Learning Objectives

• Outline how energy is stored and retrieved.

• List the complications associated with having too much or too little stored
energy.
• Explain how appetite is regulated, including the key molecules involved.
• Describe methods for assessing body size and list their strengths and
limitations.
• Outline the complex causes of obesity.
• Provide strategies for achieving and maintaining a healthy energy balance.
• Give an overview of eating disorders, including their characteristics, risk
factors and health outcomes.
An Overview of Energy
Balance
Key Terms
• Energy = ability to do work
• Energy intake = total energy consumed
from food
• Energy expenditure = energy used to
fuel basal metabolism, physical activity,
processing food
• Energy balance = when energy intake =
energy expenditure
Energy Intake
• Carbohydrates,
lipids, proteins =
the three energy-
yielding nutrients
• Alcohol (7 kcal/g)
also provides
energy, but not a
nutrient
Energy Expenditure
• We burn energy for three main purposes:
• Basal metabolic rate (~60-75%)
• Diet-induced thermogenesis(~10%)
• Physical activity (~15-30%)
Basal Metabolic Rate (BMR)
• BMR = the amount of energy the body needs to perform its most
basic, life-sustaining functions over a period of time
• Ex. Breathing, heart beat, nerve signalling
• When we say someone has a fast metabolism, we typically mean that
they burn a lot of calories to sustain their body, even before physical
activity is factored in
• They may therefore be less likely to gain fat mass
Factors that Determine BMR
• Main
controllable
factor = lean
body mass
Diet-Induced Thermogenesis
• AKA specific dynamic action, thermic
effect of food
• = energy that is used and dissipated as
heat following food intake
• More energy is required to process
protein compared to other nutrients
• However, at most, DIT accounts for 15% of
energy expenditure
Physical Activity
• = voluntary movements of the body that
burns energy
• It is the portion of energy expenditure that is
most under our control
• All daily movements contribute to it
Energy Intake vs.
Energy Expenditure
Energy
Storage
 Weight Gain

• Occurs due to an increase in:

• Fat mass
• i.e. Due to consistent energy surplus
• Lean mass
• ex. Increased muscle weight
• Water mass
• can fluctuate from day to day
• Glycogen storage
• max = 1-2 kg of weight
Energy
Retrieval
• An energy deficit
occurs when energy
intake is less than
energy expenditure
• When a consistent
energy deficit is
maintained, lipids are
removed from
adipocytes,
decreasing fat mass
and weight
 Weight Loss
• Occurs due to a decrease in:
• Fat mass
• i.e. Due to consistent energy deficit
• Lean mass
• ex. decreased muscle weight due to
proteins being broken down for
energy
• Decreases with age
• Water mass
• can fluctuate from day to day
• Glycogen storage
• max = 1-2 kg of weight
Obesity
 Energy Storage
• When energy intake is higher
than energy expenditure,
excess energy is mainly stored
as lipid within our adipocytes,
found within adipose tissue
• As adipocytes grow in size and
number, fat mass and total
weight increase
Adipocytes and Adipokines
• Adipocytes secrete adipokines =
messengers that communicate
with other body tissues
• Ex. leptin
• Below a certain level of fat mass,
adipokine secretion has a health-
promoting maintaining effect
• Above a certain level of fat mass
(obesity), adipokines are more
likely to promote low-grade
inflammation and disease
Leptin: The Fullness Hormone
• Leptin is an adipokine that acts on the
brain’s hypothalamus to promote satiety
(fullness)
• When our fat cells get larger, more leptin is
released – this decreases appetite,
promoting an energy deficit
• If leptin production is genetically
compromised (extremely rare), obesity
results quickly
• Many individuals with obesity are leptin
resistant
Obesity is a Chronic Disease
• Canadian Medical Association declared obesity a disease in 2015
• Has a long duration, requires a long-term, systematic approach to
management, occurs due to both genetic and lifestyle factors
• Has physical, mental and social effects
Determinants of Body
Size
 Evidence for the Link Between Genetics and
Obesity
• Identical twins have a stronger correlation in BMI
than fraternal twins
• When identical twins are overfed, they gain an
amount of weight similar to each other, but
different to others
• We are likely to have a similar body size/shape to
our mother/father at our age
• Genome-wide association studies (next slide)
have found ~100 mutations that are more
common in individuals with obesity
• Mainly found around genes associated with appetite
 Genetics and Obesity
• Obesity is rarely caused by a single gene mutation (monogenetic)
• It is polygenic in nature
The Complex Causes of Obesity
 Food Consumption
• Appetite = drive to consume food
• Hunger = physiological need to
consume food
• Satiety = sense of fullness that
makes us stop eating and keeps us
feeling full until the next meal
• Our appetite and satiety centers are
found within the brain’s
hypothalamus
• Receives constant cues that affect
appetite
Food Production
• The abundance of food and food cues
in our environment promote a
constant stream of signals to provoke
high energy consumption
• = obesogenic environment
• Our thoughts interpret what we see,
connect it with memory and emotion,
and a message may then be sent to our
appetite centre about it
• Also, many food offerings are energy-
dense and nutrient-poor
Individual Psychology
• Stress, mental health status and the
way we think about ourselves and our
bodies can affect both how much we
eat and how much we exercise
• Recall: our emotional brain
communicates with our appetite center
• Sometimes we are not hungry but want to
eat in order to cope with something else
that is going on
• Food has a rewarding effect on the brain
Social Psychology
• = psychology of our social
surroundings
• Can affect food preferences,
body size acceptance, physical
activity….
• Our perceived lack of time
may compromise our ability
to eat healthy and be active
 Individual Physical Activity
• = main controllable factor that affects
energy expenditure
• Our childhood experiences, physical
capacities and perceptions of physical
activity can increase/decrease desire
to be active.
• Furthermore, how much we move our
body at work and in our leisure time
all contribute to our total energy
expenditure.
 Physical Activity Environment

