Girl enjoy in sunny day outside.

Weight management and regulation of body weight

A multitude of regulatory systems exist to maintain body weight at some predetermined point (Set-Point Theory).  The theory surrounding the body’s set-point or preferred weight focuses on the idea that the human body tends to maintain a certain weight by means of its own internal control.  As Frances Sizer and Eleanor Whitney, authors of NUTRITION Concepts and Controversies, point out; the human body may prefer a particular weight and defend that weight by regulating your behaviors and hormonal actions.  Similar to your home’s thermostat setting which triggers the heater to run when air temperature drops or turns off when warmth is restored.  Same thing happens in the human body whenever weight is lost or gained, the set-point mechanism changes metabolic energy expenditures to assure internal balance or homeostasis.  Genetic inheritance is believed to determine the efficiency of your body’s regulatory systems (Rosencrans, 1994).  Some of the recent studies on set-point suggest that set-point adjusts to a new level when it is maintained over a long period of time, and that regulation may be disturbed by overeating, exercise, brain lesions, and drugs (Rosencrans 1994).  Reaching a plateau when dieting is common, yet if calorie control can be maintained, additional weight loss should occur.

Overweight should be viewed as a state in which the individual’s body weight exceeds an established standard based on height, frame, and age.  Obesity on the other hand is a condition of excessive fatness.  The formalized assessment of the obese versus underweight individual have been standardized by the Metropolitan Life Insurance Company and are widely used to establish an individual’s ideal body weight (IBW).  Other methods include:

  • Body Mass Index (BMI)
  • Quetelet Index
  • Waist – Hip Ratio (WHR)

Weight Gain 

 The nature and cause of obesity is the subject of everyday magazine articles, reality TV shows, infomercials, and everyday discussions between medical professionals, family, and friends.  Researchers chalk up factors both environmental and genetic and additional variables, which include psychological, behavioral, physiological, cultural and biologic in influence.

The subject of obesity has been researched, studied, and hypothesized for decades; the fact that no single theory can absolutely explain why some people become fat while others remain lean continues to fuel the weight loss industry with produced that influence hunger, appetite or satiety.

Obesity comes down to an imbalance of energy intake and energy output which seems simple enough to understand yet difficult for most of us to implement. The struggle to balance the energy you consume versus the energy you expend determines whether you will gain, lose, or maintain a certain level of body fatness.  Changes in ones body weight within a couple of pounds probably isn’t a change in body fat but rather a shift in body fluids.  One of the most important learning for an individual on a weight loss diet is that quick, large changes in weight are usually not changes in fat alone.  These diet fads initiate shifts in body fluids that register dramatic yet temporary results on the scale while not helping shift real life style changes.

Effective weight loss strategies focus on life style and behavioral change through nutritional education combined with diet modifications that integrate acceptable food choice while introducing  a multi-phase program of customized activities (exercise programming) targeting a desired weight loss.  Yet depending on the type and severity of the individual’s state of existing obesity, age, and life style, success at weight reduction can span from relatively a small change in life style to being a major change making weight loss virtually impossible.

Going for moderate weight loss of approximately ½ to 2 pounds a week versus rapid weight loss of 16 pounds in two weeks gives the mind and body a chance to adjust to the weight loss process over a longer period of time which limits the loss of required protein to muscle and tissue, while avoiding a crash in Resting Metabolism Rate (RMR).

For weight loss to be successful food choice changes combined with a planned food strategy and activity schedule are mandatory. Common sense tells you when you decrease your caloric intake; your body can start to utilize your energy reserve. A balanced nutritionally adequate diet which is calorically restrictive to the point where fat stores must be mobilized reinforces the basic fact that if you exercise moderately, restrict calories (watching fat and sodium intake), and consume a balanced diet that meets your nutrition and performance needs, the body will be forced to use up its excess stores of fat for future energy needs and gradual weight loss will occur which will help spare lean body mass and prevent muscle loss.

A summary of key points associated with weight gain are important to understand:

  • All food makes you fat if you eat more than you need regardless of being whole food, natural or organic
  • Carbohydrates are converted into glycogen (sugar) to maintain the nervous system and brain function and the excess is stored as fat
  • Excess protein consumption is stored as fat
  • Fat is stored easily by the body as fat tissue
  • Ethanol (alcohol) consumption provides the body with calories which are immediately used over carbohydrates, proteins, and fats while promoting storage of those macro nutrients as body fat

Weight Management

Whether your goals are to maintain your current weight, gain or loss weight, strategies need to produce substantive shifts effecting behavior, diet, food choices, consumption, portion control and serving size and level of physical activity.

