Transcript Metabolism and Energy Balance

DNT 200
NUTRITION FOR HEALTH
SCIENCES
METABOLISM AND ENERGY BALANCE
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METABOLISM AND ENERGY BALANCE
Life is largely a matter of
chemistry
William J. Mayo, MD
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METABOLISM AND ENERGY BALANCE
DEFINITIONS
Metabolism -- the sum total of all the chemical
reactions that go on in living cells
Anabolism -- reactions in which small molecules are
put together to build larger ones; anabolic
reactions consume energy
Catabolism -- reactions in which large molecules are
broken down into smaller ones; catabolic reactions
usually release energy
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METABOLISM AND ENERGY BALANCE
EXAMPLES
Anabolism
– Making of glycogen
– Making of triglycerides
– Making of protein
Catabolism
– Breakdown of glycogen
– Breakdown of triglycerides
– Breakdown of protein
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METABOLISM AND ENERGY BALANCE
BREAKING DOWN NUTRIENTS
FOR ENERGY
• If the body needs energy, it may break
apart any or all of the basic units
(glucose, fatty acids, glycerol, and
amino acids) into smaller fragments
• Glucose
– Glucose to Pyruvate
• Glycolysis is the metabolic
breakdown of glucose to
pyruvate
• Pyruvate (pyruvic acid
[C3H4O3]) is a three carbon
compound that, in
metabolism, can be derived
from glucose, certain amino
acids, or glycerol
• Is a reversible process
• Is anaerobic (does not
require oxygen) but cannot be
sustained for long
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METABOLISM AND ENERGY BALANCE
BREAKING DOWN NUTRIENTS
FOR ENERGY
• Glucose
– Pyruvate to Acetyl CoA
• If the cell needs energy and
oxygen is available, pyruvate
can then be broken down into
a smaller compound called
acetyl CoA
• CoA is the coenzyme
derived from the B-vitamin
pantothenic acid -- is central
to the energy metabolism of
nutrients
• Acetyl CoA is a two carbon
compound (acetate or acetic
acid) to which a molecule of
CoA is attached
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METABOLISM AND ENERGY BALANCE
BREAKING DOWN NUTRIENTS
FOR ENERGY
• Glucose
– Pyruvate to Acetyl CoA (con’t)
• Is aerobic (requires oxygen)
• Is an irreversible step
– Can be used as a building
block for fatty acids
– If energy is not needed,
acetyl CoA will not enter
the TCA cycle, but will
be used to make fatty
acids instead -- this is
how carbohydrate eaten
in excess of the body’s
needs can lead to fat
deposition
– Cannot be used to remake
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glucose
METABOLISM AND ENERGY BALANCE
BREAKING DOWN NUTRIENTS FOR
ENERGY
• Glucose
– Pyruvate to Acetyl CoA (con’t)
• When less oxygen is available,
pyruvate is converted to lactic
acid
• Lactic acid accumulates in the
muscles causing a burning pain
and fatigue
• To relieve this pain, relax the
muscles frequently so the
circulating blood can carry the
lactic acid back to the liver to
be converted back to glucose
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METABOLISM AND ENERGY BALANCE
BREAKING DOWN NUTRIENTS
FOR ENERGY
• Glucose
– Acetyl CoA to Carbon
dioxide
• In a series of metabolic
reactions called the
tricarboxylic acid (TCA)
cycle, acetyl CoA splits,
carbon dioxide is released,
and its energy is
– Stored
– Does the body’s work
– Produces heat
• Is aerobic (requires
oxygen)
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METABOLISM AND ENERGY BALANCE
BREAKING DOWN NUTRIENTS FOR ENERGY
Glucose Summary
Glucose
Pyruvate
Acetyl CoA
Energy
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METABOLISM AND ENERGY BALANCE
BREAKING DOWN NUTRIENTS FOR ENERGY
Glucose Summary
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METABOLISM AND ENERGY BALANCE
BREAKING DOWN NUTRIENTS FOR ENERGY
– Glycerol
• Is broken down like glucose
– Is first broken down into pyruvate
– Is then broken down into acetyl CoA
• If the cell does not need energy, the acetyl CoA
molecules combine with each other to make body fat
GLYCEROL SUMMARY
Glycerol
Glucose
Pyruvate
Acetyl CoA
Energy
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METABOLISM AND ENERGY BALANCE
BREAKING DOWN NUTRIENTS FOR ENERGY
– Fatty Acids
• Converted directly into Acetyl CoA (no pyruvate
step)
• Cannot be used to make glucose
– Because no pyruvate step
– Fats cannot normally therefore provide energy for the
brain and nervous system that require glucose
FATTY ACID SUMMARY
Fatty Acids
Acetyl CoA
Energy
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METABOLISM AND ENERGY BALANCE
THE FATS TO ENERGY PATHWAY
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METABOLISM AND ENERGY BALANCE
BREAKING DOWN NUTRIENTS FOR ENERGY
– Amino Acids
• Will ideally be used to replace needed body proteins
and will not be used for energy
• If they are needed/used for energy, they are
– Stripped of their nitrogen (deamination) -- which is used
to make other compounds or excreted as urea through the
kidneys
– Most of the amino acids can then be converted to pyruvate
and therefore provide glucose (glucogeneic). Some are
both glucogenic and ketogenic. Leucine is ketogenic only.
