Module 06: Nutritional Health

Content:

This Module contains 8 Lessons:
  • Lesson 1: Nutritional Guidelines; Carbohydrates, Fats and Proteins
  • Lesson 2: Myths and Misconceptions regarding Nutrition
  • Lesson 3: Ethnic Foods
  • Lesson 4: Dietary Supplements
  • Lesson 5: Body Composition and Metabolic Rate
  • Lesson 6: Diet and Weight Control
  • Lesson 7: Obesity
  • Lesson 8: Eating Disorders

Objectives:

Students will be able to:
  • List the dietary guidelines for Americans
  • List the health risks of obesity
  • Describe eating disorders

Lesson 1: Nutritional Guidelines: Carbohydrates, Fats and Proteins

Source: Dietary Guidelines for Americans, 2010, http://health.gov/dietaryguidelines/2010.asp

A healthy diet can reduce the risk of major chronic diseases such as heart disease, diabetes, osteoporosis, and some cancers.

The Dietary Guidelines for Americans, 2010 provides evidence-based nutrition information and advice for people age 2 and older. They serve as the basis for Federal food and nutrition education programs.
They emphasize three major goals for Americans:
  • Balance calories with physical activity to manage weight
  • Consume more of certain foods and nutrients such as fruits, vegetables, whole grains, fat-free and low-fat dairy products, and seafood
  • Consume fewer foods with sodium (salt), saturated fats, trans fats, cholesterol, added sugars, and refined grains
The Dietary Guidelines for Americans, 2010 include 23 key recommendations for the general population and 6 additional key recommendations for specific population groups, such as pregnant women. The recommendations are intended to help people choose an overall healthy diet.

Dietary Guidelines recommendations traditionally have been intended for healthy Americans ages 2 years and older. However, Dietary Guidelines for Americans, 2010 is being released at a time of rising concern about the health of the American population. Poor diet and physical inactivity are the most important factors contributing to an epidemic of overweight and obesity affecting men, women, and children in all segments of our society. Even in the absence of overweight, poor diet and physical inactivity are associated with major causes of morbidity and mortality in the United States. Therefore, the Dietary Guidelines for Americans, 2010 is intended for Americans ages 2 years and older, including those at increased risk of chronic disease.
Poor diet and physical inactivity are the most important factors contributing to an epidemic of overweight and obesity in this country. The most recent data indicate that 72 percent of men and 64 percent of women are overweight or obese, with about one-third of adults being obese. Even in the absence of overweight, poor diet and physical inactivity are associated with major causes of morbidity and mortality. These include cardiovascular disease, hypertension, type 2 diabetes, osteoporosis, and some types of cancer. Some racial and ethnic population groups are disproportionately affected by the high rates of overweight, obesity, and associated chronic diseases. These diet and health associations make a focus on improved nutrition and physical activity choices ever more urgent. These associations also provide important opportunities to reduce health disparities through dietary and physical activity changes.

Dietary Guidelines for Americans, 2010 also recognizes that in recent years nearly 15 percent of American households have been unable to acquire adequate food to meet their needs. This dietary guidance can help them maximize the nutritional content of their meals. Many other Americans consume less than optimal intake of certain nutrients even though they have adequate resources for a healthy diet. This dietary guidance and nutrition information can help them choose a healthy, nutritionally adequate diet. The intent of the Dietary Guidelines is to summarize and synthesize knowledge about individual nutrients and food components into an interrelated set of recommendations for healthy eating that can be adopted by the public.

Taken together, the Dietary Guidelines recommendations encompass two over-arching concepts:

Maintain calorie balance over time to achieve and sustain a healthy weight.

  • People who are most successful at achieving and maintaining a healthy weight do so through continued attention to consuming only enough calories from foods and beverages to meet their needs and by being physically active. To curb the obesity epidemic and improve their health, many Americans must decrease the calories they consume and increase the calories they expend through physical activity.

Focus on consuming nutrient-dense foods and beverages.

  • Americans currently consume too much sodium and too many calories from solid fats, added sugars, and refined grains. These replace nutrient-dense foods and beverages and make it difficult for people to achieve recommended nutrient intake while controlling calorie and sodium intake. A healthy eating pattern limits intake of sodium, solid fats, added sugars, and refined grains and emphasizes nutrient-dense foods and beverages;vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood, lean meats and poultry, eggs, beans and peas, and nuts and seeds. A basic premise of the Dietary Guidelines is that nutrient needs should be met primarily through consuming foods. In certain cases, fortified foods and dietary supplements may be useful in providing one or more nutrients that otherwise might be consumed in less than recommended amounts.
A healthy eating pattern needs to not only to promote health and help to decrease the risk of chronic diseases, but it also should prevent foodborne illness. Four basic food safety principles (Clean, Separate, Cook, and Chill) work together to reduce the risk of foodborne illnesses. In addition, some foods (such as milks, cheeses, and juices that have not been pasteurized, and undercooked animal foods) pose high risk for foodborne illness and should be avoided.
Dietary Guidelines for Americans key recommendations are the most important in terms of their implications for improving public health.
To get the full benefit, individuals should carry out the Dietary Guidelines recommendations in their entirety as part of an overall healthy eating pattern.

DIETARY GUIDELINES FOR AMERICANS, 2010

Individuals should meet the following recommendations as part of a healthy eating pattern while staying within their calorie needs.
  • Increase vegetable and fruit intake. Eat a variety of vegetables, especially dark-green and red and orange vegetables and beans and peas.
  • Consume at least half of all grains as whole grains. Increase whole-grain intake by replacing refined grains with whole grains.
  • Increase intake of fat-free or low-fat milk and milk products, such as milk, yogurt, cheese, or fortified soy beverages.
  • Choose a variety of protein foods, which include seafood, lean meat and poultry, eggs, beans and peas, soy products, and unsalted nuts and seeds. Increase the amount and variety of seafood consumed by choosing seafood in place of some meat and poultry. Replace protein foods that are higher in solid fats with choices that are lower in solid fats and calories and/or are sources of oils.
  • Use oils to replace solid fats where possible. Choose foods that provide more potassium, dietary fiber, calcium, and vitamin D, which are nutrients of concern in American diets. These foods include vegetables, fruits, whole grains, and milk and milk products.

Balancing Calories to Manage Weight

  • Prevent and/or reduce overweight and obesity through improved eating and physical activity behaviors. Control total calorie intake to manage body weight. For people who are overweight or obese, this will mean consuming fewer calories from foods and beverages.
  • Increase physical activity and reduce time spent in sedentary behaviors. Maintain appropriate calorie balance during each stage of life; childhood, adolescence, adulthood, pregnancy and breastfeeding, and older age.
  • Reduce daily sodium intake to less than 2,300 milligrams (mg) and further reduce intake to 1,500 mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. The 1,500 mg recommendation applies to about half of the U.S. population, including children, and the majority of adults.
  • Consume less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids. Consume less than 300 mg per day of dietary cholesterol. Keep trans fatty acid consumption as low as possible by limiting foods that contain synthetic sources of trans fats, such as partially hydrogenated oils, and by limiting other solid fats. Reduce the intake of calories from solid fats and added sugars.
  • Limit the consumption of foods that contain refined grains, especially refined grain foods that contain solid fats, added sugars, and sodium.
  • If alcohol is consumed, it should be consumed in moderation up to one drink per day for women and two drinks per day for men and only by adults of legal drinking age.

Foods and Food Components to Reduce

  • Reduce daily sodium intake to less than 2,300 milligrams (mg) and further reduce intake to 1,500 mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. The 1,500 mg recommendation applies to about half of the U.S. population, including children, and the majority of adults.
  • Consume less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids.
  • Consume less than 300 mg per day of dietary cholesterol.
  • Keep trans fatty acid consumption as low as possible by limiting foods that contain synthetic sources of trans fats, such as partially hydrogenated oils, and by limiting other solid fats.
  • Reduce the intake of calories from solid fats and added sugars.
  • Limit the consumption of foods that contain refined grains, especially refined grain foods that contain solid fats, added sugars, and sodium.
  • If alcohol is consumed, it should be consumed in moderation—up to one drink per day for women and two drinks per day for men—and only by adults of legal drinking age.

Building Healthy Eating Patterns

  • Select an eating pattern that meets nutrient needs over time at an appropriate calorie level.
  • Account for all foods and beverages consumed and assess how they fit within a total healthy eating pattern.
  • Follow food safety recommendations when preparing and eating foods to reduce the risk of foodborne illnesses.

Learning Activity 1.1: Watch this video titled: //MyPlate: Understanding the USDA Dietary Guidelines for Americans// (28 minutes)
Films Media Group, 2011. Films On Demand.

The old USDA Food Pyramid has been replaced with MyPlate, a new generation guide to healthy eating. This change was made to make nutritional guidelines easier to understand and to emphasize following a balanced diet.
  • Does MyPlate help you to better understand nutritional guidelines?

