5 Energy Balance and Weight Management

Overweight and Obesity Introduction

According to the Centers for Disease Control and Prevention (2020), obesity is a serious public health concern that poses significant health risks and is very common among adults and children. In fact, the CDC (2018) estimates obesity now affects 1 in 5 adolescents and children in the United States. The CDC (2020) estimates the prevalence of adult obesity was 42.4% in 2017-2018. Research indicates obesity is associated with a greater risk of various health concerns, including heart disease, diabetes, stroke, and cancer (CDC, 2020). The image below indicates adult obesity prevalence by state and territory using self-reported information from the Behavioral Risk Factor Surveillance System (BRFSS).

Body Composition

The human body is made up of 2 components- fat mass and fat-free mass.

• Fat-free mass is composed of muscles, bones, ligaments, tendons, organs, and water.
• Fat mass is composed of essential fat and storage fat.
• Essential fat is required by the human body in order to function properly. For example, essential fat is required for hormone production, body temperature regulation, and vitamin absorption.
• Fat is stored in the body in adipose tissue. Storage fat can be found around internal organs as visceral fat, or directly under the skin as subcutaneous fat.

Body fat percent is often estimated using skinfolds, bioelectrical impedance analysis (BIA), and hydrostatic weighing.

• Skinfold measurements- A caliper with 2 jaws determines the thickness of a skinfold of subcutaneous fat. An equation is used to estimate body density.
• Bioelectrical impedance analysis (BIA)- A small, low-level, electrical current flows through the body. BIA is often conducted using a hand-held device.
• Hydrostatic weighing- Underwater weighing technique is used to calculate body density.

Body Mass Index (BMI) is another calculation used to assess body composition. BMI is calculated as a height to weight ratio: BMI = body weight (kg) / body height (m²).

You can use the CDC (2020) BMI calculator in order to determine your BMI:
https://www.cdc.gov/healthyweight/assessing/adult-widget/iframe.html

It is important to note, there are some limitations with calculating BMI. BMI accuracy as an indicator of body fat appears to be higher in individuals with higher levels of BMI and body fat (Bray et al., 2001). At the same BMI, older adults generally tend to have greater body fat compared with younger adults (CDC, 2020). Furthermore, athletes may have a higher BMI due to increased muscle mass rather than increased body fat (CDC, 2020).

Waist Circumference helps assess body fat distribution. Excess abdominal fat can increase the risk of diabetes, heart disease, and stroke (CDC, 2019). BMI doesn’t necessarily measure abdominal fat, so waist size measurements can help predict your risk of health problems from being overweight.

In order to measure your waist correctly, stand and place a measuring tape around your mid-section (just above your hipbones). You should measure your waist after breathing out. Women with a circumference over 35 inches and men with a circumference over 40 inches are at higher health risk (CDC, 2019).

Obesity Risk Factors

There are many factors that play a role in obesity:

• • Genetics- Genes can directly cause obesity in specific disorders, or may increase one’s susceptibility for obesity (CDC, 2020). However it is important to note, genes do not always predict future health, and environmental/external factors (abundant food supply, little physical activity) may also play a role in combination with genetic factors (CDC, 2020).
  • Environment- A person’s environment can impact access to physical activity opportunities and healthy dietary choices. It is important to recognize our environmental opportunities and barriers for healthy lifestyle behaviors such as vending machines, sidewalks, parks, trails, fitness centers, and farmer’s markets.
  • Physiological Factors- Resting metabolic rate (RMR) and hormones can play a role in the development of obesity. For example, ghrelin and leptin act as “hunger hormones” in the body and play a role in regulating hunger. RMR is the energy (calories) required to maintain essential body functions (breathing, blood circulation, organ functioning) at rest. RMR does not account for calories burned during physical activity. You can use the RMR calculator RMR Calculator in order to calculate the amount of calories you burn at rest.
  • Energy Balance-

• Psychosocial/Cultural Factors- People with obesity may also experience concerns with mood, self-esteem, quality of life, and body image (Sarwer & Polonsky, 2018). Obesity has also been associated with socioeconomic factors and binge eating.
• Lifestyle Behaviors- Unhealthy dietary choices and sedentary behaviors/lack of physical activity contribute to obesity. The U.S. Department of Health and Human Services (2017) estimates less than 5% of adults participate in 30 minutes of physical activity per day. In addition, portion sizes have increased significantly over the years, which contributes to excess body weight.

