Lesson 3.08 Body Size and Weight Management

Calculating and Interpreting Body Measure

Weighing yourself on a scale seems to be the method most of us use when determining our "fatness." Our bodies, however, are made up of other cell material like muscle, bone, and non-fat tissue. This is called lean body mass. Changes in these components come on very slowly, so if you gain one pound in one week, it usually is caused by a gain of fat weight. Some situations can cause a misleading fluctuation in body weight that is not caused by fat gain or loss, such as fluid retention before menstruation or fluid losses in vomiting and diarrhea. So when menstruation begins or you become hydrated again after an illness, your seeming weight loss or gain disappears. It takes about 3,500 extra calories to put on a pound of body fat, so it takes a lot of overeating to change fat weight quickly.

Weight on a scale can also be deceptive for a person with a higher amount of lean body mass like an athlete who strength trains. They will weigh more at the same height than an average person because of their lean body mass.

Trying to establish an ideal body weight for each person is not an accurate reality, because there are so many factors affecting this, including age, body shape, genetic background, gender, medical conditions, level of physical activity, and others. A healthy weight can exist in a variety of ranges of pounds based on these factors.

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Function and Regulation of Body Fat Levels

Often we think of body fat as something to be avoided or gotten rid of at any cost to our overall health. However, body fat performs some vital functions in the human body and is needed for the continuing reproduction of the human species. The percent of body fat needed is based on your gender, with women needing the higher percentage as compared to men. Important fat weight gain occurs to support human survival during periods of life such as pregnancy and breastfeeding which allows for normal fetal weight gain, prevention of a lifetime of health problems for the child, and production of human milk supply.

On the other hand, overweight and obesity can be related to risks for developing chronic health problems such as hypertension, elevated blood cholesterol levels, Type II Diabetes, heart disease, and cancer. There are other factors involved in developing these diseases like lifestyle and heredity, but reducing body weight by even 5-10% can be helpful in improving health.

 

Storage vs. Essential Fat

Most of body fat is storage fat, which is the layer of fat under our skin which protects internal organs from major harm, provides a store of energy to endure times of fasting, and also helps you deal with extremes of climate temperatures. Have you ever noticed how a very thin person is frequently complaining of being "cold" when the other people are comfortable? That's because his or her storage fat is lower than average.

There is a small amount of essential fat that serves important functions in the body like cell membrane integrity. Essential fat for men ranges from three to eight percent of body weight. When you add storage fat, a good range for men is fifteen to twenty percent. Women have the additional component of gender-specific areas of fat which include the breasts, hips, and buttocks which evolved because of need for extra fat for childbearing

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Body Fat Distribution

Besides the amount of fat that a person has, the way it is distributed in the body makes a difference in health risks. Fat patterns vary between gender, age groups, or stage of development of children and teenagers. These fat patterns are affected by genetics and can vary according to ethnic group. You have probably seen ads for diet products that promise to get rid of "belly fat." These claims are misleading because although exercise can change the muscle tone of body areas, it will not change the personal areas of fat distribution.

The two basic types of human body shapes are android and gynoid). The apple shape people are the biggest around the waist and the pear shape carry most of their weight in the hips, buttocks, and upper thighs.

There will always be people who fit in neither shape, but most of the android shape will be men and older women, while most of the gynoid shape are women. The higher health risk seems to be when the fat is carried in the abdominal area rather than in the lower body. Waist measurements of greater than forty inches for men and thirty-five inches for women are more susceptible to chronic diseases of obesity. Fat carried under the skin in various parts of the body is easier to lose and regain than fat in the abdominal and lower body areas. Weight carried in the lower body range means lower health risks, however it seems that in our culture women often are very concerned with their shape in this area.

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Culture, Body Image, and Genetics

How did the American culture get to its current point of being obsessed with the excessive and unrealistic idea of thinness being the only measure of beauty? This has become overwhelming mainly in the last fifty years or so. It is important to learn to understand what this has done to physical and mental wellness of both sexes. Your personal body image can also be distorted and effect your sense of worth as a person. What part does genetics and the evolution of the human body's survival mechanisms play in the ultimate determinant of what is your realistic body size? This unit will help to explain some of these processes and provide you with material for thought.

