UNIT IV FOOD RELATED NUTRITIONAL DISORDERS AND ENERGY

CALCULATION
Syllabus:

Type I Disorders-Causes of life style and stress related diseases. Cardio-vascular

diseases, hypertension, obesity. Type-II Disorders: Cancer, diabetics, ulcers, electrolyte
and water imbalance. Health indices. Preventive and remedial measures. Energy
balance and methods to calculate individual nutrient and energy needs. Planning a
healthy diet.

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1. TYPE I DISORDERS: LIFESTYLE & STRESS-RELATED DISEASES

Type I disorders are non-communicable, chronic diseases that often result from
long-term unhealthy lifestyle habits and persistent stress. They tend to emerge slowly,
often without early symptoms, and are closely tied to behavioural choices, environmental
factors, and psychological health.

1.1 Cardiovascular Diseases (CVDs)

Definition
Cardiovascular diseases encompass a range of heart and blood vessel conditions,
including:
 Coronary artery disease (clogged arteries)
 Heart attack (myocardial infarction)
 Stroke (cerebrovascular accident)
 Heart failure
 Arrhythmias (irregular heartbeat)

Lifestyle and Stress Factors (Causes):

1. Atherosclerosis: Build-up of plaque (composed of cholesterol, fat, and other
substances) in the arteries, narrowing and hardening them, leading to reduced
blood flow.
2. Hypertension (High Blood Pressure): Elevated blood pressure can damage the
arteries over time, increasing the risk of CVD.
3. High Cholesterol: High levels of LDL cholesterol ("bad" cholesterol) can
contribute to plaque buildup in the arteries, increasing the risk of CVD.
4. Smoking: Tobacco smoke damages blood vessels, promotes plaque buildup,
and increases the risk of blood clots.
5. Diabetes: Uncontrolled diabetes can damage blood vessels and nerves, raising
the risk of CVD.

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 6. Obesity: Excess weight strains the heart, increases blood pressure, and
contributes to conditions like diabetes and high cholesterol, all of which raise
the risk of CVD.
7. Physical Inactivity: Lack of exercise weakens the heart and contributes to
obesity and other risk factors for CVD.
Physiological Impact
 Stress causes vasoconstriction (narrowing of blood vessels), raising blood
pressure.
 Repeated exposure leads to atherosclerosis (plaque buildup in arteries).

 Blood flow to heart and brain can be blocked, leading to heart attacks or
strokes.
Risk:
 Age: The risk of CVD increases with age, particularly after 65.
 Gender: Men are generally at higher risk
 Family history: A family history of heart disease increases the risk
 Ethnicity: Certain ethnic groups, such as African Americans, have a higher risk
of CVD
 Socioeconomic Factors: Low socioecomonic status is associated with higher
rates of CVD due to limited access to healthcare, unhealthy lifestyle habits and
other factors.
Symptoms:
 Chest Pain: Discomfort, pressure, squeezing or pain in the chest
 Shortness of breath: Difficulty breathing, especially during physical activity
 Fatigue: Feeling unusually tired or weak.
 Dizziness or Light-headedness: Feeling faint or woozy.
 Palpitations: Irregular or rapid heartbeats
 Swelling: Edema, often in the legs, ankles or abdomen.
 Nausea or Indigestion: Unexplained stomach discomfort.
Preventive Measures:
 Healthy Diet: Emphasize fruits, vegetables, whole grains, lean proteins, and
healthy fats while limiting saturated and trans fats, salt, and added sugars.
 Regular Exercise: Aim for at least 150 minutes of moderate-intensity aerobic
exercise or 75 minutes of vigorous-intensity exercise per week.
 Maintain a Healthy Weight: Achieve and maintain a healthy weight through
diet and exercise. Quit Smoking: Seek assistance if needed to quit smoking and
avoid exposure to secondhand smoke.
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  Manage Stress: Practice stress-reduction techniques such as meditation, yoga,
or deep breathing exercises.
 Control Blood Pressure and Cholesterol: Monitor blood pressure and
cholesterol levels regularly and follow medical advice to keep them within
healthy ranges.
 Limit Alcohol: If you drink alcohol, do so in moderation.
 Regular Health Check-ups: Schedule regular check-ups with a healthcare
provider to assess cardiovascular health and address any concerns.
Types of Cardiovascular Disease:
● Coronary heart disease – a disease of the blood vessels supplying the heart
muscle;
● Cerebrovascular disease – a disease of the blood vessels supplying the brain;
● Peripheral Arterial disease – a disease of blood vessels supplying the arms and
legs;
● Rheumatic heart disease – damage to the heart muscle and heart valves from
rheumatic fever, caused by streptococcal bacteria;
● Congenital heart disease – birth defects that affect the normal development and
functioning of the heart caused by malformations of the heart structure from birth;
● Deep Vein Thrombosis and Pulmonary Embolism – blood clots in the leg veins,
which can dislodge and move to the heart and lungs.
1.2 Hypertension (High Blood Pressure)
Definition
Hypertension is a condition where the force of blood against the artery walls is
consistently too high (above 130/80 mmHg). Often called a “silent killer” because it
has no obvious symptoms but causes serious damage over time.
Lifestyle and Stress Factors (Causes)
1. High Sodium Intake: Causes the body to retain water, increasing blood volume
and pressure.
2. Obesity: Extra fat, especially around the abdomen, demands more oxygen and
blood, increasing pressure on arteries.
3. Lack of Exercise: Contributes to higher resting heart rates and less flexible
blood vessels.
4. Stress and Anxiety: Activates the sympathetic nervous system, increasing
blood pressure temporarily; chronic stress makes it persistent.
5. Poor Time Management and Job Pressure: Mental strain without coping
strategies leads to chronic hypertension.
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 6. Substance Use: Tobacco and alcohol increase vascular resistance and stress
hormone levels.
Physiological Impact
 Constant high pressure thickens artery walls, reducing blood flow.
 Can damage kidneys, eyes, and brain, and cause heart enlargement.
 Increased risk of stroke, heart attack, and aneurysms.
Risk Factors:
 Obesity: Excess body weight increases the workload on the heart and raises
blood pressure
 Physical Inactivity: Lack of regular exercise weakens the heart and
cardiovascular system.
 Unhealthy Diet: High sodium intake, low potassium intake and consumption of
processes foods contribute to hypertension.
 Tobacco Use: Smoking and chewing tobacco can raise blood pressure
temporarily and damage blood vessels over time.
 Excessive Alcohol Consumption: Heavy drinking can raise blood pressure and
damage the heart.
 Stress: Chronic stress can contribute to hypertension through hormonal changes
and unhealthy coping mechanisms.

