Transcript Chapter 16 - Delmar

Chapter 16
Diet and Weight Control
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Objectives
• Discuss causes and dangers of overweight
• Discuss causes and dangers of underweight
• Identify foods suitable for high-calorie diets
and low-calorie diets
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Rule of Thumb Method
• Method for determining desired weight:
– Males
• Assume 106 pounds for first 5 feet (60 inches)
• Add 6 pounds for each inch over 60
– Females
• Assume 100 pounds for first 5 feet (60 inches)
• Add 5 pounds for each inch over 60
(continues)
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Rule of Thumb Method
• Large-boned individuals of both sexes
– Increase first sum by 10 percent
• Small-boned individuals of both sexes
– Decrease first sum by 10 percent
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Rule of Thumb Method
• Overweight
– 10 to 20 percent above average
• Obesity
– 20 percent above average
• Underweight
– 10 to 15 percent below average
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
BMI
• Medical standard used to define obesity
• Determines whether person at health risk from
excess weight
• Obtained by dividing weight in kilograms by
height in meters squared
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
BMI
• Range of 19 to 25:
– Normal weight
– Few health risks
• Greater than 25
– Overweight
– Health risks
• Above 30
– Obesity
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Fat Distribution
• Fat in abdominal cavity associated with greater
health risks than fat in thigh, buttocks, and hip
area
• Person with pear-shaped body has lower risk
for disease than someone with apple-shaped
body
(continues)
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Fat Distribution
• Waist-to-hip ratio
– Health indicator
• Caliper
– Measures body fat
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Overweight and Obesity
• Overweight
– Serious health hazard
• Increases susceptibility to diabetes mellitus,
hypertension, and other health problems
• Significant cause:
– Energy imbalance
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Theories of Weight Loss
• Fat cell theory
– Obesity develops when size of fat cells increases
• Set-point theory
– Everyone has set point or natural weight at which body is
so comfortable it does not allow for deviation
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Healthy Weight
• Not everyone can match healthy weight target
– BMI of 19 to 25
• May mean weight at which individual:
– Eats nutritiously
– Exercises
– Is free of health problems and disease
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Dietary Treatment for Obesity
• Reduce portion size
• Reduce caloric intake
– Counting fat grams may help
• Base diet on MyPyramid
• Use exchange lists to control calorie value
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Dietary Treatment for Obesity
• Lose no more than 1 to 2 pounds per week
• Eat no less than 1,200 calories per day
• Diet should consist of 10 to 35 percent protein,
45 to 65 percent carbohydrate, and 20 to 35
percent or less fat
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Dietary Treatment for Obesity
• Key:
– Changing eating habits
– Exercising for 90 minutes most days of week
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Food Selection
• Substitution foods:
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Fat-free salad dressings for regular salad dressings
Fruit for rich appetizers or desserts
Bouillon for cream soups
Water-packed canned foods for those packed in oil or syrup
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Cooking Methods
• Broiling, grilling, baking, roasting, poaching,
and boiling
• Trim fat from meat before cooking
• Skim fat from tops of soups and meat dishes
• Avoid addition of extra butter or margarine
– Replace with fat-free seasonings
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Exercise
• Excellent adjunct to any weight-loss program
• Lowers set point
• Aerobic exercise helps:
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Tone muscles
Burn calories
Increase BMR
Lower set point
(continues)
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Exercise
• To prevent chronic diseases:
– 30 minutes most days
• To prevent weight gain:
– 60 to 90 minutes most days
• To maintain weight loss:
– More than 90 minutes most days
• Children should be active for 60 minutes daily
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Behavior Modification for Weight
Loss
• Change eating habits
• Develop new and healthy eating plan and
exercise program
• Learn difference between hunger and appetite
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Stop and Share
• Consider the following scenario:
– Your client would like to use behavior modification for
weight loss. What recommendations could you give?