Recommendations for Specific Population Groups

Source: Recommendations for Specific Population Groups, USDA, http://www.cnpp.usda.gov/DietaryGuidelines.htm

Women capable of becoming pregnant

  • Choose foods that supply heme iron, which is more readily absorbed by the body, additional iron sources, and enhancers of iron absorption such as vitamin C-rich foods.
  • Consume 400 micrograms (mcg) per day of synthetic folic acid (from fortified foods and/or supplements) in addition to food forms of folate from a varied diet.

Women who are pregnant or breastfeeding

  • Consume 8 to 12 ounces of seafood per week from a variety of seafood types.
  • Due to their high methyl mercury content, limit white (albacore) tuna to 6 ounces per week and do not eat the following four types of fish: tilefish, shark, swordfish, and king mackerel.
  • If pregnant, take an iron supplement, as recommended by an obstetrician or other health care provider. Individuals ages 50 years and older Consume foods fortified with vitamin B12, such as fortified cereals, or dietary supplements.

Building Healthy Eating Patterns

  • Select an eating pattern that meets nutrient needs over time at an appropriate calorie level.
  • Account for all foods and beverages consumed and assess how they fit within a total healthy eating pattern.
  • Follow food safety recommendations when preparing and eating foods to reduce the risk of foodborne illnesses.
  • Reduce daily sodium intake to less than 2,300 milligrams (mg) and further reduce intake to 1,500 mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease.

Individuals ages 50 years and older

  • Consume foods fortified with vitamin B12, such as fortified cereals, or dietary supplements.

Children

Children are a particularly important focus of the Dietary Guidelines for Americans because of the growing body of evidence documenting the vital role that optimal nutrition plays throughout the lifespan. Today, too many children are consuming diets with too many calories and not enough nutrients and are not getting enough physical activity. Approximately 32 percent of children and adolescents ages 2 to 19 years are overweight or obese, with 17 percent of children being obese. In addition, risk factors for adult chronic diseases are increasingly found in younger ages. Eating patterns established in childhood often track into later life, making early intervention on adopting healthy nutrition and physical activity behaviors a priority. 81.1 million Americans, 37 percent of the population, have cardiovascular disease.

Diet-related Chronic Disease

Sources: Diet-related Chronic Disease, USDA, http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/Chapter1.pdf

Major risk factors include high levels of blood cholesterol and other lipids, type 2 diabetes, hypertension (high blood pressure), metabolic syndrome, overweight and obesity, physical inactivity, and tobacco use. 16 percent of the U.S. adult population has high 14 total blood cholesterol.

Cardiovascular Disease

81.1 million Americans—37 percent of the 13 population—have cardiovascular disease.Major risk factors include high levels of blood cholesterol and other lipids, type 2 diabetes, hypertension (high blood pressure), metabolic syndrome, overweight and obesity, physical inactivity, and tobacco use. 16 percent of the U.S. adult population has high 14 total blood cholesterol.

Hypertension

74.5 million Americans, 34 percent of U.S. 15 adults, have hypertension. Hypertension is a major risk factor for heart disease, stroke, congestive heart failure, and kidney disease. Dietary factors that increase blood pressure include excessive sodium and insufficient potassium intake, overweight and obesity, and excess alcohol consumption. 36 percent of American adults have prehypertension, blood pressure numbers that are higher than normal, but not yet in the 16 hypertension range. Nearly 24 million people, almost 11 percent of the population, ages 20 years and older have diabetes. The vast majority of cases are type 2 diabetes, which is heavily influenced by diet and physical activity. About 78 million Americans, 35 percent of the U.S. adult population ages 20 years or 18older, have pre-diabetes. Pre-diabetes (also called impaired glucose tolerance or impaired fasting glucose) means that blood glucose levels are higher than normal, but not high enough to be called diabetes.

Cancer

Almost one in two men and women, approximately 41 percent of the population, will be 19 diagnosed with cancer during their lifetime.Dietary factors are associated with risk of some types of cancer, including breast (post-menopausal), endometrial, colon, kidney, mouth, pharynx, larynx, and esophagus.

Osteoporosis

One out of every two women and one in four men ages 50 years and older will have an 20 osteoporosis-related fracture in their lifetime. About 85 to 90 percent of adult bone mass is acquired by the age of 18 in girls and the age 21of 20 in boys.

Optional Learning Activity:

Implement a nutritionally healthy workplace (e.g., form a potluck lunch group that emphasizes health foods; organize an event where people can taste test a variety of healthy foods that they may not have ever eaten before such as kale)

Food Safety Advice

Source: Food Safety Advice, http://www.choosemyplate.gov/healthy-eating-tips/food-safety-advice.html

Clean: Wash Hands and Surfaces Often

Bacteria can be spread throughout the kitchen and get onto hands, cutting boards, utensils, counter tops, and food. Wash your hands with warm water and soap for at least 20 seconds before and after handling food and after using the bathroom or changing diapers. Wash your hands after playing with pets or visiting petting zoos. Wash your cutting boards, dishes, utensils, and counter tops with hot soapy water after preparing each food item and before you go on to the next food. Consider using paper towels to clean up kitchen surfaces. If you use cloth towels wash them often in the hot cycle of your washing machine. Rinse fresh fruits and vegetables under running tap water, including those with skins and rinds that are not eaten. Rub firm-skinned fruits and vegetables under running tap water or scrub with a clean vegetable brush while rinsing with running tap water. Keep books, backpacks, or shopping bags off the kitchen table or counters where food is prepared or served.

Separate: Don't Cross Contaminate

Cross-contamination is how bacteria can be spread. When handling raw meat, poultry, seafood, and eggs, keep these foods and their juices away from ready-to-eat foods. Always start with a clean scene ― wash hands with warm water and soap. Wash cutting boards, dishes, countertops, and utensils with hot soapy water. Separate raw meat, poultry, seafood, and eggs from other foods in your grocery shopping cart, grocery bags, and in your refrigerator. Use one cutting board for fresh produce and a separate one for raw meat, poultry, and seafood. Use a food thermometer, which measures the internal temperature of cooked meat, poultry, and egg dishes, to make sure that the food is cooked to a safe internal temperature.

Cook: Cook to Proper Temperatures

Food is safely cooked when it reaches a high enough internal temperature to kill the harmful bacteria that cause foodborne illness. Use a food thermometer to measure the internal temperature of cooked foods.
  • Use a food thermometer, which measures the internal temperature of cooked meat, poultry, and egg dishes, to make sure that the food is cooked to a safe internal temperature.
  • Cook beef roasts and steaks to a safe minimum internal temperature of 145°F. Cook pork to a minimum of 160°F. All poultry should reach a safe minimum internal temperature of 165°F throughout the bird, as measured with a food thermometer.
  • Cook ground meat to 160°F. Information from the Centers for Disease Control and Prevention (CDC) links eating undercooked ground beef with a higher risk of illness. Remember, color is not a reliable indicator of doneness. Use a food thermometer to check the internal temperature of your burgers.
  • Cook eggs until the yolk and white are firm, not runny. Don't use recipes in which eggs remain raw or only partially cooked. Casseroles and other dishes containing eggs should be cooked to 160°F.
  • Cook fish to 145°F or until the flesh is opaque and separates easily with a fork.
  • Make sure there are no cold spots in food (where bacteria can survive) when cooking in a microwave oven. For best results, cover food, stir and rotate for even cooking. If there is no turntable, rotate the dish by hand once or twice during cooking.
  • Bring sauces, soups and gravy to a boil when reheating. Heat other leftovers thoroughly to 165°F.
  • Use microwave-safe cookware and plastic wrap when cooking foods in a microwave oven.

Chill: Refrigerate Promptly!

Refrigerate foods quickly because cold temperatures slow the growth of harmful bacteria. Do not over-stuff the refrigerator. Cold air must circulate to help keep food safe. Keeping a constant refrigerator temperature of 40°F or below is one of the most effective ways to reduce the risk of foodborne illness. Use an appliance thermometer to be sure the temperature is consistently 40°F or below. The freezer temperature should be 0°F or below.
  • Refrigerate or freeze meat, poultry, eggs, and other perishables as soon as you get them home from the store.
  • Never let raw meat, poultry, eggs, cooked food, or cut fresh fruits or vegetables sit at room temperature more than two hours before putting them in the refrigerator or freezer (one hour when the temperature is above 90°F).
  • Never defrost food at room temperature. Food must be kept at a safe temperature during thawing. There are three safe ways to defrost food: in the refrigerator, in cold water, and in the microwave using the defrost setting. Food thawed in cold water or in the microwave should be cooked immediately.
  • Always marinate food in the refrigerator.
  • Divide large amounts of leftovers into shallow containers for quicker cooling in the refrigerator.
  • Use or discard refrigerated food on a regular basis.
Some food is safe without a cold source. Items that don't require refrigeration include whole fruits and vegetables, hard cheese, unopened canned meat and fish, chips, breads, crackers, peanut butter, jelly, mustard, and pickles.