 

Influences in Body Image Perception

The term body image refers to the perceptions that you have about your body. It is not just about body functions, but ideas, feelings, and experiences about your physical appearance and attractiveness to yourself and others.

How do we form our personal image of what is attractive in fellow human beings? We currently seem to believe that women must be thin and soft, and men muscular with wide shoulders and narrow waists. This has not always been true, as for thousands of years from cavemen drawings to Renaissance paintings, we see images of full-figured women who were symbols of attractiveness, health, and fertility in their time.

Extreme fatness and thinness were considered unhealthy, but there was not a great deal of obsession with weight. Even today there may be certain cultural groups (although there are individual exceptions) that are not as concerned about thinness as the rest of the population.

In the last fifty years or so Americans have entered an era of mass media messages with television, internet, movies, and advertising exposure. New ideas of attractiveness are quickly spread throughout the world to promote sales of fitness machines, cosmetics, diet programs and products, clothing fashions, medical surgeries, and weight loss medications. Advertisements often appeal to the human need for social acceptance and to be attractive to the opposite sex. We seem to have come to a point where one definition of female and male attractiveness has been determined to fit all instead of celebrating our differences. This fuels the market economy as people spend billions of dollars trying to look like the ideal body shown continually shown to them.

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Set Point

From our day of birth do we have regulatory systems already in place for personal level of fatness or thinness? Other body systems must operate within a narrow range such as blood pressure, blood sugar, blood chemistry levels, and body temperature. If these levels become too low or too high, our body becomes ill and long term damage can occur. Set point is the term used for this narrow range of usual or natural levels that the body regulates and defends to keep it there. The development of your adult body weight — with all its genetic, environmental, cultural, and personal behaviors effects on it — is assessed by each person's body and the set point becomes established. When a person has an energy deficit either by dieting or illness, the body turns up the appetite mechanism in order to return to usual levels. Thus a person's adult weight is pretty constant. The set point can also endure through eating excesses for a short period of time, but can be overridden by consistent overeating. The new level of fatness becomes the set point that is easily maintained.

To change this set point to maintain weight loss, the level of effort required is significant with consistent changes in eating behaviors and activity level. One study showed that in successful weight loss maintenance, women ate only about 1300 calories per day and the men about 1700 calories with very low levels of fat intake (about twenty-four percent). They also exercised almost daily. In fact, some researchers recommend actually increasing your daily exercise from thirty minutes per day to sixty minutes per day once you move from dieting to weight maintenance. You cannot return to old eating behaviors and activity levels to keep this lower set point.

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Obesity: Chronic Disease and Chronic Dieting Effects

It is still a debate if obesity is a chronic disease or if wellness can be possible at any body size. Because of obesity's relationship to illness and death from other diseases like hypertension, diabetes, and cancer, it meets the criteria of chronic disease of being long term and symptoms that affect the whole body. But others argue that if you consider other signs of health in a large person, wellness is possible when things like physical fitness, normal blood fat levels, and normal blood glucose levels are present. The point has been made that the physical and emotional stress of attempting weight loss in people whose set point is higher than the norm is not worth it. Focusing on wellness factors rather than a specific body weight range seems to be more realistic for many overweight people.

Effects of chronic dieting are that when food intake is reduced the Resting Energy Expenditure (REE) is reduced and when we are at a lower body weight, it is reduced even further. This slows the rate of weight loss and regaining weight can also happen.

Studies have shown that when you overeat to the point that you increase your weight by ten percent, your total energy expenditure actually increases. However, when you diet to lose that ten percent weight gain, your total energy expenditure decreases to the lower level again. There is concern that people who are continually dieting or go through a number of weight loss and weight regain cycles actually start to lose this body ability to increase energy expenditure. This makes weight loss and maintenance more and more difficult with each cycle. A food intake that once supported a normal weight now causes weight gain. Chronic dieting can actually contribute more to continued weight gain than a people who eat their usual food intake at a stable, but higher than the normal body weight.

