Maintaining a Healthy Weight

How Do I Measure Risk?

 CHAPTER OUTLINE

YOUR EXPECTATIONS AND OTHER

FACTORS 187
Body Type and Frame Size 187
Cultural Bias 187

WHAT IS YOUR HEALTHY WEIGHT? 188

Respect the Body You Have 189

CAUSES OF WEIGHT GAIN 189

Lack of Physical Activity 190
Dieting 191
Poor Eating Habits 191

HOW TO MEASURE YOUR RISK 192

The Health Risks of Being Overweight or
Obese 192
Body Mass Index 192
Waist Measurement  194
Indirect Measures of Body Fat 195
Laboratory Body Fat Measures 195

CALCULATE ENERGY BALANCE 195

Calculating Your Daily Caloric
Expenditure 196
Track the Calories That You After reading this chapter, you will be able to:
Consume 197
Reduce Calories and Increase Exercise to
Decrease Body Fat 197 ›› LIST the factors that influence how you perceive your
body.
PRINCIPLES FOR MAINTAINING A HEALTHY
WEIGHT 199
›› DETERMINE the healthy body weight for you.

›› DESCRIBE common reasons for unhealthy weight gain.

›› IDENTIFY methods for measuring body composition to

determine health risks.

›› DESCRIBE the energy balance principle and calculate your

caloric expenditure and caloric intake.

›› UTILIZE sound principles to maintain a healthy weight.

 How Do I Measure Risk?
maintaining a healthy weight

YOUR EXPECTATIONS AND OTHER FACTORS

There are many factors that contribute to our appearance that are beyond our control—and that of adver-
tised products! These include our basic body size and shape, which are primarily determined by our genetic
makeup. In addition to our inherited characteristics, technological advances and cultural pressure contrib-
ute to our perception of how we should look.

Body Type and Frame Size

While it is important to strive for a healthy weight, one must also be realistic about his or her own body. We
have certain inherited features that constitute our physique. Both body type and frame size significantly
affect the size and shape of our body, regardless of weight.

Cultural Bias
There continues to be a cultural bias toward thinness. It seems so ironic because, over the past several de-
cades, the percentages of overweight and obese adults have reached epic proportions—about 70 percent of
the population. A great concern is that approximately one-third of school-age children and adolescents are
also overweight or obese, and in some minority groups the proportion approaches 1 in every 2. Billions of dol-
lars are being spent for health care and other costs attributed to the number of people who are overweight.

How Do I Measure Risk? 187

 While it is important to strive for a healthy weight, social stigma against being overweight is clearly not pro-
ductive—if it were, fewer people would be overweight in the United States. Being model-thin should not be
the goal or the expectation. Concentrating on combining healthy eating and exercise habits with a healthy
dose of self-acceptance should be the goal (Figure 1). We live in a time when enormous pressure is making
us overly worried and concerned about our weight.

Figure 1. How do we come to accept ourselves just as we are and be content with what, for each of us, is a healthy weight?

Healthy weight: Normal weight that minimizes health risks and feels good to the individual.

WHAT IS YOUR HEALTHY WEIGHT?

Because of the culture in which we live, having holistic attitudes and beliefs may be one of the most important
factors in maintaining a healthy weight. The key to having a healthy weight throughout our lives is to be at
peace with our bodies. The worst thing we can do is engage in a constant battle within ourselves. The resulting
negative stress can actually lead to weight gain. Attempts at losing weight by dieting—significantly reducing
food intake—has been proven to ultimately result in weight gain because of the ill effects on our metabolism.
Unfortunately, these battles with our bodies are the norm for many.
How Do I Measure Risk? 188
 Figure 2. Love and respect for who you are is an important step toward well-being.

Respect the Body You Have

Developing a genuine respect for our body just as it is—genetics, frame size, and all—is vitally important
(Figure 2). Being at peace with our body will enable us to enjoy a harmony of being, a peace within our-
selves. The lack of negative stress regarding one’s body and genuine respect for self set the stage for a
realistic acceptance of our whole self. With this healthy regard for ourselves, the various cultural pressures
won’t be so intense. That allows us to take a much more intelligent approach to weight management. We
will be guided by our own internal acceptance rather than driven by external pressures. Wouldn’t each one
of us rather be directing our own choices and attitudes rather than being run around by others—particular-
ly by those trying to make a dollar off of us?

Having a healthy self-regard will also help establish a foundation for approaching weight management in
a sensible manner. For most of us, weight management now and throughout our lives has to do with both
physical activity and what we eat. More often than not we may associate weight loss just with food. Unless
we have unusual health challenges, most of us will maintain a healthy weight by eating well and enjoying a
physically active lifestyle. (Emphasis on the enjoying!)

