors

   Genetic factors account for about 25% of a
    person’s body fat
   Variation in body fat levels in populations:
    genetics may account for 40-70%1
   Different ideas have been suggested to explain
    the impact of genetics on body fat.
     ThriftyGene Theory
     Set-point Theory

     Leptin Theory

                                            11-60
Genetic Factors

   Thrifty Gene Theory
     Proposes   that a gene (or genes) causes people to be
      energetically thrifty
     Have the gene: use less energy than other people

     Consequence: gain weight when food is plentiful

     A “thrifty gene” has not been identified




                                                   11-61
Genetic Factors

   Set-Point Theory
     Proposes that each person’s weight stays within a
      small range (set point)
     Body compensates for changes in energy balance
     Consequence: keeps a person’s weight at their set
      point
     Explains why dieting may not work: energy
      conservation contributes to rebound weight gain



                                                  11-62
ob= oh boy!
Genetic Factors

   Leptin Theory
     Leptin (OB): hormone from adiopose cells, causes
      reduced food intake, reduced weight, decreased
      body fat
     Controlled by the ob gene (OB – protein made from
      ob gene)
     Mutation causes reduced levels of leptin 
      increased food intake, reduced energy output



                                                11-65
Environmental Factors
   More conducive to weight gain:
     Ease of access to food
     Decreased need for physical activity to get food,

     Technology

     Types of food we have access to

     Urban life

     Weather

     Socioeconomic factors
  Portion Sizes – McDonald’s

Item         Size       Amount
Soft Drink   Child      250 ml (1 cup)
             Small      345 ml
             Medium     495 ml (~2 cups)
             Large      730 ml (~ 3 cups)
Fries        Small      71 g
             Medium     113 g
             Large      177 g
Childhood Factors

   Environmental factors in childhood can influence:
     Food  choices
     Activity levels

     Later adult behaviors



   Childhood overweight increases the risk of heart
    disease and premature death as an adult.


                                               11-68
Personal/Behavioural Factors
   Income/employment (to some extent)
   Education
   Food choices
   Food consumption patterns: eating out more
   Health status
   Hunger vs. Appetite
     Hunger: innate, physiological drive to eat
     Appetite: psychological desire to eat, can cause people
      to overeat
Social Factors

   Social factors influencing our diet include:
     Family or cultural traditions
     Holidays and celebrations

     Easy access to high-fat foods

     Less physically active lifestyles

     Societal expectations of the “perfect” body




                                                    11-70
4.4. ACHIEVING A
HEALTHY WEIGHT
HNU 200 Section 4: Healthy Body Weights
Achieving a Healthy Weight

   Healthy body weight change requires:
     Gradual  change in energy intake
     Regular and appropriate physical exercise

     Application of behavior modification techniques




                                                 11-72
Weight Loss

   Effective weight loss should include:
     Followingrecommended serving sizes
     Reduced intake of high-fat and high-energy foods

     Weight loss should be about 1 to 2 pounds per week

     Regular physical exercise
       To increase energy expenditure
       To increase BMR




                                                11-73
Weight Loss

   Weight loss medications and herbal supplements:
     Some  are prescribed (Meridia, Xenical)
     Others OTC

     May have dangerous side effects

     Many have been removed from market

     When to take/prescribed: BMI > 30 or BMI > 27
      with other risk factors (high bp, heart disease,
      diabetes, high cholesterol)
     Expensive

                                                 11-74
Weight Loss Products
   Ephedra/Ephendrine
   Products often labelled with claims: weight loss,
    body-building, increased energy
   Some also contained caffeine and other stimulants
   Serious side effects
   2002 HC Recall:
    >   8 mg
     Those with stimulants

     Implied or unproven claims

     Still cases of illegal sale
Risks of Weight Loss Products
   Depends on:
     Ingredients

     Whether   it’s used alone or with other products for
      weight loss, prescription and non-prescription drugs,
      certain foods; and
     Age and health status of user
Unsafe Practices
   Ordering prescription drugs online that have not
    been prescribed for you
   Taking different products together
   Buying products online and/or from unreliable
    sources
   Off-label uses: if not prescribed by a doctor
   Don’t assume it is safe because it is natural
Weight Loss

