Transcript Fundamentals of Nutrition

Section 3
Medical Nutrition Therapy
Copyright © 2003 Delmar Learning, a Thomson Learning company
Chapter 16
Diet and Weight Control
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Objectives
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Discuss the causes and dangers of
overweight
Discuss the causes and dangers of
underweight
Identify foods suitable for high-kcal
diets and those suitable for low-kcal
diets
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“Rule of Thumb”
Method for determining desired weight.
Males assume 106 pounds for the first 5
feet (60 inches) and add 6 pounds for each
inch over 60.
Females assume 100 pounds for the first 5
feet (60 inches) and add 5 pounds for each
inch over 60.
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“Rule of Thumb”
Large-boned individuals of both sexes
increase the first sum by 10%.
Small-boned individuals of both sexes
decrease the first sum by 10%.
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Definitions
Overweight:
Obesity:
Underweight:
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10 to 20% above average
20% above average
10 to 15% below average
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BMI
Body Mass Index
Medical standard used to define obesity.
Used to determine whether a person is at
health risk from excess weight.
Obtained by dividing weight in kilograms
by height in meters squared.
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BMI
Fewer health risks are associated with a
BMI range of 19 to 25 than with a BMI
above or below that range.
A BMI greater than 25 indicates obesity
and health risks.
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Fat Distribution
Fat in the abdominal cavity is associated
with a greater risk for hypertension,
diabetes, coronary heart disease, type 2
diabetes, and certain types of cancer than
fat in the thigh, buttocks, and hip area.
Pear-shaped body has a lower risk for
disease than does apple-shaped body.
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Overweight and Obesity
Overweight is a serious health hazard.
It increases susceptibility to diabetes
mellitus and hypertension.
No one cause for obesity.
Energy imbalance is a significant cause.
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Theories of Weight Loss
Fat cell theory: obesity develops when the
size of fat cells increase.
Set point theory: everyone has a set point
or natural weight at which the body is so
comfortable that it does not allow for
deviation.
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Healthy Weight
Not everyone can match the “healthy
weight target”, which is a BMI of 19 to 25.
A “healthy weight” may be the weight at
which one is eating nutritiously, is
exercising, has no health problems, and is
free from disease.
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Dietary Treatment for Obesity
Reduce one’s food intake
Weight-reduction (low-kcal) diet
Base on the Food Guide Pyramid
Use exchange lists to control kcal value
Counting fat grams is another method
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Dietary Treatment for Obesity
Reduction of 3,500 kcal results in weight
loss of one pound.
No more than 1 to 2 pounds lost in a week.
Do not reduce below 1,200 kcal per day.
Diet should consist of 15 to 20% protein,
45 to 55% carbohydrate, 30% or less fat.
Key is changing eating habits.
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Food Selection
Substitution foods:
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Fat-free milk for evaporated milk
Evaporated fat-free milk for evaporated
milk
Yogurt or low-fat sour cream for regular
sour cream
Lemon juice and herbs for heavy salad
dressings
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Food Selection
Substitution foods:
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Fat-free salad dressings for regular salad
dressings
Fruit for rich appetizers or desserts
Bouillon instead of cream soups
Water-packed canned foods rather than
those packed in oil or syrup
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Low-kcal Foods
Black coffee
Plain tea
Cantaloupe
Strawberries
Lettuce
Bean sprouts
Cabbage
Mushrooms
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Asparagus
Tomatoes
Zucchini
Cauliflower
Broccoli
Celery
Cucumbers
Spinach
Red/green peppers
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Cooking Methods
Broiling, grilling, baking, roasting,
poaching, boiling
Trim fat from meat before cooking
Skim fat from the tops of soups and meat
dishes
Avoid addition of extra butter or margarine
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Exercise
Excellent adjunct to any weight-loss
program
Lowers set point
Dancing, jogging, bicycling, skiing,
rowing, power walking
Such exercise helps tone muscles, burns
kcal, increases the BMR so food is burned
faster, and is fun for the participant.
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Stop and Share
Your client would like to use behavior
modification for weight loss.
What recommendations could you give
your client?
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Stop and Share
Weigh regularly, but not daily.
Don’t wait too long between meals.