CAUSES OF WEIGHT GAIN

There are many factors in addition to what foods we consume that can cause weight gain. An inactive life-
style is one of the leading factors that cause people to be overweight. Stress is a part of nearly everyone’s
life today and can be a major contributor to weight gain. Emotional eating can become habitual. Consider if
some of these factors are present in your own life.
How Do I Measure Risk? 189
 Figure 3. Physical activity can be an opportunity to socialize and build relationships as well as to exercise.

Lack of Physical Activity

Careless consumption of calorie-rich foods causes problems for some. But one of the reasons so many of
our citizenry are overweight comes from lack of exercise or being sedentary. Although nearly every adult
will attest that physical activity is basic to being healthy, in spite of that knowledge, a higher percentage of
those who are overweight or obese report getting no physical activity in leisure-time pursuits. We evident-
ly know that physical activity is good for us, but for some reason, we do not value it enough to do it—how
sad. When people are not being physically active each day it not only jeopardizes their health, but they miss
the enjoyment that comes with an active lifestyle. Physical activity is not just for our bodies but also for our
whole selves. Being active prompts feelings of happiness and optimism, confidence to achieve, and helps
to reduce tension and worry. Physical activity helps to create new brain cells. It also provides a setting for
socializing, healthy enjoyment with others, or if preferred, a joyful solitude (Figure 3).

Figure 4. Yo-yo dieting usually results in even more weight gain.

How Do I Measure Risk? 190
 Overweight: A person is overweight if his or her BMI exceeds 25.0–29.9.

Weight cycling: Repeated weight loss and gain; “yo-yo dieting.”

Dieting
When obsessed with weight, many if not most women and some men have become habitual dieters. A re-
striction in the amount of food eaten may result in an immediate weight loss; however, it also puts the body
into a “survival mode” characterized by a reduction in metabolism. With a slower metabolism, fewer calories
are burned. In addition, muscle may be lost during the weight loss. You don’t want to lose muscle because it
is also good for burning calories.

More often than not, the weight lost during dieting will be regained, and the newly added weight may be
composed of more fat than muscle. If repeated weight cycling is experienced, which it often is, it is called
yo-yo dieting (Figure 4). Research indicates possible added problems from yo-yo dieting such as heart prob-
lems and a predisposition to cancer due to increased stress on the body systems.It may seem to you that
losing weight is impossible, and you have just resigned yourself to being the weight you are. It would be
good to analyze your motivation for eating in a situation void of the pressures you are feeling. It may help to
talk to a counselor or take advantage of other resources available to assist you.

Poor Eating Habits

Poor eating habits and food choices also contribute to weight gain. Fast food has become a way of life, par-
ticularly for college students. But fast food is no longer the culprit that it was initially. It is possible to eat fast
food and still get the nutrients your body needs from vegetables, fruits, grains, and good sources of protein
(Figure 5). One of the biggest problems we face today is portion size at restaurants—both fast and slow. Por-
tion sizes have increased remarkably for both food and drink. But you can get the most value for your dollar
by eating half of what you are served at the time and saving the other half for later. Water is readily available,
so you can also make wise choices regarding what you drink. With the great abundance of foods and bever-
ages we enjoy today, it is up to each of us to decide what we are going to eat. Making healthy choices today
may not be easy because of all the delicious and inexpensive unhealthy options, but it is certainly possible!

Figure 5. Today we have more healthy food choices at fast-food restaurants.

How Do I Measure Risk? 191
HOW TO MEASURE YOUR RISK
Many of the measures for body composition have been developed to establish population standards for
underweight, normal weight, and overweight and obesity. Some of these measures are highly sophisticated
and only available for use in research laboratories. Others are available online as a handy guide for anyone
to use (Figure 6).

Figure 6. There are several ways to measure body composition, from more practical measurements that you can do yourself
to more sophisticated methods that are done in clinics and laboratories.

The Health Risks of Being Overweight or Obese

The AMA recognizes obesity as a chronic disease. It’s a very complex issue in a diverse culture. In North
America, tobacco use, unhealthy diet, and physical inactivity are the three leading causes of preventable
premature death. Approximately two-thirds of cancers, vascular diseases, and other chronic conditions
are directly related to these three factors. Chances for coronary heart disease, stroke, and hypertension
increase with obesity.

The American Cancer Society lists colorectal, uterine, breast, esophageal, kidney, and other cancers as relat-
ed to obesity. They estimate that obesity is a factor in 14 percent of all cancer deaths in men and 20 percent
of cancer deaths in women. Type 2 diabetes also has a direct link to obesity. Approximately 85 percent of
people diagnosed with type 2 diabetes are obese at the time of diagnosis.