Use an insulated container to keep food like soup, chili, and stew hot. Fill the container with boiling water, let stand for a few minutes, empty, and then put in the piping hot food. Keep the insulated container closed until lunchtime to keep the food hot — 140°F or above. ||

Lesson 2: Myths and Misconceptions about Nutrition


Myths and Misconceptions regarding Nutrition

Source: Weight-loss and Nutrition Myths, NIDDK, NIH, http://win.niddk.nih.gov/publications/myths.htm

How Much Do You Know?

Myth: Fad diets work for permanent weight loss.

Fact: Fad diets are not the best way to lose weight and keep it off. Fad diets often promise quick weight loss or tell you to cut certain foods out of your diet. You may lose weight at first on one of these diets. But diets that strictly limit calories or food choices are hard to follow. Most people quickly get tired of them and regain any lost weight. Fad diets may be unhealthy because they may not provide all of the nutrients your body needs. Also, losing weight at a very rapid rate (more than 3 pounds a week after the first couple of weeks) may increase your risk for developing gallstones (clusters of solid material in the gallbladder that can be painful). Diets that provide less than 800 calories per day also could result in heart rhythm abnormalities, which can be fatal. Research suggests that losing 1/2 to 2 pounds a week by making healthy food choices, eating moderate portions, and building physical activity into your daily life is the best way to lose weight and keep it off. By adopting healthy eating and physical activity habits, you may also lower your risk for developing type 2 diabetes, heart disease, and high blood pressure.

“Lose 30 pounds in 30 days!” Eat as much as you want and still lose weight!” “Try the thigh buster and lose inches fast!

And so on, and so on. With so many products and weight-loss theories out there, it is easy to get confused.

Read the following Myths and Facts to help clear up confusion about weight loss, nutrition, and physical activity.

Myth: High-protein/low-carbohydrate diets are a healthy way to lose weight.

Fact: The long-term health effects of a high-protein/low-carbohydrate diet are unknown. But getting most of your daily calories from high-protein foods like meat, eggs, and cheese is not a balanced eating plan. You may be eating too much fat and cholesterol, which may raise heart disease risk. You may be eating too few fruits, vegetables, and whole grains, which may lead to constipation due to lack of dietary fiber. Following a high-protein/low-carbohydrate diet may also make you feel nauseous, tired, and weak. Eating fewer than 130 grams of carbohydrate a day can lead to the buildup of ketones in your blood. Ketones are partially broken-down fats. A buildup of these in your blood (called ketosis) can cause your body to produce high levels of uric acid, which is a risk factor for gout (a painful swelling of the joints) and kidney stones. Ketosis may be especially risky for pregnant women and people with diabetes or kidney disease. Be sure to discuss any changes in your diet with a health care professional, especially if you have health conditions such as cardiovascular disease, kidney disease, or type 2 diabetes.

Tip: High-protein/low-carbohydrate diets are often low in calories because food choices are strictly limited, so they may cause short-term weight loss. But a reduced-calorie eating plan that includes recommended amounts of carbohydrate, protein, and fat will also allow you to lose weight. By following a balanced eating plan, you will not have to stop eating whole classes of foods, such as whole grains, fruits, and vegetables—and miss the key nutrients they contain. You may also find it easier to stick with a diet or eating plan that includes a greater variety of foods.


Myth: Starches are fattening and should be limited when trying to lose weight.

Fact: Many foods high in starch, like bread, rice, pasta, cereals, beans, fruits, and some vegetables (like potatoes and yams) are low in fat and calories. They become high in fat and calories when eaten in large portion sizes or when covered with high-fat toppings like butter, sour cream, or mayonnaise. Foods high in starch (also called complex carbohydrates) are an important source of energy for your body.

Tip: A healthy eating plan is one that:
  • Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products.
  • Includes lean meats, poultry, fish, beans, eggs, and nuts.
  • Is low in saturated fats, transfat, cholesterol, salt (sodium), and added sugars.

Myth: Certain foods, like grapefruit, celery, or cabbage soup, can burn fat and make you lose weight.

Fact: No foods can burn fat. Some foods with caffeine may speed up your metabolism (the way your body uses energy, or calories) for a short time, but they do not cause weight loss.

Tip: The best way to lose weight is to cut back on the number of calories you eat and be more physically active.


Myth: Natural or herbal weight-loss products are safe and effective.

Fact: A weight-loss product that claims to be natural or herbal is not necessarily safe. These products are not usually scientifically tested to prove that they are safe or that they work. For example, herbal products containing ephedra (now banned by the U.S. Government) have caused serious health problems and even death. Newer products that claim to be ephedra-free are not necessarily danger-free, because they may contain ingredients similar to ephedra.

Tip: Talk with your health care provider before using any weight-loss product. Some natural or herbal weight-loss products can be harmful.


Myth: I can lose weight while eating whatever I want."

Fact: To lose weight, you need to use more calories than you eat. It is possible to eat any kind of food you want and lose weight. You need to limit the number of calories you eat every day and/or increase your daily physical activity. Portion control is the key. Try eating smaller amounts of food and choosing foods that are low in calories.

Tip: When trying to lose weight, you can still eat your favorite foods—as long as you pay attention to the total number of calories that you eat.


Myth: Low-fat or fat-free means no calories.

Fact: A low-fat or fat-free food is often lower in calories than the same size portion of the full-fat product. But many processed low-fat or fat-free foods have just as many calories as the full-fat versions of the same foods or even more calories. They may contain added sugar, flour, or starch thickeners to improve flavor and texture after fat is removed. These ingredients add calories. Myth: Fast foods are always an unhealthy choice and you should not eat them when dieting.

Fact: Fast foods can be part of a healthy weight-loss program with a little bit of know-how.

Tip: Avoid supersized combo meals, or split one with a friend. Sip on water or fat-free milk instead of soda. Choose salads and grilled foods, like a grilled chicken breast sandwich or small hamburger. Try a “fresco” taco (with salsa instead of cheese or sauce) at taco stands. Fried foods, like french fries and fried chicken, are high in fat and calories, so order them only once in a while, order a small portion, or split an order with a friend. Also, use only small amounts of high-fat, high-calorie toppings, like regular mayonnaise, salad dressings, bacon, and cheese.


Myth: Skipping meals is a good way to lose weight.

Fact: Studies show that people who skip breakfast and eat fewer times during the day tend to be heavier than people who eat a healthy breakfast and eat four or five times a day. This may be because people who skip meals tend to feel hungrier later on, and eat more than they normally would. It may also be that eating many small meals throughout the day helps people control their appetites.

Tip: Eat small meals throughout the day that include a variety of healthy, low-fat, low-calorie foods.


Myth: Eating after 8 p.m. causes weight gain.

Fact: It does not matter what time of day you eat. It is what and how much you eat and how much physical activity you do during the whole day that determines whether you gain, lose, or maintain your weight. No matter when you eat, your body will store extra calories as fat.

Tip: If you want to have a snack before bedtime, think first about how many calories you have eaten that day. And try to avoid snacking in front of the TV at night—it may be easier to overeat when you are distracted by the television.


Myth: Nuts are fattening and you should not eat them if you want to lose weight.

Fact: In small amounts, nuts can be part of a healthy weight-loss program. Nuts are high in calories and fat. However, most nuts contain healthy fats that do not clog arteries. Nuts are also good sources of protein, dietary fiber, and minerals including magnesium and copper.

Tip: Enjoy small portions of nuts. One-half ounce of mixed nuts has about 84 calories.


Myth: Eating red meat is bad for your health and makes it harder to lose weight.

Fact: Eating lean meat in small amounts can be part of a healthy weight-loss plan. Red meat, pork, chicken, and fish contain some cholesterol and saturated fat (the least healthy kind of fat). They also contain healthy nutrients like protein, iron, and zinc.

Tip: Choose cuts of meat that are lower in fat and trim all visible fat. Lower fat meats include pork tenderloin and beef round steak, tenderloin, sirloin tip, flank steak, and extra lean ground beef. Also, pay attention to portion size. Three ounces of meat or poultry is the size of a deck of cards.


Myth: Dairy products are fattening and unhealthy.

Fact: Low-fat and fat-free milk, yogurt, and cheese are just as nutritious as whole-milk dairy products, but they are lower in fat and calories. Dairy products have many nutrients your body needs. They offer protein to build muscles and help organs work properly, and calcium to strengthen bones. Most milk and some yogurt are fortified with vitamin D to help your body use calcium.

Tip: If you cannot digest lactose (the sugar found in dairy products), choose low-lactose or lactose-free dairy products, or other foods and beverages that offer calcium and vitamin D (listed below).
  • Calcium: soy-based beverage or tofu made with calcium sulfate; canned salmon; dark leafy greens like collards or kale
  • Vitamin D: soy-based beverage or cereal (getting some sunlight on your skin also gives you a small amount of vitamin D)


Myth: Going vegetarian means you are sure to lose weight and be healthier.

