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Body weight is often treated as the primary measure of health, but in reality, it represents only a small part of the picture<\/strong>.<\/strong> In this chapter, we challenge the overemphasis on body weight and instead advocate for a more comprehensive understanding of health\u2014one that encompasses metabolic health (such as blood pressure, blood glucose, A1c, HDL, LDL, triglycerides), body composition, physical activity, and overall well-being.<\/p>\n\n

We will delve into the significance of metabolic health and body composition, highlighting how individuals can be healthy at any size. This perspective is especially important for athletes, who often face pressure to meet specific body standards for performance. However, it\u2019s equally relevant for the general population, where long-term health can be maintained through balanced nutrition and regular physical activity.<\/p>\n\n

Additionally, we\u2019ll address the impact of eating disorders and disordered eating. The intense focus on body weight and appearance can lead to harmful behaviors that affect both physical and mental health. We\u2019ll explore the unique challenges athletes face in this regard and discuss ways to support them in navigating these pressures while fostering a positive relationship with food and exercise.<\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"322a722f-c33e-47ad-a674-c419c6c4d0e3"},"useSeparator":"auto"}]},"library":"H5P.Column 1.18","subContentId":"0a2cce9e-813b-4dd8-b015-6a6191dd7a28","metadata":{"contentType":"Column","license":"U","title":"Introduction"}},{"params":{"content":[{"content":{"params":{"text":"

The concept of \"ideal body weight\" concerns me. <\/strong>It is my professional belief that each of us should be eating healthfully (not just saying it but doing it), exercising healthfully, and then allowing our body weight to go where it wants to go. However, medical doctors, public health officials, and others needed to find a simple tool to look at patterns of weight gain in the U.S.A. and elsewhere. The easy tool that was developed is called the Body Mass Index (BMI). BMI is a tool meant to tell an individual if they weigh too much, too little, or just right. BMI uses the information that we already have readily available from every doctor's visit: weight and height. The general idea is if you are very tall and have a low weight you are probably underweight. If you are very short and you weigh a lot you are probably overweight. It is a crude tool but one that can quickly, inexpensively give estimates of overweight and\/or underweight.<\/p>\n\n

\"Overweight\"<\/span> <\/strong>refers to having more weight than is typical for a particular height. That weight may be the result of water weight, muscle weight, or fat mass. \"Obese\"<\/span> <\/strong>refers specifically to having excess body fat. In most cases, people who are overweight also have excessive body fat and therefore body weight is an indicator of obesity in much of the population.<\/p>\n\n

The \u201cideal\u201d healthy body weight for a particular person is dependent on many things, such as frame size, sex (hormone profile), muscle mass, bone density, age, and height. The perception of the \u201cideal\u201d body weight can be additionally dependent on cultural factors and the mainstream societal advertisement of beauty.<\/p>\n\n

Although the terms \"overweight\" and \"obese\" are often used interchangeably and considered as gradations of the same thing, they can denote different things. You weigh what you weigh because of your: <\/p>\n\n

\n\t
water weight, <\/li>\n\t
lean muscle weight,<\/li>\n\t
bone weight, and<\/li>\n\t
weight from body fat (adipose). <\/li>\n<\/ul>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"f64b4a15-2ba7-412e-826b-158dbacd46e8"},"useSeparator":"auto"},{"content":{"params":{"text":"
With all of this in mind, we will explore the big question of \"What weight should you weigh?\" This has been a difficult question to answer because humans come in so many different sizes and shapes. We do know that carrying too much fat is not good for one's health. What is too much? That too varies because, as was just stated, humans come in many different shapes and sizes. We have different calculations we can use to determine \"ideal body weight\" and Body Mass Index (BMI). These are inexpensive and quick calculations that provide extremely broad estimates. <\/p>\n\n
Ideal body weight (IBW) has been used to determine one's \"desirable weight\". I put this in quotes, because weight changes with time and is impacted by many factors. Usually, IBW is determined by reference weight-for-height charts and the most commonly used chart is the Metropolitan Life Insurance Tables which include data for men and women by height and frame size. Hamwi is another method that does not require reading a table. Instead, it is a calculation:<\/p>\n\n
\n\t
Males: 106 lbs for 5' in height plus 6 lbs for every inch over<\/li>\n\t
Females: 100 lbs for 5' in height plus 5 lbs for every inch over<\/li>\n<\/ul>\n\n
If the individual has a large frame, then the number is increased by 10% and if that person's frame is small, then 10% is subtracted from the number. Once you have calculated their suggested weight, the following interpretative guidelines can be applied. If the person's weight is a certain percent over then they would be considered:<\/p>\n\n
\n\t
Overweight if greater than 10% over IBW<\/li>\n\t
Mild obesity if greater than 20% over IBW<\/li>\n\t
Moderate obesity if greater than 40% over IBW<\/li>\n\t
Severe obesity if greater than 100% over IBW<\/li>\n<\/ul>\n\n
There are limitations to both methods. Neither method is based on a representative population or all populations. The Metropolitan Life Insurance tables are based on mortality risk, not just obesity. Finally, there are many examples of people who are defined as overweight but don't have excess fat stores, for example, body builders and weight lifters.<\/p>\n\n
Example of the Hamwai Equation<\/strong><\/p>\n\n
185 lb male, 5'9\" tall: 106 lb + (6 lb x 9 inch) = 160 lb<\/p>\n\n