Body Mass Index

The Body Mass Index (BMI) is a measure of body composition based on one’s height and weight, and it is used
by the National Institutes of Health (NIH) to define underweight, normal weight, overweight, and obesity. The
BMI does not measure the percentage of body fat, but it correlates well with laboratory measures of body fat
percentages (Figure 7).
How Do I Measure Risk? 192
 Figure 7. BMI is a general measurement of body composition.

The BMI gives a more complete picture of body composition than weight alone. One limitation of the BMI is
that it does not take muscle mass into consideration because the measure is based on weight and height,
not the amounts of muscle and body fat. Therefore, people with a well-developed musculature will get more
accurate data from other measures of body composition. But the BMI is a useful measure for the general
population. Here is the formula to calculate your BMI and an example calculation:

BMI = weight/height2 × 703

For example, for a person who is 61 inches tall (5 feet, 2 inches) and weighs 160 pounds, the BMI calculation
would look like this:

160 lbs. ÷ (61 in. × 61 in.) × 703.

BMI = 30.2

Table 1 displays standard measures of overweight and obesity based on BMI.

Table 1. Standard Measures of Overweight and Obesity Based on BMI

BMI RANGE

Overweight 25 – 29.9

Obese 30 – 34.9

Very obese 35 – 39.9

Extremely obese 40+

How Do I Measure Risk? 193

Waist Measurement
Practical measures are not only available, but may help us focus our attention properly and realistically, and
help to keep us from obsessing about our weight. It may surprise you to learn that the most important tool
for helping you manage your weight is a simple tape measure. Recent studies have shown that the size of
our waist is as predictive of disease risk due to excess weight as are other measures.

Subcutaneous Fat and Intra-abdominal Fat

The reason for this is that intra-abdominal fat (that which is found deep within the abdominal cavity) and
subcutaneous fat put us at risk for obesity-related diseases. Abdominal fat has been a hot topic of discus-
sion for years, but now we are paying more attention to this phenomenon and its significance.

Body Mass Index (BMI): A calculation dividing your weight in kilograms by your height in
meters squared.

Underweight: A person is underweight when his or her BMI is less than 18.5.

Obesity: Extremely overweight; quantified by a BMI of 30.0 or more.

Percent body fat: The percentage of total body weight that is composed of fat.

Waist Size and Health Risk

A waist size of 32 ½ inches or less for women and 35 inches or less for men is considered healthy. A waist
size of over 37 inches for women and over 40 for men puts one in the highest risk category. Another stan-
dard is for your waist size to be half of your height in inches (Figure 8).

Figure 8. A healthy waist measurement is 32 ½ inches or less for women or 35 inches or less for men.
How Do I Measure Risk? 194
Indirect Measures of Body Fat
Skinfold measurements are the least expensive and, therefore, one of the most frequently performed
measures of percent body fat. If performed by skilled technicians, skinfold measures correlate highly with
underwater weighing measures (Figure 9).

Figure 9. Skinfold measurement is a way to measure body fat percentage.

Laboratory Body Fat Measures

Finally, two of the laboratory measures of body fat percentage are the bioelectrical impedance analysis (BIA)
and the total body electrical conductivity (TOBEC). In the BIA, the measure is the body’s resistance to a small
electrical current. The higher the resistance, the greater the percentage of fat since fat-free tissues are good
conductors of electrical current. TOBEC uses a magnetic field which the body passes through to measure
lean body mass.

CALCULATE ENERGY BALANCE

The age-old energy balance principle is simplistic but logical. Balance your calories consumed with those
expended and you will maintain your normal, healthy weight. Oh, if it was only that easy! If there were no
other complicating factors, this would be the answer. How does it work?

The Basal Metabolic Rate (BMR)—also termed the Resting Metabolic Rate or RMR—is measured in calories
and is the energy needed by the organs of the body to sustain life while in a resting state. While sedentary
RMR accounts for about 70 percent of calories burned, increased activity results in greater calories expend-
ed in addition to the RMR.
How Do I Measure Risk? 195
Calculating Your Daily Caloric Expenditure
The following is a simplified calculation of daily caloric expenditure using an estimate of the RMR and a gen-
eral factor for estimating physical activity.

Step 1: Calculate your RMR for your gender and age using the following formulas in Table 2.

Table 2: RMR Formulas Based on Age and Gender

AGE MEN WOMEN

18–30 6.95 × body weight + 679 6.68 × body weight + 496

31–60 5.27 × body weight + 879 3.95 × body weight + 829

Your RMR is _________ calories per day

Step 2: From Table 3, select the activity factor for your typical level of physical activity.

