Member - Academy Of Nutrition & Dietetics. USA.
Weight Loss / Gain Nutrition
‘Size zero’ is what every girl desires and six-pack abs is the dream of every boy in this present world. But weight management nutrition always focuses on ideal body weight with a physically active body. Body weight is the sum of bone, muscle, organs, body fluids and adipose tissue. Few or all of these components undergo change due to growth, reproductive status and aging. Neural, hormonal and chemical mechanisms help to maintain balance between energy expenditure and energy intake. Imbalance in these hormones results in inflated weight fluctuations. Obesity and overweight are the most common problems with underweight being treated as a secondary problem to another disease state like eating disorder or psychological problem.
Body Weight Components
Body weight is estimated using a two-component model: fat-mass and fat-free mass (FFM). FFM and lean body mass (LBM) though used interchangeably are not exactly the same. LBM is the part of the body free of adipose tissue and includes the skeletal muscle, water, bone and a small amount of essential fat in the internal organs. It is higher in men than women and increases with exercise. Body fat is categorized into essential fat and storage fat. About 3% of body fat is considered to be essential in men while in women the percentage is a bit higher, around 12%.
Regulation of Body Weight
Regulatory systems such as neurochemicals, body-fat stores, protein mass, hormones and postingestion factors play key roles in regulating intake and weight. This regulation may be on a short-term or long-term basis.
Short-term regulation mainly focuses on hunger, appetite and satiety. Long-term regulation happens when weight loss or weight gain occurs. This involves a feedback mechanism where a signal from the adipose tissue is sent when normal body composition is disturbed.
Fat storage in normal adults seems to be balanced preserving a specific body weight. A conscious effort to starve or overfeed is followed by a rapid return to the original body weight proving the result of some studies which state that body weight can be displaced only temporarily. Energy expenditure includes two components namely resting energy expenditure (REE or RMR) and thermic effect of food (TEF). Meal size, meal composition, nature of the previous meal, insulin resistance, physical activity and aging are influencing factors of TEF.
Weight Imbalance: Obesity and Overweight
Obesity and overweight are different from each other. Obesity refers to the excess amount of body fat while overweight means excess amount of body weight which might be due to muscles, bone, fat and water. Either of these scenarios comes into existence when calories consumed do not equal the calories expelled which is the present state of many adults as proved by national data. Junk food, electronic gadgets, changing labour markets and increased portion sizes prove to be underlying factors for increased obesity prevalence among individuals.
Prevalence
Almost 5% of the Indian population is obese with 30 million individuals being affected. United States tops the list among developed countries with almost 66% of adults being overweight and 32% being obese. Worldwide, in 2014, more than 1.9 billion adults were overweight out of which 600 million were obese. Both men and women are equally affected by this disease.
Weight Management throughout the Life Span
A perfect balance between energy intake and energy expenditure is what it takes to manage your weight throughout life. The key guideline here is to avoid gradual weight gain over time through small steps such as decrease in food and beverage calories and increased physical activity.
Assessment
Body mass index (BMI) is the most common and recognized method to assess obesity and overweight. Waist-to-hip (WHR) is seldom used. Weight circumference over 40 inches in men and over 35 inches in women signifies increased risk equal to a BMI of 25 to 34.9.
BMI of adults aged 20 and above is given in the table below:
Classification
BMI (kg/m2)
Underweight
<18.5
Normal
18.5-24.9
Overweight
25-29.9
Obese
≥30
Extremely Obese
≥40
Etiology
Genetic, environmental, psychological and hormonal factors influence obesity. But heredity and environmental factors have an effect on the input and output of energy.
Heredity
Genes determine the amount of fat stored and the place of fat stored. Also the quantity of food converted into energy and the calories lost during physical activity depend on your gene to some extent.
Factors Affecting Weight Gain
Dietary changes and lack of activity in the present world contribute hugely towards obesity. People tend to eat large-sized portions filled with calories but lacking the essential nutrients. Not working out after consuming such calorie-filled foods obviously leads to weight gain. Also medical conditions and medications increase your chance of gaining weight. Family members tend to eat similar meals and hence what you cook is really important for a nutritious diet and stands as a contributing factor towards gaining weight.