Symptoms:
 Headaches: Particularly in the back of the head and neck, especially in the
morning.
 Shortness of breath: Difficulty breathing or felling breathless with exertion.
 Chest Pain: Often as a result of heart strain due to hypertension.
 Dizziness or Fainting: Due to inadequate blood flow to the brain.
 Blurred Vision: Resulting from damage to blood vessels in the eyes.
 Fatigue: Feeling tired or lethargic despite adequate rest.

Prevention and Management:

 Healthy lifestyle: Maintain a balanced diet low I sodium, engage in regular

physical activity, maintain a healthy weight and limit alcohol consumption.
 Medication: If lifestyle changes alone are insufficient, medication such as
diuretics, beta-blockers, ACE inhibitors or calcium channel blockers may be
prescribed to control blood pressure.
 Regular Monitoring: Regularly check blood pressure levels and seek medical
advice if hypertension is detected or suspected.

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  Stress Management: Practice relaxation such as deep breathing, meditation or
yoga to manage stress effectively.
 Quit Smoking:
1.3 Obesity
Definition
Obesity is the accumulation of excessive body fat, typically measured by a Body
Mass Index (BMI) of 30 or higher. It increases the risk of diabetes, heart disease,
certain cancers, and joint problems.
Lifestyle and Stress Factors (Causes):
1. High-Calorie Diets: Frequent consumption of processed, high-fat, and sugary
foods leads to a calorie surplus.
2. Sedentary Lifestyle: Prolonged sitting, lack of daily movement, and screen
time lower calorie expenditure.
3. Emotional Eating: Stress, anxiety, or depression may lead to binge eating or
comfort eating.
4. Lack of Sleep: Disrupts hormones (leptin and ghrelin) that regulate appetite.
5. Endocrine Disruption: Chronic stress alters the HPA axis, leading to high
cortisol which encourages fat storage (especially belly fat).
6. Poor Meal Timing: Skipping meals or eating late at night disrupts metabolism.
7. Genetics: Genetic factors can influence an individual's susceptibility to obesity
by affecting metabolism, appetite regulation, and fat storage.
Physiological Impact
 Fat cells release inflammatory chemicals that impair insulin use, increasing
diabetes risk.
 Excess weight strains joints, heart, and liver.
 Visceral fat (around organs) is especially dangerous and linked to metabolic
syndrome.
Risk Factors:
 Poor diet: High consumption of processed food, sugary beverages, fast food and
snacks contributes to obesity.
 Physical Inactivity: Lack of regular exercise or physical activity reduces energy
expenditure and promotes weight gain.
Prevention and Management:
 Healthy Diet: Emphasize whole, nutrient-dense foods such as fruits, vegetables,
lean proteins, and whole grains while minimizing processed foods, sugars, and
saturated fats.
 Regular Exercise: Engage in regular physical activity, aiming for at least 150
minutes of moderate-intensity aerobic exercise per week.
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  Behavioral Changes: Practice portion control, mindful eating, and healthy cooking
techniques to maintain a balanced diet and control calorie intake.
 Medical Intervention: In some cases, medication or surgical interventions such as
bariatric surgery may be recommended for severe obesity or when lifestyle
interventions alone are insufficient.
 Lifestyle Modification Programs: Participate in structured lifestyle intervention
programs that combine dietary changes, physical activity, and behavioral therapy
for sustainable weight loss and management.
INTERCONNECTION BETWEEN DISORDERS
These conditions are closely linked:
 Obesity increases the risk of hypertension and cardiovascular disease.
 Hypertension and obesity both strain the heart, leading to CVDs.
 Stress is a common thread, triggering poor behaviors and direct biological
changes.

