Weight management is a significant public health issue. Gaining, losing, or maintaining weight loss can be challenging, as can balancing the energy equation on both sides. Weight management encompasses much more than just appearance and confidence. Being overweight or obese is associated with various physical and mental health issues.
This chapter offers a socio-cultural perspective on weight management that you can apply in your life. It outlines various strategies for managing weight, emphasizing the significance of balancing energy intake and expenditure. Additionally, we will address the psychological aspects related to weight management. You will also find detailed information on seeking help for yourself or a friend.
Challenges in Weight Management
Recent data indicates that around 70 percent of American adults are classified as overweight, with 38 percent categorized as obese (Centers for Disease Control and Prevention, 2016). Figure 9.1 shows the prevalence of obesity in the United States, broken down by sex and age. It is important to note that obesity impacts individuals of all demographics, including children, on a global scale.
People tend to gain weight as they age, reaching their highest weight in adulthood before usually experiencing weight loss in their later years. Consequently, those who become overweight or obese early in life are likely to face challenges in managing their weight throughout their lifetime. However, with consistent lifestyle changes, it is possible to change this trajectory.
The energy balance equation, which will be explained in further detail later, is straightforward: Energy in minus energy out equals weight status. Nonetheless, various factors influence this equation.
A Disease Linked to Many Other Diseases and Conditions
Obesity has been recognized as a disease by the American Medical Association. While overweight and obesity are diagnosed using body mass index (BMI) and waist circumference (as shown in Table 7.1), obesity is closely associated with being “overfat.” As discussed in Chapter 7, excessive fat storage, particularly in the abdominal area, is linked to numerous health conditions. Behaviors that contribute to being overweight or obese, such as poor nutrition and a sedentary lifestyle, along with the buildup of excess body fat, are linked to a variety of diseases and concerns that impact both physical and mental health (Centers for Disease Control and Prevention, 2017), as shown in Figure 9.2.
Weight Management Strategies
Although many people think of weight management primarily in terms of weight reduction, energy balance principles also play a crucial role. Maintaining weight loss can be particularly challenging due to various factors, including changes to resting metabolic rate (RMR) and the necessary permanent lifestyle changes.
Most individuals find it easier to prevent weight gain than to lose weight. Consequently, it can be helpful to think of weight management in three phases: prevention of weight gain, weight loss, and weight-loss maintenance.
If you are currently at an average weight, it is advisable to maintain that weight through healthy practices, especially as you age. If you are motivated to lose weight, understand that it may be challenging while achieving and sustaining weight loss is possible. Remember, small choices made consistently over days, months, and years can lead to significant results.
Most people experience a gradual, steady weight gain throughout their lives. To successfully manage your weight in an environment that promotes obesity, you must cultivate a lifestyle that adheres to energy balance principles on most days.
Average Values for Energy Expenditure During Various Physical Activities
| Activity | Men (kcal/min) | Women (kcal/min) | Relative to body mass (kcal/kg/min) |
|---|---|---|---|
| Basketball | 8.6 | 6.8 | 123 |
|
Cycling
|
5.0 7.2 |
3.9 5.9 |
.071 .107 |
|
Running
|
14.0 18.2 |
11.0 14.3 |
.200 .260 |
| Sitting | 1.7 | 1.3 | .024 |
| Sleeping | 1.2 | 0.9 | .017 |
| Standing | 1.8 | 1.4 | .026 |
| Swimming (crawl,) 4.8 km/h (3.0 mph)Tennis | 20.0 | 15.7 | .285 |
| Walking, 5.6 km/h (3.5 mph) | 5.0 | 3.9 | .071 |
| Weightlifting | 8.2 | 6.4 | .117 |
| Wrestling | 13.1 | 10.3 | .187 |
Healthy Strategies for Tipping the Energy Balance Scale
You must disrupt your energy balance equation to change your weight status over a specific period. Three general principles should always be followed for healthy weight management:
- avoid losing more than 2 pounds (1 kg) weekly. Rapid weight loss can make it more challenging to maintain long-term results because it may disrupt your resting metabolic rate (RMR) and often leads to more significant loss of muscle and bone mass.
- To maintain a healthy energy balance, it is essential to consider both sides of the equation. Reducing your energy intake while increasing your energy expenditure can create a more manageable total energy deficit in the short and long term. For instance, if your goal is to achieve a daily deficit of 500 calories, you might reduce your energy intake by 300 calories and increase your physical activity to burn an additional 200 calories.