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Surgical Options for Weight Loss

Bariatric surgery is surgical intervention, usually gastrointestinal surgery, for obesity. Bariatric surgery is surgical intervention, usually gastrointestinal surgery, for obesity. It has proven to be a more effective long term approach for very overweight people who have significant medical problems related to obesity but are unable to lose weight by diet and exercise. It has shown to bring about twenty to twenty-five percent of total beginning body weight loss in about ninety percent of people who have had successful surgery. This weight loss has a better retention rate of fifty to eighty percent over a five year span of time, compared to only five percent weight loss retention for other diet approaches. All bariatric surgical procedures are serious medical interventions and are not to be used by people wanting to lose twenty to thirty lbs. of perceived excess weight. Recommendations are for BMI of forty or above which is about 100 excess lb. for men and eighty excess lb. for women. If there is a serious health problem then the recommended BMI drops to thirty-five to forty. Clients should be thoroughly evaluated by a medical team consisting at least of a doctor, psychiatrist, and dietitian. Nutrition counseling is needed before surgery, immediately after surgery, and for long term follow-up. The potential surgery client must be evaluated for eating disorders, eating behaviors related to emotional needs, and willingness to make lifestyle changes after the surgery. There have been cases when poorly screened patients have developed serious post-surgery complications that result in death or permanent health problems.

Gastroplasty reduces the amount of food that the stomach can hold and affects the neurohormonal regulation of appetite. People who have had this surgery and gastric banding (see images above) report "feeling full" much faster and often lose thirty to forty percent of their body weight. If they eat too much or too fast, vomiting will often occur. With these two surgeries, these smaller pouches of stomach capacity can stretch out to hold more food, or if activity levels decrease or intake levels of food are increased the body's starvation mechanism kicks in and weight is regained.

A form of gastric bypass and malabsorption surgery called the Roux-en-Y gastric bypass consists of creating a small stomach pouch and attaching a smaller portion of the small intestine to this pouch (see image above). Fewer calories and nutrients are absorbed by the body with this procedure, but is more risky surgery and can cause nutritional deficiency. Being followed by the medical profession after this surgery is especially important to prevent disorders like protein-calorie malnutrition and vitamin/mineral deficiency diseases as a result of this shortening of the small intestine which we have learned is where most of the body's absorption of nutrients occurs.

Liposuction is a cosmetic surgery involving removal of fat under the skin by a inserting a thin tube into a small incision in the skin and using a suction-type machine to remove fat deposits. This is usually done in the hip, thigh, and abdominal area. This surgery carries with it the risk of infection and also can cause disfiguring skin depressions or blood clots. It is used to improve body appearance, but studies have shown that it does not reduce some overweight related health problems like hypertension, high cholesterol, or Type II diabetes.

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Eating Disorders

Eating disorders are a rising concern as more than five million Americans have them in this age of pursuit of the perfect body. They are considered mental disorders, but the abnormal eating patterns and relationship to food make them an important section in body size and weight management.

Eating disorders have been around for centuries and have appeared in the medical literature over time and were described in the 1800s by English and French doctors. Eating disorders are prominently thought of as being found in young teen-age women. However, they are becoming more common in males, children as young as age nine, and middle-aged women. The United States population is becoming more and more obsessed with meeting the "perfect" body ideal.

Eating disorders are defined as a group of behaviors related to emotional conflict that has symptoms of altered food intake and can include both the starvation of anorexia to the uncontrollable food intake and weight gain of binge eating. Chronic dieting syndrome is a term that refers to lifestyle controlled by a constant concern about food intake, body shape, or weight that affects a person's physical and mental wellness. These dieters continually try to restrict food intake, but overall body weight can stay the same or get higher. Be aware that only a small percentage of the millions of people on a "diet" develop true eating disorders, although many people can have several signs or symptoms of them. The potential risk of developing them is present in a lot of young people.

In a sample of 16,000 teenagers, fifty-eight percent of the girls and twenty-five percent of the boys were dieting. In young males, besides possible weight-loss concern, eating disorders can take the shape of trying to gain weight or increase muscle mass. These dieters often eat excess protein or high fat foods or use questionable supplements like protein powders.

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Developing a Wellness Approach to Body Size

Most humans cannot try to change their bodies into current society's ideal for size, weight, and shape without great risk to physical and mental health. You do have the ability, however, to adopt attitudes and behaviors in life that lead to personal satisfaction and wellness at the size and shape most natural for you personally. The focus is on long-term changes in eating habits and activity levels. If you eat right and implement healthy behaviors, you will look and feel good at any body size.