Summary Table
Key Lifestyle Health
Disorder Key Stress Impacts
Factors Consequences
Inflammation, high
Diet, inactivity, Heart attack, stroke,
Cardiovascular heart rate, artery
smoking, alcohol heart failure
damage
Sympathetic Kidney failure,
Salt, inactivity,
Hypertension activation, cortisol stroke, heart
obesity, alcohol
increase damage
Overeating,
Hormonal imbalance, Diabetes, CVDs,
Obesity sedentary habits,
emotional eating arthritis, fatty liver
poor sleep

Preventive Measures
 Regular physical activity (at least 30 min/day)
 Balanced diet (low in salt, sugar, and saturated fats)
 Stress management (meditation, therapy, hobbies)
 Adequate sleep (7–8 hours)
 Avoiding tobacco and limiting alcohol
 Regular health screenings

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2. TYPE II DISORDERS:
a. CANCER:
Cancer is an abnormal growth of cells which has the ability to involve
adjacent tissues and even distant organs and eventful death of the affected patient if
the tumour has progressed to the stage where it cannot be treated.
Categories of Cancer:
There are numerous types of cancer, which can be categorized based on various
criteria such as the affected organ or tissue, the type of cell from which the
cancer originates, and its behaviour. Here are some common categories of
cancer based on these criteria.
 Organ or Tissue Specific
o Breast cancer: Cancer that forms in the cells of the breasts, most
commonly affecting women but can also occur in men.
o Lung cancer: Cancer that begins in the lungs, often associated with
smoking but can also occur in non-smokers.
o Prostate cancer: Cancer that develops in the prostate gland, a part of
the male reproductive system.
o Colorectal cancer: Cancer that starts in the colon or rectum, usually
developing from polyps in the lining of the intestine.
o Skin cancer (such as melanoma): Cancer that forms in the skin cells,
including melanoma which is the most serious type of skin cancer.
o Brain cancer (such as glioblastoma): Cancer that originates in the
brain or spinal cord, often aggressive and difficult to treat.
o Liver cancer: Cancer that begins in the liver cells, commonly
associated with underlying liver disease such as cirrhosis.
o Ovarian cancer: Cancer that forms in the ovaries, often diagnosed at
an advanced stage due to vague symptoms.
o Pancreatic cancer: Cancer that starts in the pancreas, usually
diagnosed at an advanced stage with a poor prognosis.
o Bladder cancer: Cancer that develops in the bladder, often
characterized by blood in the urine and frequent urination.
o Thyroid cancer: Cancer that begins in the thyroid gland, usually
highly treatable with a high survival rate.
 Cell Type
o Carcinoma: Cancer that starts in epithelial cells (tissues that cover the
body's surfaces and line the internal organs). Examples include breast,
lung, prostate, and colorectal cancer.
o Sarcoma: Cancer that arises from connective tissues such as bones,
muscles, cartilage, or blood vessels.
o Leukemia: Cancer of the blood or bone marrow, characterized by the
overproduction of abnormal white blood cells.
o Lymphoma: Cancer that begins in the lymphatic system, which is part
of the body's immune system.