Join a support group and go to meetings
during and after the weight loss.
Eat slowly.
Use a small plate.
Use low-kcal garnishes.
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Stop and Share
Eat whole, fresh foods and avoid
processed foods.
Treat yourself with something besides
food.
Anticipate problems (banquets and
holidays) and “undereat” slightly before
and after.
“Save” some kcal for snacks and treats.
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Stop and Share
If something goes wrong, don’t punish
yourself by eating.
If no weight loss for 1 week, realize it may
be from exercising (production of lean
muscle) or water retention.
If binging occurs, don’t punish yourself.
Go for a walk, movie, or museum. Call a
friend.
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Stop and Share
Adapt family meals to suit your needs.
Don’t make a production of your diet.
Avoid the heavy-kcal items.
Limit yourself to a spoonful of something
too rich for a weight-loss diet.
Substitute something you like that is low
in kcal.
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Stop and Share
Take small portions.
Eat vegetables and bread without butter or
margarine.
Include daily exercise. Park further from
work and walk.
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Crash Diet
Intended to cause a very rapid rate of
weight reduction.
Results in an initial rapid weight loss.
Weight loss caused by a loss of body water
and lean muscle mass rather than body fat.
Plateau period follows in which weight
does not decrease.
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Yo-Yo Effect
Disillusionment occurs and may lead to
“eating binge”.
This can result in regaining weight.
Causes dieter to try another weight-loss
diet, creating a yo-yo effect.
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Popular Reducing Diets
Severely limit the foods allowed,
providing a danger of nutrient deficiencies
over time.
May provide too much cholesterol and fat.
May contain an excess of protein which
puts too great a demand on the kidneys and
may be life threatening if sufficient
potassium is not provided for the heart.
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Surgical Treatment of Obesity
May be used when obesity becomes
morbid (damaging to health)
Two types
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Gastric bypass
Stomach banding
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Gastric Bypass
Most of the stomach is stapled off, creating
a pouch in the upper part.
The pouch is attached directly to the
jejunum.
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Stomach Banding
Stomach is also stapled but to a slightly
lesser degree than in gastric bypass.
Food moves to the duodenum, but the
outlet from the upper stomach is somewhat
restricted.
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Gastric Bypass and Stomach
Banding
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Surgery for Obesity
Common complications include diarrhea,
electrolyte and fluid imbalances, liver
problems, kidney stones, and bone disease.
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Pharmaceutical Treatment of
Obesity
Miracles are still in short supply.
Amphetamines (pep pills) depress appetite.
Effectiveness reduced within a short time.
Causes nervousness and insomnia.
Can become habit-forming.
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Over-the-Counter Diet Pills
Intended to reduce appetite, not thought to
be effective.
Contain caffeine, artificial sweeteners, and
phenylpropanolamine, which can damage
blood vessels and should be avoided.
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Diuretics and Laxatives
Do not cause a reduction of body fat, only
water.
An excess can result in fluid and
electrolyte imbalance.
Laxatives can become habit-forming.
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Sibutramine (Meridia)
Suppresses appetite.
Used in conjunction with a reduced calorie
diet.
Indicated for those with a BMI of at least
30.
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Orlistat (Xenical)
Blocks one-third of the fat in food from
being digested.
Reduced calorie diet with no more than
30% fat should be followed.
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Underweight
Treated by a high-kcal diet or high-kcal
diet combined with psychological
counseling.
It can be as difficult for an underweight
person to gain weight as it is for an
overweight person to lose it.
Diet should be based on the Food Guide
Pyramid.
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Underweight
3,500 kcal added to normal weekly intake
to gain 1 pound per week.
An extra 500 kcal taken in each day.
Easily digested food is recommended.
Avoid fried and bulky foods.
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Conclusion
The health care professional must support
and encourage the client regarding weight
control.
Excessive weight endangers health and
should be lost using a restricted-kcal diet
based on the Food Guide Pyramid.
Excess weight is caused by energy
imbalance.
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Conclusion
Underweight is also dangerous to health,
and psychological counseling as well as a
high-kcal diet may be required for proper
treatment.
Behavior modification must be an essential
component of any weight-loss or weightgain regimen.
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