Health Effects of Overweight and Obesity

Overweight and obesity are associated with an increased risk for multiple health concerns and diseases:

• All-causes of death (mortality)
• High blood pressure (Hypertension)
• High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (Dyslipidemia)
• Type 2 diabetes
• Coronary heart disease
• Stroke
• Gallbladder disease
• Osteoarthritis (a breakdown of cartilage and bone within a joint)
• Sleep apnea and breathing problems
• Many types of cancer
• Low quality of life
• Mental illness such as clinical depression, anxiety, and other mental disorders
• Body pain and difficulty with physical functioning

Health Effects of Underweight

It is important to note the health effects associated with being underweight as well. Falling below essential body fat and body mass index recommendations has been associated with malnutrition (vitamin and mineral deficiencies), decreased immune functioning, fertility issues, osteoporosis (decreased bone density), and growth/development issues in children and teens (Frey, 2020). With this concept in mind, it is important to focus on maintaining a healthy body weight.

Healthy Weight Management

Balancing diet and physical activity can help you achieve your weight goal.

Tracking your diet and physical activity can be a great step in managing weight. The CDC (2020) provides tracking tools you can use: Food Diary and Physical Activity Diary

Aim for at least 3 entries each day and try to stay consistent in your tracking. You can use this interactive body weight planner in order to calculate the number of calories and physical activity required in order to reach your goal weight and maintain it: Body Weight Planner

Focus on healthy nutrition choices:

• Choose fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products
• Include lean meats, poultry, fish, beans, eggs, and nuts
• Choose foods low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars
• Stay within your daily calorie needs
• Limit portion sizes

Use the following resources when focusing on nutrition and dietary changes:

• Healthy Eating for a Healthy Weight
• Meal Planning
• Cutting Calories
• Follow MyPlate Recommendations

Move Your Way Physical Activity Plan

You can make your physical activity plan using this “Activity Planner” interactive tool.

Setting Body Composition Goals

Focus on setting SMART goals. For example, instead of saying “I will get more active,” you could say “I will walk at least 15 minutes a day on 3 days a week starting next week.”

• Specific
• Measurable
• Attainable
• Realistic
• Time-Bound

Small lifestyle changes can add up to big improvements in health. Any physical activity is better than none. Monitor your internal thoughts and recognize how negative emotions can impede your progress. Positive self-talk can help manage thoughts and emotions. Be cautious if using dietary supplements/aids. Many of these products are not evaluated by the Food and Drug Administration for efficacy, and may contain hidden ingredients or make false claims. You can use this Supplement Safety Scorecard in order to screen your supplement for safety.

You do not have to lose a lot of weight in order to see health benefits. In fact, losing 5-10% (that’s 10-20 pounds for a 200 pound person) can lead to improvements in health and wellness (CDC, 2019). People who lose weight gradually (~.5-2 pounds/week) are more successful at keeping weight off long-term (CDC, 2020).

As stated by Flynn et al. (2018), one pound of fat loss is going to require a reduction in caloric intake of 3,500 calories. When viewed in terms of daily food intake, to lose a pound a week, a person needs to reduce their daily food intake by 500 calories a day: 3,500 calories/7 days= 500 calories per day. To successfully lose 2 pounds per week, that reduction would have to be doubled to 1,000 calories per day. Attempting to lose 2 pounds or more per week would require a calorie reduction too drastic to be maintained and too restrictive to be healthy. Thus, the recommendation of combining diet and exercise is the most effective method for experiencing weight loss. Subtracting 500 calories of food intake and exerting 500 calories in exercise will provide that same 1000 calorie reduction, but in a manner that is far easier to maintain, and certainly more enjoyable.