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 o Myeloma: Cancer of plasma cells, a type of white blood cell,
primarily affecting bone marrow.
o Germ Cell Tumors: Cancer that starts in germ cells, the cells that
develop into sperm and eggs. Examples include testicular and ovarian
cancer.
 Behaviour and Growth
● Benign tumors: Non-cancerous growths that do not spread to other
parts of the body. eg:Fibroadenoma, adenoma, Meningioma.
● Malignant tumors: Cancerous growths that can invade nearby tissues
and spread to other parts of the body (metastasis). Eg: Breast
carcinoma, Lung adenocarcinoma, Melanoma.
● In situ tumors: Cancer that is confined to the tissue where it originated
and has not invaded surrounding tissues. Eg: Ductal carcinoma in situ
(DCIS), Carcinoma in situ of the cervix, Colon adenoma
 Hereditary vs. Sporadic
o Hereditary cancers: Caused by inherited genetic mutations that
increases the risk of developing cancer. Examples include hereditary
breast and ovarian cancer syndrome (BRCA mutations) and Lynch
syndrome (hereditary non-polyposis colorectal cancer).
o Sporadic cancers: Develop due to a combination of genetic,
environmental, and lifestyle factors, without a clear hereditary
predisposition.

Causes & Risk Factors:

❏ Tobacco Use
❏ Alcohol Consumption
❏ Obesity and Overweight
❏ Unhealthy Diet and Physical Inactivity
❏ UV Radiation
❏ Environmental Carcinogens
❏ Genetic Factors (BRCA1 and BRCA2 mutations ,Lynch syndrome )
❏ Chronic Infections
❏ Hormonal Factors
❏ Aging
Symptoms:
● Persistent cough or hoarseness
● Unexplained weight loss
● Changes in bowel or bladder habits
● Difficulty swallowing
● Persistent fatigue
● Unexplained pain
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 ● Persistent lumps or swelling
● Changes in skin appearance or texture
● Difficulty breathing
● Changes in a wart or mole
● Persistent indigestion or discomfort after eating
● Persistent fever or night sweats
● Frequent infections
● Unexplained bleeding or bruising
● Changes in appetite
Preventive Measure:
❏ Tobacco Control
❏ Limit Alcohol Consumption
❏ Maintain Healthy Weight
❏ Adopt a Balanced Diet and Exercise Regularly
❏ Protect Yourself from UV Radiation
❏ Reduce Exposure to Environmental Carcinogens
❏ Understand and Manage Genetic Risks
❏ Vaccination Against Cancer-causing Infections
❏ Hormonal Therapy Awareness and Management
❏ Regular Screening and Early Detection

b. DIABETICS
A disorder of metabolism where the pancreas produces little or no insulin or the
cells do not respond to the insulin produced. Glucose, or sugar, builds up in the
blood, overflows and is lost into urine. Meanwhile the cells are denied of their
source of energy.

Types of Diabetes:

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Type 1 Diabetes:
● Autoimmune destruction of insulin-producing beta cells in the pancreas.
● Genetic predisposition or family history.
● Environmental triggers like viral infections may play a role.

Type 2 Diabetes:
● Insulin resistance, where the body's cells do not respond effectively to insulin.
● Genetic factors and family history.
● Obesity and sedentary lifestyle.
● Poor diet high in refined sugars and carbohydrates.
● Aging, as the risk increases with age

Type 3 Diabetes (Gestational Diabetes):

● Hormonal changes during pregnancy that can lead to insulin resistance.
● Insufficient insulin production to meet increased demands during pregnancy.
● Obesity or being overweight before pregnancy.
● Family history of gestational diabetes.
● Certain ethnicities (e.g., Hispanic, African American, Native American).

Causes:
 Tobacco use
 Environmental Carcinogens
 Dietary Factors
 Alcohol Consumption
 Obesity and Overweight
 Ultraviolet(UV) Radiation
 Hormonal Factors
 Chronic Infections
 Genetic Predisposition
 Ageing
Risk Factors:
 Obesity and Overweight
 Family history
 Physical Inactivity
 Unhealthy diet
 Age
 Ethnicity
 Gestational Diabetes
 Poly Cystic Ovary Syndrome (PCOS)

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  Hypertension (High Blood Pressure)
 Impaired Glucose Tolerance (Pre-diabetes)
 History of Cardiovascular Disease
 Sleep Disorders
Preventive Measures:
❏ Healthy Eating
❏ Regular Physical Activity
❏ Weight Management
❏ Avoid Tobacco Use
❏ Limit Alcohol Consumption
❏ Regular Health Check-ups
❏ Manage Stress
❏ Sleep Hygiene
❏ Screenings and Early Detection
❏ Genetic Counseling (for individuals with family history)
❏ Medication Adherence (for individuals at high risk or with pre-diabetes)
❏ Education and Awareness

c. ULCERS
An ulcer is a localized area of tissue erosion or damage within the body,
commonly occurring in the digestive tract, skin or mucous membranes.
Types of Ulcers:
 Pep c Ulcers:
o Gastric Ulcer: Develops in the lining of the stomach.
o Duodenal Ulcer: Occurs in the first part of the small intestine
(duodenum).
 Pressure Ulcers (Bedsores): Develop due to prolonged pressure on the skin,
typically over bony prominences, leading to tissue damage. Common in
individuals who are bedridden or wheelchair-bound.
 Venous Ulcers (leg sores): Result from venous insufficiency, leading to
poor circulation and tissue damage, often occurring on the lower legs or
ankles.
 Arterial Ulcers: Caused by arterial insufficiency, usually associated with
conditions like peripheral artery disease (PAD), resulting in inadequate
blood supply to tissues and subsequent ulceration, often seen on the lower
extremities.