Fact: Research shows that people who follow a vegetarian eating plan, on average, eat fewer calories and less fat than nonvegetarians. They also tend to have lower body weights relative to their heights than nonvegetarians. Choosing a vegetarian eating plan with a low fat content may be helpful for weight loss. But vegetarians—like nonvegetarians—can make food choices that contribute to weight gain, like eating large amounts of high-fat, high-calorie foods or foods with little or no nutritional value. Vegetarian diets should be as carefully planned as nonvegetarian diets to make sure they are balanced. Nutrients that nonvegetarians normally get from animal products, but that are not always found in a vegetarian eating plan, are iron, calcium, vitamin D, vitamin B12, zinc, and protein.

Tip: Choose a vegetarian eating plan that is low in fat and that provides all of the nutrients your body needs. Food and beverage sources of nutrients that may be lacking in a vegetarian diet are listed below.
  • Iron: cashews, spinach, lentils, garbanzo beans, fortified bread or cereal
  • Calcium: dairy products, fortified soy-based beverages, tofu made with calcium sulfate, collard greens, kale, broccoli
  • Vitamin D: fortified foods and beverages including milk, soy-based beverages, or cereal Vitamin B12 eggs, dairy products, fortified cereal or soy-based beverages, tempeh, miso (tempeh and miso are foods made from soybeans)
  • Protein: eggs, dairy products, beans, peas, nuts, seeds, tofu, tempeh, soy-based burgers ||

Lesson 3: Ethnic Foods


Tipsheet: Eating Healthy Ethnic Food

Source: Eating Healthy Ethnic Food, NHIBI, NIH, http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/eth_dine.htm

Trying different ethnic cuisines to give yourself a taste treat is possible while counting calories and fat. Many ethnic cuisines offer lots of low-fat, low-calorie choices.
So if you want to eat healthy and still have lots of different choices, take a taste adventure with ethnic foods. Here's a sample of healthy food choices (lower in calories and fat) and terms to look for when making your selection:

Chinese

  • Zheng (steamed)
  • Jum (poached)
  • Kao (roasted)
  • Shao (barbecued)
  • Steamed rice
  • Dishes without MSG added

Italian

  • Red sauces
  • Primavera (no cream)
  • Piccata (lemon)
  • Sun-dried tomatoes
  • Crushed tomatoes
  • Lightly sauteed
  • Grilled

Mexican

  • Spicy chicken
  • Rice and black beans
  • Salsa or picante
  • Soft corn tortillas

Learning Activity 3.1:

Try some of the healthy food recipes in these cookbooks -

Heart Healthy Home Cooking African American Style - With Every Heartbeat is Life
Prepare your favorite African American dishes in ways that protect you and your family from heart disease and stroke. This cookbook provides recipes for 26 tested and tasty favorite African American dishes. Recipes give nutrient analyses that include carbohydrates and protein. Also covers heart healthy food substitutions and food safety.
Delicious Heart Healthy Latino Recipes
Provides recipes for 26 popular easy to prepare taste-tested Latino dishes created in a heart healthy style (lower in fat and sodium than traditional versions). Includes heart healthy food substitutions, food safety, a glossary of international terms

Lesson 4: Dietary Supplements

Dietary Supplements

Source: Wise Use, NCCAM, NIH, http://nccam.nih.gov/health/supplements/wiseuse.htm

What are the benefits and risks of dietary supplements?

Many people take dietary supplements in an effort to be well and stay healthy. With so many dietary supplements available and so many claims made about their health benefits, how can a consumer decide what's safe and effective? This fact sheet provides a general overview of dietary supplements, discusses safety considerations, and suggests sources for additional information.

Key Points

  • Federal regulations for dietary supplements are very different from those for prescription and over-the-counter drugs. For example, a dietary supplement manufacturer does not have to prove a product's safety and effectiveness before it is marketed.
  • If you are thinking about using a dietary supplement, first get information on it from reliable sources. Keep in mind that dietary supplements may interact with medications or other dietary supplements and may contain ingredients not listed on the label.
  • Tell your health care providers about any complementary and alternative practices you use, including dietary supplements. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

About Dietary Supplements

Dietary supplements were defined in a law passed by Congress in 1994 called the Dietary Supplement Health and Education Act (DSHEA). According to DSHEA, a dietary supplement is a product that:
  • Is intended to supplement the diet
  • Contains one or more dietary ingredients (including vitamins, minerals, herbs or other botanicals, amino acids, and certain other substances) or their constituents
  • Is intended to be taken by mouth, in forms such as tablet, capsule, powder, softgel, gelcap, or liquid
  • Is labeled as being a dietary supplement.
Herbal supplements are one type of dietary supplement. An herb is a plant or plant part (such as leaves, flowers, or seeds) that is used for its flavor, scent, and/or therapeutic properties. "Botanical" is often used as a synonym for "herb." An herbal supplement may contain a single herb or mixtures of herbs.
Research has shown that some uses of dietary supplements are effective in preventing or treating diseases. For example, scientists have found that folic acid (a vitamin) prevents certain birth defects, and a regimen of vitamins and zinc can slow the progression of the age- related eye disease macular degeneration. Also, calcium and vitamin D supplements can be helpful in preventing and treating bone loss and osteoporosis (thinning of bone tissue).
Research has also produced some promising results suggesting that other dietary supplements may be helpful for other health conditions (e.g., omega-3 fatty acids for coronary disease), but in most cases, additional research is needed before firm conclusions can be drawn.

Dietary Supplement Use in the United States

A national survey conducted in 2007 found that 17.7 percent of American adults had used "natural products" (i.e., dietary supplements other than vitamins and minerals) in the past 12 months. The most popular products used by adults for health reasons in the past 30 days were fish oil/omega 3/DHA (37.4 percent), glucosamine (19.9 percent), echinacea (19.8 percent), flaxseed oil or pills (15.9 percent), and ginseng (14.1 percent). In another, earlier national survey covering all types of dietary supplements, approximately 52 percent of adult respondents said they had used some type of supplement in the last 30 days; the most commonly reported were multivitamins/multiminerals (35 percent), vitamins E and C (12–13 percent), calcium (10 percent), and B-complex vitamins (5 percent).

Federal Regulation of Dietary Supplements

The Federal Government regulates dietary supplements through the U.S. Food and Drug Administration (FDA). The regulations for dietary supplements are not the same as those for prescription or over-the-counter drugs. In general, the regulations for dietary supplements are less strict.
  • A manufacturer does not have to prove the safety and effectiveness of a dietary supplement before it is marketed. A manufacturer is permitted to say that a dietary supplement addresses a nutrient deficiency, supports health, or is linked to a particular body function (e.g., immunity), if there is research to support the claim. Such a claim must be followed by the words "This statement has not been evaluated by the U.S. Food and Drug Administration (FDA). This product is not intended to diagnose, treat, cure, or prevent any disease."
  • Manufacturers are expected to follow certain "good manufacturing practices" (GMPs) to ensure that dietary supplements are processed consistently and meet quality standards. Requirements for GMPs went into effect in 2008 for large manufacturers and are being phased in for small manufacturers through 2010.
  • Once a dietary supplement is on the market, the FDA monitors safety. If it finds a product to be unsafe, it can take action against the manufacturer and/or distributor, and may issue a warning or require that the product be removed from the marketplace.
Also, once a dietary supplement is on the market, the FDA monitors product information, such as label claims and package inserts. The Federal Trade Commission (FTC) is responsible for regulating product advertising; it requires that all information be truthful and not misleading.
The Federal Government has taken legal action against a number of dietary supplement promoters or Web sites that promote or sell dietary supplements because they have made false or deceptive statements about their products or because marketed products have proven to be unsafe.

Sources of Science-Based Information for Dietary Supplements

It's important to look for reliable sources of information on dietary supplements so you can evaluate the claims that are made about them. The most reliable information on dietary supplements is based on the results of rigorous scientific testing.
To get reliable information on a particular dietary supplement:
  • Ask your health care providers. Even if they do not know about a specific dietary supplement, they may be able to access the latest medical guidance about its uses and risks.
  • Look for scientific research findings on the dietary supplement. The National Center for Complementary and Alternative Medicine (NCCAM) and the National Institutes of Health (NIH) Office of Dietary Supplements (ODS), as well as other Federal agencies, have free publications, clearinghouses, and information on their Web sites.

Safety Considerations of Dietary Supplements

If you are thinking about or are using a dietary supplement, here are some points to keep in mind.
Tell your health care providers about any complementary and alternative practices you use, including dietary supplements. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care. For tips about talking with your health care providers about complementary and alternative medicine (CAM), see NCCAM's Time to Talk campaign at nccam.nih.gov/timetotalk.