(continues)
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Stop and Share
• Weigh regularly
– But not daily
• Avoid waiting too long between meals
• Join support group
– Go to meetings during and after weight loss
• Eat slowly
• Use small plate
(continues)
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Stop and Share
• Use low-calorie garnishes
• Eat whole, fresh foods
– Avoid processed foods
• Treat yourself with something other than food
• Anticipate problems and under-eat slightly
before and after
– E.g., banquets, holidays
(continues)
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Stop and Share
• Save some calories for snacks and treats
• If something goes wrong, avoid punishing
yourself by eating
• If weight not lost for one week, may be from
exercising (production of lean muscle) or
water retention
(continues)
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Stop and Share
• If bingeing occurs, avoid punishing yourself
– Go for a walk, attend a movie or museum, or call a friend
• Adapt family meals to suit your needs
• Avoid making a production of your diet
• Avoid heavy-calorie items
(continues)
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Stop and Share
• Limit yourself to spoonful of something too
rich for weight-loss diet
• Substitute something you like low in calories
• Take small portions
(continues)
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Stop and Share
• Eat vegetables and bread without butter or
margarine
• Include daily exercise
– Park farther from work and walk
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Crash Diet
• Intended to cause very rapid rate of weight
reduction
• Results in initial rapid weight loss
(continues)
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Crash Diet
• Weight loss caused by loss of body water and
lean muscle mass
– Rather than body fat
• Plateau period follows
– Weight does not decrease
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Fad Diets
• Many are crash diets
– Usually rapid weight loss followed by plateau period
• Disillusionment occurs
– May lead to binge
• Can result in regaining weight
• Causes dieter to try another weight-loss diet
– Creating yo-yo effect
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Surgical Treatment of Obesity
• May be used when obesity becomes morbid
– Damaging to health
• Requires psychological evaluation and
counseling
• Two types:
1. Gastric bypass
2. Stomach banding
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Gastric Bypass
• Most of stomach stapled off
– Creating pouch in upper part
• Pouch attached directly to jejunum
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Stomach Banding
• Stomach stapled, but to slightly less degree
than gastric bypass
• Food moves to duodenum
– But outlet from upper stomach somewhat restricted
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Surgical Treatment of Obesity
• Complications:
– Bleeding, infections, gastritis, gallstones, and vitamin and
mineral deficiencies
– Dumping syndrome
• Nausea, vomiting, diarrhea, bloating, and dizziness
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Pharmaceutical Treatment of Obesity
• Amphetamines depress appetite
– Pep pills
• Effectiveness reduced within short time
• Causes nervousness and insomnia
• Can become habit-forming
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Over-the-Counter Diet Pills
• Intended to reduce appetite
– Not considered effective
• Contain caffeine, artificial sweeteners, and
phenylpropanolamine
• Can damage blood vessels
• Should be avoided
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Diuretics and Laxatives
• Do not cause reduction of body fat
– Only water
• Excess can result in fluid and electrolyte
imbalance
• Laxatives can become habit-forming
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Sibutramine (Meridia)
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FDA-approved for weight loss
Suppresses appetite
Used in conjunction with reduced calorie diet
Indicated for those with BMI of at least 30
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Orlistat (Xenical)
• FDA-approved for weight loss
• Blocks one-third of fat in food from being
digested
• Follow reduced-calorie diet with no more than
30 percent fat
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Underweight
• Possible causes:
– Poor nutrition, psychological or physical conditions, or
genetics
• Treated with high-calorie diet
– Combined with counseling if cause psychological
• Can be as difficult for underweight person to
gain weight as overweight person to lose it
(continues)
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Underweight
• Base diet on MyPyramid
• 3,500 calories added to normal weekly intake
leads to gain of 1 pound per week
• Must introduce extra calories progressively
• Recommend easily digested food
• Avoid fried and bulky foods
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Conclusion
• Health care professional must support and
encourage client regarding weight control
• Excessive weight endangers health and should
be lost using restricted-calorie diet based on
MyPyramid
• Excess weight caused by energy imbalance
(continues)
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Conclusion
• Underweight also dangerous to health
– Psychological counseling and high-calorie diet may be
required
• Behavior modification
– Essential component of any weight-loss or weight-gain
regimen
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