Medication adverse effects (Table 21,17,18) are common but often overlooked causative factors.17 Polypharmacy has been shown to interfere with taste and can cause anorexia.19 In addition, a variety of social factors are associated with unintentional weight loss and include poverty, alcoholism, isolation, financial constraints, and other barriers obtaining food (e.g., impairment in activities of daily living, lack of assistance in grocery shopping or preparing meals).1 In 16% to 28% of patients, no readily identifiable cause for unintentional weight loss is determined.11–16
Maintaining your ideal body weight is a balancing act between food consumption and calories needed by the body for energy. You are what you eat. The kinds and amounts of food you eat affect your ability to maintain your ideal weight and to lose weight.
Several parts of your body, such as your stomach, intestines, pancreas, and fat tissue, use hormones to control how your brain decides if you are hungry or full. Some of these hormones are insulin, leptin, glucagon-like peptide (GLP-1), peptide YY, and ghrelin.
Are food choices flexible and well-suited to the individual? Are weight goals set by the client and the health professional? The program should consider your food likes and dislikes and your lifestyle when your weight-loss goals are planned.
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“We’re all creatures of habit,” Campbell says. So, she says, imagine you’re 75 years old and have to change your habits and incorporate new foods like tofu. Although most diets offer plenty of online and printed resources, they can be overwhelming. “It’s hard sometimes to pick up a book and say, ‘what should I be eating,'” she says. For older adults, it can help to work with dietitians.
27. Wassertheil-Smoller S, Fann C, Allman RM, Black HR, Camel GH, Davis B, Masaki K, Pressel S, Prineas RJ, Stamler J, Vogt TM: Relation of low body mass to death and stroke in the systolic hypertension in the elderly program: the SHEP Cooperative Research Group. Arch Intern Med 2000; 160: 494– 500 [PubMed]
An excess of subcutaneous fat in proportion to lean body mass. Excess fat accumulation is associated with increase in the size (hypertrophy) as well as the number (hyperplasia) of adipose tissue cells. Obesity is variously defined in terms of absolute weight, weight:height ratio, distribution of subcutaneous fat, and societal and esthetic norms. Measures of weight in proportion to height include relative weight (RW, body weight divided by median desirable weight for a person of the same height and medium frame according to actuarial tables), body mass index (BMI, kg/m2) and ponderal index (kg/m3). These do not differentiate between excess adiposity and increased lean body mass. In contrast, subscapular and triceps skinfold measurements and determination of the waist:hip ratio help define the regional deposition of fat and differentiate the more medically significant central obesity from peripheral obesity in adults. No single cause can explain all cases of obesity. Ultimately it results from an imbalance between energy intake and energy expenditure. Although faulty eating habits related to failure of normal satiety feedback mechanisms may be responsible for some cases, many obese people neither consume more calories nor eat different proportions of foodstuffs than nonobese persons. Contrary to popular belief, obesity is not caused by disorders of pituitary, thyroid, or adrenal gland metabolism. However, it is often associated with hyperinsulinism and relative insulin resistance. Studies of obese twins strongly suggest the presence of genetic influences on resting metabolic rate, feeding behavior, changes in energy expenditures in response to overfeeding, lipoprotein lipase activity, and basal rate of lipolysis. Environmental factors associated with obesity include socioeconomic status, race, region of residence, season, urban living, and being part of a smaller family. The prevalence of obesity is greater when weight is measured during winter rather than summer. Obesity is much more common in the southeastern U.S., although the northeastern and midwestern states also have high rates, a phenomenon independent of race, population density, and season.
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Obesity in pets is common in many countries. In the United States, 23–41% of dogs are overweight, and about 5.1% are obese. The rate of obesity in cats was slightly higher at 6.4%. In Australia the rate of obesity among dogs in a veterinary setting has been found to be 7.6%. The risk of obesity in dogs is related to whether or not their owners are obese; however, there is no similar correlation between cats and their owners.
Researchers now know more about visceral fat, which is deep in the abdomen of overweight and obese patients. Visceral fat releases factors that promote inflammation. Chronic obesity-related inflammation is thought to lead to insulin resistance and diabetes, changes in the liver or non-alcoholic fatty acid liver disease, and cancers. More research is needed to understand what triggers inflammation in some obese patients and to find new treatments.
Hoyo C, Cook MB, Kamangar F, et al. Body mass index in relation to oesophageal and oesophagogastric junction adenocarcinomas: a pooled analysis from the International BEACON Consortium. International Journal of Epidemiology 2012; 41(6):1706-1718.
The one fast-food restaurant near that busy East L.A. intersection otherwise filled with bodegas was a Carl’s Jr. I went in and saw that the biggest and most prominent posters in the store were pushing a new grilled-cod sandwich. It actually looked pretty good, but it wasn’t quite lunchtime, and I just wanted a cup of coffee. I went to the counter to order it, but before I could say anything, the cashier greeted me and asked, “Would you like to try our new Charbroiled Atlantic Cod Fish Sandwich today?” Oh, well, sure, why not? (I asked her to hold the tartar sauce, which is mostly fat, but found out later that the sandwich is normally served with about half as much tartar sauce as the notoriously fatty Filet-O-Fish sandwich at McDonald’s, where the fish is battered and fried.) The sandwich was delicious. It was less than half the cost of the Sea Cake appetizer at Real Food Daily. It took less than a minute to prepare. In some ways, it was the best meal I had in L.A., and it was probably the healthiest.