It is especially important to talk to your health care provider if you are
  • Thinking about replacing your regular medication with one or more dietary supplements.
  • Taking any medications (whether prescription or over-the-counter), as some dietary supplements have been found to interact with medications.
  • Planning to have surgery. Certain dietary supplements may increase the risk of bleeding or affect the response to anesthesia.
  • Pregnant or nursing a baby, or are considering giving a child a dietary supplement. Most dietary supplements have not been tested in pregnant women, nursing mothers, or children.
If you are taking a dietary supplement, read the label instructions. Talk to your health care provider if you have any questions, particularly about the best dosage for you to take. If you experience any side effects that concern you, stop taking the dietary supplement, and contact your health care provider.

Keep in mind that although many dietary supplements (and some prescription drugs) come from natural sources, "natural" does not always mean "safe." For example, the herbs comfrey and kava can cause serious harm to the liver. Also, a manufacturer's use of the term "standardized" (or "verified" or "certified") does not necessarily guarantee product quality or consistency.
Be aware that an herbal supplement may contain dozens of compounds and that its active ingredients may not be known. Researchers are studying many of these products in an effort to identify active ingredients and understand their effects in the body. Also consider the possibility that what's on the label may not be what's in the bottle. Analyses of dietary supplements sometimes find differences between labeled and actual ingredients.

For example:
  • An herbal supplement may not contain the correct plant species.
  • The amount of the active ingredient may be lower or higher than the label states. That means you may be taking less—or more—of the dietary supplement than you realize.
  • The dietary supplement may be contaminated with other herbs, pesticides, or metals, or even adulterated with unlabeled ingredients such as prescription drugs.

Learning Activity 4.1: Watch this short video from the U.S. Food and Drug Administration, Warning on Body Building Products

Optional Video: Dietary Supplements


Video: Dietary Supplements: Health or Hype?

Much of the information provided in Module 6, Lesson 4: Dietary Supplements is also presented in a 16 minute video titled: Dietary Supplements: Health or Hype?

  • "Walk down the aisle of any supermarket or pharmacy and you are bound to be confronted by shelves full of nutrient supplements, from vitamin A to zinc. But are they worth the staggering prices many people pay for them? What exactly are supplements, and when should they be avoided? This program looks at a wide range of supplements that are currently available and examines their potential impact on elderly consumers, high performance athletes, and pregnant women. Also spotlighting issues of product labeling and celebrity endorsement, this is a much-needed look at an industry which, despite public concerns, is only getting bigger." (from Films Media Group, 1994. Films On Demand,© 2011)

To view this video -
  1. Click on Dietary Supplements: Health or Hype?
  2. Enter your Foothill College Student ID Number
  3. Click on Login

  • Click on the Expand icon (left of Speaker Volume icon) to expand the image to fill the screen.
  • Click on the Play button in the center of the screen or in the bottom left corner.
  • At any time you can press the ESC key on your computer to return to the browser window or you can move your cursor to the bottom of the screen to make the toolbar visible again; then you can pause or adjust the volume.
  • Closed captioning is available for this video. You’ll see a “Turn CC On” button in the upper right hand of the video player. Click on this button to toggle captions on/off

Lesson 5: Body Composition


Body Mass Index (BMI)

Source: Assessing Your Weight and Health Risk, NHIBI, NIH, http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/risk.htm

BMI is a useful measure of overweight and obesity. It is calculated from your height and weight. BMI is an estimate of body fat and a good gauge of your risk for diseases that can occur with more body fat. The higher your BMI, the higher your risk for certain diseases such as heart disease, high blood pressure, type 2 diabetes, gallstones, breathing problems, and certain cancers.
Although BMI can be used for most men and women, it does have some limits:
  • It may overestimate body fat in athletes and others who have a muscular build.
  • It may underestimate body fat in older persons and others who have lost muscle.

How is obesity measured?

Source: Understanding Adult Obesity, WIN, NIDDK, NIH, http://win.niddk.nih.gov/publications/understanding.htm

Measuring the exact amount of a person’s body fat is not easy. The most accurate measures are to weigh a person underwater or in a chamber that uses air displacement to measure body volume, or to use an X-ray test called Dual Energy X-ray Absorptiometry, also known as DEXA. These methods are not practical for the average person, and are done only in research centers with special equipment.
There are simpler methods to estimate body fat. One is to measure the thickness of the layer of fat just under the skin in several parts of the body. Another involves sending a harmless amount of electricity through a person’s body. Results from these methods, however, can be inaccurate if done by an inexperienced person or on someone with extreme obesity.
Because measuring a person’s body fat is difficult, health care professionals often rely on other means to diagnose obesity. Weight-for-height tables, used for decades, have a range of acceptable weights for a person of a given height. One problem with these tables is that there are many versions, all with different weight ranges. Another problem is that they do not distinguish between excess fat and muscle. According to the tables, a very muscular person may be classified obese when he or she is not. The Body Mass Index (BMI) is less likely to misidentify a person’s appropriate weight-for-height range.

Body Mass Index

The BMI is a tool used to assess overweight and obesity and monitor changes in body weight. Like the weight-for-height tables, BMI has its limitations because it does not measure body fat or muscle directly. It is calculated by dividing a person’s weight in pounds by height in inches squared and multiplied by 703.
Men and women can have the same BMI but different body fat percentages. As a rule, women usually have more body fat than men. A bodybuilder with a large muscle mass and low percentage of body fat may have the same BMI as a person who has more body fat. However, a BMI of 30 or higher usually indicates excess body fat.

A BMI of 25 to 29.9 is considered overweight. A person with a BMI of 30 or higher is considered obese. Please review your findings with your health care provider if your BMI is outside of the normal range.

Waist Circumference

Measuring waist circumference helps screen for possible health risks that come with overweight and obesity. If most of your fat is around your waist rather than at your hips, you’re at a higher risk for heart disease and type 2 diabetes. This risk goes up with a waist size that is greater than 35 inches for women or greater than 40 inches for men. To correctly measure your waist, stand and place a tape measure around your middle, just above your hipbones. Measure your waist just after you breathe out.
The table **Risks of Obesity-Associated Diseases by BMI and Waist Circumference** provides you with an idea of whether your BMI combined with your waist circumference increases your risk for developing obesity-associated diseases or conditions.

Body Fat Distribution

Health care professionals are concerned not only with how much fat a person has, but also where the fat is located on the body. Women typically collect fat in their hips and buttocks, giving them a “pear” shape. Men usually build up fat around their bellies, giving them more of an “apple” shape. Of course, some men are pear-shaped and some women become apple-shaped, especially after menopause.
Excess abdominal fat is an important, independent risk factor for disease. Research has shown that waist circumference is directly associated with abdominal fat and can be used in the assessment of the risks associated with obesity or overweight. If you carry fat mainly around your waist, you are more likely to develop obesity-related health problems.
Women with a waist measurement of more than 35 inches and men with a waist measurement of more than 40 inches may have more health risks than people with lower waist measurements because of their body fat distribution.

Learning Activity 5.1:

The BMI Calculator is an easy-to-use online tool to help you estimate body fat. The higher your BMI, the higher your risk of obesity-related disease.
Use the BMI Calculator or BMI Tables to estimate your body fat. The BMI score means the following: || || BMI ||
Underweight
Below 18.5
Normal
18.5–24.9
Overweight
25.0–29.9
Obesity
30.0 and Above



Lesson 6: Obesity


Overweight and Obesity

Source: Information for Health Professionals, NHLBI, NIH,http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/profmats.htm

Overweight and obesity is a serious health problem that affects millions of Americans. These conditions substantially increase the risk of morbidity from hypertension; dyslipidemia; type 2 diabetes; coronary heart disease; stroke; gallbladder disease; osteoarthritis; sleep apnea and respiratory problems; and endometrial, breast, prostate, and colon cancers. Higher body weights also are associated with increases in all-cause mortality.

Adults

According to the National Health and Nutrition Examination Survey (NHANES) data from 2007–08, the overall prevalence of overweight and obesity for adults was 68 percent (approximately 72 percent among men and 64 percent among women).
  • Among women, the overall prevalence of obesity was 35.5 percent.
  • Among men, the overall prevalence of obesity was 32.2 percent.

Children and Teens

This rate, though, remains alarmingly high. Statistics show about 17 percent of American children ages 2 to 19, or 1 in 6, are obese. Further, the latest data continue to suggest that overweight and obesity are having a greater effect on minorities, including blacks and Hispanics.

Understanding Adult Obesity

Source: Understanding Adult Obesity, WIN, NIDDK, NIH, http://win.niddk.nih.gov/publications/understanding.htm

Today, 66 percent of adults in the United States are considered overweight or obese. Obesity puts people at increased risk for chronic diseases such as heart disease, type 2 diabetes, high blood pressure, stroke, and some forms of cancer.

The large number of people considered to be obese and the serious health risks that come with it make understanding its causes and treatment crucial. This fact sheet provides basic information about obesity: What is it? How is it measured? What causes it? What are the health risks? What can you do about it?
What is obesity? Obesity specifically refers to an excessive amount of body fat. “Overweight” refers to an excessive amount of body weight that includes muscle, bone, fat, and water. There are few studies in humans that link direct measurements of total body fat to morbidity and mortality. There are also no official standards identified by the National Institutes of Health (NIH) that define obesity based on the amount or percentage of a person’s total body fat.