Health Risks
Obesity is directly linked to chronic diseases such as heart disease, type 2 diabetes, hypertension, stroke, gallbladder disease and osteoarthritis. These diseases tend to worsen with increasing obesity levels.
Fat Distribution
Fat deposition can be excess subcutaneous truncal-abdominal fat or excess gluteofemoral fat. The first type is common in men and is termed as android or ‘apple’ shaped obesity. The second type is common in women and termed as ‘pear shape’ obesity. A comination of the two types is also feasible and found commonly in women.
Management of Obesity in Adults
Weight management has acquired importance in recent times. Initially even the clinicians focused only on weight loss assuming that weight maintenance would follow automatically. But the practicality has been proved clearly that weight loss without considering weight maintenance is unfair, inappropriate and possibly harmful. Treatment has also become diverse with lifestyle modifications and therapies involving physicians, dietitians and exercise specialists.
Goals of Treatment
Target must be shifted from weight loss alone to weight management during treatment. Obese individuals who lose even 5% to 10% of initial body weight tend to reduce their risk of associated diseases. Obese people often have unrealistic goals for weight loss and the involvement of a healthcare professional is crucial to set practical targets.
Rate and Extent of Weight Loss
Weight loss includes protein and fat loss. Any steady loss that happens over a period of time reduces fat stores, limits loss of vital protein tissues and evades decline in RMR that happens along with weight reduction. Worldwide reputed dietary organizations recommend a loss of about 0.2 to 0.4 kg per week for people with a BMI of 27 to 35, and 0.4 to 0.9 kg per week for people with BMIs greater than 35. When this continues for about 6 months it leads to around 10% loss in body weight. After 6 months focus should shift from weight loss to weight maintenance. Once this happens you can again concentrate on losing more weight.
Lifestyle Modifications
Any weight-loss program should be a combination of dietary changes, physical activity, nutrition education and psychological support.
Restricted-Energy Diets
Reduction in weight is definite when restricted-energy diets are prescribed. The restriction can be between 500 to 1000 kcal daily. The energy levels differ for each person and can range anywhere from 1200 to 1800 kcal daily. Carbohydrates must constitute around 50% to 55% of total kilocalories in the form of fruits, vegetables and whole grains. Proteins make up 15% to 25% of kilocalories with fats not exceeding 30% of total calories consumed. Dividing ideal calorie intake level by 4 for a 25% fat intake gives you the desired fat intake levels. Vitamin and mineral supplements are usually advised for women who consume less than 1200 kcal/day and for men whose daily calorie consumption is less than 1800 kcal. Though a tricky process to balance both caloric requirements and nutritional needs, once practiced it becomes straightforward and simple to follow.
Formula Diets and Meal Replacement Programs
Formula diets or meal replacements are commercially prepared, ready-to-use and portion-controlled foods or drinks. These can be found in supermarkets and weight-loss centers. The main purpose of these foods is to replace high-calorie foods and provide nutritional benefits. These types of replacements can be a substitute for one or two meals or snacks daily and is a successful and relied upon weight loss and maintenance strategy.
Commercial Programs
Commercial weight-loss and self-help programs have become popular among people today and many of them include pre-packaged diets, behaviour modification, self-introspection and nutrition. Internet programs are gaining momentum recently where contact happens every week with behavioural therapy and individualised feedbacks.
Extreme Energy Restriction and Fasting
Extreme energy restriction diets provide less than 800 kcal/day and starvation or fasting diets provide fewer than 200 kcal/day. These are seldom suggested as they lead to hypotension problems, gout, gallstones and eating disorders such as anorexia nervosa.
Very Low-Calorie Diets
Very low-calorie diets (VLCDs) include vitamins, minerals, electrolytes and essential fatty acids with zero calories. They provide between 200 to 800 kcal and are suggested only for people with a BMI above 30 for whom all other diet programs have been futile. Though VLCDs provide rapid weight loss they are often discouraged due to their potential side effects. They can lead to gout (increased serum uric acid levels), dry skin, nervousness, constipation or diarrhea and menstrual irregularities. Though VLCDs give you short term benefits from weight loss there is not much difference in weight reduction in the long run. Physical activity and dietary intake should be monitored for at least 3 years after weight loss from VLDCs to prevent weight regain.
