Jamie Pope, Steven Nizielski, and Alison McCook

NUTRITION
for a Changing World
SECOND EDITION

Chapter 11
Energy Balance and Obesity
The Sitting Disease

© 2022 by W. H. Freeman and Company & Scientific American

 • List the health consequences associated with
obesity, and describe how excess body fat
increases the risk of developing these
conditions
• Describe the concept of energy balance
• Identify and describe the components of total
energy expenditure
• Describe factors that affect basal metabolic
rate

Objectives
• Describe activities that are examples of
nonexercise activity thermogenesis (NEAT)
• Describe factors that contribute to the
development of obesity
• Use body mass index and waist
circumference to evaluate someone’s risk of
chronic disease
• Describe methods for determining body
composition
• Discuss strategies for successful weight loss
and maintenance
Health Consequences of Obesity
 Obesity

• Complex disease influenced

by multiple factors
• Genetics
• Environment
America’s • A dietary pattern high in
energy dense foods
Health • Behavior
• Almost 42.4% of U.S. adults
Crisis as of 2018 (39.8%)

Overweight

• Over 70% of U.S. adults as of

2018
Prevalence of Obesity in the United States
 CDC –
February
2020
 Ene
Capacity to do work
rgy

Energy required to raise

Cal
orie
1 g of water by 1°C

Energy In, Energy required to raise

Kilo
1 kg of water by 1°C
Energy calo
rie

Out Ene Energy we consume

rgy
in

Ene Energy we burn

rgy
out
Energy Balance

1 pound = 3,500 calories

Excess Body
Fat

• Enlarged fat cells produce

excess hormones and
hormone-like messengers
• Hormones cause low-
grade inflammation
• Increases the risk of
__________________
__________________
 Short-term system

• Mediated by hormones
• ___________
• “Go Hormone”
• “Hunger Hormone”
• Mediated by stomach pressure
Biology of • Secreted by the stomach
• Regulates hunger and satiety
Hunger
Long-term system

• Mediated by hormones
• ______________
• Adjusts food intake and energy
expenditure
• Maintains adequate fat stores
Hormones in Energy Balance
 Satiation

• _____________________
• Leads to termination of a meal

Satiety
Factors • _______________________
Affecting • Lacking interest in food
• Best way to increase satiety is to
Fullness eat foods high in fiber and protein

Gastric distention

Gut peptides
 Hunger

Hunger Appetite
and
• Liking or wanting of food
Appetite • A product of sensory stimuli
and perceived pleasure
• Affected by sight of food,
smell of food,
advertisement of food
Components of Energy Expenditure

• Total energy expenditure (TEE)

Energy • Basal metabolic rate (BMR)
Expenditure • Thermic effect of food (TEF)
• Activity energy expenditure (AEE)
 Basal Metabolism
• Energy expenditure required to maintain
essential functions that sustain life
– Chemical reactions in cells
– Maintenance of muscle tone
– Work done by heart, lungs, liver, brain, and
kidneys
– Active transport of electrolytes and other nutrients
• Largest component of total energy expenditure
(TEE)
– ~66% of TEE
Estimating BMR
Factors that Affect Basal Metabolic Rate (BMR)
 Thermic Effect of Food (TEF)

• Energy needed to digest, absorb, and

metabolize nutrients in our food
• Generally equivalent to 10% of the energy
content of the food ingested
• Does not vary greatly between people
Activity Energy
Expenditure

• Exercise
• Nonexercise activity
thermogenesis (NEAT)
• Activities of daily
living
The Sitting Disease
Lifestyle and Energy Balance
 What Is a
Healthy Body
Weight?

• Body Mass Index

(BMI)
– Body weight
(kg)/height2
(m2)

• Should not be
used for:
 Body Mass Index (BMI)
• BMI is an indirect measure of body fat
calculated from a person’s weight and height
• The greater the BMI, the higher the risk of
obesity-associated diseases
– Underweight < 18.5 kg/m²
– Normal weight 18.5–24.9 kg/m²
– Overweight 25–29.9 kg/m²
– Obese > 30 kg/m²
Calculating BMI
 Estimator of abdominal
obesity
Waist circumference Waist circumference
exceeds exceeds
___________________ ________________

Waist
Circumference

Visceral fat is an
independent health risk
Cardiovascular Type 2 Premature all-
disease diabetes cause mortality
Distribution of Body Fat

______________
______________
______________
______________
______________
______________
Measuring Waist Circumference
Analyzing Body Composition
 • Weight loss recommended for anyone
with a BMI of 30 or greater and anyone
overweight with two or more other risk
factors:
– Elevated waist circumference
– Cardiovascular disease
– Family history of cardiovascular
Weight Loss disease
Recommendations – Smoking
– Hypertension
– Diabetes
– Physical inactivity
– Age (men 45 years or older;
women 55 years or older or
postmenopausal)
 • Even a modest reduction of body
weight results in health
improvements.
Weight • Losing ______________ of body
weight and then maintaining that
Loss lower weight can reduce the risk of
chronic disease and all-cause
mortality by about 50%.
Surgical Approaches to
Weight Loss