We don't know frame size and weight is somewhat arbitrary, so we're going to give the +\/- 10% range: 160 x 0.10 = 16 lb. When we look at the high and low end of the estimated range per the Hamwi equation, we find out that the range is 144 lb to 176 lb for this person.<\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"880554a7-e934-4415-8014-292306990c92"},"useSeparator":"auto"},{"content":{"params":{"decorative":true,"contentName":"Image","expandImage":"Expand Image","minimizeImage":"Minimize Image","file":{"path":"images\/file-6827b20e295dc.png","mime":"image\/png","copyright":{"license":"U"},"width":500,"height":385},"title":"Obesity and BMI. (CC BY-SA 4.0; BruceBlaus)"},"library":"H5P.Image 1.1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"},"subContentId":"8b2d9800-3ec4-4836-af12-7a24cee70be5"},"useSeparator":"auto"},{"content":{"params":{"text":"
The Body Mass Index (BMI) and Its Limitations<\/strong><\/h2>\n\n
Body mass index (BMI)<\/span> is calculated using height<\/strong> and weight<\/strong> measurements and is more predictive of a health risk than using weight alone. BMI measurements are used to indicate whether an individual may be underweight (with a BMI less than 18.5), overweight (with a BMI over 25), or obese (with a BMI over 30). Very high AND very low BMIs appear to increase a person's risk of dying. If you look at a graph of BMI (Figure 6.7.1) as it relates to your risk of dying, it has a \"J-shaped curve\" or a \"U-shaped curve\" because being too low and\/or too high both raise your risk of mortality. Instead, you'd like to be in the middle range of the BMI which is what they use for \"Normal weight\". You will notice that, even though you will be categorized as \"overweight\" at a BMI of 25 and \"obese\" at a BMI of 30, the risk of dying goes up gradually. Like a teacher assigning a letter grade, the decision of exactly where to draw the lines for underweight, normal weight, overweight and obese are somewhat arbitrary.<\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"ab8564f7-d04c-4afb-9f4a-48c85df79713"},"useSeparator":"auto"},{"content":{"params":{"decorative":true,"contentName":"Image","expandImage":"Expand Image","minimizeImage":"Minimize Image","file":{"path":"images\/file-6827b5cf8dc2c.png","mime":"image\/png","copyright":{"license":"U"},"width":734,"height":460},"title":"Calculate BMI"},"library":"H5P.Image 1.1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"},"subContentId":"8706cd37-e7a4-494f-bdc4-5c0eafc12efc"},"useSeparator":"auto"},{"content":{"params":{"decorative":true,"contentName":"Image","expandImage":"Expand Image","minimizeImage":"Minimize Image","file":{"path":"images\/file-6827b659a0478.png","mime":"image\/png","copyright":{"license":"U"},"width":350,"height":349},"title":"BMI vs. Mortality"},"library":"H5P.Image 1.1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"},"subContentId":"0ce548f0-65df-4ea1-99dd-68f32a6d70e0"},"useSeparator":"auto"},{"content":{"params":{"text":"
To calculate your BMI, multiply your weight in pounds by 703 (conversion factor for converting to metric units) and then divide the product by your height in inches, squared.<\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"0ea6dc04-c70b-46c8-ba0f-f80d9e423c3c"},"useSeparator":"auto"},{"content":{"params":{"decorative":true,"contentName":"Image","expandImage":"Expand Image","minimizeImage":"Minimize Image","title":"BMI Classificaitons"},"library":"H5P.Image 1.1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"},"subContentId":"1dede5a7-a62f-4349-9c44-aad6cb1c5905"},"useSeparator":"auto"},{"content":{"params":{"decorative":true,"contentName":"Image","expandImage":"Expand Image","minimizeImage":"Minimize Image","file":{"path":"images\/file-6827b5f23ddc9.png","mime":"image\/png","copyright":{"license":"U"},"width":676,"height":500}},"library":"H5P.Image 1.1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"},"subContentId":"69d893ff-db55-4d52-afdb-0f8375bf047c"},"useSeparator":"auto"},{"content":{"params":{"text":"
BMI Limitations<\/strong><\/h3>\n\n
A BMI is a fairly simple measurement and does not take into account fat mass or fat distribution in the body, both of which are additional predictors of disease risk. Body fat weighs less than muscle mass. Therefore, BMI can sometimes underestimate the amount of body fat in overweight or obese people and overestimate it in more muscular people. For instance, a muscular athlete will have more muscle mass (which is heavier than fat mass) than a couch potato of the same height. Based on their BMIs the muscular athlete would be less \u201cideal\u201d and may be categorized as more overweight or obese than the couch potato; however, this is an infrequent problem with BMI calculation. Additionally, an older person with osteoporosis (decreased bone mass) will have a lower BMI than an older person of the same height without osteoporosis, even though the person with osteoporosis may have more fat mass. A BMI is a useful inexpensive tool to categorize people and is highly correlative with disease risk, but other measurements are needed to diagnose obesity and more accurately assess disease risk.<\/p>\n\n
BMI is not a good measure for children and adolescents because they are growing. A new BMI for these ages was recently introduced in which the weight in kg is divided by the height in meters cubed. Its use is not well-established yet.<\/p>\n\n
BMI does not consider where the fat is located. Individuals with abdominal fat or android shape have a greater risk of obesity-associated diseases than individuals who carry their fat in the hips (gynoid or \"pear shape\"). Men tend to be \"apple-shaped\" while women tend to be \"pear-shaped.\" Gynoid shape tends to be associated with fewer health risks. For this reason, a ratio of body waist circumference to hip circumference may be measured and the ratio calculated. If you are male and your ratio is greater than 0.95, then you have excessive abdominal fat. If you are female and your ratio is greater than 0.86, then you have excessive abdominal fat.<\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"3c21160c-494b-43b9-8718-35af18cca415"},"useSeparator":"auto"},{"content":{"params":{"text":"