Popular Diets and Practices
Press and media provide the best platform for many weight loss programs to be advertised and popularised. Though some of them may be practical and sensible providing positive results few others stress on rapid weight loss without straining oneself. Many of these diets lead to nutritional deficiencies and health hazards but are rarely known as these programs are abandoned after a few weeks of practise. Diets offered in these programs fall into one of these four categories: high-fat, low-carbohydrate; moderate-fat, balanced-nutrient reduction; low-fat and very-low-fat diets.
Exercise
Physical activity plays a pivotal role in weight loss and weight management. Engaging yourself in any form of exercise or physical activity for 60 to 90 minutes daily is mandatory for weight loss. Obese or overweight individuals unable to manage these levels can start off with 30 minutes of moderate intensity exercise and gradually increase their level of momentum and time period. Aerobic exercises, especially cycling, are great options for weight-reduction programs and improve cardiovascular health. Spot reduction is not possible with exercise as fat gets automatically burned where there is maximum concentration of adipose tissue. Regardless of duration, type of activity and weight it is recommended to maintain cardiovascular health at maximum levels for total benefit.
Surgical Procedures
Only when the above mentioned treatment options are not favourable healthcare professionals take help of surgical procedures to remove the excess fat in persons having a BMI of 40 or greater. Bariatric surgery, gastric bypass, gastroplasty and liposuction are popular surgical options available. These come along with a heavy price tag in the form of side effects and life-long aftercare treatment.
Maintenance of Reduced Body Weight
Most of the reduced-obese persons do not appear for follow-up or regular check up after treatment. Energy requirements tend to be 25% lower for weight maintenance after weight loss. It is indispensable for reduced-obese individuals to reduce energy intake and engage themselves in high levels of physical activity to maintain weight loss. When this is done for a period of 2 to 5 years weight loss maintenance becomes less strenuous and chance of long-term success is possible. Diets that are boring, monotonous and repetitious are useful for weight maintenance as people eat just for hunger and not desire when hungry.
Common Problems Encountered in Obesity Management
After some weight loss the weight remains constant for a period of time and then halts completely known as the plateau effect. Increase in activity level is essential at this juncture to move out of this phase.
Weight Management in Children
About 17% of children and adolescents in the age group of 2 to 17 years are obese. A child who is obese after 6 years of age tends to grow up into an obese adult. A different BMI table is available for children and when BMI is greater than the 85th percentile such children are 6 times more likely to become overweight adults. Childhood obesity is linked with abnormalities in blood pressure, lipid, lipoprotein and insulin levels in adulthood.
Treatment should not be energy-restricted diets but should be weight maintenance or gradual decline in weight gain. In children who have already surpassed their optimal adult weight a moderate weight loss of around 4 to 5 kg per year can be followed until optimal adult weight is reached. Sedentary lifestyle like watching television or playing computer games is the root cause for childhood obesity. The entire family should participate in changing their eating habits and involve themselves in outdoor activities for encouraging weight reduction in obese children.
Weight Imbalance: Excessive Leanness or Unintentional Weight Loss
The term underweight is applicable for people who are 15% to 20% or more below acceptable weight standards. A low BMI (less than 18.5) is associated with increased mortality risk and may lead to underfunction of the thyroid, pituitary, gonads and adrenaline.
Underweight or unintentional weight loss may be due to:
Dietary programs must be carefully strategized for weight gain. A cushion of 500 to 1000 kcal daily should be allowed. This calorie increment should happen gradually to avoid gastric discomfort, electrolyte imbalance and heart dysfunction. About 30% of kilocalories consumed must be from fat, especially monounsaturated and polyunsaturated fats, and 12% to 15% of kilocalories should come from proteins. The underweight individual must be encouraged to eat frequently, even if not hungry. Snacks should also be introduced between meals with liquid supplements.
Underweight, often a symptom of some disease, is shadowed by the importance of obesity and overweight problems. Underweight individuals often catch cold or other infections as their immune system is not functioning to the expected levels. Also loss of weight can lead to fertility problems in women. Hence it is 100% necessary that you take excessive leanness or unintentional weight loss as a serious problem and seek medical help immediately.
