316. A Clinical Guide To Weight Loss And Maintenance

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316. A Clinical Guide To Weight Loss And Maintenance

CATEGORY: Fitness, Workout & Exercise 500 Courses

COURSE NUMBER: 01

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Syllabus

FOREWORD …………………………xvii
Albert J. Stunkard, M.D.
A TALE OF TWO FATHERS………………..xxiii
Sylvia R. Karasu, M.D.
ACKNOWLEDGMENTS . . . . . . . . . . . . . . . . . . . . . . . xxv
1 INTRODUCTION ………………………..1
The Unbearable Heaviness of Being . . . . . . . . . . . 1
The “Minded Brain” . . . . . . . . . . . . . . . . . . . . 5
The Dieter as Well as the Diet . . . . . . . . . . . . . . 7

2 OBESITY IN THE UNITED STATES:
THE GRAVITY OF THE SITUATION . . . . . . . . . . . . . . . 11
Definitions of Obesity: Body Mass Index . . . . . . . . .11
Some Methodological Problems in Studying Obesity . .18
Genetics and Obesity . . . . . . . . . . . . . . . . . . .20
The National Weight Control Registry: Weight Loss
Versus Maintenance . . . . . . . . . . . . . . . . . .23
The Medical Consequences of Obesity . . . . . . . . .30
The Metabolic Syndrome . . . . . . . . . . . . . . . . . 35
Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Other Medical Consequences of Obesity . . . . . . . . 38
Weight Cycling (Yo-Yo Dieting) . . . . . . . . . . . . . . 39
Discrimination Against the Obese . . . . . . . . . . . .44

3 FOOD: THE BASIC PRINCIPLES OF CALORIES. . . . . . 55
Factors Involved in Daily Energy Requirements . . . . .55
Carbohydrates . . . . . . . . . . . . . . . . . . . . . . .63
Classification of Carbohydrates . . . . . . . . . . . . . 64
Glycemic Index . . . . . . . . . . . . . . . . . . . . . . 65
High-Fructose Corn Syrup (HFCS) . . . . . . . . . . . 69
Nonnutritive Sweeteners . . . . . . . . . . . . . . . . . 74
Fiber . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Water . . . . . . . . . . . . . . . . . . . . . . . . . . .81
Energy Density . . . . . . . . . . . . . . . . . . . . . .84
Proteins . . . . . . . . . . . . . . . . . . . . . . . . . .86
Fats . . . . . . . . . . . . . . . . . . . . . . . . . . . .89
Fatty Acids . . . . . . . . . . . . . . . . . . . . . . . . 90
Fat Substitutes . . . . . . . . . . . . . . . . . . . . . . 92
Lipoproteins and Cholesterol . . . . . . . . . . . . . . . 92
4 THE PSYCHOLOGY OF THE EATER . . . . . . . . . . . . . 101
Obesity as a Brain Disorder . . . . . . . . . . . . . . 101
Homeostasis, Allostasis, Stress,
and the HPA Axis . . . . . . . . . . . . . . . . . . . 106
Personality, Temperament, and Character . . . . . . . 113
Psychological Defense Mechanisms . . . . . . . . . . 117
The Psychology of Temptation and Self-Control . . . . 121
Reward, Cravings, and Addiction (Dopamine,
Endocannabinoids) . . . . . . . . . . . . . . . . . . 128

5 THE METABOLIC COMPLEXITIES
OF WEIGHT CONTROL . . . . . . . . . . . . . . . . . . . . . 141
General Considerations . . . . . . . . . . . . . . . . . 141
The Set Point . . . . . . . . . . . . . . . . . . . . . . 143
Adipose Tissue . . . . . . . . . . . . . . . . . . . . . 146
Brown Adipose Tissue . . . . . . . . . . . . . . . . . .146
White Adipose Tissue . . . . . . . . . . . . . . . . . .147