– Other amino acids are
» Converted into Acetyl CoA (ketogenic) or
» Enter the TCA cycle at a later point
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METABOLISM AND ENERGY BALANCE
BREAKING DOWN NUTRIENTS FOR ENERGY
AMINO ACID SUMMARY
Glucogenic
Amino Acids
Ketogenic
Amino Acids
Glucose
Pyruvate
Acetyl CoA
Energy
Other amino acids enter the TCA chain directly
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METABOLISM AND ENERGY BALANCE
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METABOLISM AND ENERGY BALANCE
BREAKING DOWN NUTRIENTS FOR ENERGY
OVERALL SUMMARY
PROTEIN
EATEN
AMINO
ACIDS
STARCH OR
SUGARS EATEN
FAT
EATEN
GLUCOSE
GLYCEROL
BODY
PROTEIN
FATTY
ACIDS
GLYCOGEN
STORES
FAT
STORES
GLUCOSE
AMINO
ACIDS*
PYRUVATE
N
N
N
ACETYL
COA
TCA
CYCLE
WATER
CO2, ENERGY
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METABOLISM AND ENERGY BALANCE
•
•
•
•
ECONOMICS OF FEASTING
When you consume more energy
than you expend, much of the
excess is stored as body fat
Fat can be made from an excess
of any energy yielding nutrient
you eat.
Fat cells enlarge as they fill with
fat
Body’s fat-storing capacity
seems to be able to expand
indefinitely
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METABOLISM AND ENERGY BALANCE
ECONOMICS OF FEASTING
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METABOLISM AND ENERGY BALANCE
ECONOMICS OF FASTING
• Even when asleep and totally relaxed, the cells of
many organs are consuming energy -- represents
2/3 of the total energy expenditure per day
• Body’s top priority is to meet energy needs for this
ongoing activity
• When food is not available, body must find other
fuel sources in its own tissues
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METABOLISM AND ENERGY BALANCE
ECONOMICS OF FASTING (continued)
• Activities in starving/fasting
– Glucose from the liver’s stored glycogen and fatty
acids from the body’s stored fat supply energy to cells
– After several hours, glycogen stores are exhausted and
low blood glucose concentrations signal to further
promote fat breakdown
– Most of the body’s cells can use fatty acids as their
fuel
• Nervous system and brain cells need glucose -- cannot use
fatty acids
• Body protein tissues (liver and muscles) break down to
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supply 90% of the needed glucose
METABOLISM AND ENERGY BALANCE
ECONOMICS OF FASTING (continued)
• Activities in starving/fasting
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METABOLISM AND ENERGY BALANCE
ECONOMICS OF FASTING (continued)
• Activities in starving/fasting
– As the fast continues, brain finds a way to use fat as fuel
• Condenses acetyl CoA fragments (called ketone bodies)
derived from fatty acids
• Meets about half of the nervous system’s needs
• Many of the areas of the brain still rely exclusively on
glucose -- body protein continues to be sacrificed
– As the fast continues, metabolism slows
• Body reduces its energy output
• Conserves both fat and lean tissue
• Fat loss falls to a minimum
• Therefore, although weight loss during fasting may be
dramatic, fat loss may actually be less than when at least
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some food is supplied
METABOLISM AND ENERGY BALANCE
ECONOMICS OF FASTING (continued)
• Activities in starving/fasting
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METABOLISM AND ENERGY BALANCE
ECONOMICS OF FASTING (continued)
• Activities in starving/fasting
– Other body adaptations
• Wasting of lean tissues
• Impairment of disease resistance
• Lowering of body temperature
• Disturbances of the body’s salt and water
balance
• Minimal effect on
– Mental alertness
– Physical energy
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METABOLISM AND ENERGY BALANCE
•
•
•
•
THE LOW CARBOHYDRATE DIET
Presents the body with the same problems as a fast
Once available glucose stores are spent, the only
available significant glucose source is protein
Most low carbohydrate diets provide some protein
from food, some is still taken from body tissue
Initial weight loss is, at best, 1-2 pounds of fat and
5-6 pounds of lean tissue, water, and minerals -once off the diet, these are replaced and weight
reverts to a few pounds of the starting point
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METABOLISM AND ENERGY BALANCE
THE PROTEIN SPARING FAST
• Theory
– Eat only protein, which will spare lean tissue and
provide needed glucose
– Fat breakdown will be at a maximal rate to meet other
energy needs
• Has met with mixed results
• Has not been shown to be more effective than a
diet containing a mixture of protein and
carbohydrate
• Most people regain the lost weight
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METABOLISM AND ENERGY BALANCE
MODERATE WEIGHT LOSS
• There is a limit to the rate at which body fat will
break down -- the maximum rate, except in a very
large, very active person is 1-2 pounds per week
• The most effective diet supplies all three energy
nutrients in reasonable amounts
• Energy expenditure should include a reasonable
level of physical activity
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METABOLISM AND ENERGY BALANCE
ENERGY BALANCE
• If weight is within
acceptable range for
height, the person has
a balanced energy
budget
• A negative change in
fat stores results from
more “energy out”
than “energy in”
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METABOLISM AND ENERGY BALANCE
ENERGY BALANCE
• A pound of body fat stores approximately 3,500
kcalories
– To loose a pound, a person must spend 3,500
kcalories more than is taken in
– To gain a pound, a person must take in 3,500 kcalories
more than is spent
– On average, a deficit or excess of 500 kcalories per
day brings about weight loss or gain of 1 pound per
week
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METABOLISM AND ENERGY BALANCE
ENERGY IN: THE kCALORIES OF FOOD
Estimating Food Energy
• Amount of energy received from foods depends
on
– The food’s composition
– How much the person eats
• Methods of estimating food energy
– Direct measurement -- measuring the heat given off
– Indirect measurement -- measuring the amount of
oxygen consumed in burning
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METABOLISM AND ENERGY BALANCE
ENERGY IN: THE
kCALORIES OF
FOOD
Estimating Food
Energy
– Bomb Calorimeter
is an instrument
that measures the
heat energy
released when
foods are burned
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METABOLISM AND ENERGY BALANCE
ENERGY IN: THE kCALORIES OF FOOD
Estimating Food Energy
– Tables of food values -- reflect mathematically
corrected calorimetry measurements
– Calculate from amounts of carbohydrate,
protein, fat, and alcohol in the food
•
•
•
•
Carbohydrate has 4 kcalories per gram
Protein has 4 kcalories per gram
Fat has 9 kcalories per gram
Alcohol has 7 kcalories per gram
– Exchange system -- sorts foods of similar origin
and nutrient content into groups
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METABOLISM AND ENERGY BALANCE
ENERGY IN: THE kCALORIES FOODS PROVIDE
Determinants of Food Intake
• Hunger -- The physiological drive for food that
initiates food-seeking behavior. Influenced by:
–
–
–
–
–
–
–
–
–
–
–
–
Empty stomach
Gastric contractions
Absence of nutrients in the small intestine
GI hormones
Brain peptides
Thought, sight, smell, taste of food
Presence of others; special occasions
Perception of hunger; awareness of fullness
Favorite, ethnic, or religious foods
Time of day
Abundance of food or free food
Appetite
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METABOLISM AND ENERGY BALANCE
ENERGY IN: THE kCALORIES FOODS PROVIDE
Determinants of Food Intake
• Satiation -- The feeling of satisfaction and
fullness that occurs during a meal and halts
eating; satiation determines how much food is
consumed during a meal
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METABOLISM AND ENERGY BALANCE
ENERGY IN: THE kCALORIES FOODS PROVIDE
Determinants of Food Intake
• Satiation
– Food in the stomach triggers stretch receptors and the
person begins to feel too uncomfortable to continue to
eat
– Nutrients in the small intestine elicit hormones which
send messages to the hypothalamus to stop eating (e.g.