It is a proven scientific fact that the key to weight loss isn’t as simple as what you eat but what you acknowledge you consume (to yourself) on a daily basis.  So write it down.  What ever it takes to gain awareness around food and your consumption level, which is what you need to do for yourself.  If you are like a typical client, you have no idea how much food you consume on a day-to-day basis.  Thanks to fast food, working long hours, computers and television, weight loss has become a real challenge.  Hey, it is tough to watch every mouthful you eat, even if you’re an expert on nutrition.  Even the pros under estimate their caloric intake, lowballing the number of calories consumed by 10 percent.  I guess that may explain why it’s so hard to lose those extra pounds.

The first step to weight loss is the “Food Diary”; this phase sends dread into the heart of all my clients.   This is the first tool any respectable, nutritional law biding professional needs to help you to lose real weight.

Step 1

Buy a regular notebook, the kind you used in first grade or go high tech and set up a food diary on your computer, there are even web sites where you can record your diet like myfooddiary.com or nutrihand.com and there is software available such as weightbydate.com.  Regardless of high tech or low tech methods you have to start recording.  Think about the time you ate, what you ate, and the amount you consumed.  Write down the information right after you eat for accuracy.  If you wait till the end of day it gets kind of sketchy.  This means you need to take paper with you to the restaurants, so you can write it all down. When at home if you do not currently own a measuring cup you may want to purchase one, it is an amazing awareness tool.  It will help you learn what a one-and-a-half-cup portion actually looks like.

Step 2

Customize your food diary and more important be “honest”.  This information must reflect what you do on a daily bases.  If you snack a lot then add a snack column.  Remember this tool is all about figuring out when you are drawn to food the most.  If you have a specific urge, then create a column to spell out exactly when you indulge.  Include every single bite and don’t forget to keep track of any slip.  Make a deal with yourself never to eat a single bite unless you write it down.

Step 3

What good is awareness unless you examine the evidence?  Behavioral change only happens if you analyze it.  At the end of each day, find the time to sit down and calculate how many calories you actually consumed.  A big advantage of online tools is that they do a lot of the analysis for you, totaling everything with a click, yet remember you are only as good as your level of awareness.

Step 4

Look for themes and see where you can cut 100 calories.  Remember it is not cutting a food group but rather see where you can cut 100 calories here and 50 calories there.  It is the aggregate of calories that matters.

Step 5

Make behavior changes in your consumption. Eat complex carbohydrates, lean protein, healthy fats, while minimizing white refined carbohydrates.  Work on eating healthy between 100-200 calories. Be vigilant with serving sizes. Minimize or alter your definition of desserts.  Every caloric change supports the cause.

The General Goals for Weight Management

>to maintain a realistic and healthy body weight over a life time by consuming a broad range of  whole foods and moderate intake of alcohol.

>to reduce body weight by approximately 10 percent within a 6 month period; at a rate of ½ -2 pounds a week.

>to internalize behavioral shift that will prevent further ongoing weight gain through the acceptance of healthy eating habits, understanding portion control versus serving size and living a more active lifestyle.

Readiness for Weight Loss

Evaluation includes determining the individuals’ degree of obesity, overall health status, mental attitude and tolerance regarding food, weight loss, and exercise.

Weight Loss Profile and Assessments

  • Age
  • Height
  • BMI
  • Current weight
  • Highest and lowest adult weight
  • Weight at 18
  • Blood pressure
  • Heart rate
  • Thyroid level
  • Cholesterol level
  • Ratio of Body Fat to lean muscle tissue

Once the decision for weight loss has been determined, the individual can set initial goals.  A realistic objective is to decrease body weight by 10% at a rate of ½ or 2 lb/week for a period of six months.  The rationale for this initial goal is that even a 10% reduction in body weight can significantly impact an over fat (obese) person’s health and wellness profile.

Factors Impacting Weight Loss

  • Diet
  • Physical Activity
  • Behaviors
  • Mindset

Diet

Weight loss begins with a healthy eating program that is tailored to an individual’s genetic food preference.  Once preferences have been determined, modifications and retraining of ones taste buds are the next step.

  • Energy values (caloric density verses volume)
  • Serving size verses actual portion
  • Food composition of macronutrients including fiber
  • Nutrition Food Labels and panel
  • Shopping for the food
  • Cooking techniques
  • H2O intake
  • Alcohol consumption

Medications

  • Antidepressants
  • Antihypertensive
  • Hyperlipidemics
  • Hormones
  • Insulin/antidiabetic orals
  • Herbals

Changing Behavior

Food choices, consumption and physical activity are all behaviors that influence weight.  When implementing a weight loss or weight gain plan, readiness to change must be assessed.

The intent of this phase is to clarify the scope of lifestyle change, assess readiness, and examine levels of capability, willingness and commitment to the process.  In order for the change to succeed the degree of disruption to the current lifestyle needs to be analyzed and addressed while in tandem taking a look at potential barriers that must be overcome.

Assess Readiness

  • Why now? And is the change considered major or minor?
  • Assess the gap between the current state and desired state of change.
  • What types of change strategies should be put in place?
  • Identify potential barriers to the lifestyle change strategies
  • What types of education, training, or skills need to be implemented?