Satiety . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Hormones of Food Intake . . . . . . . . . . . . . . . . 153
Gastrin . . . . . . . . . . . . . . . . . . . . . . . . . .153
Leptin . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Adiponectin . . . . . . . . . . . . . . . . . . . . . . . 159
Ghrelin . . . . . . . . . . . . . . . . . . . . . . . . . .161
Insulin, Amylin, and Glucagon . . . . . . . . . . . . . 164
Cholecystokinin . . . . . . . . . . . . . . . . . . . . 169
Neuropeptide Y . . . . . . . . . . . . . . . . . . . . . .170
Other Neurochemical Mechanisms Involved in Eating . .171
Conclusion . . . . . . . . . . . . . . . . . . . . . . . 174
6 PSYCHIATRIC DISORDERS AND WEIGHT . . . . . . . . . 181
Cause or Consequence? . . . . . . . . . . . . . . . . 181
Excessive Weight and Comorbid Psychiatric
Symptoms . . . . . . . . . . . . . . . . . . . . . . 183
Dieting and Psychological Symptoms . . . . . . . . . 194
The Psychology of Weight Cycling . . . . . . . . . . . 197
Body Image, Fat Acceptance, and Body
Dysmorphic Disorder . . . . . . . . . . . . . . . . . 198
Certain Psychiatric Illnesses and Comorbid
Abnormal Weight . . . . . . . . . . . . . . . . . . . 201
Depression . . . . . . . . . . . . . . . . . . . . . . . .201
Hypochondriasis . . . . . . . . . . . . . . . . . . . . 205
Comorbidity of Eating Disorders
With Psychiatric Symptoms . . . . . . . . . . . . . 209
Binge Eating Disorder . . . . . . . . . . . . . . . . . .211
Anorexia Nervosa . . . . . . . . . . . . . . . . . . . . .213
Bulimia Nervosa . . . . . . . . . . . . . . . . . . . . .217
Comorbidity of Eating Disorders With Alcohol
and Drug Abuse . . . . . . . . . . . . . . . . . . . .219
Alcohol and Weight . . . . . . . . . . . . . . . . . . . 221

7 MEDICAL CONDITIONS AND WEIGHT . . . . . . . . . . . 229
Some Physical Causes of Weight Gain . . . . . . . . 229
Sexual and Reproductive Functioning and Obesity . . 230
Pregnancy . . . . . . . . . . . . . . . . . . . . . . . .232
Smoking and Weight . . . . . . . . . . . . . . . . . . 237
Infectious Agents and Weight Gain . . . . . . . . . . 239
Medications That Cause Weight Gain . . . . . . . . . 241
Antipsychotics . . . . . . . . . . . . . . . . . . . . . .243
Mood Stabilizers . . . . . . . . . . . . . . . . . . . . .245
Antidepressants . . . . . . . . . . . . . . . . . . . . .246
Other Medications . . . . . . . . . . . . . . . . . . . .247
Cellulite (Gynoid Lipodystrophy) . . . . . . . . . . . . 248
8 EXERCISE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Exercise and Nonexercise Activity Thermogenesis . . 255
Exercise . . . . . . . . . . . . . . . . . . . . . . . . 256
Nonexercise Physical Activity . . . . . . . . . . . . . 259
Determinants of Exercise . . . . . . . . . . . . . . . . 262
Metabolic Consequences of Exercise . . . . . . . . . 263
Exercise for Initial Weight Loss Versus
Minimizing Weight Regain . . . . . . . . . . . . . . 266
Exercise and Appetite . . . . . . . . . . . . . . . . . . 271
General Health Effects of Exercise . . . . . . . . . . . 273
Exercise, Depression, and Anxiety . . . . . . . . . . . .273
Exercise and Cognitive Functioning . . . . . . . . . . .276
Exercise and Medical Consequences . . . . . . . . . .277
Recommendations: How Much, How Often,
What Kind? . . . . . . . . . . . . . . . . . . . . . . 285
9 CIRCADIAN RHYTHMS, SLEEP, AND WEIGHT . . . . . 297
Biological Clocks . . . . . . . . . . . . . . . . . . . . 297
What Are Circadian Rhythms? . . . . . . . . . . . . . .297
The Master Clock: The Suprachiasmatic Nucleus . . . 299
Other Clocks (Central and Peripheral) . . . . . . . . . .300