fat elicits cholecystokinin which slows gastric
emptying)
– The hypothalamus is a brain center that controls
activities such as appetite as well as the maintenance
of water balance and regulation of body temperature
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METABOLISM AND ENERGY BALANCE
ENERGY OUT: THE kCALORIES THE BODY SPENDS
Components of Energy Expenditure
• Basal Metabolism -- The energy needed to
maintain life when a body is at complete rest
after a 12 hour fast
– Examples
• Beating heart
• Maintenance of body temperature
• Lungs breathing
– About 65% of the total energy needs support basal
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metabolism
METABOLISM AND ENERGY BALANCE
ENERGY OUT: THE kCALORIES THE BODY SPENDS
Components of Energy Expenditure
– Influencing factors on the basal metabolic rate (BMR)
DECREASE EE
INCREASE EE
•Total Body
weight
•Large body
surface area
•Hot and
cold
ambient
temperature
•Fever
•Hypothyroidism
•Stress
•Caffeine
•Smoking
•Increased
LBM
•Rapid
growth
•Pregnancy
& lactation
•Aging
• Genes
• Some
meds
•Female gender
•Fasting/starvation
•Hypothyroidism
•Sleep
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METABOLISM AND ENERGY BALANCE
ENERGY OUT: THE kCALORIES THE BODY SPENDS
Components of Energy Expenditure
• Voluntary Activities -- Conscious and deliberate
muscular work; physical activity
– Examples
• Walking
• Lifting
• Climbing
– kCalorie expenditure depends on
• Larger muscle mass required
• Heavier the weight of the body part being moved
• Longer the activity takes
– The more intense the activity, the more kcalories
spent
– Streamlined moves will conserve energy (e.g.
swimming)
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METABOLISM AND ENERGY BALANCE
ENERGY OUT: THE kCALORIES THE BODY SPENDS
Components of Energy Expenditure
• Thermic Effect of Food
– Includes digestion, absorption, utilization of nutrients
– Peaks 1 hour after eating
– Effect disappears 4 hours after eating also known as
the specific dynamic effect of food
– Examples
• Muscles that move food through the intestinal tract speed
up their rhythmic contractions
• Cells that manufacture and secrete digestive juices begin
their tasks
– Represents 6-10% of the total energy taken in
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METABOLISM AND ENERGY BALANCE
ENERGY OUT: THE kCALORIES THE BODY SPENDS
Components of Energy Expenditure
• Adaptive Thermogenesis -- adjustments in energy
expenditure related to changes in environment
such as cold and to physiological events such
overfeeding, trauma, and changes in hormone
status
– Changed circumstances may cause the body to do
extra work
• Building tissue
• Producing enzymes and hormones
– Is quite variable and specific to individuals -- is not
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included when calculating the energy RDA
METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Component
•
•
•
•
•
Water
Fat
Protein
Minerals
Carbohydrate
Lean Man
%
62%
16%
16%
5-6%
<1%
Lean Woman
%
59%
22%
14%
4-5%
<1%
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
• Body Mass Index is an index of a person’s weight in
relation to height, determined by dividing the weight in
kilograms by the square of the height (in meters) -- doesn’t
consider body fat
– Can also be expressed as Weight (lbs.) * 705
Height (in)2
• 64% of Americans are overweight by BMI (CDC)
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
BMI
Underweight
OBESITY CLASS
<18.5
Normal
18.5 - 24.9
Overweight
25.0 - 29.9
Obesity
30.0 - 34.0
I
35.0 - 39.9
II
>40
III
Extreme Obesity
(Morbid Obesity)
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
• Body Weight/BMI says little about body fat
– A person who doesn’t seem to weigh too much may be
too fat
– A person who seems to weigh too much may not be too
fat
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
• Weight is still the measure that people most
commonly use as an index of body composition
• Obesity is a major problem in developed countries
• Health hazards associated with obesity include
–
–
–
–
–
–
–
Abdominal hernias
Arthritis (especially in knees, hips, and lower spine)
Complications after surgery
High blood cholesterol
Hypertension
Respiratory problems
Varicose veins
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Obesity Trends* Among U.S. Adults
BRFSS, 1985
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
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Obesity Trends* Among U.S. Adults
BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
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Obesity Trends* Among U.S. Adults
BRFSS, 1995
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
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Obesity Trends* Among U.S. Adults
BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
≥20
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Obesity Trends* Among U.S. Adults
BRFSS, 2002
(*BMI(*BMI
≥30,
oror~
30lbs
lbs
overweight
5’ 4” woman)
30,
~ 30
overweight
for 5’4” for
person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
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Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends Among U.S. Adults
MEN’S FITNESS MAGAZINE, 2005
Source, Non-scientific study : Men’s Fitness Magazine, 2005
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
• Location of fat on the body may be as critical (or
even more critical) than the total amount
– Fat around the abdomen may represent a greater risk
to health than fat elsewhere around the body
– Abdominal fat (even in the absence of obesity) is
associated with
• Heart disease
• Diabetes
• Hypertension
– Fat around the hips and thighs (most common in
females) seems relatively harmless
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS
TOO MUCH?