- Small weight changes can lead to significant health benefits. However, the journey to weight loss can be long, challenging, and frustrating; even small reductions in weight (around 3 to 5 percent of body weight) can make a difference. If accomplished by improving your diet and moving regularly, weight loss can reduce your risk for several chronic diseases (Jensen et al., 2014).
Reducing Energy Intake
In our society, “diet” functions as nouns and verbs. Everyone has a diet, but only some are actively dieting. Managing caloric intake can be challenging because we live in a world with abundant food options. Fortunately, several key strategies can help you reduce calorie consumption without feeling deprived. To find the best approach for you, it is essential to mix and match these strategies based on your social situation.
However, it is essential to exercise caution. Your specific caloric needs depend on your body size, activity level, age, and more. As you work to adjust your energy balance, only consume 800 calories per day if you are under medical supervision. A very low-calorie intake can leave you feeling unwell—leading to low energy and difficulty concentrating—and you may not receive the necessary nutrients.
Your body needs a certain amount of high-quality fuel to function effectively. Extremely low-calorie diets are not sustainable and may ultimately fail. Table 9.2 highlights some critical strategies for reducing energy intake and suggests ways you might apply them to your daily life.
Move More: Expend More Energy
Previous chapters have outlined how to increase physical activity and reduce sedentary behavior. While all forms of exercise contribute to overall health, two types are essential for managing energy balance.
Aerobic endurance activities improve cardiovascular health and help you burn substantial energy. The greater the intensity and duration of these activities, the more energy you expend, which can positively influence your resting metabolic rate (RMR). Including these activities in your daily routine is essential, whether through structured workouts like running or by opting for active transportation.
metabolism active. This aspect of fitness is crucial at every stage of weight management—whether you are preventing weight gain, losing weight, or maintaining your current weight. It is essential during weight loss due to its positive relationship with RMR. From the perspective of achieving and sustaining your healthiest self, regular strength training is vital to preserving muscle mass and RMR, particularly as you age, primarily through middle age and beyond.
Consider incorporating these daily strategies into your life:
- Eliminate the bus and other devices that save steps, such as elevators, escalators, and sidewalks. Do not let anyone rob you of your steps. Start viewing them as a way to spend your energy effectively.
- Fill your backpack as much as possible to increase the intensity of your walking exercise. Maintain good posture to prevent back or shoulder pain and injuries.
- When planning your cardiorespiratory exercise, aim to work hard for extended durations to stimulate your metabolism effectively.
- Stand whenever possible and fidget (if it is socially acceptable) to burn calories throughout the day. Take scheduled breaks from sitting. For example, if your building has stairs, try to go up and down the stairs for a few minutes every hour. Consider these breaks as small ways to expend energy, even if they only use a small quantity of effort each time.
- Make it a habit to engage in resistance training that challenges your body beyond your weight. This is especially important for women, who often focus primarily on cardio exercises for weight management. Understanding the significant role that muscle mass plays in energy balance is crucial.
Daily Movement Is Essential for Weight Management
Regular exercise and physical activity are essential for weight management during all three phases. However, the required amount of exercise and the reasons for engaging in it may differ.
Prevention of Weight Gain
Due to difficulties in study designs, the role of energy expenditure in preventing weight gain must be established. However, it is reasonable to assume that energy expenditure is significant, particularly as people age and their resting metabolic rate (RMR) begins to decline. Engaging in high levels of physical activity, especially resistance training, helps mitigate this decline in RMR that often occurs after middle age by maintaining muscle mass and ensuring that existing muscle mass remains metabolically active.
Weight Loss and Healthy Body-Composition Change
Incorporating cardiorespiratory and resistance training into your weight loss program is essential for several reasons. First, it enables you to eat more while still reaching your energy deficit goals, which can help you adhere to your program more effectively. Second, it promotes healthier changes in body composition. When weight loss occurs solely through calorie restriction, a significant portion often comes from lean tissue (muscle mass). However, engaging in exercise and physical activity helps preserve muscle.
Additionally, loading your bones during weight loss can help mitigate the bone loss that often occurs with caloric restriction. Lastly, engaging in physical activity, particularly high-intensity cardiorespiratory and strength training, protects against reduced resting metabolic rate (RMR) that can accompany weight loss.
According to the American College of Sports Medicine (ACSM) 2018 guidelines, moderate to vigorous-intensity aerobic activities involving large muscle groups should be performed for at least 30 minutes daily, progressing to 60 minutes daily, on at least five days each week.
