# Fundamentals of Human Nutrition/Interventions
## Interventions

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### 10.3.3.1 Interventions

INTERVENTIONS IN WEIGHT MANAGEMENT IN CASES OF OBESITY AND OVERWEIGHT
Interventions in weight management in cases of obesity and overweight
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Coursera Wikibook Fundamentals of Human Nutrition Section 10.3.3.1 Energy and Body composition Weight management Interventions
Abstract This work is a contribution to the Wikibook Fundamentals of Human Nutrition Section 10.3.3.1 Energy and Body composition Weight management Interventions
A small percentage of obesity cases may be caused by genetic and endocrine reasons, but the large majority of cases of obesity are caused by environment reasons (socio-economic environment, inappropriate diet and lack of physical activity). The intervention has to be individual and normally consist in changing lifestyle (better nutrition, increase physical activity and when required for obesity type II and III the prescription of medicine and/or surgery).
Keywords: emotions, obesity, overweight, intervention, Mediterranean diet, exercise
Interventions in weight management in cases of obesity and overweight
Introduction
A small percentage of obesity cases may be caused by genetic and endocrine reasons, but the large majority of cases of obesity are caused by environment reasons (inappropriate diet and lack of physical activity). Therefore the treatment of obesity has to be individual and customized for a given patient.
In order to perform an appropriate intervention it is necessary to know the factors which have contributed to the obesity in a particular individual. It is easier and cheaper to prevent the pandemic obesity than to treat the pandemic obesity, once it has been established. The intervention has to be individual and normally consist in changing lifestyle (better nutrition, increase physical activity and when required for obesity type II and III the prescription of medicine and/or the bariatric surgery, bypass, etc.).
Influence of genetic endowment
The genetic factors predisposing to obesity are not yet well understood. A genome-wide search for type 2 diabetes-susceptibility genes identified a common variant in the FTO (fat mass and obesity associated) gene that predisposes to diabetes through an effect on body mass index (BMI). To identify common variants influencing body mass index (BMI), the study have analyzed genome-wide association data from 16,876 individuals of European descent. The main results have confirmed the BMI association in 60,352 adults (per-allele effect = 0.05 Z-score units; P = 2.8 x 10(-15)) and 5,988 children aged 7–11 (0.13 Z-score units; P = 1.5 x 10(-8)). In case-control analyses (n = 10,583), the odds for severe childhood obesity reached 1.30 (P = 8.0 x 10(-11)) (1)
Other studies have shown as well that In European general populations, the combined effects of common polymorphisms in FTO and MC4R are therefore additive, predictive of obesity and T2D, and may be influenced by interactions with physical activity levels and gender, respectively (2)
Common MC4R variants contribute to variation in BMI and obesity risk in the general population. Of particular interest is the finding from genome-wide association studies that suggests that the region downstream of MC4R contributes to its regulation (3)
According to the findings of a recent study, people who have a mutation in the gene APOA2 (which regulates a component of HDL or good cholesterol) have a higher risk of obesity if they have a diet rich in saturated fats. The CC genotype was associated with a 6.8% greater BMI in those consuming a high (P = 0.018), but not a low (P = 0.316) saturated fat diet (4)
Complex interaction of factors contributing to obesity
The inappropriate diet or the lack of physical activity may be due to multiple causes: · Bad emotional control (stress, depression, anxiety, compulsory behaviour, etc.) · Poor socio-economic environment (emotional support, frequency of friends, marital status changes, and a Social Relationship) · Lack of education · Bad food choices · Eating abroad frequently · And so on
Bad emotional control (stress, depression, anxiety, compulsory behaviour, etc.)
An important factor in the failure to achieve a correct weight management are bad handling of emotions. It is well known that our emotions have a powerful effect on our food choices and eating habits. Found empirical evidence that the influence of emotions on eating behavior is stronger in obese than in non-obese and dieters in relation to people who do not practice rigid diets (1) It has also been suggested that the emotion itself can not be responsible for excessive intake but rather, the real cause of overweight, how emotion is fronted by person (6,7) Only by knowing the emotional factors one can reinforce healthy habits that allow us to control weight. Therefore in emotional eaters to control overweight and obesity is recommended to follow cognitive therapy to control emotions better, a healthy diet and regular exercise practice. In a longitudinal study of 6 months with 41 sedentary obese people which have lost an average of 8% of their weight and 41 physically active non-obese people. The influence of emotions in their food intake was assesed by means of a questionnaire (Garaulet M., 2010) (8)
The most significant findings have been:
A lower BMI better emotional control intake. The higher the emotional score, less amount of weight lost. Women have been more influenced by their emotions than men. The weight control strategy was sedentary people use diets. Instead cyclists do by controlling the amount of exercise they do.