Updates from the American Medical Association<\/strong><\/h3>\n\n
In 2023 the American Medical Association (AMA) officially recognized that BMI is an imperfect tool that should not be used as a standalone measure. When used, it must be used in conjunction with measures of body composition (which we will discuss next) and\/or measures of metabolic health. On it's own, BMI does not reflect meaningful information beyond weight versus height.<\/p>\n\n
\n\t
2023 Daily Briefing:AMA: BMI alone should not be used to determine a healthy weight <\/a><\/li>\n<\/ul>\n\n
Additionally, the fat-phobic racial origins of BMI are also finally recognized and being more openly discussed in the medical community and other spaces. I encourage you to check out this article:<\/p>\n\n
\n\t
How the Use of BMI Fetishizes White Embodiment and Racializes Fat Phobia<\/a><\/li>\n<\/ul>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"7b7983bf-91c9-4213-b5d4-67988ab1bc2a"},"useSeparator":"auto"}]},"library":"H5P.Column 1.18","metadata":{"contentType":"Column","license":"U","title":"Body Weight - let's take a look and then move on"},"subContentId":"e7ff0187-c856-4e84-9494-f39d0a927083"},{"params":{"content":[{"content":{"params":{"text":"
Measuring Body Fat Content<\/h2>\n\n
Water, organs, bone tissue, fat, and muscle tissue make up a person\u2019s weight. Having more fat mass may be indicative of disease risk, but fat mass also varies with sex, age, and physical activity level. Females have more fat mass, which is needed for reproduction and, in part, is a consequence of different levels of hormones. The optimal fat content of a female is between 20 and 30T of her total weight and for a male is between 12 and 20%. Fat mass can be measured in a variety of ways. The simplest and lowest-cost way is the skin-fold test. A health professional uses a caliper to measure the thickness of skin on the back, arm, and other parts of the body and compares it to standards to assess body fatness. It is a non-invasive and fairly accurate method of measuring fat mass, but similar to BMI, is compared to standards of mostly young to middle-aged adults. Other methods of measuring fat mass are more expensive and more technically challenging. They include:<\/p>\n\n
\n\t
Underwater Weighing (Hydrostatic).<\/strong> This technique requires a chamber full of water big enough for the whole body can fit in. First, a person is weighed outside the chamber and then weighed again while immersed in water. Bone and muscle weigh more than water, but fat does not\u2014therefore a person with a higher muscle and bone mass will weigh more when in water than a person with less bone and muscle mass. This method is considered the gold standard but requires special facilities and not many places offer underwater weighing even for highly trained athletes. Also, this method is not easy or useful for children, the elderly, or those afraid of water.<\/li>\n\t
Bioelectric Impedance Analysis (BIA).<\/strong> This device is based on the fact that fat slows down the passage of electricity through the body. When a small amount of electricity is passed through the body, the rate at which it travels is used to determine body composition. The percent of body fat is proportional to the body's resistance to the flow of current. A limitation of the method is BIA measures total body water which only estimates muscle and fat. Since water conducts the current, it is imperative that the individual is fully hydrated. These devices are also sold for home use and are commonly called body composition scales.<\/li>\n\t
Dual-energy x-ray absorptiometry.<\/strong> This technique can be used to measure bone density. It also can determine fat content via the same method, which directs two low-dose x-ray beams through the body and determines the amount of energy absorbed from the beams. The amount of energy absorbed is dependent on the body\u2019s content of bone, lean tissue mass, and fat mass. Using standard mathematical formulas, fat content can be accurately estimated.<\/li>\n\t
Skinfold measurements.<\/strong> This technique picks up the skin and measures the thickness. Calipers are used to measure the thickness of the fold which is bigger if there are abundant fat stores. A number of body sites are measured and the selection of sites depends on gender and which method is going to be used to estimate body fat percent. This method has several limitations and its accuracy is dependent on the training of the person completing the measurements. Several body sites must be measured and there is wide variation in the numbers obtained among different technicians.<\/li>\n\t
BOD POD (Air Displacement)<\/strong>. This machine measures how much air your body displaces within its chamber. Percent body fat is calculated based on the relationship between body weight, density, and volume. This machine requires a special facility and is not easy or useful for children and the elderly.<\/li>\n<\/ul>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"794d9185-c2ae-4181-bb39-4545cc9936cf"},"useSeparator":"auto"},{"content":{"params":{"decorative":true,"contentName":"Image","expandImage":"Expand Image","minimizeImage":"Minimize Image","file":{"path":"images\/file-682a6237f3852.jpg","mime":"image\/jpeg","copyright":{"license":"U"},"width":1024,"height":683},"title":"BOD POD (Air Displacement)."