Welcome in DPT

Obesity
management

Faculty of Physical Therapy- Cairo University

Teaching Prof. Dr /Maher el kabalawy
Staff Professor in Basic science Department -Faculty of Physical
Therapy-Cairo University

Prof. Dr /Wafaa H. Borhan

Professor in Physical Therapy Department for surgery-Faculty of
Physical Therapy-Cairo University

Dr /Haidy N. Ashem
Lecturer in Physical Therapy Department for surgery-Faculty of
Physical Therapy-Cairo University
 Diet therapy (2)

Prof. Dr /Wafaa H. Borhan

Professor in Physical Therapy Department for surgery-
Faculty of Physical Therapy-Cairo University
By the end of this lecture, the students will be able to:

• What’s meant by fad diets?

• Explain Different types of diets..

• Enumerate Advantages and disadvantages of each

type.
• Definition
– Body fat is composed of:
– Essential fat—amount necessary for maintenance
of life and reproductive functions, including:
» Insulation, cushion, nerve conduction, vitamin
absorption, energy, and body temperature
regulation
» Dropping body fat too low can compromise
performance and normal bodily function,
including amenorrhea for females
– Storage fat—the nonessential fat that many of us
try to shed
• Definition
• Basal metabolic rate (BMR)—the rate of energy expenditure
by a body at complete rest in a neutral environment
A BMR for the average healthy adult is usually between
1,200 and 1,800 calories per day.
• Resting metabolic rate (RMR) includes the BMR plus any
additional energy expended through daily sedentary
activities.
• Exercise metabolic rate (EMR) is the energy expenditure
that occurs during exercise.
• Definition
– Hunger—an inborn physiological response to
nutritional needs
– Appetite—a learned response to food that is tied
to an emotional or psychological craving
– Satiety—to feel satisfied, or full, when one has
satisfied their nutritional needs and the stomach
signals “no more”
• Definition
• Thermic Effect of Food
An estimate of how much energy is necessary to burn
food calories
• Adaptive Thermogenesis
The theory that thin people send more effective
messages to the hypothalamus and therefore can
consume large amounts of food without gaining weight
• Yo-Yo Diets
Refer to dieters who resume eating after their weight
loss so their BMR is set lower, making it almost certain
that they will regain the pounds they just lost
 Yo-Yo Dieting
• Increased resistance
to weight loss

• Increased efficiency
of weight gain
• The concept of weight cycling or Yo-Yo dieting
suggests that with repeated cycles of dieting there is
increased resistance to weight loss and increased
efficiency of weight gain
(Essentially the body adapts to fewer calories and
becomes more efficient).
 Why do diets fail?
• Cycle of Dieting People begin a diet and have good initial
motivation. They may see some initial positive results but
eventually they will have trouble with compliance (party,
eating out, stress). They may give up and blow diet and
gain the weight back. Eventually, people regain inspiration
and decide to try again.START DIET

INITIAL
REGAIN MOTIVATION
INSPIRATION

FAIL W / DIET POSITIVE RESULTS

BLAME SELF

TROUBLE WITH COMPLIANCE

Total Caloric Intake
Total caloric content = sum of cal/gm:
(gm CHO x 4 ) + ( gm fat x 9) + ( gm protein x 4)

Caloric distribution ( %) : CHO / Fat / ptn

( CHO : 50-70%) / ( fat 20-25% ) / (protein 15 %)
An Example in Diet Construction:
1- if a Pt needs daily requirement =
2500 calories
2- and is obese ( BMI = 35 )

Goal : to lower body weight by 1kg/ wk

( 1 kg loss requires loss of 7000 calories
i.e. 1000 /day X 7)

 3-  subtract from his intake 1000

calories / day
4-  daily intake : 2500 -1000 = 1500
calories
5- To distribute the 1500 calories :- e.g.
60% CHO + 24 % fat + 16 % protein = 100 %

(900 cal.) (360 cal.) (240 cal.)

↓ ↓ ↓
( 225 gm ) ( 40 gm ) ( 60 gm )
CHO fat protein

Weight Loss Calculations

1 pound of fat = 3500 calories

Maximum weight loss should be no more than 1-2 pounds per

week:

500 calories/day x 7 days/week = 3500 calories/week (1 pound)

1000 calories/day x 7 days/week = 7000 calories/week (2 pounds)

 Major Dietary Approaches For Weight Loss

• Healthy Diet/Non-Diet Approach

• Food Guide Pyramid
• Balanced Reduced (Hypo caloric) low
caloric Diet
• Weight Watchers.
• Low Carbohydrate Diet
• Dr. Atkins.
• Low fat diet
• eat more weight less
• Novelty diet
• cabbage soup
 Treatments for the Overweight Patient
(BMI 25-30)
The Non-Diet or Healthy Diet Approach
• Focus on becoming healthy
• Success is measured in “units of health”, not units of
weight
• Strategies are lifetime, not temporary
• Make a commitment because you want to, not
because you have too
• Focus first on the quality of the diet, second on the
quantity.
1. Food Guide Pyramid
2. Dietary Guidelines for Americans
3. DASH diet
4. Focus on fruits, vegetables and whole grains
Food Guide Pyramid
 Healthy Diet Effects
• Healthy diet may or may not result in
weight loss
– if weight loss occurs, it will be
gradual
• Healthy diet should result in improved
health
• Improved health may require more
significant weight loss
• A healthy diet is probably the best diet
for long-term weight maintenance
 Low Calorie Diet(1200-1800)
• For those who are :
– significantly overweight
• BMI >30 w/ health risks
– can not attain good health without significant
weight loss
• Usually provide a total calorie deficit to allow for
1 to 1 1/2 pounds of weight loss per week.