Causes Of Weight Gain
• Most Common:
– Energy input > energy
output
– Too many calories and/or
not enough aerobic
exercise
• Less Common Causes:
– Medical Disposition
• Hypothyroidism
– Genetics
– Medications
• Prescribed steroids
• Some hormonals
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Fat Cell Development
– The amount of fat on a person’s body reflects both
the number and size of the fat cells
– When fat cells reach their maximum size they may
also divide
– A gain or loss in weight can take place through an
increase or decrease in either the size or number of fat
cells
– People with the greatest number of fat cells
(hyperplastic obesity) are least likely to loose weight
successfully
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Fat Cell Development
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Genetics
– Tendency toward obesity is inherited but the
environment is influential in the sense that it can
prevent or permit the development of obesity when
the potential is there
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Learned Behavior
• Habits learned in childhood tend to persist
throughout life
– Overeating at mealtimes
– Rapid eating
– Excessive snacking
– Eating to meet needs other than hunger
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Set Point Theory
– The body sends out signals to establish, regulate, and
maintain a set body weight
– Not only do these signals maintain a constant body
weight, they defend that body weight when it is
challenged
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO
MUCH?
Environmental Factors
– People overeat because they are
pushed to do so by factors in their
surroundings -- foremost among
them, the availability of a multitude
of delectable foods
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS
TOO MUCH?
Deep Emotional Needs
– Primitive fear of
starvation
– Infants association of
food with motherly love
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Treatments For Obesity
• Drugs
– Diuretics
• Temporary water retention may add
several pounds to a person’s weight
• Water does not cause obesity
• Obesity does not cause water retention
• When people take diuretics they loose
water, not fat
• Weight loss is temporary and may result
in dehydration and mineral imbalances
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Treatments For Obesity
• Drugs (con’t)
– Amphetamines
• Speeds up metabolism
• No longer approved by the FDA for
weight loss
• Are highly addictive
• Side effects include dizziness, irritability,
blurred vision, nausea, vomiting, and
diarrhea
• Have not been proven effective in
treating obesity
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Treatments For Obesity
• Drugs (con’t)
– Other Drugs
• Mechanisms include appetite suppression and
reduced nutrient digestion and absorption
• Significant side effects include
– Increased blood pressure
– Intestinal gas, cramping, and diarrhea
– Tremors
– Cardiac events
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Treatments For Obesity
• Drugs (con’t)
– Prescription Drugs
• Safe and effective prescription drug therapy has
proven elusive
• Sibutramine (Meridia®)
– Inhibits serotonin reuptake (may produce enhanced
satiety) and inhibits norepinephrine reuptake (raises
metabolic rate)
– Doesn’t work that well
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Treatments For Obesity
• Drugs (con’t)
– Prescription Drugs
• Orlistat (Xenical ®)
– A gastrointestinal lipase inhibitor
– Decreases the absorption of fat
– May reduce absorption of fat soluble vitamins and beta
carotene
– Still need to follow a low Calorie diet
• Venlafaxine (Effexor ®)
– A combined serotonin and norepinephrine reuptake
inhibitor
– Decreases weight in 43% of patients
– Side effects include dry mouth, sexual dysfunction, 67
insomnia, nausea
METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Treatments For Obesity
• Drugs (con’t)
– Over-The-Counter Drugs
• Phenylpropanolamine
– Suppresses appetite
– Enhances weight loss when used in conjunction with a
low kcalorie diet
– Side effects include dry mouth, rapid pulse,
nervousness, sleeplessness, hypertension, irregular
heartbeats, kidney failure, seizures, and strokes
• Benzocaine
– Comes in a candy or gum form
– Anesthetizes the tongue reducing taste sensations
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Treatments For Obesity
• Drugs (con’t)
– Herbal Products
• St. John’s Wort
– Contains substances that enhance seratonin (a
neurotransmitter important in appetite control)
and thus suppresses appetite
• Ephedrine
– Often St John’s Wort is prepared in combination
with the herbal stimulant ephedrine
– Some ephedrine-containing supplements have
been implicated in heart attacks and seizures
and have been linked to a number of deaths69
METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Treatments For Obesity
• Drugs (con’t)
– Herbal Products
• Herbal Laxatives
– Commonly sold as “dieter’s tea”
– Commonly cause nausea, vomiting, diarrhea,
cramping, and fainting
– Laxatives act on the lower large intestine -nutrient absorption occurs primarily in the upper
small intestine; therefore kcalories are not “saved”
– Other ‘treatments’
• Hot baths -- may dehydrate individuals
resulting in lost water weight
• Brushes, Sponges, Wraps, Creams, Massages 70
- are ineffective
METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Treatments For Obesity
• Very Low kCalorie Diets (VLCD)
– Provide 800 kcalories, at least 1 gram high quality
protein per kilogram of body weight, little or no fat, and
a minimum of 50 grams carbohydrate
– Vitamin and mineral supplements given
– Meals consist of a limited number of foods each day
and/or a powdered formula available by prescription
– Body reacts as to prepare for starvation
– VLCD’s appropriate for short-term use only and under
medical supervision
– Many side effects to include a decline in cardiac output,
irregular heartbeats, formation of gallstones and kidney
stones, nausea, vomiting, diarrhea, abdominal
discomfort, diminished immune response, headaches,
and sleeplessness
– Weight loss can be dramatic but weight regains are
almost certain
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO
MUCH?