‘Size zero’ is what every girl desires and six-pack abs is the dream of every boy in this present world. But weight management nutrition always focuses on ideal body weight with a physically active body. Body weight is the sum of bone, muscle, organs, body fluids and adipose tissue. Few or all of these components undergo change due to growth, reproductive status and aging. Neural, hormonal and chemical mechanisms help to maintain balance between energy expenditure and energy intake. Imbalance in these hormones results in inflated weight fluctuations. Obesity and overweight are the most common problems with underweight being treated as a secondary problem to another disease state like eating disorder or psychological problem.
Body Weight Components
Body weight is estimated using a two-component model: fat-mass and fat-free mass (FFM). FFM and lean body mass (LBM) though used interchangeably are not exactly the same. LBM is the part of the body free of adipose tissue and includes the skeletal muscle, water, bone and a small amount of essential fat in the internal organs. It is higher in men than women and increases with exercise. Body fat is categorized into essential fat and storage fat. About 3% of body fat is considered to be essential in men while in women the percentage is a bit higher, around 12%.
Regulation of Body Weight
Regulatory systems such as neurochemicals, body-fat stores, protein mass, hormones and postingestion factors play key roles in regulating intake and weight. This regulation may be on a short-term or long-term basis.
Short-term regulation mainly focuses on hunger, appetite and satiety. Long-term regulation happens when weight loss or weight gain occurs. This involves a feedback mechanism where a signal from the adipose tissue is sent when normal body composition is disturbed.
Fat storage in normal adults seems to be balanced preserving a specific body weight. A conscious effort to starve or overfeed is followed by a rapid return to the original body weight proving the result of some studies which state that body weight can be displaced only temporarily. Energy expenditure includes two components namely resting energy expenditure (REE or RMR) and thermic effect of food (TEF). Meal size, meal composition, nature of the previous meal, insulin resistance, physical activity and aging are influencing factors of TEF.
Weight Imbalance: Obesity and Overweight
Obesity and overweight are different from each other. Obesity refers to the excess amount of body fat while overweight means excess amount of body weight which might be due to muscles, bone, fat and water. Either of these scenarios comes into existence when calories consumed do not equal the calories expelled which is the present state of many adults as proved by national data. Junk food, electronic gadgets, changing labour markets and increased portion sizes prove to be underlying factors for increased obesity prevalence among individuals.
Prevalence
Almost 5% of the Indian population is obese with 30 million individuals being affected. United States tops the list among developed countries with almost 66% of adults being overweight and 32% being obese. Worldwide, in 2014, more than 1.9 billion adults were overweight out of which 600 million were obese. Both men and women are equally affected by this disease.
Weight Management throughout the Life Span
A perfect balance between energy intake and energy expenditure is what it takes to manage your weight throughout life. The key guideline here is to avoid gradual weight gain over time through small steps such as decrease in food and beverage calories and increased physical activity.
Assessment
Body mass index (BMI) is the most common and recognized method to assess obesity and overweight. Waist-to-hip (WHR) is seldom used. Weight circumference over 40 inches in men and over 35 inches in women signifies increased risk equal to a BMI of 25 to 34.9.
BMI of adults aged 20 and above is given in the table below:
Classification
BMI (kg/m2)
Underweight
<18.5
Normal
18.5-24.9
Overweight
25-29.9
Obese
≥30
Extremely Obese
≥40
Etiology
Genetic, environmental, psychological and hormonal factors influence obesity. But heredity and environmental factors have an effect on the input and output of energy.
Heredity
Genes determine the amount of fat stored and the place of fat stored. Also the quantity of food converted into energy and the calories lost during physical activity depend on your gene to some extent.
Factors Affecting Weight Gain
Dietary changes and lack of activity in the present world contribute hugely towards obesity. People tend to eat large-sized portions filled with calories but lacking the essential nutrients. Not working out after consuming such calorie-filled foods obviously leads to weight gain. Also medical conditions and medications increase your chance of gaining weight. Family members tend to eat similar meals and hence what you cook is really important for a nutritious diet and stands as a contributing factor towards gaining weight.
Health Risks
Obesity is directly linked to chronic diseases such as heart disease, type 2 diabetes, hypertension, stroke, gallbladder disease and osteoarthritis. These diseases tend to worsen with increasing obesity levels.
Fat Distribution
Fat deposition can be excess subcutaneous truncal-abdominal fat or excess gluteofemoral fat. The first type is common in men and is termed as android or ‘apple’ shaped obesity. The second type is common in women and termed as ‘pear shape’ obesity. A comination of the two types is also feasible and found commonly in women.
