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Chapter 17

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NUTR 2050
Simone Holligan

Chapter 17 Adult Nutrition Conditions and InterventionsKey Nutrition Concepts1 Dietary intake body weight and body composition and physical activity influence changes in the health status of adults2 Nutritionrelated chronic diseases are interrelated and share common risk factors3 Nutrition interventions to modify early risk factors for nutritionrelated diseases can change the course of disease progression4 Nutritional intervention practiced in the context of lifestyle change can lead to sustainable improvements that affect health status and quality of life5 The cognitive behavioural change approach incorporates strategies to build skills and to modify thinking and behaviourdiseases that develop during the adult years fully or partially result from the cumulative effects of excessive energy intake diets high in saturated fats and low in vegetables fruits and fibre tobacco use and alcoholobesity emerged as major contributor to lifestyle related diseases ex Cancer heart disease cerebrovascular diseases diabetes chronic liver disease and cirrhosis these counted for 55 of all deaths for adults aged 2064 in the US in year 2007Overweight and ObesityNearly 13 of US adults are obesedefined as having an excess accumulation of adipose tissue results from long term energy in energyout imbalance involving excess calorie consumption andor low energy output through physical activity Obesity and overweight vary across age gender race and income see Table 172 on p430being overweight or obese increase risk of developing hypertension dyslipidemia coronary heart disease osteoarthritis sleep apnea and respiratory problems back problems and endometrial breast prostate and colon cancers these risks rise as the degree of excess weight risespersons who are obese face psychosocial complications ex Low self esteem and depression social and job discrimination and social stigma obesity associated with shorter life expectancyInsulin Resistance A condition in which cells resist the action of insulin in facilitating the passage of glucose into cellsEtiology of ObesityOverweight and obesity are complex and chronic conditions physiological processes that protect the body from starvation favour fat storage and adjust to a lower metabolic rate during periods of prolonged energy deficit ie dieting Internal mechanisms that govern energy metabolism and appetite regulation are altered by obesityLoss of appetite control may be due to disturbances in hormone signal that rise and fall in response to eating patterns and adjust hunger and fullness sensations such as leptin from adipose tissue and ghrelin from the gutAnother hormone regulatory system the hedonic system responds to the cognitive motivational and emotional aspects of food intake perceived pleasantness liking and wantingLife changing events such as a transition to college life and pregnancy are associated with weight gainEnvironmental factors such as food advertising the easy availability of high palatable snack foods and beverages larger retail package sizes larger portions served in restaurants and the low cost of energy dense foods contribute to obesity epidemicTechnological advances in every dimension of life have replaced physical activity with sedentary activityNumerous expert groups agree that environmental and policy interventions at the national and community level in addition to individual interventions are necessary strategies to curb the obesity epidemic Screening and AssessmentBody Mass Index BMI is correlated with total body fatTo calculate BMI using English measurements follow these steps Multiply body weight in pounds by 703Divide that number by height in inchesDivide that number by height once moreOverweight adults defined as BMI of 25299 obesity is BMI of 30 or greater chart p431Some exceptions for BMI athletes or others with greaterthan average percentages of muscle mass individuals with little muscle mass individuals with dense large bones dehydrated and over hydrated individualsAsian and Pacific Islanders experience obesity related health problems at lower BMIsCentral Adiposityincreased waist circumference is associated with higher risk even in persons of normal weightRecommendation for WeightManagement TherapyNutritional Assessment After the need for weight management is identified a comprehensive assessment is used to understand that individuals experience with overweight current eating and physicalactivity patterns psychosocial and medical factors and hisher motivation and readiness to change and goals Table 174 outlines possible factors to consider during an assessment for weight management p 433Motivation several factors contribute to understanding the clients motivation to engage in a weight loss program reasons and motivations for weight reduction previous weightloss attempts patients understanding of causes of obesity and how obesity contributes to several diseases attitude towards physical activity capacity to engage in physical activity and time available for weight loss intervention and financial consideration
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