Treatments For Obesity
• Surgery
– Gastric Partitioning
• Limit food intake by reducing
the size of the stomach
• Size of outlet is also reduced,
delaying the passage of food
from the stomach into the
intestine
• Complications include vitamin
and mineral deficiencies as well
as psychological problems
• Lifelong medical supervision
necessary
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Treatments For Obesity
Gastric Surgery is on the Rise
160,000
140,000
150,000
120,000
100,000
80,000
60,000
40,000
2002
103,000
2003
2004*
63,000
20,000
0
# Surgeries (*2004 projected)
JADA 9/04
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
• Surgery
Treatments For Obesity
– Liposuction
• Does not treat obesity but removes the evidence
• Has little effect on body weight but can alter the
body shape slightly in specific areas
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METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Treatments For Obesity
• Eating Plans
– Should be realistic
– Emphasize nutrient-dense foods that
you like
– Make tasty vegetables and fruits central
– Encourage complex carbohydrate-rich
foods high in bulk
– Use fats cautiously
– Drink plenty of water
– Anticipate a plateau
– Learn, practice and eat right for the rest
75
of your life
METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Treatments For Obesity
• Exercise
– Helps to speed weight loss
– To loose fat, exercise intensely and
expend as much energy as your
time allows
– Activity speeds up the basal
metabolism
• Remains elevated as long as the
person keeps exercising regularly
• Over long term, daily vigorous
activity gradually changes body
composition toward more lean tissue
– Metabolic rate rises accordingly
– Supports continued weight loss or
maintenance
76
METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Treatments For Obesity
• Exercise (con’t)
– Activity helps to control appetite
• Immediately after an intense
workout, most people do not feel
like eating
– Body has released fuels from storage
to support exercise
– Glucose and fatty acids are abundant
in the blood
– Digestive functions are suppressed
77
METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO
MUCH?
Treatments For Obesity
• Exercise (con’t)
– Activity helps to reduce stress
• Stress can cue eating
• Fit person looks and feels healthy,
increasing self esteem
– Types of activities
• Sustained physical activity of
moderate intensity (aerobic
activities) are more effective in
weight control than short bursts of
vigorous exercise
• Do what you enjoy doing and do it
often
78
METABOLISM AND ENERGY BALANCE
79
METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Treatments For Obesity
• Exercise (con’t)
– Spot reducing
• Muscles do not “own” the fat around them
• Fat cells all over the body release fat in response to
the demand of physical activity for use by whatever
muscles are active
• No exercise can remove the fat from any one
particular area
• Strength training can help to improve the tone of
muscles in a “trouble” area
80
METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Treatments For Obesity
• Behavior and Attitude
– Become aware of behaviors
• Keep a record of eating and exercise
behaviors
• Establish a baseline against which to
measure future progress
– Change behaviors
• Eliminate inappropriate eating cues
– Buy foods that are low in fat
– Shop when you are not hungry
81
METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Treatments For Obesity
– Change behaviors (con’t)
• Suppress the cues you cannot eliminate
– Eat only in one place (at a table) and in one
room
– Make small portions of food look large by
spreading food out and serving on small plates
• Strengthen cues to appropriate eating and
exercise
– Keep your appropriate foods in the front of the
refrigerator
– Learn appropriate portion sizes and prepare one
portion at a time
82
METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Treatments For Obesity
– Change behaviors (con’t)
• Engage in desired eating or exercise
behaviors
– Eat only at planned times; plan not to eat after a
specified time
– Slow down (pause several times during a meal,
put down utensils between mouthfuls, chew
thoroughly before swallowing, swallow before
reloading the fork, always use utensils)
• Arrange or emphasize negative
consequences of inappropriate eating
– Eat your meals with other people
– Ask that others respond neutrally when you
deviate from your plan (make no comment).
This is a negative consequence because it
withholds attention
83
METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Treatments For Obesity
– Change behaviors (con’t)
• Arrange or emphasize positive consequences
of appropriate behaviors
– Update records of food intake, exercise, and
weight change regularly
– Arrange for rewards for each unit of behavior
change or weight loss
84
METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Treatments For Obesity
• Behavior and Attitude
– Personal Attitude
• Those who fully understand their personal relationships
with food are best prepared to make healthful changes in
eating and exercise behavior
– Support Groups
• Is important when making life changes
• Some find groups such as Take Off Pounds Sensibly,
Weight Watchers, and Overeaters Anonymous helpful in
85
providing support in efforts to loose weight
METABOLISM AND ENERGY BALANCE
86
METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Treatments For Obesity
• National Weight Control Registry
– A research study developed by Rena Wing and
James Hill in 1993
– Identified nearly 3,000 individuals who have lost
significant amounts of weight and kept it off for
long periods of time
87
METABOLISM AND ENERGY BALANCE
WEIGHT: HOW MUCH IS TOO MUCH?
Treatments For Obesity
• National Weight Control Registry
– Characteristics of successful weight losers
•
•
•
•
•
•
•
•
•
Rarely ate at fast food restaurants
Used a variety of weight loss efforts
Consumed a low fat diet
Ate all foods but limited the quantity
On average, ate five times per day (smaller but more
frequent meals
80% ate breakfast
Exercised
Weighed themselves regularly
Have an improved quality of life
88
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
Diet Planning Using Exchange Lists
• Food Groups sort foods by protein, vitamin, and
mineral content
• Exchange Lists sort foods by energy,
carbohydrate, protein, fat, and portion size
• Exchange Lists are diet planning tools that
organize foods by their proportions of
carbohydrate, protein, and fat.