Psycological factors:
According to research conducted at the University Hospital Infanta Leonor de Madrid, obese people are not allways happy. According to results presented by the XVI congress of psquiatry 2012 in Bilbao, Spain (10) · 31% of obese patients had presented an anxiety disorder associated with obesity · 35% had a history of a depressive disorder. · 17% of obese people "have a history of having anorexia nervosa and bulimia nervosa · 10% revealed having had a disorder in impulse control · The report also shows a high prevalence of attention deficit disorder and hyperactivity disorder (ADHD) among patients analyzed: · 20.4% of patients had ADHD, a figure five times higher than expected in the general population · In addition, 62% of the patients reported regular dieting 15% had tried dieting organized more than 5 times throughout his life.
Choosing a healthy Diet to prevent and to reverse obesity
The inappropriate diet or the lack of control of the energy balance are the main contributors to obesity. For instance beverages, cakes and sugar consumption is contributing greatly to world obesity.
The appropriate diet has to be healthy, complete in food groups, palatable and easy to flollow, otherways it will be abandoned sooner or later.
The MD has demonstrated to be a good choice; as well as other diets followed by Japonneese, vegetarian people, and so on. The Mediterranean diet is rich in nutrients such as vitamins, minerals, antioxidants, fibre, omega-3 fatty acids (from fish) and monounsaturated fatty acids (from olive oil), whose beneficial effects on health have been widely demonstrated (11)
These studies show as well the progressive abandonment of the MD and the gradual progress of cardiovascular diseases and chronic diseases in the world ; particularly in countries like China, India, Mexico and Arab countries. The most critical point is the pandemia of childhood obesity (11,12)
A logitudinal study which included 6319 participans within thr SUN Project have demonstrated that adherence to Mediterranean diet was inversely associated with weight gain (13)
Another logitudinal study which included 11 015 participants with 4 years of follow-up in the SUN Project have demonstrated a significant direct association between adherence to Mediterranean diet and all the physical and most mental health domains (vitality, social functioning and role emotional) (14)
Adherence to the Mediterranean diet was associated with higher scoring for self-perceived health according to cross-sectional survey made in Catalonia Spain, among a random sample of the 35-74-year-old population (3910 men and 4285 women) in 2000 and 2005 (15.)
Choosing a meals distribution and timing
Another factor to be taken into account in therapeutic strategies should incorporate not macronutrient distribution in addition to the caloric intake. Five meals distributed along the day are recommended. The time clock is as well important and is influenced by the CLOCK gene polymorphism. Late lunch eaters lost less weight and displayed a slower weight-loss rate during the 20 weeks of treatment than early eaters (5 vs. 12% weight loss respectively). Late eaters were more evening types, had less energetic breakfasts and skipped breakfast more frequently that early eaters. CLOCK rs4580704 single nucleotide polymorphism (SNP) associated with the timing of the main meal with a higher frequency of minor allele (C) carriers among the late eaters (Garaulet M., P Gómez-Abellán, J J Alburquerque-Béjar, Y-C Lee, J M Ordovás and F A J L Scheer (2013) (16)
Choosing a program of physical activity to prevent and to reverse obesity
There are a great variety of physical activity programs which could be used in weight management, it is essential to perform aerobic exercise as well a strength and stretching exercises. The program has to have on a weekly basis at least 150 minutes of moderate aerobic activity (the ones preferred by one: walking, bicycling, swimming, etc), or at least 75 minutes of vigorous exercise, or the combination of both. Experts have found that participating in high intensity interval workouts are more successful at losing body fat. These intensity sessions put you at higher risk for injury and burnout.
High intensity exercise is possible if you are fit, if it is not yet the case you need a training program that on a weekly basis increments the duration and intensity of tour physical activity. High intensity exercise also requires low intensity recovery time in the days following the session. This is where careful exercise programming comes into play.
It is important to engage in sport teams in our locality. This will prevent the abandon of the exercise program.