},"library":"H5P.Image 1.1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"},"subContentId":"7e9de1d9-bc12-4a1c-87b2-2367522596b8"},"useSeparator":"auto"},{"content":{"params":{"decorative":true,"contentName":"Image","expandImage":"Expand Image","minimizeImage":"Minimize Image","file":{"path":"images\/file-682a626960bb1.jpg","mime":"image\/jpeg","copyright":{"license":"U"},"width":824,"height":1024},"title":"Bioelectrical Imedence (BIA) - hands and feet"},"library":"H5P.Image 1.1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"},"subContentId":"2ecfe4bf-7d13-4100-a445-123fa60f7b03"},"useSeparator":"auto"},{"content":{"params":{"decorative":true,"contentName":"Image","expandImage":"Expand Image","minimizeImage":"Minimize Image","file":{"path":"images\/file-682a62b2313d0.jpeg","mime":"image\/jpeg","copyright":{"license":"U"},"width":1000,"height":1500},"title":"Skin fold caliper"},"library":"H5P.Image 1.1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"},"subContentId":"be4385c7-7b07-491e-a649-b8e6dd315e53"},"useSeparator":"auto"},{"content":{"params":{"decorative":true,"contentName":"Image","expandImage":"Expand Image","minimizeImage":"Minimize Image","file":{"path":"images\/file-682a62d1c4ff9.png","mime":"image\/png","copyright":{"license":"U"},"width":550,"height":550},"title":"DEXA Scan"},"library":"H5P.Image 1.1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"},"subContentId":"7ab31aaa-e73d-4dd3-b718-cb732e2f4832"},"useSeparator":"auto"},{"useSeparator":"auto"},{"content":{"params":{"text":"Waist circumference and waist-to-hip ratio is the least expensive, easiest measure to obtain. All that is needed is a non-stretch tape measure. Watch the short video below about how to properly take the waist circumference measure and hip circumference measure. There are times when the waist measurement technique is not appropriate to use (pregnancy, any medical condition where there abdomen is distended, for example). Also, the guidelines for waist circumference were developed does not adequately represent all people. Therefore, the measurements below do not apply to Aboriginal and Torres Strait Islander peoples, South Asian, Chinese and Japanese adults, according to the American Heart Association<\/a>.<\/span><\/p>\n\n
You can use these values, in combination with your most recent lab results and BMI to determine if a small amount of weight loss might benefit your health.<\/p>\n\n
\n\t
\n\t
Moderate weight change might make sense if your waist circumference is<\/p>\n\n\t
\n\t\t
\n\t\t
Men: over 37 inces (over 94 cm)*<\/p>\n\t\t<\/li>\n\t\t
\n\t\t
Weomn: over 31.5 inches (over 80 cm)*<\/p>\n\t\t<\/li>\n\t<\/ul>\n\t<\/li>\n<\/ul>\n\n
<\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"933100b7-0059-43fa-b66d-bf420de01d01"},"useSeparator":"auto"},{"content":{"params":{"visuals":{"fit":true,"controls":true},"playback":{"autoplay":false,"loop":false},"l10n":{"name":"Video","loading":"Video player loading...","noPlayers":"Found no video players that supports the given video format.","noSources":"Video is missing sources.","aborted":"Media playback has been aborted.","networkFailure":"Network failure.","cannotDecode":"Unable to decode media.","formatNotSupported":"Video format not supported.","mediaEncrypted":"Media encrypted.","unknownError":"Unknown error.","invalidYtId":"Invalid YouTube ID.","unknownYtId":"Unable to find video with the given YouTube ID.","restrictedYt":"The owner of this video does not allow it to be embedded."},"sources":[{"path":"https:\/\/youtu.be\/jyL8UfGZMJE?si=fEaJvF0ZOLizDfhr","mime":"video\/YouTube","copyright":{"license":"U"}}]},"library":"H5P.Video 1.6","metadata":{"contentType":"Video","license":"U","title":"Waist Circumference, Hip Circumference and Wasit to Hip Ratio | ACE Fitness"},"subContentId":"5eab5c41-e291-458f-acbe-358f4a58dd7f"},"useSeparator":"auto"}]},"library":"H5P.Column 1.18","subContentId":"dfadc1f0-6d6c-46e3-a19a-c288958d0a23","metadata":{"contentType":"Column","license":"U","title":"Body Composition"}},{"params":{"content":[{"content":{"params":{"text":"
The reason we talk about obesity is that the majority of people with type 2 diabetes, cardiovascular disease and certain types of cancers are also obese. Excess body fat is a concern when it does not support health. I want to be very clear that if someone has excess body fat and has good metabolic health, is able to perform activities of daily living and is enjoying their life, Obesity itself is not \"bad\" or a \"problem.\"<\/p>\n\n
In an effort to improve health outcomes for people with type 2 diabetes. cardiovascular disease, and diet-associated liver disease, and in an effort to reduce the number of people developing these diseases we - the medical profession and educators - have \"demonized\" fatness; however, we have not seen any improvement in reducing obesity. We have unintentionally fueled a multi-billion dollar weight loss industry. We have learned that people are really good at losing weight for a little while and then end up gaining more back than they lost. We have not made a dent in the chronic diseases. I ask that you keep this in mind throughout the chapter as we talk about different topics. It is the educated opinion of this author that obesity itself is not the issue; rather it is our relationship with food, eating, emotional triggers, physical activity and exercise - all stuff that lies beneath what and how we eat or don't eat, exercise or don't exercise - that might benefit from exploration and examination.<\/p>\n\n
Theories of Obesity<\/strong><\/h2>\n\n
Scientists have been looking for a cause of obesity for many decades now. Clearly, the evidence shows when excess body fat is associated with negative health conseuqences is not associated with one specific gene. Energy imbalance - too many calories in for the calories expended is part of the equation. There are also other factors that contribute to if or how much excess body fat poses a risk to health. These factors include genetic variation, metabolic, and environmental influences and each interact with the other. For example, since the sequencing of the human genome was completed, scientists have learned that the environment plays a powerful role in determining which genes are expressed.<\/p>\n\n
Genetic Influences:<\/strong> <\/em>A number of examples suggest genes can play a role in one's weight. There is an 80% propensity for offspring to gain weight if both parents are overweight, 60% chance if one parent is obese, and a 10% chance if neither parent is obese. Identical twins raised apart have similar weight gain patterns and gain fat in similar sites. Also, body shape is a heritable trait. The ectomorph tends to be lean, the mesomorph muscular and the endomorph large. Finally, rare genetic disorders give us insight into genes that control weight. There are several rare genetic defects that cause excessive weight gain. Examples are Prader-Willi syndrome (absence of chromosome 15) and Laurence-Moon syndrome. Individuals with Prader-Willi have an insatiable appetite.<\/p>\n\n