– Foods on any single list can be used interchangeably
– Were originally developed for diabetic diets but were so
useful they are now in general use for diet planning
89
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
Diet Planning Using Exchange Lists
LIST
Carbohydrate Group
Starch
Fruit
Milk
Skim
Low-fat
Whole
Other Carbohydrates
Vegetables
Meat & Sub Group
Meats, Very Lean
Meats, Lean
Meats, Med Fat
Meats, High
Fats
PORTION
SIZE
CHO, g PRO, g FAT, g
ENERGY,
Kcal
varies
varies
15
15
3
---
1 or less
---
80
60
1 cup
1 cup
1 cup
varies
1/2 cup
12
12
12
15
5
8
8
8
varies
2
0-3
5
8
varies
---
90
90
150
varies
25
1 oz
1 oz
1 oz
1 oz
1 tsp
-----------
7
7
7
7
---
0-1
3
5
8
5
35
55
75
100
45
90
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
Diet Planning Using Exchange Lists
Carbohydrate Group
Starch List (Examples)
• Bread, 1 slice
• Animal Crackers, 8 ea
• Ready-to-eat Cereal, 3/4 cup
• Graham Crackers, 3 ea
• Cooked Pasta, 1/2 cup
• Popcorn (no fat added), 3 cups
• Cooked Rice, 1/3 cup
• Lima Beans, 2/3 cup
• Cooked Beans, 1/2 cup
• Hot Dog or Hamburger Bun, 1 ea
• Corn, 1/2 cup
• Sugar Frosted Cereal, 1/2 cup
• Potato, 1 small (3 oz)
• Saltine Crackers, 6 ea
• French Fried Potatoes, 16-25 ea
(omit one fat)
• Waffle, 4-1/2” Square, 1 ea (omit
one fat)
91
• Pancake, 4”, (omit one fat)
• Bagel or English Muffin, 1/2
• Tortilla, 1
• Cooked Cereal, 1/2 cup
• Peas, Green, 1/2 cup
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
Diet Planning Using Exchange Lists
Carbohydrate Group
Fruit List (Examples)
• Apple, 1 small
• Applesauce, Unsweetened, 1/2 cup
• Banana, 1small (4 oz)
• Peach, 1 small
• Orange, 1 small
• Pear, 1 small
• Grapefruit, 1/2 ea
• Orange Juice, 1/2 cup
• Grapefruit Juice, 1/2 cup
•
•
•
•
•
•
•
•
•
•
• Grapes, 15 small (3/4 cup)
• Cantaloupe, 1/3 (3/4 cup)
•
Canned Pineapple, 1/2 cup
Apple Juice, 1/2 cup
Grape Juice, 1/3 cup
Prune Juice, 1/3 cup
Raisins, 2 Tablespoons
Dried Prunes, 3 ea
Unsweetened Fruit Cocktail, 1/2
cup
Fresh Cherries, 12 ea (3 oz)
Unsweetened Canned Pears 1/2 cup
Unsweetened Canned Peaches, 1/2
cup
Strawberries, 1-1/4 cup whole 92
berries
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
Diet Planning Using Exchange Lists
Carbohydrate Group
Milk List (Examples)
Non-Fat
Low Fat
• Non-Fat Milk, 1 cup
• 2% Milk, 1 cup
• Plain Non-Fat Yogurt, 1 cup
• Plain Low Fat Yogurt, 1 cup
• Non Fat or Low Fat Buttermilk,
1 cup
• Evaporated Non Fat Milk, 1/2
cup
• Non-Fat Dry Milk, 1/3 cup
Whole
• Whole Milk, 1 cup
• Evaporated Whole Milk, 1 cup
• Whole Yogurt, Plain, 1 cup
93
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
Diet Planning Using Exchange Lists
Carbohydrate Group
•
•
•
•
•
•
Other Carbohydrates (Examples)
Angel Food Cake, 1/12 (2
• Fruit Pie (2 crusts), 1/6 pie (3
carbohydrates)
carbohydrates and 2 fats)
Frosted Cake, 2” Square (2
• Potato Chips, 12-18 (1 oz) (1
carbohydrate and 2 fats)
carbohydrates and 1 fat)
• Canned Spaghetti or Pasta Sauce,
Glazed Donut, 3-3/4” across (2
1/2 cup (1 carbohydrate and 1 fat)
carbohydrate and 2 fat)
• Sweet Roll or Danish , 2-1/2 oz, 2Regular Gelatin, 1/2 cup (1
1/2 carbohydrates and 2 fats)
carbohydrate)
• Pancake Syrup, 1 Tbsp (1
Ice Cream, 1/2 cup (1
carbohydrate)
carbohydrate and 2 fats)
• Low Fat Frozen Yogurt, 1/3 cup (1
Regular Jam or Jelly, 1 Tbsp (1
carbohydrate and 1 fat)
carbohydrate)
• Vanilla Wafers, 5 ea (1
94
carbohydrate and 1 fat)
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
Diet Planning Using Exchange Lists
Carbohydrate Group
Vegetable List (Examples)
• Cooked Carrots, 1/2 cup
• Raw Tomatoes, 1 cup
• Cooked Greens, 1/2 cup
• Raw Peppers, 1 cup
• Cooked Brussels Sprouts, 1/2 cup
• Raw Carrots, 1 cup
• Cooked Beets, 1/2 cup
• Raw Onions, 1 cup
• Cooked Asparagus, 1/2 cup
• Raw Celery, 1 cup
• Cooked Broccoli, 1/2 cup
• Raw Cucumber, 1 cup
• Cooked Zucchini, 1/2 cup
• Salad Greens, 1 cup
• Cooked Mixed Vegetables (no
corn, peas, or pasta), 1/2 cup
• Canned Tomatoes, 1/2 cup
• Cooked Cabbage, 1/2 cup
• Tomato Juice, 1/2 cup
• Sauerkraut, 1/2 cup
• Tomato Sauce, 1/2 cup
95
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
Diet Planning Using Exchange Lists
Meat and Meat Substitute Group
Meats, Very Lean (Examples)
Game
Poultry
or Pheasant (no skin), Venison,
• Chicken or Turkey (white meat, no • Duck
Buffalo, Ostrich, 1 oz
skin), 1 oz
Cheese (with 1 gram or less fat per
• Cornish Hen (no skin), 1 oz
ounce)
• Non-Fat or Low Fat Cottage cheese,
Fish
1/4 cup
• Fat-Free Cheese, 1 oz
• Fresh or Frozen Cod, Flounder,
Haddock, Halibut, Trout; Tuna,
Other
fresh or canned in water, 1 oz
• Processed Sandwich Meats (with 1
gram or less fat per ounce), 1 oz
Shellfish
• Egg Whites, 2 ea