• Both the natural and built

environment can affect
our activity levels
• Infrastructure, urban
planning, transit, safety,
weather can all affect
activity level
• Governments can help
promote a better physical
activity environment
 Physiology
• We all handle energy
differently
• Ex. Different BMRs,
hormonal activity, genetics
• Also, differences in
microbiome and appetite
regulation can have
significant effects on energy
balance
 Microbiome and Energy Balance
• Individuals with obesity are more likely to
have more Firmicutes in their colon
• These bacteria are better at harvesting
energy from food, increasing energy intake
• There is also mounting evidence of a gut-
brain axis that increases obesity risk
• =communication between microbiota and
brain
• May affect appetite etc.
Key Appetite Hormones
Body Composition
Body Composition

• = proportion of fat mass vs.

lean mass on body
• A body that has more lean
mass and less fat mass is
associated with health
 Weight and Percent Body Fat
• Weight cannot fully capture body
composition
• Body Mass Index (BMI) considers body
height and weight, but still does not
capture body composition
• Percent body fat expresses fat mass as
a percentage of total mass
• Better at determining body composition
Visceral vs.
Subcutaneous Fat
• Visceral adiposity
is associated with
higher disease risk
 Measuring Body Composition
Gold standards for measuring body comp

• DEXA/ dual X-ray absorptiometry = low dose X-ray that scans the body
in two planes
• Gives image of the body used to determine body composition
• Can also indicate bone density
• Air/Water Displacement
Measuring Body Composition