Metabolic Influences:<\/em><\/strong> A number of metabolic theories have been proposed. A few are detailed here:<\/p>\n\n
\n\t
Set-point theory:<\/strong> This theory states that a person is programmed to be a certain weight and have a certain body fat content. If a person weighs less than this setpoint, then their body will make adjustments in food intake or BMR to compensate and get the person back to their set point weight. If a person weighs more, again, their body will compensate to bring them back to the set point. People become obese because they have a high set point.<\/li>\n\t
Enzyme theory<\/strong>: Lipoprotein lipase (LPL) is an enzyme that breaks down LDL or VLDL at the cell surface to release the particles triglyceride into the cell. The activity of LPL increases when a fat cell is starving or seeking fat. Obese people have more LPL, but they also have more fat cells.<\/li>\n\t
Fat cell theory: <\/strong>This theory is based on the number of fat cells in your body. Fat cells want to store fat and body fat is related to the number of fat cells you have and the amount of fat they are storing. According to this theory, childhood overeating increases the number of fat cells. Obese children tend to have the same number of adipocytes as lean adults. Obese adults have more fat cells. We do not grow much more fat cells as an adult; these are laid down when we are children. When someone who is obese loses weight, they shrink the size of the fat cells and do not reduce the number of fat cells. These cells then are very hungry and hoard fat causing the person to gain back the weight they lost.<\/li>\n\t
Brown fat thermogenesis: <\/strong>Our body has white and brown fat. Brown fat makes heat from fat. It does not store fat like white fat. Newborns and true hibernators, like bears, have a lot of brown fat while adult humans have less. This theory states that obese people have less brown fat.<\/li>\n<\/ul>\n\n
Environmental Influences<\/em>:<\/strong> A wide variety of influences in our social and built environment encourage a lifestyle associated with fat accumulation. We call these environmental influences and examples include lack of activity such as walking more (i.e., 10,000 steps a day); lack of aerobic exercise; an excessive amount of time spent sitting at our computers, playing video games and\/or watching television; excessive portion sizes; an infrastructure conducive to driving not walking or bike riding; and easy access to food high in calories.<\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"8de3cb0b-f839-4a25-a2f0-076433442d5f"},"useSeparator":"auto"},{"content":{"params":{"text":"
Combating Excessive Fat<\/strong><\/h3>\n\n
Throughout the years, many different weight loss programs have come and gone each promising quick weight loss. All weight-change program involves reducing one's caloric intake but sustainable, successful programs also<\/p>\n\n
\n\t
meets the individual's nutrient needs while adjusting Calories during the change phase (for loss or gain),<\/li>\n\t
incorporates physical activity and exercise,<\/li>\n\t
meet the individual's tastes and habits,<\/li>\n\t
favors the development and maintenance of lifestyle change (eating patterns as well as physical activity and exercise) - maintenance needs are different than needs during weight change,<\/li>\n\t
is consistent with the improvement of overall health. <\/li>\n<\/ul>\n\n
The programs with the greatest probability of long-term success modify a person's eating behavior, encourage portion awareness, and includes moderate to vigorous exercise most days of the week.<\/p>\n\n
Weight change is a slow process to emphasize to promote loss of fat (weight loss) and increased lean tissue (weight loos or weight gain). A loss of up to two pounds or less a week is recommended. A pound of fat is approximately 3500 kcal so to lose 1 lbs of fat a week one should cut 500 calories from their diet without falling below 1,200 calories per day. This is the minimum amount of calories to assure adequate nutrient intake. Another approach is to reduce caloric intake by 250 calories and increase energy expenditure through exercise by 250 calories each day to achieve the 500 calories a day reduction.<\/p>\n\n
When weight gain is the goal, similar principles apply. Increasing calories along with strength training exercises promotes weigh gain. Increasing portion sizes and adding in nutrient dense snacks in the morning, afternoon and evening are ways to incorporate more calories into your day.<\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"d19c94b6-3b0c-4054-a33b-a9c72bc2f8d3"},"useSeparator":"auto"},{"content":{"params":{"visuals":{"fit":true,"controls":true},"playback":{"autoplay":false,"loop":false},"l10n":{"name":"Video","loading":"Video player loading...","noPlayers":"Found no video players that supports the given video format.","noSources":"Video is missing sources.","aborted":"Media playback has been aborted.","networkFailure":"Network failure.","cannotDecode":"Unable to decode media.","formatNotSupported":"Video format not supported.","mediaEncrypted":"Media encrypted.","unknownError":"Unknown error.","invalidYtId":"Invalid YouTube ID.","unknownYtId":"Unable to find video with the given YouTube ID.","restrictedYt":"The owner of this video does not allow it to be embedded."},"sources":[{"path":"https:\/\/youtu.be\/v1gluQwieog?si=obKDAUOQhvknjlSP","mime":"video\/YouTube","copyright":{"license":"U"}}]},"library":"H5P.Video 1.6","metadata":{"contentType":"Video","license":"U","title":"Body Weight Planner: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)"},"subContentId":"140b817e-8796-4cf0-9f79-c7ca2b297194"},"useSeparator":"auto"},{"content":{"params":{"text":"
Key Dietary Guidelines <\/strong><\/h3>\n\n
The 2020 Dietary Guidelines for Americans<\/em> offer specific, evidence-based recommendations for dietary changes aimed at keeping calorie intake in balance with physical activity, which is key for weight management. These recommendations include:<\/p>\n\n