   Treatments for obesity may include:
     Low-calorie  diet and regular exercise
     Prescription medications

     Surgery
       Gastroplasty
       Gastric bypass
       Gastric banding




                                               11-78
Weight Control Surgery




                         11-79
Weight Control Surgery




                         11-80
Weight Control Surgery

 Risks of Surgery
  Increased   infections, blood clots, adverse reactions
   just after surgery
  Chronic problems that could last a lifetime

  Staples or gastric bands may loosen

  Surgery is only recommended for those with Class II
   or III obesity who have not been able to lose weight
   with other treatments.



                                                 11-81
Weight Gain

   Effective weight gain should include:
     Eating 500 to 1,000 extra Cal/day
     Eating frequently throughout the day

     Maintaining a balanced diet, limiting fat intake to
      15-30% of total energy intake
     Avoiding tobacco products which depress appetite
      and increase BMR
     Regular exercise with resistance training




                                                   11-82
Case Study
References
   Health Canada. (2003). Dangers of Ephedra/Ephedrine products. Retrieved
    Oct 6, 2009, from http://www.hc-sc.gc.ca/ahc-asc/media/advisories-
    avis/_2003/2003_43-eng.php
   Medline Plus Medical Encyclopedia. (2009). Gastric bypass surgery.
    Retrieved Oct 6, 2009, from
    http://www.nlm.nih.gov/medlineplus/ency/article/007199.htm
   Medline Plus Medical Encyclopedia. (2009). Laparoscopic gastric banding.
    Retrieved Oct 6, 2009, from
    http://www.nlm.nih.gov/medlineplus/ency/article/007388.htm
   Medline Plus Medical Encyclopedia. (2009). Vertical banded gastroplasty.
    Retrieved Oct 6, 2009, from
    http://www.nlm.nih.gov/medlineplus/ency/imagepages/19498.htm
   National Heart, Blood, and Lung Institute. (ND). Aim for a healthy weight.
    Retrieved Oct 8, 2009, from
    http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/recom
    men.htm
4.5. WEIGHT
AND THE MEDIA
HNU 200 Section 4: Healthy Body Weights
Activity
   Think about your favourite shows or movies
   Now think about the main characters in these
   Would you estimate that they are
    under/normal/overweight, obese?
   What types of roles do they play?
   Are overweight or obese characters depicted as
    loving or hating their bodies? What message does
    this send?
Examples

  Show/Character   Weight   Role
Weight on the TV
   http://www.youtube.com/watch?v=v6VSjwSonXw
   http://www.ebaumsworld.com/video/watch/28466
    5/
Weight on TV
Positive TV?
   http://www.vidoemo.com/yvideo.php?i=Q0V0Ukd
    RcWuRpV09ibVk&supersize-vs-superskinny-fear-of-
    food-channel-4=
   http://www.youtube.com/watch?v=RizlP4Gtqs0&N
    R=1
Health Warning on Photos?
   Sept 21, 2009
   France parlimentarian Valerie Boyer and 50 other
    politicians
   Campaign against eating disorders
   Want photoshopped/altered pics to have warning:
    “Photograph retouched to modify the physical
    appearance of a person.“

   http://in.reuters.com/article/entertainmentNews/idI
    NIndia-42600920090921
A picture is worth a thousand???




http://www.hemmy.net/2007/05/25/celebrities-before-and-after-photoshop/
http://www.hemmy.net/2007/05/25/celebrities-before-and-after-photoshop/
http://www.hemmy.net/2007/05/25/celebrities-before-and-after-photoshop/
http://www.hemmy.net/2007/05/25/celebrities-before-and-after-photoshop/
http://www.hemmy.net/2007/05/25/celebrities-before-and-after-photoshop/
                      http://bloggingexperiments.wordpress.com/2008/11/26/thanksgiving-tidbits/
Happy Thanksgiving!




                                                                                            http://www.youtube.com/watch?v=13s9vzXMbks

				
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