Classification of Us Population
Life insurance tables (IBW, DBW). The NCHS defines overweight at or above 85th percentile for the 20 to 30 age groups.
Ideal Body Weight
Women=100(for first 5 ft)+5(additional inches) +/- 10%. Men=106(5ft)+6(additional inch)+/-10%
=BMR+ thermic effect of food + activity. The ability to increase the number of fat cells is unlimited, but can't get rid of them. REE is higher in persons having higher amounts of LBM(lean body mass)
basal metabolic rate. What you need to live without anything else
Set point theory
theory that the human body is content at a certain wt. Wt loss or gain beyond a certain point is difficult.
excess of adipose tissue or body fat. Defined as the portion of body wt composed of adipose tissue that exceeds a range that is considered healthy. Men >25% Women>33%
Measurements of Obesity
Skin fold(calipers are used. Usually not a good gage unless the person is consistent. Very subjecticve. Large margin of error. Underwater weighing-expensive but works well. Bioelectrical impedence-passage of electrical currents through the body that measure how much fat vs muscle you have. It tends to flow slower through fat than muscle. Not effect unless the whole body is done. Air displacement. Dexa(dual energy xray absorptimetry). All these require time and experience.
Body Mass Index (BMI)
Kg/m^2 Example-(lbs/2.2)/(inches*.0254)^2 It is inaccurate for people who have lots of muscle. Good for people who are sedentary and not active. Releationship reasonable correlation bw wt and ht.
Morbidity and Mortality
risk raises once the person has reached a BMI of 29 or higher
Under<18.5 Normal(18.5-24.9) Overweight (25-29.9) Obese class 1(30-34.9) Obese Class 2 (35-39.9) Extreme Obese >40
usually in males, apple or android shap. Correalated with higher risk of CVD
Lower Body Obesity
usually in females. Pear or gynoid shap. Fat mainly on trunk not central. Less incidence of CVD
Adverse consequences of Obesity
Premature death, CVD, Systolic pressure rises by 6.5 pts for every 10% wt increase, elevated blood lipids, increased insulin resistance(insulin can't get in bc of the fat in the way), HDL lowers, LDL highers, Diabetes, Hyperinsulinimia and insulin resistance(fat blocks it) HTN, Respiratory problems(central fat) Gall bladder disease, Arthritis, gout, cancer
Etiology of Obesity
Medical Disorders, treatments, Genetics, Obesigenic Environment, Low energy expenditure
Low Calorie Diet
Most recommended for Overweight. 500-1000 less calories. No less than 1200 calories. 30% total Fat(8-10%Sat, 15%mono, 10%poly) <300 mg Cholesterol, 55% CHO, 15% Pro, 2300 mg Na+, 1000-1500 mg/day Ca+, 20-30 g fiber
Modified Ketogenic Diet
less cho/pro. 1gFat=1/4 g cho/pro. Ketosis is possible. Body uses fat as an alternate fuel sources. Ketones loweres the pH in the body can cause organ failure. CHO 40-45%, Pro 30-35%, Fat 20-25%. The real diet should be watched by doctor.
Protein supplement modified fasts (VLCD)
very low cal diet. 400-800 cal of shakes. Outpatient, your choice
causes loss of lean body mass
surgery less invasive. Doesn't remove anything. band is placed on the fundus
Gastric by-pass surgery
remova of part f the stomach. Digestion issues. Jejunum takes duodenum work. Vit and min malabsorption happens. 10% mortality rate, it has decreased over time. Long term: dumping syndrome, vomiting, diarrhea
2 vitamin/min per day. Eliminate sweets, alcohol, caf, carbohydrated drinks. Drink water. Regular exercise
Must take multivitamin, no eating and drinking at the same time, no straws or gum, increased water consumption.
PS Phase 1
Day 1, clear liquid diet, 2T at a time every 15-20 minutes. No sugar. Examples-water, decaf tea, splenda, flat soda
PS Phase 2
Day 2 to Week 2, full liquid diet. Add 2 childrens multivitamin, atleast 30 g protein. Examples-clear liquid, skim milk, cream of wheat, sugar free, instant breakfast, light creamy yogurt. 2 T every 15-20 minutes. If lactose intolerant use lactase
PS Phase 3
weeks 3 to 6, pure diet, adding Ca+ supplement, 60 g proten, 2 vitamins. Example-scrambled egg, baby food, pured veg/fruit, fish/tuna smashed, smashed potatoes, hummus
PS long term
5-6 meals/day ½-3/4 cup of food per sitting. Avoid sugary and high fat foods. Add b12 supplement, 48-60 oz of water, 10-20 g fat, 80-100 g CHO.
wt loss, improvements in glucose tolerance, HTN, sleep apnea, joint problems