• Hot Dogs (with 1 gram or less fat per
• Clams, Crab, Lobster, Scallops,
96
ounce) 1 oz
Shrimp, Imitation Shellfish, 1 oz
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
Diet Planning Using Exchange Lists
Meat and Meat Substitute Group
Meats, Lean (Examples)
Beef
• USDA Select or Choice Grades
of Lean Beef Trimmed of Fat
Such As Round, Sirloin, and
Flank Steak; Tenderloin; Roast
(Rib, Chuck, Rump); Steak (TBone-Porterhouse, Cubed)
Ground Round, 1 oz
Pork
• Lean Pork Such As Fresh Ham;
Canned, Cured, or Boiled Ham;
Canadian Bacon; Tenderloin,
Center Loin Chop, 1 oz
Lamb
• Roast, Chop, Leg, 1 oz
Veal
• Lean, Chop, Roast, 1 oz
Poultry
• Chicken, Turkey (Dark Meat, No
Skin) Chicken (White Meat With
Skin)
Fish
• Herring, 1 oz
• Salmon (Fresh or Canned),
Catfish, 1 oz
• Tuna (canned in oil, drained) 1 oz
Cheese
• Cheeses with 3 grams or less fat
97
per ounce, 1 oz
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
Diet Planning Using Exchange Lists
Meat and Meat Substitute Group
Meats, Medium Fat (Examples)
Beef
• Ground Beef, Meat Loaf,
Corned Beef, Short Ribs, Prime
Grades of Meat Trimmed Of
Fat (Such As Prime Rib), 1 oz
Pork
• Top Loin, Chop, Boston Butt,
Cutlet, 1 oz
Lamb
• Rib Roast, Ground, 1 oz
Poultry
• Chicken (Dark Meat, With Skin)
Ground Turkey or Ground Chicken
Fried Chicken (With Skin), 1 oz
Fish
• Any Fried Fish Product, 1 oz
Cheese
• Cheeses with 5 grams Or Less Fat
Per Ounce, 1 oz
Other
Veal
• Cutlet (Ground or Cubed,
Unbreaded), 1 oz
• Egg, 1
• Sausage (With 5 Grams or Less98Fat
Per Ounce), 1 oz
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
Diet Planning Using Exchange Lists
Meat and Meat Substitute Group
Meats, High Fat (Examples)
•
Pork
• Spareribs, Ground Pork, Pork
Sausage, 1 oz
•
Cheese
• All Regular Cheeses Such As
American, Cheddar, Monterey
Jack, Swiss, 1 oz
•
•
Other
Process Sandwich Meats With 8
Grams Or Less Fat Per Ounce (Such
As Bologna, Pimento Loaf, Salami),
1 oz
Sausage (Such As Bratwurst,
Knockwurst, Polish), 1 oz
Hot Dog (Turkey Or Chicken), 1
(10/lb.)
Bacon, 3 slices
Peanut Butter
• Peanut Butter, 2 Tbsp
99
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
Diet Planning Using Exchange Lists
Fats (Examples)
•
•
•
•
•
•
•
•
•
•
•
Monounsaturated Fats
Avocado, medium, 1/8 (1 oz)
Oil (Canola, Olive, Peanut), 1 tsp
Black Olives, 8 large
Green Stuffed Olives, 10 large
Almonds, Cashews, 6 ea
Peanuts, 10 ea
Polyunsaturated
Margarine (Stick, Tub, Squeeze), 1
tsp
Regular Mayonnaise, 1 tsp
Reduced Fat Mayonnaise, 1 Tbsp
Regular Salad Dressing, 1 Tbsp
Reduced Fat Salad Dressing, 2 Tbsp
•
•
•
•
•
•
•
•
•
Saturated Fats
Bacon, Cooked, 1 slice
Stick Butter, 1 tsp
Butter, Whipped, 2 tsp
Chitterlings, Boiled, 1 Tbsp
Regular Cream Cheese, 1 Tbsp
Reduced Fat Cream Cheese, 2
Tbsp
Shortening or Lard, 1 tsp
Regular Sour Cream, 2 Tbsp
Reduced Fat Sour cream, 3
100
Tbsp
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
How To Plan A Diet Using Exchange Lists
• Estimate Desirable Body Weight
– Males -- Allow 106 pounds for the first 5 feet; then add
6 pounds for every inch over 5 feet
– Females -- Allow 100 pounds for the first 5 feet; then
add 5 pounds for every inch over 5 feet
– Add 10% for large frame individuals; subtract 10% for
small frame individuals
– For children, refer to growth charts in textbook
appendix
101
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
How To Plan A Diet Using Exchange Lists (con’t)
• Determine whether individual needs a weight
loss or weight maintenance diet
• Calculate energy needs in kilocalories
– Simplified method
• Multiply the desirable body weight by 15 for men and
active women
• Multiply the desirable body weight by 13 for most women,
sedentary men, and adults over 55
• Multiply the desirable body weight by 10 for sedentary
women, obese people, and sedentary adults over 55 102
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
How To Plan A Diet Using Exchange Lists (con’t)
– Children
• Need about 100 kilocalories daily for the first year of life
plus 100 kilocalories per year up to 2000 kilocalories by
age 11
• For children 12-15, add 100 kilocalories per year for girls
and 200 kilocalories per year for boys
– Harris-Benedict Equation -- Can also be used to
determine energy requirements
• Males -- 66+(6.165*pounds)+(12.82*inches)-(6.8*age)
• Females -- 655+(4.32*pounds)+(4.359*inches)-(4.7*age)
103
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
How To Plan A Diet Using Exchange Lists (con’t)
• Add factors
– Activity
» + 20% for sedentary
» + 35% for moderate
» + 50% for active
– Stress
» + 10-15% for uncomplicated elective surgery
» + 20-40% for complicated surgery/fractures
» + 50-100% for major burns
– Fever
» + 13% for each degree Celsius over normal