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  Neurotrophic Ulcers: Occur due to nerve damage, commonly seen in
individuals with diabetes or other neuropathic conditions, leading to
decreased sensation and impaired wound healing.
 Corneal Ulcers: Ulcers affecting the cornea of the eye, often caused by
infections, trauma, or underlying ocular conditions, which can lead to severe
eye pain and vision loss if left untreated.
 Mouth Ulcers (Canker Sores): Small, painful ulcers that develop inside the
mouth, commonly on the inner cheeks, lips, gums, or tongue, with various
causes including injury, stress, hormonal changes, or immune system
disorders.
 Ischemic Ulcers: Develop due to inadequate blood supply to tissues, often
seen in conditions like atherosclerosis or vasculitis, leading to tissue necrosis
and ulcer formation.
 Chemical Ulcers: Result from exposure to corrosive substances such as
acids or alkalis, leading to tissue damage and ulceration, often seen in cases
of ingestion or contact with these substances.
 Stress Ulcers: Develop in response to severe physiological stress, such as
trauma, surgery, or critical illness, often occurring in the stomach or upper
gastrointestinal tract.
Causes:
 Helicobacter pylori Infection
 Regular Use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
 Advanced Age
 Smoking
 Excessive Alcohol Consumption
 History of Ulcers
 Chronic Diseases (e.g., Diabetes, Cardiovascular Disease)
 Poor Dietary Habits
 High Stress Levels
 Genetic Predisposition

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Preventive Measures:
 Healthy lifestyle Practices
 Medication management
 Pressure ulcer prevention
 Venous ulcer prevention
 Arterial ulcer prevention
 Diabetes management
 Eye care
 Oral hygiene
 Cardiovascular health
 Stress management

d. ELECTROLYTE
An electrolyte imbalance can occur if the body has too much or too little water.
Electrolytes are minerals in the blood, tissues and elsewhere throughout the body.
Types:
 Dehydration: Fluid Loss
 Hyponatremia: Low Sodium
 Hypernatremia: High Sodium
 Hypokalemia: Low Potassium
 Hyperkalemia: High Potassium
 Hypocalcemia: Low Calcium
 Hypercalcemia: High Calcium
 Hypomagnesemia: Low Magnesium
 Hypermagnesemia: High Magnesium
 Hypochloremia: Low Chloride
 Hyperchloremia: High Chloride
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Symptoms:
 Thirst
 Fatigue
 Muscle cramps
 Nausea and vomiting
 Irregular heartbeat
 Weakness
 Confusion
 Headache
 Seizures
 Swelling (edema)

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3. HEALTH INCIDES
Health indices are measurements or indicators used to assess various aspects of health
within population or individuals. These indices help in understanding the overall health
status, identifying health disparities, monitoring trends over time and evaluating the
effectiveness of health interventions. Some common health indices include:
 Life Expectancy: This index measures the average number of years a person is
expected to live from birth. It provides a snapshot of overall health and healthcare
effectiveness within a population.
 Infant Mortality Rate: This index measures the number of deaths of infants under
one year of age per 1,000 live births in a given year. It reflects the health of newborns
and the effectiveness of maternal and child healthcare services.
 Maternal Mortality Ratio: This index measures the number of maternal deaths per
100,000 live births during pregnancy or within 42 days of termination of pregnancy. It
reflects the quality of maternal healthcare services and access to prenatal care.
 Child Mortality Rate: This index measures the number of deaths of children under
five years of age per 1,000 live births. It indicates the overall health and well-being of
children and the effectiveness of healthcare services targeting this age group.
 Disease-specific Mortality Rates: These indices measure the number of deaths
attributed to specific diseases or conditions, such as cardiovascular diseases, cancer,
HIV/AIDS, tuberculosis, etc. They help in understanding the burden of specific health
conditions and targeting interventions accordingly.
 Prevalence and Incidence Rates: These indices measure the proportion of
individuals within a population who have a particular disease (prevalence) or the rate
at which new cases of a disease occur (incidence). They provide insights into disease
burden and transmission dynamics.
 Healthy Life Expectancy: This index measures the number of years an individual is
expected to live in good health, free from disability or disease. It provides a more
nuanced perspective on overall health by considering both longevity and quality of
life.
 Healthcare Access and Utilization Indicators: These indices measure factors such
as healthcare coverage, access to essential healthcare services, utilization rates of
preventive and curative services, and healthcare expenditure per capita. They reflect
the accessibility and affordability of healthcare services within a population.
 Health Behavior Indicators: These indices measure lifestyle factors and behaviors
that influence health outcomes, such as tobacco use, alcohol consumption, physical
activity levels, dietary habits, and adherence to preventive health practices.
 Environmental Health Indicators: These indices measure environmental factors that
impact health, such as air and water quality, sanitation, access to clean drinking water,
exposure to pollutants, and prevalence of vector-borne diseases.