Monitoring Tools

  • Food Diary – self-monitoring with daily records of food intake, accompanied by place, time, thoughts and
  • Feelings, which assist in identifying physical and emotional setting in which eating occurs
  • Calorie Calculation
  • Stimulus cues and control – identifies the circumstances that precede eating, preferred food choices, and feelings / consequences once the eating has occurred
  • Weigh-ins
  • Measurements
  • Body Fat analysis – Increases in lean body mass results in 8 to 14 percent higher daily energy expenditures
  • Activity – Exercise Diary – Exercise management programs help increase lean muscle tissue in proportion to fat, exercise creates balance between LBM and the reduction of resting metabolism rate which are key components of a weight reduction program
  • Incentives – rewards for controlling consumption

Education surrounding:

  • Food Fact Panel
  • Macro and Micro nutrients
  • Food Shopping
  • Cooking technique and preparation
  • Food Choices
  • Eating out
  • Snacks
  • Craving
  • Alcohol Intake

Monitoring Adherence

  • Expectation setting
  • Consequence management
  • Examine each area of non adherence

Set Realistic Expectations

  • Choice a realistic weight
  • Design a sustainable diet
  • Determine goals and the results associated with those outcomes

Myths and Truisms Surrounding Diet and Exercise

 Spot reduction is not possible with exercise and can lead to muscular imbalance

Body fat is burned from the largest area of fat tissue. As you diet it sequentially utilized from other existing sites of body fat.

Exercise does not leave you hungrier.  In fact, obese individuals tend to exercise at a much less strenuous level, making the concept of hunger more psychological or reward oriented.

Fad diets are usually complicated systems that require you to calculate protein requirements, count good carbs and bad carb grams, combine foods, time food, purchase special supplements and food products.

Weight loss books, supplements and exercise systems prey on people’s desire for quick fixes and simple solutions to a more systemic problem.

Success stories surrounding diet plans are exactly that “stories” usually not validated or scientific.

Carbohydrates (sugar) doesn’t dramatically raise blood sugar and insulin levels, triggering fat storage in

Fact carbs elicits only a moderate rise in blood glucose and insulin, and fat storage occurs only when energy intake exceeds energy needs.

No diet can reset your genetic code, you inherit your genes.

You can not lose weight by eating a specific percentage of macro nutrients (protein, carbs, and fat); weight loss comes down to creating an energy (caloric) deficit not the nutrient composition of the diet.

References:

>L. Kathleen Mahan and Sylvia Escott-T-Stump, Krause’s Food Nutrition & Diet Therapy

>Frances Sizer and Eleanor Whitney, Nutrition Concepts and Controversies

>Center for Disease Control and Prevention, The continuing epidemic of obesity in the United States, Journal of American Medical Association 284 (2000): 1650-1651.

>World Health Organization, J.M Rippe, S. Crossley and R. Ringer, Obesity as a chronic disease: Modern medical and lifestyle management, Journal of the American Dietetic Association 98 (1998): S9-S15.

>www.cdc.gov/nccdphp/dnpa/obesity/epidemic.htm. 200.

>U.S. Department of Health and Human Services, Healthy People 2010.

>J.P. Flatt, How NOT to approach the obesity problem, Obesity Research 5 (1997): 632-633.

>L.J. Harnack, R. W. Jeffrey, and K. N. Boutelle, Temporal trends in energy intake in the United States: ecologic perspective, American Journal of Clinical Nutrition 71 (2000):1478-1484.

>David A. Kessler, MD, The end of overeating. Taking Control of the Insatiable American Appetite.

>Debra Waterhouse, M.P.H., R. D. Outsmarting the Female Fat Cell.

>Gabe Mirkin, M.D., Getting Thin, All About Fat, How you get it, How you lose it, How to keep it off for good.

>A. S. Livine and C. J. Billington, Why do we eat? A neural systems approach, Annual Review of Nutrition 17 (1997):59-619.

>D.D. Ludwig, Dietary glycemic index and obesity, Journal of Nutrition 130 (2000); S280-S283.

>S L. Booth and coauthors, Environmental and societal factors affect food choice and physical activity: Rationale, influences, and leverage points, Nutritional Reviews 59 (2001): S21-S39.

>L. R. Young and M. Nestle, The contribution of expanding portion sizes to the US obesity epidemic, American Journal of Public Health 92 (2002): 246-249.

>M. Nestle and M. F. Jacobson, Halting the obesity epidemic: A public health policy approach, Public Health Report 115 (2000): 12-24.

>American College of Sports Medicine, Medicine and Science in Sports and Exercise.

>P. D. Wood, Clinical applications of diet and physical activity in weight loss, Nutrition Reviews 54 (1998): S131-S135; M. L. Klem and coauthors, A descriptive study of individuals successful at long-term maintenance of substantial weight loss, American Journal of Clinical Nutrition 66 (1997): 239-246.