References

Centers for Disease Control and Prevention. 2010, August 3. Medical complications of obesity. https://www.cdc.gov/vitalsigns/adultobesity/infographic.html

Centers for Disease Control and Prevention. 2017, November 21. The new (Ab)normal. https://www.cdc.gov/nccdphp/dnpao/multimedia/infographics/newabnormal.html

Centers for Disease Control and Prevention. 2019, July 26. Healthy weight. https://www.cdc.gov/diabetes/managing/healthy-weight.html

Centers for Disease Control and Prevention. 2020, August 17. Losing weight. https://www.cdc.gov/healthyweight/losing_weight/index.html

Centers for Disease Control and Prevention. 2020, September 17. The health effects of overweight and obesity. https://www.cdc.gov/healthyweight/effects/index.html

Centers for Disease Control and Prevention. 2020, October 7. How much physical activity do adults need? https://www.cdc.gov/physicalactivity/basics/adults/index.htm

Centers for Disease Control and Prevention. 2020, December 16. Getting started with physical activity for a healthy weight? https://www.cdc.gov/healthyweight/physical_activity/getting_started.html

Comana, F. (2019, August 21). Resting metabolic rate: How to calculate and improve yours. NASM. https://blog.nasm.org/nutrition/resting-metabolic-rate-how-to-calculate-and-improve-yours#:~:text=The%20Mifflin%2DSt%20Jeor%20formula,%C3%97%20age%20in%20years)%20%2D%20161

Derma, F. (n.d.). RMR calculator – Resting metabolic rate. Omni Calculator. https://www.omnicalculator.com/health/rmr

Evans, M. [DocMikeEvans]. 2011, December 2. 23 and 1/2 hours: What is the single best thing we can do for our health? [Video]. YouTube. https://www.youtube.com/watch?v=aUaInS6HIGo

Flynn, S., Jellum, L., Howard, J., Moser, A., Mathis, D., Collins, C., Henderson, S., & Watjen, C. (2018). Concepts of fitness and wellness (2^nd ed.). Nursing and Health Sciences Open Textbooks. 4. https://oer.galileo.usg.edu/health-textbooks/4

Frey, M. 2020, July 9. Signs that you are underweight. Verywellfit. https://www.verywellfit.com/signs-of-being-underweight-4108192

Hefele, L. 2020, August 29. Brain Bites – Energy Balance. [Video]. YouTube. https://www.youtube.com/watch?v=yVS2BPI0ugE

Kravitz, L., & Heyward, V. H. (n.d.). Getting a grip on body composition. https://www.unm.edu/~lkravitz/Article%20folder/underbodycomp.html

Lee Health. 2016, July 3. BMI vs Body Fat. [Video]. YouTube. https://www.youtube.com/watch?v=saR8zNPRTio

MD Anderson Cancer Center. 2019, December 12. How to measure your waist circumference. [Video]. YouTube. https://www.youtube.com/watch?v=t4LYqIxWHQQ

Office of Disease Prevention and Health Promotion. 2021, January 8. Activity planner. https://health.gov/moveyourway/activity-planner

Operation Supplement Safety. (n.d.). Screen your supplement for safety. https://www.opss.org/screen-your-supplement-safety-read-label-your-supplement-and-answer-these-questions

Sarwer, D. B., & Polonsky, H. M. (2018). The psychosocial burden of obesity. Endocrinology and Metabolism Clinics of North America, 45(3), 677-688. https://doi.org/10.1016/j.ecl.2016.04.016

United States Department of Agriculture. (n.d.). What is MyPlate? https://www.myplate.gov/eat-healthy/what-is-myplate

United States Department of Health and Human Services. 2017, January 26. Physical activity facts and statistics. https://www.hhs.gov/fitness/resource-center/facts-and-statistics/index.html