• Balanced nutritional food plan.

(15% protein, 30% fat, 55% carbohydrate)

• Mulitvitamin/mineral supplement recommended.

Example: weight watchers diet
 • Weight watchers
• Traditional program includes a balanced low calorie
diet containing 1200 calories per day for women;
1800 calories for men.
• based on a “point system” which allows dieter to eat
whatever foods they want based on points (which
are really calories—which ultimately allows wt loss)
• Advantages: variety, no restrictions or foods
eliminated, teaches portion control and eating in
moderation, weekly weigh-ins and support-groups,
ability to eat out at restaurants
• Disadvantages: hard to maintain
• Long-Term Success: better than most diets in terms
of teaching healthy habits, but still hard to maintain
 How to recognize a fad diet??

• Promise quick weight loss.

• Limit food selections and dictate specific rituals.

• They bill themselves as cure-alls.

• They often recommend expensive supplements.

• No attempts are made to change eating habits

permanently.
 Types of Fad Diets:

Macronutrient Restrictions
1- Low or Restricted-Carbohydrate
Approaches
2- Low-Fat Approaches
Novelty Diets
 Low or Restricted Carbohydrate Approaches
How it • The brain requires glucose for normal
works functioning.

• Glucose is made from tissue proteins.

• This leads to protein tissue loss.

Why
you • Dieter loses weight very rapidly with the loss of
lose carbohydrates and fluids.
weight • Work in the short run because of limited food
on it intake.
• Reduced eating due to limited selection.
• On normal diet fluids are restored and the weight
is regained.
 Problems • The plan lacks: fruits, vegetables, and whole grains.
• Not intended for long-term use.
• The plan includes excessive intake of animal fats.
• Individuals experience reduced exercise capacity due to
limited carbohydrate intake.

• Can result in metabolic dehydration.

consequences
Metabolic

• Due to use of body’s own stores of carbohydrates and

protein.

• Results in initial weight loss.

• This is extremely stressful and forces the brain to alter its

metabolism.
• Example: atkins diet
 Atkins diet
• Diet consists of pure proteins and fat with < 20 grams carbohydrates
per day.
Sample menu:
– Breakfast: Ham, cheese, mushroom omelet with bacon or smoked fish with cream
cheese.
– Lunch: Chef salad with ham, chicken, cheese, eggs, creamy Italian dressing or
bacon cheeseburger- no bun.
– Dinner: rack of lamb, salmon or chicken and salad.
– Dessert: assorted cheeses or diet Jello with heavy cream.

• claims that dieters can lose weight by eliminating CHO and sugars
from their diets
• -focuses on CHO and insulin, not excess calories that are responsible
for obesity
• -the low-carb, high-protein diet consists of 1200-1800 calories and this
hypocaloric diet would result in wt loss no matter what combination
of foods were eaten
 Advantages:
-simplicity
-allows consumption of high fat, previously “forbidden”
foods
Disadvantages:
• reliance on protein
• -puts body into ketosis with side effects of headaches,
bad breath, nausea, CHO cravings
• -too high in saturated fats and too low in fruits, whole
grains, calcium, and fiber
• -hard to maintain, rebound
• Long-Term Success:
diets focusing on high-protein, low-CHO are not
maintained for life
-after the initial wt loss, dieters eventually introduce
CHO back into the diet
 Low fat Approaches
• Less than 20% of energy comes from fat, usually only 5-10%.

• There is limited (or elimination of) animal protein sources; also all fats,
nuts, and seeds.

• Dieters eat primarily grains, fruit, and vegetables, which most people
cannot do for a very long time.

• Eventually, the individual wants some foods higher in fat or protein.

Little satiety
Problems

• Flatulence

• Possibly poor mineral absorption from excess dietary fiber

• Limited food choices sometimes leading to deprivation

• The diet is much lower in fat than a typical American diet.

• Example: eat more weight less diet
 eat more weight less diet
• in contrast to the high-protein diets, this diet is extremely low-fat (10%
of total kcal), high in CHO, and primarily vegetarian
• -average calories 1200-1350/day
• -based on the concept that fat in the diet is responsible for wt gain and
heart disease
• -also relies on volume of daily food intake: replacing dietary fat with
CHO (fruits, veggies, and grains) allows the dieter to eat more volume
of food for the same amt of calories
• Advantages:
• people like to be able to eat more food
• Disadvantages:
• the majority of individuals lose wt and keep it off with a diet of 55%
CHO, 20% protein, and 25% fat. This diet encourages minimal fat and
protein intake
• Long-Term Success:
• dietary fat is important in the success of a diet because it leads to
satiety and pleasure from eating
• -again, diets are successful only if energy (calories) in are less than
energy (calories) expended
 Novelty Approaches
• Some novelty diets emphasize one food or food group
and exclude almost all others.
• Problems:
• They promote certain nutrients, foods, or combinations of
foods as having unique, magical, or previously undiscovered
qualities

• They can lead to malnutrition

• No change in everyday eating habits leading to relapse

• Unrealistic food choices leading to possible bingeing

• Example: cabbage soup diet

 cabbage soup diet
• claims that patients can lose as much as 20# in 7 days by eating only
an onion based soup mix and a cabbage based soup
• -plan consists of less than 1000 calories per day and this allows rapid
wt loss to occur
• -the book stresses that this diet should only be used for a few days
• Advantages:
• -rapid wt loss
• Disadvantages:
• extreme approach
• -temporary results—usually water wt
• -nausea, headedness, gas
• Long-Term Success:
• -maintenance of wt loss is impossible
• -lifestyle changes of healthy diet and exercise are not stressed