What causes obesity?

Obesity occurs when a person consumes more calories from food than he or she burns. Our bodies need calories to sustain life and be physically active, but to maintain weight we need to balance the energy we eat with the energy we use. When a person eats more calories than he or she burns, the energy balance is tipped toward weight gain and obesity. This imbalance between calories-in and calories-out may differ from one person to another. Genetic, environmental, and other factors may all play a part.
Genetic Factors
Obesity tends to run in families, suggesting a genetic cause. However, families also share diet and lifestyle habits that may contribute to obesity. Separating genetic from other influences on obesity is often difficult. Even so, science does show a link between obesity and heredity.
Environmental and Social Factors
Environment strongly influences obesity. Consider that most people in the United States alive today were also alive in 1980, when obesity rates were lower. Since this time, our genetic make-up has not changed, but our environment has.
Environment includes lifestyle behaviors such as what a person eats and his or her level of physical activity. Too often Americans eat out, consume large meals and high-fat foods, and put taste and convenience ahead of nutrition. Also, most people in the United States do not get enough physical activity.
Environment also includes the world around us—our access to places to walk and healthy foods, for example. Today, more people drive long distances to work instead of walking, live in neighborhoods without sidewalks, tend to eat out or get “take out” instead of cooking, or have vending machines with high-calorie, high-fat snacks at their workplace. Our environment often does not support healthy habits.
In addition, social factors including poverty and a lower level of education have been linked to obesity. One reason for this may be that high-calorie processed foods cost less and are easier to find and prepare than healthier foods, such as fresh vegetables and fruits. Other reasons may include inadequate access to safe recreation places or the cost of gym memberships, limiting opportunities for physical activity. However, the link between low socioeconomic status and obesity has not been conclusively established, and recent research shows that obesity is also increasing among high-income groups.
Cultural Factors
An individual’s cultural background may also play a role in his or her weight. For instance, foods specific to certain cultures that are prepared with a lot of fat or salt may hamper one’s weight-loss efforts. Similarly, family gatherings offering large amounts of food may make it difficult to pay attention to proper portion control and serving sizes. Lastly, research has shown that individuals originally from countries other than the United States have difficulty adjusting to the calorie-rich foods offered here. These individuals may not be able to prepare food with the ingredients they would use in their native countries.
Although you cannot change your genetic makeup, you can work on changing your eating habits, levels of physical activity, and other environmental factors. Try these ideas:
  • Learn to choose sensible portions of nutritious meals that are lower in fat.
  • Learn healthier ways to make your favorite foods.
  • Learn to recognize and control environmental cues (like inviting smells or a package of cookies on the counter) that make you want to eat when you are not hungry.
  • Have a healthy snack an hour or two before a social gathering to prevent overeating. Mingle and talk between bites to prevent eating too much too quickly.
  • Engage in at least 30 minutes of moderate-intensity physical activity (like brisk walking) on most, preferably all, days of the week.
  • Take a walk instead of watching television.
  • Eat meals and snacks at a table, not in front of the TV.
  • Pay attention to why you are eating. Determine if you are eating because you are actually hungry or because you are bored, depressed, or lonely.
  • Keep records of your food intake and physical activity.
Other Causes of Obesity
Some illnesses may lead to or are associated with weight gain or obesity. These include:
  • Hypothyroidism, a condition in which the thyroid gland fails to produce enough thyroid hormone. It often results in lowered metabolic rate and loss of vigor.
  • Cushing’s syndrome, a hormonal disorder caused by prolonged exposure of the body’s tissues to high levels of the hormone cortisol. Symptoms vary, but most people have upper body obesity, rounded face, increased fat around the neck, and thinning arms and legs.
  • Polycystic ovary syndrome, a condition characterized by high levels of androgens (male hormone), irregular or missed menstrual cycles, and in some cases, multiple small cysts in the ovaries. Cysts are fluid-filled sacs.
A doctor can tell whether there are underlying medical conditions that are causing weight gain or making weight loss difficult.
Lack of sleep may also contribute to obesity. Recent studies suggest that people with sleep problems may gain weight over time. On the other hand, obesity may contribute to sleep problems due to medical conditions such as sleep apnea, where a person briefly stops breathing at multiple times during the night. (Visit Health Risks for more information on the relationship between sleep apnea and obesity.) You may wish to talk with your health care provider if you have difficulty sleeping.
Certain drugs such as steroids, some antidepressants, and some medications for psychiatric conditions or seizure disorders may cause weight gain. These drugs may slow the rate at which the body burns calories, stimulate appetite, or cause the body to hold on to extra water. Be sure your doctor knows all the medications you are taking (including over-the-counter medications and dietary supplements). He or she may recommend a different medication that has less effect on weight gain.

What are the consequences of obesity?

Health Risks

Obesity is more than a cosmetic problem. Many serious medical conditions have been linked to obesity, including type 2 diabetes, heart disease, high blood pressure, and stroke. Obesity is also linked to higher rates of certain types of cancer. Esophageal cancer has also been associated with obesity.
  • Men who are considered obese are more likely than nonobese men to develop cancer of the colon, rectum, or prostate.
  • Women who are considered obese are more likely than nonobese women to develop cancer of the gallbladder, uterus, cervix, or ovaries.
Other diseases and health problems linked to obesity include:
  • Gallbladder disease and gallstones.
  • Fatty liver disease (also called nonalcoholic steatohepatitis or NASH).
  • Gastroesophageal reflux, or what is sometimes called GERD. This problem occurs when the lower esophageal sphincter does not close properly and stomach contents leak back—or reflux—into the esophagus.
  • Osteoarthritis, a disease in which the joints deteriorate. This is possibly the result of excess weight on the joints.
  • Gout, another disease affecting the joints.
  • Pulmonary (breathing) problems, including sleep apnea, which causes a person to stop breathing for a short time during sleep.
  • Reproductive problems in women, including menstrual irregularities and infertility.
Health care professionals generally agree that the more obese a person is, the more likely he or she is to develop health problems.
Emotional suffering may be one of the most painful parts of obesity. American society emphasizes physical appearance and often equates attractiveness with slimness, especially for women. Such messages may make people considered overweight feel unattractive.
Many people think that individuals who are considered obese are gluttonous, lazy, or both. This is not true. As a result, people who are considered obese often face prejudice or discrimination in the job market, at school, and in social situations. Feelings of rejection, shame, or depression may occur.

Risk Factors for Health Associated With Obesity

Along with being overweight or obese, the following conditions will put you at greater risk for heart disease and other conditions:
Risk Factors
  • High blood pressure (hypertension)
  • High LDL cholesterol ("bad" cholesterol)
  • High triglycerides
  • Family history of premature heart disease
  • Physical inactivity
  • Cigarette smoking
For people who are considered obese (BMI greater than or equal to 30) or those who are overweight (BMI of 25 to 29.9) and have two or more risk factors, it is recommended that you lose weight. Even a small weight loss (between 5 and 10 percent of your current weight) will help lower your risk of developing diseases associated with obesity. People who are overweight, do not have a high waist measurement, and have fewer than two risk factors may need to prevent further weight gain rather than lose weight.
Talk to your doctor to see whether you are at an increased risk and whether you should lose weight. Your doctor will evaluate your BMI, waist measurement, and other risk factors for heart disease.


Learning Activity 7.1:
Watch these two videos about diet and disease:
To view these videos -
  1. Enter your Foothill College Student ID Number (8 digits)
  2. Click on Login

How is obesity treated?

Source: Understanding Adult Obesity, NIDDK, NIH, http://win.niddk.nih.gov/publications/PDFs/understandingobesityrev.pdf

The method of treatment depends on your level of obesity, overall health condition, and readiness to lose weight. Treatment may include a combination of diet, exercise, behavior modification, and sometimes weight-loss drugs. In some cases of extreme obesity, bariatric surgery may be recommended. (Visit http://www.win.niddk.nih.gov/publications/gastric.htm for more information on bariatric surgery.)
Remember, weight control is a life-long effort, and having realistic expectations about weight loss is an important consideration. Eating healthier foods and getting at least 30 minutes of moderate-intensity physical activity on most, preferably all, days of the week have important health benefits. Sixty minutes of physical activity a day may be required to prevent gradual weight gain in adulthood. Individuals who were previously considered overweight and obese individuals are encouraged to get 60 to 90 minutes of exercise a day to sustain weight loss.
Although most adults do not need to see their health care professional before starting a moderate-intensity physical activity program, men older than 40 years and women older than 50 years who plan a vigorous program, or who have either chronic disease or risk factors for chronic illnesses, should speak with their health care provider before starting a physical activity program.