Zeitgebers . . . . . . . . . . . . . . . . . . . . . . . .302
Chronotypes . . . . . . . . . . . . . . . . . . . . . . .303
Jet Lag . . . . . . . . . . . . . . . . . . . . . . . . . 304
Chronopharmacology . . . . . . . . . . . . . . . . . . .307
Hormones, Sleep, and Weight . . . . . . . . . . . . . 308
Orexins . . . . . . . . . . . . . . . . . . . . . . . . . 308
Ghrelin . . . . . . . . . . . . . . . . . . . . . . . . . .310
Serotonin . . . . . . . . . . . . . . . . . . . . . . . . .310
Histamine . . . . . . . . . . . . . . . . . . . . . . . . .311
Hibernating Animals and a Model for Human Obesity . .312
Sleep Disruption and Weight . . . . . . . . . . . . . . 313
Normal Sleep Architecture . . . . . . . . . . . . . . . .313
Fragmented Sleep, Excessive Daytime Sleepiness,
and Obstructive Sleep Apnea . . . . . . . . . . . . .314
Inadequate Sleep and Hormone Secretion . . . . . . . .317
High-Fat Feeding and Disrupted Rhythms . . . . . . . .319
Can Inadequate Sleep Lead to Obesity? . . . . . . . . .320
The Night Eating Syndrome
(Disorder of Circadian Rhythms) . . . . . . . . . . . 323
10 DIET AND WEIGHT . . . . . . . . . . . . . . . . . . . . . . . . 335
General Principles of Diet . . . . . . . . . . . . . . . . 335
Dieting Within Our Environment . . . . . . . . . . . . .335
The Science of Calorie Counting . . . . . . . . . . . .339
The Regimen of Diet . . . . . . . . . . . . . . . . . . .341
Early Research . . . . . . . . . . . . . . . . . . . . . 343
Clara Davis . . . . . . . . . . . . . . . . . . . . . . . .343
Ancel Keys . . . . . . . . . . . . . . . . . . . . . . . 345
Therapeutic Calorie Restriction . . . . . . . . . . . . . 347
Fasting for Weight Control . . . . . . . . . . . . . . . .347
Very-Low-Calorie Diets . . . . . . . . . . . . . . . . . 349
Calorie Restriction and Longevity . . . . . . . . . . . .351
Alternate-Day Fasting . . . . . . . . . . . . . . . . . . .353
Meal Frequency and Rate of Eating . . . . . . . . . . 354
Popular Diets . . . . . . . . . . . . . . . . . . . . . . 357
General Principles . . . . . . . . . . . . . . . . . . . .357

Examples of Dietary Supplementation . . . . . . . . . 358
The Advantages and Perils of High-Protein Diets
and Their Relationship to Low Carbohydrate and
High Fat Intake . . . . . . . . . . . . . . . . . . . 360
The Advantages and Perils of High-Carbohydrate
Diets and Their Relationship to Fat Intake . . . . . . 364
A Review of Some Popular Diets . . . . . . . . . . . .367
Recommendations for a Healthy Diet . . . . . . . . . . 373

11 PSYCHOLOGICAL TREATMENT STRATEGIES
AND WEIGHT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
Our Psychological Relationship to Weight
and Food . . . . . . . . . . . . . . . . . . . . . . . 383
Psychological Treatment Modalities for Weight . . . . 386
The Psychodynamic Therapies . . . . . . . . . . . . .387
Interpersonal Therapy. . . . . . . . . . . . . . . . . . 394
Neurolinguistic Programming . . . . . . . . . . . . . . 395
Gestalt Therapy . . . . . . . . . . . . . . . . . . . . . 395
Cognitive-Behavioral Therapy . . . . . . . . . . . . . .397
Dialectical Behavioral Therapy . . . . . . . . . . . . . 399
Eastern Approaches . . . . . . . . . . . . . . . . . . .401
Self-Help . . . . . . . . . . . . . . . . . . . . . . . . .401
Research on Psychological Treatments for Obesity . . 407
Methodological Issues . . . . . . . . . . . . . . . . . .407
Research Data on Psychotherapeutic
Treatment Strategies . . . . . . . . . . . . . . . . . 408
Research Data on Self-Help Treatment Strategies . . . .412
12 PHARMACOLOGICAL AND SURGICAL TREATMENTS
FOR OVERWEIGHT AND OBESITY . . . . . . . . . . . . . . 421
General Considerations . . . . . . . . . . . . . . . . . 421
A Treatment Decision Tree . . . . . . . . . . . . . . . 427
Pharmacological Approaches to Weight Loss . . . . . 428
FDA-Approved Medications for Weight Loss . . . . . . .429

Off-Label Uses of Medications to Achieve
Weight Loss . . . . . . . . . . . . . . . . . . . . . .431
Dietary Supplements . . . . . . . . . . . . . . . . . . .436
Summary: Medication Management . . . . . . . . . . .437
Surgical Approaches . . . . . . . . . . . . . . . . . . 438
Plastic Surgery . . . . . . . . . . . . . . . . . . . . . .438
Bariatric Surgery . . . . . . . . . . . . . . . . . . . . 445
APPENDIX: SELECTED READINGS AND
WEB SITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461
INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465

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