Management of Obesity in Adults
Weight management has acquired importance in recent times. Initially even the clinicians focused only on weight loss assuming that weight maintenance would follow automatically. But the practicality has been proved clearly that weight loss without considering weight maintenance is unfair, inappropriate and possibly harmful. Treatment has also become diverse with lifestyle modifications and therapies involving physicians, dietitians and exercise specialists.
Goals of Treatment
Target must be shifted from weight loss alone to weight management during treatment. Obese individuals who lose even 5% to 10% of initial body weight tend to reduce their risk of associated diseases. Obese people often have unrealistic goals for weight loss and the involvement of a healthcare professional is crucial to set practical targets.
Rate and Extent of Weight Loss
Weight loss includes protein and fat loss. Any steady loss that happens over a period of time reduces fat stores, limits loss of vital protein tissues and evades decline in RMR that happens along with weight reduction. Worldwide reputed dietary organizations recommend a loss of about 0.2 to 0.4 kg per week for people with a BMI of 27 to 35, and 0.4 to 0.9 kg per week for people with BMIs greater than 35. When this continues for about 6 months it leads to around 10% loss in body weight. After 6 months focus should shift from weight loss to weight maintenance. Once this happens you can again concentrate on losing more weight.
Lifestyle Modifications
- Always set realistic and achievable goals.
- Maintain a record of everything you eat and the physical activity done. Jot done your weight every week.
- Indulge yourself in meditation or yoga daily. Go for a walk regularly and increase the time span during weekends.
- It is always easy to work in a group as you have a strong support system to rely upon. So plan for group workouts, aerobic sessions and plan your diet programs together.
Any weight-loss program should be a combination of dietary changes, physical activity, nutrition education and psychological support.
Restricted-Energy Diets
Reduction in weight is definite when restricted-energy diets are prescribed. The restriction can be between 500 to 1000 kcal daily. The energy levels differ for each person and can range anywhere from 1200 to 1800 kcal daily. Carbohydrates must constitute around 50% to 55% of total kilocalories in the form of fruits, vegetables and whole grains. Proteins make up 15% to 25% of kilocalories with fats not exceeding 30% of total calories consumed. Dividing ideal calorie intake level by 4 for a 25% fat intake gives you the desired fat intake levels. Vitamin and mineral supplements are usually advised for women who consume less than 1200 kcal/day and for men whose daily calorie consumption is less than 1800 kcal. Though a tricky process to balance both caloric requirements and nutritional needs, once practiced it becomes straightforward and simple to follow.
Formula Diets and Meal Replacement Programs
Formula diets or meal replacements are commercially prepared, ready-to-use and portion-controlled foods or drinks. These can be found in supermarkets and weight-loss centers. The main purpose of these foods is to replace high-calorie foods and provide nutritional benefits. These types of replacements can be a substitute for one or two meals or snacks daily and is a successful and relied upon weight loss and maintenance strategy.
Commercial Programs
Commercial weight-loss and self-help programs have become popular among people today and many of them include pre-packaged diets, behaviour modification, self-introspection and nutrition. Internet programs are gaining momentum recently where contact happens every week with behavioural therapy and individualised feedbacks.
Extreme Energy Restriction and Fasting
Extreme energy restriction diets provide less than 800 kcal/day and starvation or fasting diets provide fewer than 200 kcal/day. These are seldom suggested as they lead to hypotension problems, gout, gallstones and eating disorders such as anorexia nervosa.
Very Low-Calorie Diets
Very low-calorie diets (VLCDs) include vitamins, minerals, electrolytes and essential fatty acids with zero calories. They provide between 200 to 800 kcal and are suggested only for people with a BMI above 30 for whom all other diet programs have been futile. Though VLCDs provide rapid weight loss they are often discouraged due to their potential side effects. They can lead to gout (increased serum uric acid levels), dry skin, nervousness, constipation or diarrhea and menstrual irregularities. Though VLCDs give you short term benefits from weight loss there is not much difference in weight reduction in the long run. Physical activity and dietary intake should be monitored for at least 3 years after weight loss from VLDCs to prevent weight regain.