\n\t
Follow a healthy dietary pattern at every life stage<\/li>\n\t
Customize and enjoy food and beverage choices to reflect personal preferances, cultural traditions and budgetary considerations<\/li>\n\t
Focus on meeting food group needs with nutrient-dense foods and beverages, and stay within calorie limits<\/li>\n\t
Limit foods and beverages higher in added sugars, saturated fat, and sodium, and limit alcoholic beverages<\/li>\n<\/ul>\n\n
<\/p>\n\n
Key Physical Activity Guidelines (Adults)<\/strong><\/h3>\n\n
Even small amounts of activity are beneficial to your health. Starting with 10 minute increments can be beneficial.<\/p>\n\n
\n\t
For substantial health benefits,<\/strong> adults should do at least 150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Preferably, aerobic activity should be spread throughout the week.<\/li>\n\t
Additional health benefits<\/strong> are gained by engaging in physical activity beyond the equivalent of 300 minutes (5 hours) of moderate-intensity physical activity a week. <\/li>\n\t
Muscle-strengthening activities of moderate or greater intensity<\/strong> and that involve all major muscle groups on 2 or more days a week, as these activities provide additional health benefits.<\/li>\n<\/ul>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"1d195682-edd5-4973-a270-8b607787b379"},"useSeparator":"auto"},{"content":{"params":{"text":"
Campaigns for a Healthy-Weight America<\/strong><\/h2>\n\n
On a national level, strategies addressing overweight and obesity in the past have not been all that successful as obesity levels continue to climb. However, in the past (2007\u20132011) several newly created initiatives and organizations are actively reinforcing strategies aimed to meet the challenge of improving the health of all Americans.<\/p>\n\n
In 2010 the national campaign to reduce obesity was reinforced when First Lady Michelle Obama launched the \u201cLet\u2019s Move\u201d initiative, which has the goal of \u201csolving the challenge of childhood obesity within a generation so that children born today will reach adulthood at a healthy weight.\u201dThe White House, Office of the First Lady. \u201cFirst Lady Michelle Obama Launches Let\u2019s Move: America\u2019s Move to Raise a Healthier Generation of Kids.\u201d <\/span>Another campaign, \u201cCampaign to End Obesity,\u201d was recently established to try to enable more Americans to eat healthily and be active by bringing together leaders from academia and industry, as well as public health policymakers in order to create policies that will reverse the obesity trend and its associated diseases. It remains to be seen whether these new initiatives will finally help improve American health.<\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"bb26de73-2bde-4176-b6ed-381a34955e45"},"useSeparator":"auto"},{"content":{"params":{"visuals":{"fit":true,"controls":true},"playback":{"autoplay":false,"loop":false},"l10n":{"name":"Video","loading":"Video player loading...","noPlayers":"Found no video players that supports the given video format.","noSources":"Video is missing sources.","aborted":"Media playback has been aborted.","networkFailure":"Network failure.","cannotDecode":"Unable to decode media.","formatNotSupported":"Video format not supported.","mediaEncrypted":"Media encrypted.","unknownError":"Unknown error.","invalidYtId":"Invalid YouTube ID.","unknownYtId":"Unable to find video with the given YouTube ID.","restrictedYt":"The owner of this video does not allow it to be embedded."},"sources":[{"path":"https:\/\/youtu.be\/R4yfFpKTbmU","mime":"video\/YouTube","copyright":{"license":"U"}}]},"library":"H5P.Video 1.6","metadata":{"contentType":"Video","license":"U","title":"View this brief video on the Campaign to End Obesity."},"subContentId":"c10d15d0-830a-40af-ae43-c24a7e0497d4"},"useSeparator":"auto"},{"content":{"params":{"text":"
The \u201cSmall-Change\u201d Approach<\/strong><\/h2>\n\n
Currently, most people are not obese in this country. The gradual rise in overweight is happening because, on average, people consume slightly more calories daily than they expand, resulting in a gradual weight gain of one to two pounds a year. In 2003 the idea was first published that promoting small lifestyle changes to reduce weight gain occurring over time in all age groups may better reduce obesity rates in the American population. <\/span> <\/span>Scientific studies have demonstrated that asking people to increase the number of steps they take each day while providing them with pedometers that count the steps they take each day successfully prevented weight gain. A \u201csmall-changes\u201d study published in the October 2007 issue of Pediatrics<\/em> evaluated whether families that made two small lifestyle changes, which were to walk an additional two thousand steps per day and to eliminate 100 kilocalories per day from their typical diet by replacing dietary sugar with a noncaloric sweetener, would prevent weight gain in overweight children. The results of this study were that a higher percentage of children who made the small changes maintained or reduced their BMI in comparison to children of families given a pedometer but were not asked to also make physical activity or dietary changes. <\/span> <\/span> Several more studies funded by the National Institutes of Health and USDA are ongoing and are evaluating the effectiveness of the \u201csmall-changes\u201d approach in reducing weight gain.<\/p>\n\n
In 2009, a report of the Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council proposed that the \u201csmall-changes\u201d approach when supported by the community, industry, and governmental levels will be more effective than current strategies in gradually reducing the obesity rate in America.The HHS encouraged the approach and launched a \u201cSmall Step\" website in 2008.<\/p>\n\n
As you can see, nutrition science, dietetics, kinesiology and medical professionals as well as government agencies have promoted healthy lifestyles (nutrition and exercise) for decades. These are not new concepts or ideas in 2025.