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Preventive and Remedial Measures:

1. Type 1 Disorders (Cardiovascular diseases, hypertension, obesity)

Preventive Measures:
● Healthy Diet: Encourage a balanced diet rich in fruits, vegetables, whole
grains, lean proteins, and healthy fats. Limit intake of processed foods, sugary
beverages, and foods high in saturated and trans fats.
● Regular Physical Activity: Promote regular exercise for at least 30 minutes
most days of the week. This can include aerobic exercises like walking,
jogging, swimming, or cycling, as well as strength training exercises.
● Maintain Healthy Weight: Promote weight management through healthy
eating and regular exercise. Encourage individuals to achieve and maintain a
healthy body weight.
● Stress Management: Teach stress-reduction techniques such as mindfulness,
meditation, yoga, or deep breathing exercises.
● Limit Alcohol and Tobacco Use: Encourage moderation in alcohol
consumption and support efforts to quit smoking.
● Regular Health Check-ups: Encourage regular monitoring of blood pressure,
cholesterol levels, and other cardiovascular risk factors. Early detection can lead
to early intervention and prevention of complications.
Remedial Measures:
● Medication: Depending on the severity of the condition, medications such as
antihypertensive drugs, statins, or anti-obesity drugs may be prescribed.
● Dietary Changes: Provide nutrition counseling and support individuals in
making dietary changes to improve cardiovascular health and manage weight.
● Exercise Programs: Design exercise programs tailored to individual needs and
fitness levels to improve cardiovascular fitness and aid in weight management.
● Behavioral Therapy: Offer behavioral therapy or counseling to address
unhealthy lifestyle habits and promote adherence to treatment plans.
● Surgical Intervention: In severe cases of obesity, bariatric surgery may be
considered as a treatment option.

2. Type 2 Disorders (Cancer, Diabetes, Ulcers, Electrolyte and water imbalance)

Preventive Measures:
● Healthy Lifestyle: Encourage healthy eating habits, regular physical activity,
maintaining a healthy weight, and avoiding tobacco and excessive alcohol
consumption.
● Screening and Early Detection: Promote regular screenings for cancer (e.g.,
mammograms, colonoscopies, Pap smears), diabetes (e.g., blood glucose tests),

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 and other relevant conditions to detect them early when treatment is most
effective.
● Stress Management: Support stress reduction techniques to mitigate the
impact of stress on overall health.
● Education and Awareness: Raise awareness about the risk factors associated
with these conditions and encourage proactive health behaviors.
● Infection Control: Address factors contributing to ulcers such as Helicobacter
pylori infection through appropriate treatment and hygiene practices.
● Hydration: Encourage adequate fluid intake and electrolyte balance through a
balanced diet and regular hydration.
Remedial Measures:
● Medical Treatment: Provide medical treatment tailored to the specific
condition, which may include chemotherapy, radiation therapy, surgery, insulin
therapy, or medications for ulcer management and electrolyte imbalance.
● Nutritional Support: Offer nutritional counseling and support to manage
dietary requirements and side effects of treatment.
● Psychosocial Support: Provide emotional and psychological support to
individuals and families coping with the diagnosis and treatment of these
conditions.
● Rehabilitation: Offer rehabilitation services as needed to support recovery and
improve quality of life post-treatment.
● Palliative Care: Provide palliative care for individuals with advanced or
terminal illness to manage symptoms and improve comfort and quality of life.