Reserved for Benefit

extreme obesity should be
• BMI > 40 kg/m²
greater
• BMI > 35 kg/m²
with the presence
than
of one or more significant
risk factors risk
Surgical Treatments for Obesity
 • Effective approaches
– Increase physical activity
– Reduce calorie intake and eat
Dietary and nutrient-dense foods
Lifestyle – Eat a moderately low-fat diet
(less than 30% of calories)
Approaches – Eat a moderately high-protein
to Weight diet (25% to 30% of calories)
Loss – Include plenty of nonstarchy
vegetables, fruit, whole grains
with high fiber, and lean sources
of protein
Determine Your Estimated Energy Requirement
Weight Loss Maintenance
 • Obesity is at epidemic proportions in the United State,
with more than two-thirds of adults classified as
overweight or obese.
• Obesity increases the risk of multiple chronic diseases
and premature death. Hormonal changes associated with
excess body fat cause a low-grade chronic inflammation
throughout the body that has adverse health effects.
• Energy, the capacity to do work, is required to perform all
functions necessary to sustain life. It is obtained through
the breakdown of carbohydrates, fats, proteins, and

Summary •
alcohol in food.
A calorie is defined as the energy required to raise 1 gram
of water by 1°C. The energy in food is commonly
measured in units of kilocalories (1000 calories); 1
kilocalorie (kcal) is the energy required to raise 1 kilogram
of water by 1°C.
• Energy balance reflects energy intake versus expenditure.
Although many factors contribute to the development of
obesity, fundamentally it results from chronic positive
energy balance. Negative energy balance is necessary for
weight loss.
 • Energy balance and food intake are regulated
through a short-term system and a long-term
system.
– The short-term system, which is mediated by
hormones and stomach pressure, is
responsible for triggering hunger and satiety
during individual meals.
– The long-term system, which is mediated by
a different set of hormones, adjusts food

Summary •
intake and energy expenditure to maintain
adequate fat stores.
Satiation is the sense of fullness we feel while
eating and leads to the termination of a meal.
Satiety is the effect that the meal has on our
interest in food and hunger levels after and
between meals.
• The hormone ghrelin stimulates hunger by
activating specific neurons in the brain.
Circulating levels of ghrelin in the blood increase
just before meals and decrease after eating.
 • The hormone leptin is produced
primarily by adipose (fat) tissue and
has a role in long-term energy
balance. Its circulating
concentration is closely associated
with total body fat.
• Hunger is the biological impulse
that drives us to seek out food and
Summary consume it to meet our energy
needs. Appetite is a desire for or
liking of food for reasons other than,
or in addition to, hunger.
• Total energy expenditure (TEE) is
composed of basal metabolism, the
thermic effect of food, and activity
energy expenditure (AEE).
 • Basal metabolism is the energy expenditure
required to maintain the essential functions that
sustain life. It accounts for about 60% of TEE
in a typical sedentary individual, with most
variation from person to person attributable to
differences in fat-free mass.
• Thermic effect of food (TEF) is the energy
needed to digest, absorb, and metabolize
nutrients in our food. TEF is generally
equivalent to 10% of the energy content of the
Summary food ingested and does not vary greatly
between people.
• Activity energy expenditure is the amount of
energy individuals expend in physical activity
per day and is the most variable component of
TEE.
• Body mass index (BMI) is an indirect measure
of body fat, calculated from a person’s weight
and height. “Underweight,” “normal,”
“overweight,” and “obese” are labels for ranges
of body weight on the BMI scale.
 • The greater the BMI, the higher the risk
of premature mortality and the risk of
obesity-associated diseases. A BMI in
the underweight range is also
associated with increased premature
mortality.
• Waist circumference indicates body fat
distribution and the presence of excess
Summary visceral fat, which has been shown to
be an independent health risk.
• Body composition can be measured in
a variety of ways, including skinfold
thickness with calipers, underwater
weighing, air displacement, bioelectrical
impedance, and dual-energy x-ray
absorptiometry.
 • Weight loss, including dietary modifications
and increased physical activity, is
recommended for anyone with a BMI of 30 or
greater or individuals who are overweight and
have two or more risk factors, or have an
elevated waist circumference. For those with
extreme obesity (BMI of at least 40 or BMI of at
least 35 with additional risk factors), weight
loss (bariatric) surgery may be recommended.

Summary • Modest weight loss (5% to 10% of body

weight) and maintenance of the lower weight
can improve health, as well as reduce the risk
of chronic diseases and premature death.
• Healthy weight loss plans maximize nutrient
density while reducing calorie intake; increase
physical activity; incorporate behavioral
strategies to enhance compliance; address
individual health concerns; and consider
maintenance of a lower body weight.