Popular Diets and Practices
Press and media provide the best platform for many weight loss programs to be advertised and popularised. Though some of them may be practical and sensible providing positive results few others stress on rapid weight loss without straining oneself. Many of these diets lead to nutritional deficiencies and health hazards but are rarely known as these programs are abandoned after a few weeks of practise. Diets offered in these programs fall into one of these four categories: high-fat, low-carbohydrate; moderate-fat, balanced-nutrient reduction; low-fat and very-low-fat diets.
Exercise
Physical activity plays a pivotal role in weight loss and weight management. Engaging yourself in any form of exercise or physical activity for 60 to 90 minutes daily is mandatory for weight loss. Obese or overweight individuals unable to manage these levels can start off with 30 minutes of moderate intensity exercise and gradually increase their level of momentum and time period. Aerobic exercises, especially cycling, are great options for weight-reduction programs and improve cardiovascular health. Spot reduction is not possible with exercise as fat gets automatically burned where there is maximum concentration of adipose tissue. Regardless of duration, type of activity and weight it is recommended to maintain cardiovascular health at maximum levels for total benefit.
Surgical Procedures
Only when the above mentioned treatment options are not favourable healthcare professionals take help of surgical procedures to remove the excess fat in persons having a BMI of 40 or greater. Bariatric surgery, gastric bypass, gastroplasty and liposuction are popular surgical options available. These come along with a heavy price tag in the form of side effects and life-long aftercare treatment.
Maintenance of Reduced Body Weight
Most of the reduced-obese persons do not appear for follow-up or regular check up after treatment. Energy requirements tend to be 25% lower for weight maintenance after weight loss. It is indispensable for reduced-obese individuals to reduce energy intake and engage themselves in high levels of physical activity to maintain weight loss. When this is done for a period of 2 to 5 years weight loss maintenance becomes less strenuous and chance of long-term success is possible. Diets that are boring, monotonous and repetitious are useful for weight maintenance as people eat just for hunger and not desire when hungry.
Common Problems Encountered in Obesity Management
After some weight loss the weight remains constant for a period of time and then halts completely known as the plateau effect. Increase in activity level is essential at this juncture to move out of this phase.
Weight Management in Children
About 17% of children and adolescents in the age group of 2 to 17 years are obese. A child who is obese after 6 years of age tends to grow up into an obese adult. A different BMI table is available for children and when BMI is greater than the 85th percentile such children are 6 times more likely to become overweight adults. Childhood obesity is linked with abnormalities in blood pressure, lipid, lipoprotein and insulin levels in adulthood.
Treatment should not be energy-restricted diets but should be weight maintenance or gradual decline in weight gain. In children who have already surpassed their optimal adult weight a moderate weight loss of around 4 to 5 kg per year can be followed until optimal adult weight is reached. Sedentary lifestyle like watching television or playing computer games is the root cause for childhood obesity. The entire family should participate in changing their eating habits and involve themselves in outdoor activities for encouraging weight reduction in obese children.
Weight Imbalance: Excessive Leanness or Unintentional Weight Loss
The term underweight is applicable for people who are 15% to 20% or more below acceptable weight standards. A low BMI (less than 18.5) is associated with increased mortality risk and may lead to underfunction of the thyroid, pituitary, gonads and adrenaline.
Underweight or unintentional weight loss may be due to:
- Insufficient intake to meet the required activity levels.
- Poor absorption or metabolism of the food consumed.
- Extreme dieting, depression or loss of appetite.
- Medical conditions such as cancer or thyroid problem.
Dietary programs must be carefully strategized for weight gain. A cushion of 500 to 1000 kcal daily should be allowed. This calorie increment should happen gradually to avoid gastric discomfort, electrolyte imbalance and heart dysfunction. About 30% of kilocalories consumed must be from fat, especially monounsaturated and polyunsaturated fats, and 12% to 15% of kilocalories should come from proteins. The underweight individual must be encouraged to eat frequently, even if not hungry. Snacks should also be introduced between meals with liquid supplements.
Underweight, often a symptom of some disease, is shadowed by the importance of obesity and overweight problems. Underweight individuals often catch cold or other infections as their immune system is not functioning to the expected levels. Also loss of weight can lead to fertility problems in women. Hence it is 100% necessary that you take excessive leanness or unintentional weight loss as a serious problem and seek medical help immediately.