4. ENERGY BALANCE AND METHODS TO CALCULATE INDIVIDUAL

NUTRIENT AND ENERGY NEEDS

 Obesity stems from imbalance between energy intake and energy expenditure.
 Reducing obesity requires addressing both, not just one.
 Humans are physiologically biased to achieve energy balance at high energy flux
(high intake + high expenditure), not through low intake alone.
 Prevention of weight gain is more feasible than treatment, as the body defends
against weight loss more than weight gain.
 Small behavior changes may suffice for prevention, while larger changes are needed
for treatment.
Framing the Issue
 Obesity results from positive energy balance, not just overconsumption or inactivity.
 Both energy intake and expenditure must be modified to address obesity.
 Energy balance theory can guide more effective interventions.

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Energy Balance: Definitions
 Components:
o Energy intake (EIN): from food (protein, fat, carbs, alcohol).
o Energy expenditure (EOUT): includes Resting Metabolic Rate (RMR),
Thermic Effect of Food (TEF), and Energy Expended in Physical Activity
(EEPA).
 Body weight changes only when EIN ≠ EOUT.
 Energy balance control timeframe varies by individual and impacts response to
interventions.

How the Body Achieves Energy Balance

 Controlled by physiological mechanisms with signals from body stores.
 Components of energy balance interact: changes in one affect others.
 Stability in body weight over time suggests robust physiological regulation.

Obesity Is Not Due to One Component Alone

 Evidence shows both intake has increased and activity decreased in recent decades.
 Examples:
o NHANES: increased caloric intake since 1970s.
o Amish study: 18,000 steps/day vs. 5,000 in modern Americans.
 Changes in intake/expenditure would predict more weight gain if not for physiological
compensation.
 Components interact dynamically (e.g., reduced intake lowers expenditure).

Does It Matter How Energy Balance Is Achieved?

 Yes. The body prefers energy balance at high energy flux.
 Sedentary people must eat less, but often fail to match low energy needs, resulting in
weight gain.

A Physiological Drive for High Energy Expenditure

 Human physiology evolved to match energy intake with high physical activity.
 Jean Mayer’s research: energy intake aligns better with expenditure at moderate to
high activity levels.
 Low activity disrupts appetite regulation → increased obesity risk.
 Concept of “regulated zone” (high activity) vs. “unregulated zone” (low activity):
o In regulated zone: better sensitivity between intake and expenditure.
o In unregulated zone: intake does not adjust, leading to weight gain.

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Debate: Is Physical Activity Still Relevant?
 Some claim food environment is more to blame than declining activity.
 Authors argue that early 20th-century declines in activity created conditions that
allowed food environment to trigger obesity.
 Obesity raises RMR and EEPA, keeping total expenditure stable despite inactivity.

Food Restriction Alone Is Not the Answer

 Food restriction reduces weight but also:
o Lowers energy expenditure (RMR, TEF, EEPA).
o Increases hunger.
 Matching low intake to low expenditure is unsustainable.
 Long-term maintainers of weight loss are highly active.
 Strategy: increase physical activity to allow more food flexibility and better energy
balance.

Treatment vs. Prevention

 Prevention is easier than treatment:
o Body resists weight loss more than weight gain.
 Post-weight loss:
o RMR drops significantly (170–480 kcal/day depending on % lost).
o Requires large permanent behavior changes.
 Preventing gain requires smaller changes, as the average gain is 1–2 lbs/year (~15–50
kcal/day surplus).

The Energy Gap

 To prevent gain in 90% of adults: cut ~100 kcal/day.
 In children: ~150 kcal/day.
 Prevention programs can promote:
o Small food changes.
o Increased lifestyle physical activity.
 America on the Move (AOM) initiative:
o Walk 2,000 more steps + eat 100 fewer kcal/day.
o Effective in children and adults.

Misuse of the Small Changes Approach

 Claiming that cutting 100 kcal/day will result in 10 lbs/year lost is misleading.
 As body weight drops, so do energy needs → diminishing returns.
 Small changes prevent gain, not promote major loss.

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Children and Obesity

 Children face same obesogenic factors as adults.

 Important to instill healthy habits early.
 Pediatricians emphasize nutrition more than activity—this must change.
 Children need higher activity levels than adults for healthy development.

How to Produce Behavior Change

 Environment matters but won’t suffice alone.

 Individuals need cognitive skills to make good energy balance choices.
 Educating children about energy balance could empower them long term.

Summary and Recommendations

1. Increase physical activity to move people into the regulated zone.

2. Focus on prevention—easier than reversing obesity.
3. Equip individuals, especially children, with skills to manage energy balance.
4. Modify physical environments to support healthier choices.

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5. PLANNING A HEALTHY DIET

Planning a healthy diet is essential for promoting overall well-being, maintaining a healthy weight, and
reducing the risk of chronic diseases such as diabetes, heart disease, and obesity. A healthy diet provides the
body with essential nutrients, maintains energy balance, and supports optimal physiological function. This
section outlines the core components, principles, tools, and international recommendations for effectively
planning a healthy diet.