Skin Folds Bioelectric Impedance

Body Mass Index
• Useful for population-level data
• Main limitation = does not fully capture body composition
Waist Circumference
• Often used in combination with BMI
to better assess body composition
• If BMI > 30 and waist circumference
is above a threshold = obesity, higher
health risk
• Threshold:
• Men: 102 cm
• Women: 88 cm
Weight Management
Weight Loss
• Based on one key
concept: consistent
energy deficit
• Many strategies can
achieve this
• But are they:
• Healthy?
• Sustainable?
• Compatible with our
lives?
National Weight Control Registry
• Database of people
who have lost 30+ lbs
and kept them off for
at least two years
Decreasing Food Intake
• Many ways to achieve this,
including:
• Tracking food intake/calories
• Portion control
• Hunger control
• Whole foods, protein, fibre,
volume-rich foods, eating slowly,
eating smaller meals more often
• Willpower (next slide)
 Willpower
• = our thinking brain’s ability
to override other signals
• Cannot always be relied on
• Can be exhausted
• Is lowest at the end of the day
• Recommend using skillpower
in addition to willpower
Physical Activity for Energy Balance
• Physical activity is one of the best things we can do for our overall
health
• However, very high levels are needed to promote weight loss
Psychological Aspects of Weight Loss and
Maintenance
• Our psychological health impacts
appetite, desire to be active
• Self-efficacy = belief in our ability
to achieve a certain task
• Setting small, achievable goals,
celebrating victories, affirming
thoughts can help build it
Psychological Aspects of Weight Loss and
Maintenance
• Emotional eating may be used to cope
with negative emotions, feelings
• Positive coping, psychology mechanisms
may help decrease it
• Ex. Talking to others, spending time in nature,
journaling, crying, speaking to a counsellor
• Mindfulness may also help
• = practice of being aware of and experiencing
the present moment with a judgement-free,
curious approach
• ex. Mindful eating, mindfulness meditation
 Fad Diets
• = ones that are
popular for a period
• Often promise quick
results that are not
sustainable
Fad Diet Red Flags
Weight Gain
• Some people have a lower body weight and struggle to gain weight
• May be due to genetics, higher BMR
• Best way to increase lean body mass is through muscle-building
exercises
• Can also increase fat mass by increasing caloric intake
 Our Best Weight
• “…whatever weight [we] achieve while
living the healthiest lifestyle [we] can
truly enjoy. There comes a point when
a person cannot simply eat less or
exercise more and still like their life
(Sharma & Freedhoff, 2010).”
• = one that supports physical, mental,
social wellbeing
Pharmaceutical Interventions for Obesity
• Orlistat
• Blocks the activity of lipase in small intestine
• Fat absorption, caloric intake decrease
• Liraglutide
• Increases the activity of GLP-1
• Promotes satiety
• Naltrexone/Bupropion
• Reduces food cravings by altering the reward circuit in the brain that drives
food-seeking behaviour
Bariatric Surgery
Eating Disorders
Risk Factors for Eating Disorders (EDs)
• EDs are multifactorial
• Contributing factors may include:
• Genetics
• Female gender
• Socio-cultural factors
• Ex. Pressure to be thin
• Personality
• Ex. Perfectionism, sensitivity towards
reward and punishment
• History of sexual/physical abuse
 Binge Eating
• Occurs in bulimia and binge eating
disorder and sometimes in anorexia
• Main symptom = loss of control
eating
• A bingeing episode:
• Occurs in a specific amount of time (ex.
2 hours)
• Typically occurs in the absence of
hunger, is typically at a fast rate, occurs
while the person is alone, and is
associated with feelings of guilt and
shame
Bulimia Nervosa
• Involves binge eating episode + compensation
• Ex. Vomiting, excessive exercise, laxatives
• Risk Factors:
• Preoccupation with food
• Distorted perceptions around body weight
• Depression
• Frequent dieting increase risk
• Vomiting can damage teeth, cause electrolyte imbalances
Binge Eating Disorder
• Most common eating disorder
• Binge eating without compensation
• Promotes obesity and its related
complications
• Risk factors include:
• Frequent dieting
• Inability to interpret hunger/satiety
signals
Anorexia Nervosa
• = significant restriction in energy intake
leading to a unhealthfully low body
weight
• Individuals with anorexia often:
• Have an intense fear of weight gain
• Feel disturbed by their weight/shape
• Struggle with self-worth and acceptance
• Experience amenorrhea
• It is the psychiatric disorder with the
highest mortality rate
Night Eating Syndrome
• Currently not recognized as
own eating disorder
• Increases obesity risk
• Proposed diagnostic criteria:
• Abnormal increase in food
intake at night
• >25% of calories consumed after
dinner
• Lack of morning hunger
• Insomnia
 Orthorexia Nervosa
• = an obsession with eating healthy that has negative
psychological implications
• it is the obsession and negative mental health implications of
these restrictions that may cause it to be a disordered eating
pattern
• Also, increases risk for micronutrient deficiencies
• Believed to be promoted by societal pressure toward
‘clean eating’
• Signs:
• Compulsively checking nutrition labels
• Cutting out foods, nutrients, etc.
• Limiting food intake to narrow range of foods
Treatment for Eating Disorders
• Typically begins with diagnosis by
health care professional
• However, symptoms often go
unrecognized
• Main treatment strategies are
psychological
• Medication may also be prescribed
• Ex. Cognitive behavioural therapy (CBT)
Recommendations
• Achieve a healthy energy balance by moderating caloric intake and
regularly participating in physical activity.
• To lose fat mass, consume less calories than are expended.
• To gain fat mass, consume more calories than are expended.
• Individualize fat loss programs to support physical, mental and social
wellbeing.
• Practice self-care, mindfulness, and skillpower.
• Participate in regular physical activity to promote health.
Recommendations
• To manage energy balance, follow the physical activity
recommendations outlined in Table 10.3.
• Avoid fad diets.
• Consult a doctor for potential medical interventions if obesity is
significantly impacting physical and mental health and lifestyle
interventions are insufficient.
• Recognize the signs and symptoms of eating disorders.
• Consult a doctor, psychologist or psychiatrist if an eating disorder is
present.