Chapter 9 : Designing weight management and body comp programs

Question 1

What is the definition of obesity?

Answer 1

• An excessive amount of body fat relative to body weight
• BMI 95th percentile for age and sex and more for kids/teens
• 30 kg/m2 in adults

Question 2

Risks of obesity?

Answer 2

• Cardiovascular ischemic HD
• Stroke
• Dyslipidemia
• Hypertension
• Glucose intolerance
• Insuline resistance
• Diabetes mellitus
• Obstructive pulmonary disease
• Osteoarthritis
• Cancers (colon, prostate, ovary, breast, endometrium, cervix, esophagus, gallbladder)

Question 3

Risks of being underweight?

Answer 3

• Fluid-electrolyte imbalance
• Osteoporosis
• Osteopenia
• Bone fractures
• Muscle wasting
• Cardiac arrhytmias
• Sudden death
• Pulmonary edema
• Renal disorders
• Reproductive disorders

Question 4

What are the different types of obesity?

Answer 4

Android and gynoid obesity

Question 5

Characteristics of android obesity?

Answer 5

• Upper body obesity
• Apple-shaped
• More typical in males
• Post menopausal women

Question 6

What are the characteristics of gynoid obesity?

Answer 6

• Lower body obesity
• Pear-shaped
• More typical in females

Question 7

What are the different subtypes of obesity?

Answer 7

• Metabolically healthy, but obese (MHO)
• Metabolically obese, but normal weight (MONW)
• Metabolically unhealthy and obese (MUHO)

Question 8

What are the differences between MONW and MUHO?

Answer 8

• MONW: Low BMI

- MUHO: High BMI

Question 9

Causes of obesity and overweight?

Answer 9

Physiological ( metabolism and energy balance, hormones), developmental, genetic, life style and psychosocial factors

Question 10

What is the difference between direct and indirect calorimetry?

Answer 10

• Direct calorimetry: used to measure the energy yield and caloric equivalent of various foods
• Indirect calorimetry: Used to measure energy expenditure during basal, resting or activity states. And energy expenditure estimates from O2 utilization (1L O2 = 5kcal)

Question 11

What is energy or caloric need dependent upon?

Answer 11

Metabolic rate and physical activity level

Question 12

What is the energy yield of carbohydrates, protein and fat?

Answer 12

• Carbohydrate: 4.1 kcal/g
• Protein: 4.3 kcal/g
• Fat: 9.3 kcal/g

Question 13

What is basal metabolic rate (BMR)?

Answer 13

A measure of the minimal amount of energy (kcal) needed to maintain basic and essential physiological functions such as breathing, blood circulation and temperature regulation

Question 14

What is the resting metabolic rate (RMR)?

Answer 14

The energy required to maintain essential physiological processes in a relaxed, awake and reclined state (10% higher than BMR)

Question 15

When are BMR and RMR measured?

Answer 15

• BMR (actually RMR that is assessed): at least 12 hours rested and fasted in a controlled environment
• RMR: measured 3-4 hours after a light meal without prior physical activity

Question 16

How can TEE be measured or estimated?

Answer 16

• Doubly-labeled water method (gold standard)
• Prediction equations (age and gender specific)
• Indirect calorimetry
• Digital activity log

Question 17

Which factors affect RMR?

Answer 17

• Heredity and environment
• Hormones
• Age
• Gender
• Body composition
• Body size
• Weight loss /gain
• Exercise

Question 18

Factors that increase RMR?

Answer 18

• Hot, humid environments
• GH, epinepherine, norepinepherine, sex hormones
• Men higher than women
• More muscle
• Larger body surface area
• Weight gain
• Exercise

Question 19

Factors that decrease RMR

Answer 19

• Underproduction of thyroxine
• Age (decrease 2-5% every decade after 25)
• Weight loss

Question 20

What is energy balance?

Answer 20

• Static energy balance approach:
  Assumes that a change in one side of EB equation does not influence the other
• Dynamic energy balance approach:
  numerous biological and behavioural factors regulate/influence both sides

Question 21

What are the assumptions of the static and dynamic energy balance approaches?

Answer 21

• Exclusive loss of adipose tissue
• Each lb of adipose tissue contains 87% fat (395g)
• 1lb= 454 g
• 1lb= 3555 kcal

Question 22

What is the importance of energy balance relative to the design of weight management and body composition programs?

Answer 22

Negative energy balance (more out than in) or

Positive energy balance (more in than out)

Question 23

What is Wishnofsky’s Rule?