104
body temperature
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
How To Plan A Diet Using Exchange Lists (con’t)
– Growth (if necessary)
» + 5% for moderate weight loss
» + 10-15% for moderate to severe weight loss
– For Overweight -- For people who are greater
than 125% of their IBW
» Adjusted body weight = (Actual body weight
- Ideal body weight)*125
105
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
How To Plan A Diet Using Exchange Lists (con’t)
Case Study
• Subject: Female, moderately active, 50 years old,
65 inches tall, 150 pounds
• Step 1 -- Calculate BEE
– Harris-Benedict Equation
• = 655 + (4.32*pounds) + (4.359*inches) - (4.7*age)
• = 655 + 648 + 283 - 235
• = 1351
– Add 35% for moderate activity
• = 1351 * 1.35
• = 1824 (Round to 1800)
106
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
How To Plan A Diet Using Exchange Lists (con’t)
Case Study
• Step 2 -- Determine Grams of CHO, Fat, and Protein
– 55-60% of kcalories come from CHO
• 1800*55% = 900 kcalories
• 900 kcalories/4 = 247.5 grams
– 25-30% of kcalories come from Fat
• 1800*25% = 450 kcalories
• 450 kcalories/9 = 50 grams
– 12-20% of kcalories come from Protein
• 1800*20% = 360 kcalories
• 360 kcalories/4 = 90 grams
107
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
How To Plan A Diet Using Exchange Lists (con’t)
Case Study
• Step 2 -- Translate The Diet Prescription Into A Meal
Plan
– Become familiar with the client’s usual pattern of meals,
likes, and dislikes
– Include basic foods to ensure adequate levels of minerals
and vitamins
•
•
•
•
•
2-3 exchanges of milk
3-5 exchanges of vegetables
2-4 exchanges of fruit
6-11 exchanges of starch
*****
4-6 exchanges of meat
108
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
How To Plan A Diet Using Exchange Lists (con’t)
Case Study
• Step 2a -- Translate The Diet
Prescription Into A Meal Plan
LIST # EXCH CHO, g PRO, g FAT, g
Milk, Skim
2
24
16
-Vegetables
3
15
6
-Fruit
4
60
--Subtotal
99
Bread
Subtotal
Meat, Lean
Subtotal
Fat
TOTAL
– List the carbohydrate, protein,
and fat values for the milk,
vegetables, and fruit
– Subtotal the carbohydrate
– Subtract this subtotal from the
carbohydrate level prescribed,
in this case 247.5 grams - 99
grams
– The resultant answer is 148.5
grams
****
109
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
How To Plan A Diet Using Exchange Lists (con’t)
Case Study
• Step 2b -- Translate The Diet
Prescription Into A Meal Plan
LIST # EXCH CHO, g PRO, g FAT, g
Milk, Skim
2
24
16
-Vegetables
3
15
6
-Fruit
4
60
--Subtotal
99
Bread
10
150
30
-Subtotal
52
Meat, Lean
Subtotal
Fat
TOTAL
249
– We know each exchange of
bread contains 15 grams of
carbohydrate
– The balance of 148.5 grams of
carbohydrate allows for 10
bread exchanges (148.5/15)
– Since there is no carbohydrate in
Meat or Fat, the total amount of
carbohydrate is 249 grams
– Subtotal the protein
***
110
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
How To Plan A Diet Using Exchange Lists (con’t)
Case Study
• Step 2c -- Translate The Diet
Prescription Into A Meal Plan
– Subtract this subtotal from the
protein level prescribed, in this
case 90 grams - 52 grams
– The resultant answer is 38
grams
– We know each exchange of
meat contains 7 grams of protein
– The balance of 38 grams of
protein allows for 5 meat
exchanges (38/7)
– Since there is no protein in Fat,
the total amount of protein is 87
grams
– Subtotal the fat
LIST # EXCH CHO, g PRO, g FAT, g
Milk, Skim
2
24
16
-Vegetables
3
15
6
-Fruit
4
60
--Subtotal
99
Bread
10
150
30
-Subtotal
52
Meat, Lean 5
-35
15
Subtotal
Fat
TOTAL
249
87
**
111
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
How To Plan A Diet Using Exchange Lists (con’t)
Case Study
• Step 2d -- Translate The Diet
Prescription Into A Meal Plan
LIST # EXCH CHO, g PRO, g FAT, g
Milk, Skim
2
24
16
-Vegetables
3
15
6
-Fruit
4
60
--Subtotal
99
Bread
10
150
30
-Subtotal
52
Meat, Lean 5
-35
15
Subtotal
15
Fat
7
--35
TOTAL
249
87
50
– Subtract this subtotal from the
fat level prescribed, in this case
50 grams - 15 grams
– The resultant answer is 35
grams
– We know each exchange of fat
contains 5 grams of fat
– The balance of 35 grams of fat
allows for 7 fat exchanges
(35/5)
*
112
METABOLISM AND ENERGY BALANCE
WEIGHT CONTROL
How To Plan A Diet Using Exchange Lists (con’t)
Case Study
• The resultant pattern of
exchanges compares
favorably with the
prescription of 247.5
grams of carbohydrate, 90
grams of protein, and 50
grams of fat yielding 1794
kcalories
LIST # EXCH CHO, g PRO, g FAT, g
Milk, Skim
2
24
16
-Vegetables
3
15
6
-Fruit
4
60
--Subtotal
99
Bread
10
150
30
-Subtotal
52
Meat, Lean 5
-35
15
Subtotal
15
Fat
7
--35
TOTAL
249
87
50
113