The benefits of physical exercise in the prevention of overweight and obesity are well documented. Regular physical activity reduces heart diseases , certain types of cancer and also helps maintain healthy body weight (17,18). The 2008 Physical Activity Guidelines for Americans (19) , suggests incorporating a minimum weekly total of two and a half hours of moderate-to-vigorous intensity physical activity, spread over at least five days of the week. Exercising five or more hours per week is recommended for weight loss. The calories burned during exercise depends on each individual anthropometrical parameters (gender, weight, physical conditions, fitness, etc.). We have to set our goals of intensity and duration of the exercise on a weekly basis and when a goal has been met, we have to choose a higher goal. It is interesting to focus on the fact that exercising and eating certain foods, like olive oil and foods rich in fiber, are useful to control the appetite. Therefore we have to use foods low dense on energy after exercising to facilitate weight management.
A recent study with nine female runners and ten walkers completed a 60 min moderate-intensity (70% VO2max) run or walk, or 60 min rest The runners often consumed fewer calories than they burned during the run (20). Other studies suggests as well that long- and short-acting signals interact to alter hypothalamic sensitivity to satiation signals (21) which could influence eating behaviour following exercise of moderate intensity.
Study case: Longitudinal study of six months of intervention in obese people
Introduction
The influence of emotions on the intake is stronger in sedentary, obese dieters.
Objective
To study the influence of emotions on the food intake of sedentary and physically active people. To study weight control strategies used by those persons.
Methods
We have performed a longitudinal observational study of weight loss with dietary intervention of 6 months in Madrid Pharmacies. 41 sedentary people and 41 physically active people have participated. The emotional score was obtained by questionnaire "emotional eater" (Garaulet M., 2010) (22). The score can be classified as: Dining little emotional (0-10 points); Moderately emotional (11-20points), very emotional. (21-30points).
Results
Anthropometrical data
Sedentary people Age = 53.9 ± 12.4 years, BMI = 33.6 ± 4.9 kg/m2. N=10 men and 31 women. Weight 87.5 ± 14.5 Kg. Weight loss was significant (10.2% kg in 6 months) The emotional eater score were as average= 13.2 ± 4.4 points over 30 points for sedentary people (13.1 points in men and 13.4 points in women). In cyclists emotional eater score were as average = 7.1 ± 3.7, they were significantly less emotional eaters than sedentary people (p <0.001). The most influential emotional factors were: Cravings and intake of excessive food in men. Binge eating and Obsession for food in women Little emotional eaters have lost more weight than very emotional eaters (12% vs 8%, respectively.). Correlation coefficient = -0.39. Active people Age = 49.9 ± 10.4 years, BMI = 23.1 ± 2.1 kg/m2. N=41 men. Weight 70.5 ± 10.5 Kg.
Intervention sedentary people
Average Hypo-caloric diet: Daily Expenditure = 2000 Kcal Daily Intake = 1700 Kcal Do not skip Breakfast Lunch before 15h Dinner at least two hours before going to bed Exercise = walking 30 to 60 min/day Weight evolution during 6 months intervention
| START M0 | MONTH 1 | MONTH 2 | MONTH 3 | MONTH 4 | MONTH 5 | MONTH 6 |
| weight loss (Kg) | 2.7 | 2.3 | 1.7 | 0.98 | 1.39 | 1.5 |
Total WEIGHT LOSS = 10.2%
Intervention active cyclists
Average Iso-caloric diet: Daily Expenditure = 3000 Kcal Daily Intake = 2980 Kcal Exercise = cycling 90 to 120 min/day Weight evolution during 6 months intervention
| START M0 | MONTH 1 | MONTH 2 | MONTH 3 | MONTH 4 | MONTH 5 | MONTH 6 |
| weight loss (Kg) | 0.7 | 0.8 | 0.9 | 0.7 | 0.9 | 0.5 |
Total WEIGHT LOSS = 0.7%
Conclusion
The intervention based on hypo-caloric diet and increasing physical exercise by sedentary people was effective. The higher was the emotional score, the lower was the amount of weight lost and higher value of the BMI The very emotional eaters have lost less weight than low emotional eaters. The weight management strategy of sedentary people was recurrent dieting. By the contrary the cyclists weight management strategy was controlling duration and intensity of physical exercise.
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