\n <\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"c04063fd-73ae-40ad-bd41-63ae753dce7a"},"useSeparator":"auto"}]},"library":"H5P.Column 1.18","subContentId":"41a6c83b-c5c3-4d1e-a45f-478516144cd6","metadata":{"contentType":"Column","license":"U","title":"Dietary, Behavioral, and Physical Activity Recommendations"}},{"params":{"content":[{"content":{"params":{"text":"
The Female Athlete Triad<\/strong><\/h2>\n\n
In 1992, an association between disordered eating, amenorrhea, and osteoporosis was observed in female athletes concerned about a lean physique. The phrase, female athlete triad, was coined and is now used to describe a syndrome in which eating disorders (or low energy availability), amenorrhoea\/oligomenorrhoea, and decreased bone mineral density (osteoporosis and osteopenia) are present.<\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"22f89eb1-a387-4190-ae3c-6a3f1a51785c"},"useSeparator":"auto"},{"content":{"params":{"text":"
Relaive Energy Deficiency in Sport (RED-S)<\/strong><\/h2>\n\n\n\n\n\n
In 2005, the International Olympic Committee (IOC) defined the Female Athlete Triad<\/strong> as a condition involving three key issues:<\/p>\n\n
\n\t
\n\t
Disordered eating<\/p>\n\t<\/li>\n\t
\n\t
Irregular or missing periods<\/p>\n\t<\/li>\n\t
\n\t
Low bone mineral density (weak bones)<\/p>\n\t<\/li>\n<\/ol>\n\n
At the time, this was thought to be a problem mainly for female athletes. It was believed that not eating enough led to hormone changes, which inturn affected menstrual cycles (stopped them) and harmed bone health.<\/p>\n\n
However, over time, researchers discovered that the root cause of the Triad was actually low energy availability<\/strong>. In other words, some athletes aren't eating enough to cover the energy needed for exercise, daily activities, and basic body functions like growth and repair. This energy deficiency was found to be the main issue driving all the other symptoms, including amenorrhea (lack of menstruation), osteopenia (low bone density) and so much more.<\/p>\n\n
Because of this, in 2014 the IOC introduced a broader concept called Relative Energy Deficiency in Sport (REDs)<\/strong>. This new term includes both female and male athletes and looks at how low energy intake affects many areas of health and performance, not just menstruation and bone health. The current definition of REDs:<\/p>\n\n
\"a syndrome of impaired physiological and\/or psychological functioning experienced by female and male athletes that is caused by exposure to problematic (prolonged and\/or severe) low energy availability. The detrimental outcomes include, but are not limited to, decreases in energy metabolism, reproductive function, musculoskeletal health, immunity, glycogen synthesis and cardiovascular and haematological health, which can all individually and synergistically lead to impaired well-being, increased injury risk and decreased sports performance.\" (Mountjoy, M et al. 2023)<\/p>\n\n
Since 2018, over 170 research studies have expanded what we know about REDs. Some of the latest findings include:<\/p>\n\n
\n\t
\n\t
The importance of eating enough carbohydrates\u2014not just calories.<\/p>\n\t<\/li>\n\t
\n\t
A growing connection between REDs and mental health challenges.<\/p>\n\t<\/li>\n\t
\n\t
More research focusing on how REDs affects male athletes<\/strong>, who were not included in the original Triad model.<\/p>\n\t<\/li>\n<\/ul>\n\n
With new knowledge, experts have updated how we think about and detect REDs. As a result, they have created<\/p>\n\n
\n\t
\n\t
A new Physiological Model<\/strong> that shows how REDs can affect people differently depending on the severity and individual factors.<\/p>\n\t<\/li>\n\t
\n\t
REDs Clinical Assessment Tool \u2013 Version 2<\/strong>, which helps coaches and health professionals identify REDs, assess the level of risk, and make training recommendations.<\/p>\n\t<\/li>\n\t
\n\t
Safe body composition guidelines<\/strong> to help prevent REDs during athlete assessments.<\/p>\n\t<\/li>\n<\/ul>\n\n\n\n\n\n \n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"0e0f007c-a1dc-4a25-8b0e-fedc083a2e08"},"useSeparator":"auto"},{"useSeparator":"auto"}]},"library":"H5P.Column 1.18","subContentId":"2313c834-0f6e-4595-bab2-c904d1231aed","metadata":{"contentType":"Column","license":"U","title":"Disordered Eating and Eating Disorders"}},{"params":{"content":[{"content":{"params":{"text":"