1. The Purpose of a Healthy Diet

A healthy diet helps individuals:
 Meet their nutritional needs
 Maintain appropriate body weight
 Support growth, development, and tissue repair
 Prevent nutrition-related diseases
According to the Dietary Guidelines for Americans (2020–2025), a healthy eating pattern includes nutrient-
dense foods and beverages across all food groups in appropriate amounts while limiting intake of added
sugars, saturated fats, and sodium.

2. Key Principles of Diet Planning

There are six fundamental principles that guide healthy diet planning:
a. Adequacy
A diet should provide sufficient essential nutrients, fiber, and energy to meet the needs of healthy
individuals. Inadequacy can lead to malnutrition or nutrient deficiencies.
b. Balance
Balancing food intake from various food groups ensures that no single nutrient overshadows others. For
example, balancing calcium and iron-rich foods supports bone and blood health simultaneously.
c. Calorie (Energy) Control
This involves managing food portions to match energy intake with energy expenditure, helping to prevent
weight gain or loss unless desired for health goals.
d. Nutrient Density
Foods should provide the highest amount of vitamins, minerals, and other beneficial substances for the
fewest calories. Whole fruits, vegetables, lean proteins, and whole grains are nutrient-dense options.
e. Moderation
Avoiding excess intake of added sugars, saturated fats, sodium, and alcohol helps maintain health and
lowers disease risk.
f. Variety
Eating a diverse array of foods within each food group prevents monotony and ensures a broad intake of
nutrients.

3. Components of a Healthy Eating Pattern

Based on USDA MyPlate and the Dietary Guidelines for Americans, a healthy dietary pattern includes:
✔ Vegetables
Consume a variety from all subgroups: dark green, red and orange, legumes (beans and peas), starchy, and
others.
✔ Fruits
Emphasize whole fruits over juice to increase fiber and reduce sugar intake.

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✔ Grains
At least half should be whole grains like brown rice, oats, and whole wheat bread.
✔ Dairy
Include low-fat or fat-free dairy products, such as milk, yogurt, and cheese, or fortified soy alternatives.
✔ Protein
Consume a variety including seafood, lean meats, poultry, eggs, legumes, nuts, seeds, and soy products.
✔ Oils
Choose unsaturated fats (e.g., olive, canola, avocado oil) over saturated or trans fats.

4. Tools to Guide Healthy Eating

USDA MyPlate
This visual model suggests:
 ½ plate = fruits and vegetables
 ¼ plate = grains (preferably whole)
 ¼ plate = protein
 Include a serving of dairy or dairy alternatives on the side

5. International Recommendations: WHO Guidelines

The World Health Organization (WHO) recommends the following for a globally healthy diet:
 Fruit and vegetables: ≥400g per day (excluding starchy roots)
 Free sugars: <10% of total energy intake (ideally <5%)
 Fats: <30% of total energy intake, with <10% from saturated fats and trans fats minimized
 Salt: <5g (≈2,000mg sodium) per day
These guidelines also emphasize avoiding processed foods and sugary beverages and encouraging whole,
fresh food choices.

6. Meal Planning and Portion Control

Effective meal planning includes:
 Creating balanced meals with vegetables, lean protein, and whole grains
 Controlling portion sizes using hand or plate models
 Preparing meals ahead of time to reduce reliance on processed or fast foods
 Reading food labels to monitor nutrient content and serving sizes

7. Personalized Diet Planning

A healthy diet must be tailored to:
 Age
 Sex
 Physical activity level
 Cultural or religious dietary practices
 Health conditions (e.g., diabetes, hypertension, allergies)
For personalized guidance, consulting a registered dietitian is recommended.

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8. Hydration and Physical Activity
 Drink 6–8 cups of water daily (more with physical activity or in hot climates)
 Limit sugar-sweetened beverages
 Combine healthy eating with regular physical activity (150 minutes per week minimum for adults)

9. Sustainability and Behavior Change

Making long-term dietary changes requires:
 Setting realistic goals (e.g., adding one vegetable serving per day)
 Focusing on progress, not perfection
 Educating children and families about food choices
 Modifying home and community food environments to support healthy behaviors

Planning a healthy diet involves more than just choosing the right foods—it’s about ensuring
adequacy, balance, moderation, variety, and nutrient density. By following evidence-based guidelines like
those from the Dietary Guidelines for Americans, USDA MyPlate, and the World Health Organization,
individuals can develop sustainable, culturally appropriate eating habits that support lifelong health.
Combining this with physical activity and nutrition education ensures a holistic approach to wellness.

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