Stigma of Obesity

Source: OpenStax College. Health in the United States. Connexions, May 18, 2012. http://cnx.org/content/m42931/1.2/

What is your reaction to this photo of a man and girl at the beach? Compassion? Fear? Disgust? Many people will look at this picture and make negative assumptions about the man based on his weight. According to a study from the Yale Rudd Center for Food Policy and Obesity, large people are the object of “widespread negative stereotypes that overweight and obese persons are lazy, unmotivated, lacking in self-discipline, less competent, noncompliant, and sloppy” (Puhl and Heuer 2009).
Historically, both in the United States and elsewhere, it was considered acceptable to discriminate against people based on prejudiced opinions. Even after slavery was abolished in 1865, the next 100 years of American history saw institutionalized racism and prejudice against black people. In an example of stereotype interchangeability, the same insults that are flung today at the overweight and obese population (lazy, for instance), have been flung at various racial and ethnic groups in earlier history. Of course, no one gives voice to these kinds of views in public now, except when talking about obese people.Why is it considered acceptable to feel prejudice toward—even to hate—obese people? Puhl and Heuer suggest that these feelings stem from the perception that obesity is preventable through self-control, better diet, and more exercise. Highlighting this contention is the fact that studies have shown that people’s perceptions of obesity are more positive when they think the obesity was caused by non-controllable factors like biology (a thyroid condition, for instance) or genetics.
Even with some understanding of non-controllable factors that might affect obesity, obese people are still subject to stigmatization. Puhl and Heuer’s study is one of many that document discrimination at work, in the media, and even in the medical profession. Obese people are less likely to get into college than thinner people, and they are less likely to succeed at work.

Stigmatization of obese people comes in many forms, from the seemingly benign to the potentially illegal. In movies and television show, overweight people are often portrayed negatively, or as stock characters who are the butt of jokes. One study found that in children’s movies “obesity was equated with negative traits (evil, unattractive, unfriendly, cruel) in 64 percent of the most popular children's videos. In 72 percent of the videos, characters with thin bodies had desirable traits, such as kindness or happiness” (Hines and Thompson 2007). In movies and television for adults, the negative portrayal is often meant to be funny. “Fat suits”—inflatable suits that make people look obese—are commonly used in a way that perpetuates negative stereotypes. Think about the way you have seen obese people portrayed in movies and on television; now think of any other subordinate group being openly denigrated in such a way. It is difficult to find a parallel example.

Lesson 7: Diet and Weight Control


Who should lose weight?

Source: Understanding Adult Obesity, WIN, NIDDK, NIH, http://win.niddk.nih.gov/publications/understanding.htm

Health care professionals generally agree that people who have a BMI of 30 or greater can improve their health through weight loss.This is especially true for people with a BMI of 40 or greater, who are considered extremely obese.
Preventing additional weight gain is recommended if you have a BMI between 25 and 29.9, unless you have other risk factors for obesity-related diseases. Obesity experts recommend you try to lose weight if you have two or more of the following:
  • Family history of certain chronic diseases. If you have close relatives who have had heart disease or diabetes, you are more likely to develop these problems if you are obese.
  • Preexisting medical conditions. High blood pressure, high LDL cholesterol levels, low HDL cholesterol levels, high triglycerides, and high blood glucose are all warning signs of some obesity-associated diseases.
  • Large waist circumference. Men who have waist circumferences greater than 40 inches, and women who have waist circumferences greater than 35 inches, are at higher risk of diabetes, dyslipidemia (abnormal amounts of fat in the blood), high blood pressure, and heart disease.
Fortunately, a weight loss of 5 to 10 percent of your initial body weight can do much to improve health by lowering blood pressure and other risk factors for obesity-related diseases. In addition, research shows that a 5- to 7-percent weight loss brought about by moderate diet and exercise can delay or possibly prevent type 2 diabetes in people at high risk for the disease. In a recent study, participants who were considered overweight and had pre-diabetes—a condition in which a person’s blood glucose level is higher than normal, but not high enough to be classified as diabetes—were able to delay or prevent the onset of type 2 diabetes by adopting a low-fat, low-calorie diet and exercising for 30 minutes a day, 5 days a week.

Selecting a Weight Loss Program

Source: Lose Weight Program, NHLBI, NIH, http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/wtl_prog.htm

Some people lose weight on their own; others like the support of a structured program. Overweight people who are successful at losing weight, and keeping it off, can reduce their risk factors for heart disease. If you decide to join any kind of weight-control program, here are some questions to ask before you join.
  • Does the program provide counseling to help you change your eating activity and personal habits?
    The program should teach you how to change permanently those eating habits and lifestyle factors, such as lack of physical activity, that have contributed to weight gain.
  • Is the staff made up of a variety of qualified counselors and health professionals such as nutritionists, registered dietitians, doctors, nurses, psychologists, and exercise physiologists?
    You need to be evaluated by a physician if you have any health problems, are currently taking any medicine or plan on taking any medicine, or plan to lose more than 15 to 20 pounds. If your weight-control plan uses a very low-calorie diet (a special liquid formula that replaces all food for 1 to 4 months), an exam and followup visits by a doctor also are needed.
  • Is training available on how to deal with times when you may feel stressed and slip back to old habits?
    The program should provide long-term strategies to deal with weight problems you may have in the future. These strategies might include things like setting up a support system and establishing a physical activity routine.
  • Is attention paid to keeping the weight off? How long is this phase?
    Choose a program that teaches skills and techniques to make permanent changes in eating habits and levels of physical activity to prevent weight gain.
  • Are food choices flexible and suitable? Are weight goals set by the client and the health professional?
    The program should consider your food likes and dislikes and your lifestyle when your weight-loss goals are planned.
There are other questions you can ask about how well a weight-loss program works. Because many programs don't gather this information, you may not get answers. But it's still important to ask them:
  • What percentage of people complete the program?
  • What is the average weight loss among people who finish the program?
  • What percentage of people have problems or side effects? What are they?
  • Are there fees or costs for additional items, such as dietary supplements?
Remember, quick weight loss methods don't provide lasting results. Weight-loss methods that rely on diet aids like drinks, prepackaged foods, or diet pills don't work in the long run. Whether you lose weight on your own or with a group, remember that the most important changes are long term. No matter how much weight you have to lose, modest goals and a slow course will increase your chances of both losing the weight and keeping it off.

Optional Learning Activity: Watch this video - 10 Things You Need to Know about Losing Weight (51 minutes)

Guide to Behavior Change

Source: Guide to Behavior Change, NHLBI, NIH, http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/behavior.htm

Your Weight Is Important

Over the past few years it has become clear that weight is an important health issue. Some people who need to lose weight for their health don't recognize it, while others who don't need to lose weight want to get thinner for cosmetic reasons. We understand that in some ways your weight is different from, for example, your cholesterol level or your blood pressure, because you can't see what these are by looking at someone. Many patients have had health care providers who approached their weight in a less-than-sensitive or helpful manner. Some patients may have had health care encounters in which they felt blamed, but not helped. Successful weight management is a long-term challenge.
Weight can affect a person's self-esteem. Excess weight is highly visible and evokes some powerful reactions, however unfairly, from other people and from the people who carry the excess weight. The amount of weight loss needed to improve your health may be much less than you wish to lose, when you consider how you evaluate your weight. Research has shown that your health can be greatly improved by a loss of 5–10 percent of your starting weight. That doesn't mean you have to stop there, but it does mean that an initial goal of losing 5–10 percent of your starting weight is both realistic and valuable.

Behaviors That Will Help You Lose Weight and Maintain It

Set the Right Goals

Setting the right goals is an important first step. Most people trying to lose weight focus on just that one goal: weight loss. However, the most productive areas to focus on are the dietary and physical activity changes that will lead to long-term weight change. Successful weight managers are those who select two or three goals at a time that are manageable.
Useful goals should be (1) specific; (2) attainable (doable); and (3) forgiving (less than perfect). "Exercise more" is a great goal, but it's not specific. "Walk 5 miles every day" is specific and measurable, but is it doable if you're just starting out? "Walk 30 minutes every day" is more attainable, but what happens if you're held up at work one day and there's a thunderstorm during your walking time another day? "Walk 30 minutes, 5 days each week" is specific, doable, and forgiving. In short, a great goal!

Nothing Succeeds Like Success

Shaping is a behavioral technique in which you select a series of short-term goals that get closer and closer to the ultimate goal (e.g., an initial reduction of fat intake from 40 percent of calories to 35 percent of calories, and later to 30 percent). It is based on the concept that "nothing succeeds like success." Shaping uses two important behavioral principles: (1) consecutive goals that move you ahead in small steps are the best way to reach a distant point; and (2) consecutive rewards keep the overall effort invigorated.

Reward Success (But Not With Food)

An effective reward is something that is desirable, timely, and dependent on meeting your goal. The rewards you choose may be material (e.g., a movie or music download, or a payment toward buying a more costly item) or an act of self-kindness (e.g., an afternoon off from work or just an hour of quiet time away from family). Frequent small rewards, earned for meeting smaller goals, are more effective than bigger rewards that require a long, difficult effort.