Statista. \u201cTopic: Fast Food Restaurants in the U.S.\u201d Statista, 30 June 2022, www.statista.com\/topics\/863\/fast-food\/#topicOverview<\/a>.<\/span><\/span><\/span><\/p>\n\n
<\/p>\n\n
Wu, Yangfeng. \u201cOverweight and obesity in China.\u201d BMJ. 2006 August 19; 333(7564): 362\u2013363. doi: 10.1136\/bmj.333.7564.362. http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1550451\/<\/a><\/span><\/span><\/span><\/p>\n\n
US Department of Agriculture. 2010 Dietary Guidelines for Americans. 2010. Accessed October 7, 2011. http:\/\/health.gov\/dietaryguidelines\/dga2010\/DietaryGuidelines 2010.pdf<\/a>.<\/span><\/span><\/span><\/p>\n\n
<\/p>\n\n
<\/span><\/span><\/span><\/p>\n\n
Dietary Guidelines for Americans. \u201cDietary Guidelines for Americans, 2020-2025 and Online Materials | Dietary Guidelines for Americans.\u201d Www.dietaryguidelines.gov, Dec. 2020, www.dietaryguidelines.gov\/resources\/2020-2025-dietary-guidelines-online-materials<\/a>. <\/span><\/span><\/span><\/p>\n\n
U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans 2nd Edition. 2018. <\/span><\/span><\/span><\/p>\n\n
Eschmeyer, Debra. \u201cLet\u2019s Move!\u201d Archives.gov, 4 Jan. 2017, letsmove.obamawhitehouse.archives.gov\/.<\/span><\/span><\/span><\/p>\n\n
Hill, J. O. \u201cCan a Small-Changes Approach Help Address the Obesity Epidemic? A Report of the Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council.\u201d Am J Clin Nutr 89, no. 2 (2009): 477\u201384. http:\/\/www.ajcn.org\/content\/89\/2\/477.long<\/a>.<\/span><\/span><\/span><\/p>\n\n
Rodearmel, S. J. et al. \u201cSmall Changes in Dietary Sugar and Physical Activity As an Approach to Preventing Excessive Weight Gain: The America on the Move Family Study.\u201d Pediatrics 120, no. 4 (2007): e869\u201379. http:\/\/pediatrics.aappublications.org\/content\/120\/4\/e869.long<\/a>.<\/span><\/span><\/span><\/p>\n\n
Hill, J. O. \u201cCan a Small-Changes Approach Help Address the Obesity Epidemic? A Report of the Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council.\u201d Am J Clin Nutr 89, no. 2 (2009): 477\u201384. http:\/\/www.ajcn.org\/content\/89\/2\/477.long<\/a>.<\/span><\/span><\/span><\/p>\n\n
Mountjoy, Margo, et al. \u201cThe IOC Consensus Statement: Beyond the Female Athlete Triad\u2014Relative Energy Deficiency in Sport (RED-S).\u201d British Journal of Sports Medicine, vol. 48, no. 7, 11 Mar. 2014, pp. 491\u2013497.<\/span><\/span><\/span><\/p>\n\n
Mountjoy, Margo, et al. \u201c2023 International Olympic Committee\u2019s (IOC) Consensus Statement on Relative Energy Deficiency in Sport (REDs).\u201d British Journal of Sports Medicine, vol. 57, no. 17, 1 Sept. 2023, pp. 1073\u20131097, https:\/\/doi.org\/10.1136\/bjsports-2023-106994.<\/span><\/span><\/span><\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"3877ef60-139f-4fc0-b49c-ec36406a0a8f"},"useSeparator":"auto"}]},"library":"H5P.Column 1.18","subContentId":"e692c3b2-3171-417d-9a3b-5260f5572f9d","metadata":{"contentType":"Column","license":"U","title":"References"}}],"behaviour":{"baseColor":"#1768c4","defaultTableOfContents":true,"progressIndicators":true,"progressAuto":true,"displaySummary":true,"enableRetry":true},"read":"Read","displayTOC":"Display 'Table of contents'","hideTOC":"Hide 'Table of contents'","nextPage":"Next page","previousPage":"Previous page","chapterCompleted":"Page completed!","partCompleted":"@pages of @total completed","incompleteChapter":"Incomplete page","navigateToTop":"Navigate to the top","markAsFinished":"I have finished this page","fullscreen":"Fullscreen","exitFullscreen":"Exit fullscreen","bookProgressSubtext":"@count of @total pages","interactionsProgressSubtext":"@count of @total interactions","submitReport":"Submit Report","restartLabel":"Restart","summaryHeader":"Summary","allInteractions":"All interactions","unansweredInteractions":"Unanswered interactions","scoreText":"@score \/ @maxscore","leftOutOfTotalCompleted":"@left of @max interactions completed","noInteractions":"No interactions","score":"Score","summaryAndSubmit":"Summary & submit","noChapterInteractionBoldText":"You have not interacted with any pages.","noChapterInteractionText":"You have to interact with at least one page before you can see the summary.","yourAnswersAreSubmittedForReview":"Your answers are submitted for review!","bookProgress":"Book progress","interactionsProgress":"Interactions progress","totalScoreLabel":"Total score","a11y":{"progress":"Page @page of @total.","menu":"Toggle navigation menu"}}

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