Weight Loss Maintenance
Exercise and physical activity are crucial not only during weight loss but also for maintaining that weight loss. Research indicates, and the American College of Sports Medicine (ACSM) supports, that increased cardiorespiratory activity is essential for weight-loss maintenance. Specifically, following the FITT guidelines—frequency, intensity, time, and type—it is recommended to engage in moderate to vigorous-intensity activities, utilizing large muscle groups, at least five to seven days per week, aiming for a total of about 250 minutes per week.
This can be achieved through intentional exercise and lifestyle activities, such as active transportation, as long as they are of moderate intensity. Some of the most substantial evidence highlighting the importance of energy expenditure in weight-loss maintenance comes from the National Weight Control Registry. This registry is a longitudinal study that tracks successful strategies utilized by individuals who have lost weight and maintained their weight loss. It also offers an online weight-management program. One of the primary strategies for success includes engaging in at least 60 minutes of physical activity or exercise each day (Hill & Wyatt, 2013). Additionally, adopting a macronutrient-balanced approach to eating can further enhance weight-loss maintenance efforts.
Psychological Concerns Regarding Weight Management
We live in an environment that makes managing weight through healthy behaviors difficult. Additionally, our society places a strong emphasis on being thin and fit, which contributes to a constant state of psychological distress related to body image issues for many individuals. Most body image concerns arise from a disconnect between how people perceive themselves (or think they look) and societal expectations shaped by cultural messages, family pressures, and personal belief systems.
There exists a continuum ranging from a healthy body image at one end to life-threatening eating disorders at the other. Unfortunately, it is increasingly rare to find someone—male or female—who feels satisfied with their body shape, size, and appearance. While an in-depth examination of these issues is beyond our scope, it is essential to encourage those struggling with body image to seek professional help.
Weight management should occur in a positive and supportive environment, including the mindset you cultivate within yourself. With few exceptions, most people can maintain relative health at any weight. Additionally, being content in your skin—regardless of appearance—and having self-confidence are attractive qualities.
Reducing Body Size and Fatness: Anorexia, Bulimia, and Exercise Addiction
- Anorexia: People with anorexia may express a strong interest in food, yet they do not consume enough to maintain a healthy weight, often leading to a shallow body mass index (BMI). While this condition primarily affects young women, it is becoming increasingly common among older women and men. Tragically, in some cases, this severe state of starvation can result in death.
- Bulimia nervosa:A person with bulimia nervosa experiences recurrent episodes of binge eating, which are followed by purging behaviors such as vomiting, using laxatives, or taking diuretics. Bulimia can be more challenging to identify because these behaviors often occur in private, and individuals may maintain an average weight. However, fluctuations in weight can be a warning sign. The binge-purge cycle stresses various body systems, including the teeth and esophagus, the liver and kidneys, and the heart.
- Binge-eating disorder:Individuals who binge eat often do so uncontrollably in response to stress, intense emotions, or personal conflicts. After these uncontrolled eating episodes, they frequently experience feelings of shame and depression, which can lead to increased efforts to manage their weight. Typically, those who binge eat are at a higher risk of obesity, which compromises their health. They also tend to suffer from elevated rates of anxiety and depression.
- Exercise addiction: While most behaviors focus on energy intake, excessive exercise can also be used to manage weight.
Increasing Body Size and Muscle Mass: Muscle Dysmorphia
Eating disorders are often associated with young women striving for extreme thinness, but men can also experience a condition known as muscle dysmorphia. This disorder leads individuals — typically men and women — to feel that they are not muscular and fit despite having good muscle mass and tone. For men aiming to become more prominent, this condition is commonly referred to as “bigorexia.”
While the goal of those with this condition is the opposite of those with traditional eating disorders—seeking increased muscle size rather than decreased body weight—the underlying issue is often similar: poor body image that results in unhealthy eating and exercise behaviors. The mental distress experienced can be just as severe and may lead to dangerous behaviors, including the use of steroids.
Summary
Weight management is a significant challenge in our society, which often encourages obesity due to easy access to highly palatable foods and a reduced need for physical activity. Focusing on the energy balance equation, particularly the relationship between energy intake and expenditure through physical activity and exercise, is crucial to managing weight effectively. Incorporating movement, primarily through cardiorespiratory and resistance training, can significantly improve your success in controlling your weight. Regular exercise helps maintain or enhance your resting metabolic rate, enabling you to burn calories more efficiently and stay closer to an energy balance.
By educating yourself and paying attention to your daily habits, you can adopt various strategies to maintain this balance. However, managing weight can be emotionally challenging, and unhealthy eating and exercise behaviors can negatively affect both mental and physical health. Recognizing when to seek professional assistance may be crucial to your weight management journey.