Answer 23

Every 1lb of fat is 3500kcal

Question 24

According to the Dynamic Energy Balance approach, does an energy deficit of 3500 kcal per week correspond to a 1-lb loss of body weight or fat?

Answer 24

Yes

Question 25

What is the difference between hypertrophy and hyperplasia of fat cells?

Answer 25

Hypertrophy is the increase in size, hyperplasia is the increase in number

Question 26

What are the key components of a weight management program?

Answer 26

Proper nutrition and daily physical activity

Question 27

What are the preliminary steps in the design of a weight management program?

Answer 27

- Set Body Weight Goals | - Assessing Energy (caloric) intake/expenditure

Question 28

Setting body weight goals

Answer 28

- Assess body weight, BMI or body fat levels | - Use body composition technique to estimate a clients healthy body weight and body fat levels (assess FFM and %BF)

Question 29

Assessing Energy Intake

Answer 29

- Food record and RDA profile - record type and quantity of foods consumed each day for 3-7days - assess average daily caloric intake - compare average nutrient intake of each nutrient to recommend amounts - analyze dietary patterns

Question 30

Assessing Energy Expenditure

Answer 30

1. Factorial Method | 2. Total Energy Expenditure (TEE)

Question 31

Factorial method

Answer 31

TEE (kcal)= RMR+Occupational Activity + Physical Activity

Question 32

Total Energy Expenditure Method

Answer 32

- Estimated using prediction equation derived from doubly-labeled water measures of TEE in free-living individuals - Equations predict TEE from a clients age, body weight, height and physical activity coefficient (PAC)

Question 33

How are a client's RMR, occupational activity level, and physical activity level determined using the factorial method?

Answer 33

- RMR: Indirect calorimetry - Occupational activity level: Work, household chores, personal daily activities and exercise - Physical activity: Physical activity log used to estimate additional caloric expenditure due to physical activity and exercise

Question 34

How can you obtain a quicker but less accurate estimate of RMR when using the factorial method to assess a client's energy needs?

Answer 34

Prediction equations

Question 35

Which equations were widely used in the past to estimate RMR?

Answer 35

- Body Surface Area (BSA) - Harris-Benedict Equation - Mifflin et al. Equations - FFM - Quick estimate from body mass

Question 36

Which equations are recommended to estimate the RMR of healthy individuals by the American Dietetic Association?

Answer 36

Mifflin equation

Question 37

Which equations that are used to estimate RMR take into account the gender, height, weight, and age of a client?

Answer 37

- Harris-Benedict Equation | - Mifflin et al. Equation

Question 38

What is the physical activity coefficient (PAC)?

Answer 38

- The physical activity coefficient depends on your clients physical activity level (PAL) - PAL= TEE/BMR

Question 39

How is a client's physical activity level (PAL) determined?

Answer 39

- Self reported physical activity level - Physical activity diaries - Pedometers - Accelerometers - Heart rate monitors - Digital activity logs

Question 40

What is the gold standard for determining PAL and measuring TEE?

Answer 40

Prediction equations derived from doubly-labeled water measures of TEE in free living individuals

Question 41

Weight management principles for weight loss

Answer 41

- Well balanced diet for good nutrition - No more than 2 lbs per week - Caloric intake should not be less than 1200kcal/day - Caloric deficit should not exceed 1000 kcal/day - Calorie deficit of 3500kcal is needed to lose 1lb of fat - Weight loss due to fat not LBM - Weight loss rate decreases over time - Men lose weight faster due to higher RMR - Should eat at least 3 meals/day - Fast weight loss methods should be avoided - Carnitine supplementation does not promoted body fat loss - Compulsive eating disorders should be identified and modified

Question 42

What is the amount of weight loss in pounds recommended by CSEP?

Answer 42

1.1-2.2 pounds per week

Question 43

What are the reasons that exercise is an essential part of weight loss programs?

Answer 43

- Maximizes energy expenditure - Larger negative energy balance - In creases fat loss when combined with diet - Maintains/slows loss of FFM that occurs while only dieting - Maintains weight loss after dieting - Positive effect on RMR - Counter the reduction in RMR that occurs while dieting - Increase post exercise RMR

Question 44

Exercise Program Design for weight loss

Answer 44

- Moderate weight loss >150mins of PA and exercise/week - Significant weight loss: >250 mins of PA and exercise/week - Add resistance training to increase lean body mass, increase loss of fat mass and prevent declines in metabolic rate - Light intensity PA can make a substantial contribution to daily energy expenditure