One author's comparison of this current tendency to "carve up the human body into unnatural shapes" as similar to this world's current problems of pollution, global warming, destroying of natural lands and resources. We have not yet learned to live in harmony with nature which has its beautiful designs, great variety of life forms and sizes, but also limits for exploitation and molding to human designs.

Good lifelong management of body weight has an emphasis on a personalized program of improved physical fitness and a regularly well-balanced diet, rather than on calorie counting and focusing on what the scale says about your body weight. When doing any planning, make sure that it is realistic for your individual needs and lifestyle, or you won't follow through with it. An example of this would be planning two hours of strenuous exercise from five o'clock a.m. to seven o'clock a.m. before school if you are not a morning person. The following is a listing of six methods to use when making your personal plan.

• Learn to Enjoy Food and Eating. In our "chronic dieting" society, we often classify foods into "good foods" or "bad foods," and thus develop a love-hate relationship with food. You feel deprived if you "have to" eat foods like lettuce and raw vegetables, or guilty and ashamed it you weaken and eat the bad foods like cheesecake. Thus you often develop cravings for them and end up going on "eating binges" where you eat way more of them than you would normally. Eating is meant to be an enjoyable process where you are relaxed, aware of your limits, and allow yourself to eat without guilt reasonable quantities of a variety of food. It means being willing to try new foods or new ways of preparing them. If you don't like boiled carrots, try something new like roasting them in the oven with a small amount of olive oil coating until brown and crispy which gives them a whole different flavor.

• Learn to listen to your hunger and satiety signals. Many of us lost our ability to follow physiologic cues to hunger when we were children and were told to "clean our plates" or a treat for good behavior was a candy bar or ice cream (instead of fruits or vegetables). We use cues in our environment for eating like the time on the clock says its twelve o'clock noon and our lunch break, or we are at a social function like a wedding where lots of sweet and rich food is presented and we don't want to insult the hostess by not eating — it doesn't matter if we are actually physically hungry or not. One way to start regaining your hunger/satiety cues is stopping midway through a meal and checking to see if you are still hungry or not. It takes about twenty minutes for the signal from the stomach to reach the brain and say "I'm full." Check again after consuming more of your meal. If you are rapidly eating a fast food meal, you can down it and be out the door before this mechanism kicks in.

• Note some of your food behaviors. Often food is eaten in response to stressful situations like anxiety or the feeling that you are a worthless person. People have described this as trying to use food as a means to "fill up the emptiness" inside. If you have had a stressful day at school or work, you could be "treating" yourself to high calorie foods like pizza and a large soda pop to help yourself feel better. Food is also used for celebrations such as friends' birthdays or a victory at a sports event. Management of eating behaviors involves looking at when, why, where, how, and how much food is eaten. Recognize thoughts like "I have to take servings of everything at a buffet meal and go back for more because it is there and included in the price of the meal." Emphasize eating a variety of foods, watch portion size, and distribute food intake evenly throughout the day. Skipping meals is a poor weight control measure, as often you are so hungry by the time you do eat something you tend to overeat or eat high calorie, high carbohydrate foods like candy bars or chips.

• Daily activity patterns and individualized exercise have been stressed as an important partner in long term weight management. A big problem with many resolutions to increase physical activity is that it has a high drop out rate. You need to set realistic exercise goals. The best health benefits results from thirty minutes or so done three or more times (preferably daily) per week. It helps to have access to a variety of activities that you personally enjoy from walking, participation in school sports programs, swimming, bicycling, or even cleaning out your room. Remember that one doesn't have to have a runner's physique to experience the benefits of physical activity.

• Learn stress reduction exercises. As mentioned previously, stress can become your body's cue to overeat. Practice using muscle and mind relaxation methods like increasing physical activity, talking to a supportive friend or family member, using guided imagery, or tapes of natural sounds or calming music. In our "fast-forward" society, often people do not know how to relax or feel guilty if they do.

• Find a personal interest area. Often a person feels that they are always trying to meet other people's expectations of them and do not take time to do something that they enjoy doing just for themselves. Developing a personal interest area like participating in a rock band or community theater group or hobby of collecting items (i.e. like items with Coca-Cola emblems on them). Find something that engages your creative energies and stimulates your mind.

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