Balance Your Food Checkbook

"Self-monitoring" refers to observing and recording some aspect of your behavior, such as calorie intake, servings of fruits and vegetables, amount of physical activity, etc., or an outcome of these behaviors, such as weight. Self-monitoring of a behavior can be used at times when you're not sure how you're doing, and at times when you want the behavior to improve. Self-monitoring of a behavior usually moves you closer to the desired direction and can produce "real-time" records for review by you and your health care provider. For example, keeping a record of your physical activity can let you and your provider know quickly how you're doing. When the record shows that your activity is increasing, you'll be encouraged to keep it up. Some patients find that specific self-monitoring forms make it easier, while others prefer to use their own recording system.
While you may or may not wish to weigh yourself frequently while losing weight, regular monitoring of your weight will be essential to help you maintain your lower weight. When keeping a record of your weight, a graph may be more informative than a list of your weights. When weighing yourself and keeping a weight graph or table, however, remember that one day's diet and exercise patterns won't have a measurable effect on your weight the next day. Today's weight is not a true measure of how well you followed your program yesterday, because your body's water weight will change from day to day, and water changes are often the result of things that have nothing to do with your weight-management efforts.

Avoid a Chain Reaction

Stimulus (cue) control involves learning what social or environmental cues seem to encourage undesired eating, and then changing those cues. For example, you may learn from reflection or from self-monitoring records that you're more likely to overeat while watching television, or whenever treats are on display by the office coffee pot, or when around a certain friend. You might then try to change the situation, such as by separating the association of eating from the cue (don't eat while watching television), avoiding or eliminating the cue (leave the coffee room immediately after pouring coffee), or changing the circumstances surrounding the cue (plan to meet your friend in a nonfood setting). In general, visible and reachable food items are often cues for unplanned eating.

Get the Fullness Message

Changing the way you go about eating can make it easier to eat less without feeling deprived. It takes 15 or more minutes for your brain to get the message that you've been fed. Eating slowly will help you feel satisfied. Eating lots of vegetables and fruits can make you feel fuller. Another trick is to use smaller plates so that moderate portions do not appear too small. Changing your eating schedule, or setting one, can be helpful, especially if you tend to skip, or delay, meals and overeat later.

Learning Activity 7.1: Find out about Weight Loss Fraud.
How can you protect yourself?
What should you keep in mind when buying supplements?
How do you spot fraud?

Optional Learning Activity: Read this article - How Sweet It Isn't (Facts and Fears)
  • Should excess sugar consumption be regulated?

Lesson 8: Eating Disorders


Anorexia Nervosa

Source: Anorexia Nervosa,NIH,http://womenshealth.gov/mental-health/illnesses/anorexia-nervosa.cfm

Anorexia nervosa, or anorexia, is a type of eating disorder that mainly affects adolescent girls and young women. A person with this disease has an intense fear of gaining weight and limits the food she eats. She:
  • Has a low body weight
  • Refuses to keep a normal body weight
  • Is extremely afraid of becoming fat
  • Believes she is fat even when she's very thin
  • Misses three (menstrual) periods in a row (for girls/women who have started having their periods)
Anorexia affects your health because it can damage many parts of your body. A person with anorexia will have many of these signs:
  • Loses a lot of weight
  • Talks about weight and food all the time
  • Moves food around the plate; doesn't eat it
  • Weighs food and counts calories
  • Follows a strict diet
  • Won't eat in front of others
  • Ignores/denies hunger
  • Uses extreme measures to lose weight (self-induced vomiting, laxative abuse, diuretic abuse, diet pills, fasting, excessive exercise)
  • Thinks she's fat when she's too thin
  • Gets sick a lot
  • Weighs self several times a day
  • Feels depressed
  • Feels irritable
  • Doesn't socialize
  • Wears baggy clothes to hide appearance

Treatment

A health care team of doctors, nutritionists, and therapists will help the patient get better. They will:
  • Help bring the person back to a normal weight
  • Treat any psychological issues related to anorexia
  • Help the person get rid of any actions or thoughts that cause the eating disorder
Some research suggests that the use of medicines — such as antidepressants, antipsychotics, or mood stabilizers — may sometimes work for anorexic patients. It is thought that these medicines help the mood and anxiety symptoms that often co-exist with anorexia. Other recent studies, however, suggest that antidepressants may not stop some patients with anorexia from relapsing. Also, no medicine has shown to work 100 percent of the time during the important first step of restoring a patient to healthy weight. So, it is not clear if and how medications can help anorexic patients get better, but research is still happening.
Some forms of psychotherapy can help make the psychological reasons for anorexia better. Psychotherapy is sometimes known as "talk therapy." It uses different ways of communicating to change a patient's thoughts or behavior. This kind of therapy can be useful for treating eating disorders in young patients who have not had anorexia for a long time.
Individual counseling can help someone with anorexia. If the patient is young, counseling may involve the whole family. Support groups may also be a part of treatment. In support groups, patients, and families meet and share what they've been through.
Some researchers point out that prescribing medicines and using psychotherapy designed just for anorexic patients works better at treating anorexia than just psychotherapy alone. Whether or not a treatment works, though, depends on the person involved and his or her situation. Unfortunately, no one kind of psychotherapy always works for treating adults with anorexia.
Anorexia Nervosa Fact Sheet — This fact sheet explains anorexia's causes, signs and symptoms, and its effects on the body. It also provides information for pregnant women who have or have had anorexia.

Bulimia Nervosa

Source: Bulimia Nervosa, http://womenshealth.gov/mental-health/illnesses/bulimia-nervosa.cfm

Bulimia nervosa, or bulimia, is a type of eating disorder. Someone with bulimia eats a lot of food in a short amount of time (bingeing) and then tries to get rid of the calories by purging. Purging might be done in these ways:
  • Making oneself throw up
  • Taking laxatives (pills or liquids that increase how fast food moves through your body and leads to a bowel movement)
A person with bulimia may also use these ways to prevent weight gain:
  • Exercising a lot (more than normal)
  • Restricting her eating or not eating at all (like going without food for a day)
  • Taking diuretics (pills that make you urinate)
Bulimia is more than just a problem with food. It's a way of using food to feel in control of other feelings that may seem overwhelming. Purging and other behaviors to prevent weight gain are ways for people with bulimia to feel more in control of their lives and to ease stress and anxiety.
Unlike anorexia, when people are severely underweight, people with bulimia may be underweight, overweight, or have a normal weight. This makes it harder to know if someone has this disease. However, someone with bulimia may have these signs:
  • Thinks about food a lot
  • Binges (normally in secret)
  • Throws up after bingeing
  • Uses laxatives, diet pills, or diuretics to control weight
  • Is depressed
  • Is unhappy and/or thinks a lot about her body shape and weight
  • Eats large amounts of food quickly
  • Goes to the bathroom all the time after she eats (to throw up)
  • Exercises a lot, even during bad weather, fatigue, illness, or injury
  • Unusual swelling of the cheeks or jaw area
  • Cuts and calluses on the back of the hands and knuckles from making herself throw up
  • White enamel of teeth wears away making teeth look clear
  • Doesn't see friends or participate in activities as much
  • Has rules about food — has "good" foods and "bad" foods

Video


Much of the information provided in Module 6, Lesson 8: Eating Disorders is also presented in a 46 minute video titled: The Silent Hunger: Anorexia and Bulimia.
  • "This program answers two important questions: what are eating disorders, and what causes them? The program specifically examines anorexia nervosa, bulimia nervosa, and binge eating syndrome. Seven females who have all suffered from eating disorders, the father of a woman who died as a result of her disorder, and health professionals offer their insights and knowledge. These interviews are highlighted by dramatic sequences designed to encourage a greater understanding of the issues and emotions associated with eating disorders."


Instructions:
  • Click on the Expand icon (left of Speaker Volume icon) to expand the image to fill the screen.
  • Click on the Play button in the center of the screen or in the bottom left corner.
  • At any time you can press the ESC key on your computer to return to the browser window or you can move your cursor to the bottom of the screen to make the toolbar visible again; then you can pause or adjust the volume.
  • Closed captioning is available for this video. You’ll see a “Turn CC On” button in the upper right hand of the video player. Click on this button to toggle captions on/off.
* To view specific segments from this video, click on Segments button then click on the title of the segment that interests you.

Optional: Ten Tips Nutrition Education Series


Ten Tips

Optional: Healthy Weight Menu Planner


Instructions: Designed to guide daily food and meal choices based on one day's calorie allowance. Choose your total number of calories for the day, and then choose a meal.
Menu Planner

Optional: Nutrition and Fitness


Instructions: Quick Guide to Healthy Living: Click on at least 5 topics to explore from this list of links. Be prepared to justify your selections and describe what you learned.
Nutrition & Fitness


Contemporary Health Issues

Open Courseware

This compilation is openly licensed under Creative Commons Attribution-ShareAlike by Judy Baker, September 2012.
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