Table 3. Activity Factor for Physical Activity Level

TYPICAL PHYSICAL ACTIVITY LEVEL ACTIVITY FACTOR

Sedentary mostly resting with little or no activity 1.2

Light occasional activity 1.4

Moderate daily planned walk or other activity 1.6

Heavy daily workout for several hours 1.9

Extremely daily vigorous workouts, training for competition 2.3

Your activity factor is _________

Step 3: Multiply your RMR by your activity factor to find your daily energy requirement.

Your calories/day energy expenditure is _________

How Do I Measure Risk? 196

Track the Calories That You Consume
The second part of the energy balance equation is the calories you consume. Keep track of the calories you
consume for several days to get an approximation of your normal caloric intake (Figure 10).

If your goal is to maintain your current weight, your caloric intake and caloric expenditure should be close
to the same. What if your goal is to lose some weight? To lose a pound of weight per week requires the
expenditure of 3,500 calories per week, or 500 calories per day. Accumulating 10,000 steps per day for the
150-pound person in the previous example would just about do it! Any combination of lowering caloric
intake and increasing caloric output to burn off 500 calories a day would give you the results you desire. A
safe and healthy rate of weight loss would be 1–2 pounds per week.

Figure 10. To maintain your weight, you should balance physical activity (caloric expenditure) with how much you eat
(caloric intake).

Reduce Calories and Increase Exercise to Decrease Body Fat

Studies show that wisely reducing caloric intake combined with regular exercise decreases body fat. In
longitudinal studies of weight management, the group that only exercised maintained weight loss better
than those that only reduced calories and those that combined reduced caloric intake with exercise. Regular
exercise is a key to weight loss and maintenance!

How important is intensity of exercise to weight management? A combination of both aerobic exercise and
resistance training, when possible, is ideal for losing body fat.

How Do I Measure Risk? 197

National standards recommend that adults accumulate 30–60 minutes of exercise per day. An easy and fun
way to measure this is to use a pedometer or digital device and accumulate at least 10,000 steps per day,
which is equivalent to about 5 miles (Figure 11). To be effective, one simply needs to accumulate that num-
ber of steps. These can be accumulated throughout your day or in small 10–15 minute increments, rather
than all at once for about an hour. Studies show that incorporating activity into each day is the best way to
maintain a healthy weight throughout your life.

Figure 11. Using a smart watch is an easy way to track your activity.
Strive for about 10,000 steps per day—it may be easier than you expect!

The energy balance principle emphasizes the equalization of calories taken in and then burned. How can
you use your best thinking to achieve a positive balance in your life? Not by punishing or fighting against
your body, but by eating sensibly and exercising regularly—which can become the mainstays of a very en-
joyable life. Ask yourself, do you eat to live, or live to eat?

Basal Metabolic Rate (BMR): The energy needed by the body to sustain life while in a rest-
ing state; measured in calories.

How Do I Measure Risk? 198

PRINCIPLES FOR MAINTAINING A HEALTHY WEIGHT
How important to you is maintaining a healthy weight? You can begin by claiming your ability to do some-
thing about it starting with your own attitudes. Believe in yourself, in your goodness. Be your own best
friend. Be grateful for who you are, just as you are. If you’ve spent any time contesting against your own
body, analyze why and bring that disharmony within yourself to an end. This first step is crucial. Without it,
other efforts will be weakened. Take this first step of respecting who you are and finding joy in the harmony
of your being. This is up to you. If, in your culture, it is fashionable to be disparaging toward your body, take
a stand and change the culture! At least begin with yourself (Figure 12).

Figure 12. A healthy self-image is important.

There are many wonderful programs available that promote physical activity. One such program is “Active
at Any Size” that asks, “Would you like to be more physically active, but are not sure if you can do it? Good
news—if you are a very large person, you can be physically active and have fun and feel good doing it.” No
matter your circumstances, you can find a way to be positive about being physically active. Maybe this is not
an issue for you, or maybe it is a big issue in your life. Again, analyze why it is a problem if that is the case.
Decide now that you will discover ways to be physically active. Decide now that this can be fun for you and
bring a wonderful dimension to your life.

Are you in any way obsessive about eating? Do you often think about eating? Is there anything about your
eating habits that you feel you need to lie about or hide? If so, do something positive to eliminate those
behaviors. Find ways to make your eating fairly automatic so it doesn’t require much thought. Find ways to
enjoy eating healthy foods—it is possible to change your tastes, your likes and dislikes.

Don’t go to extremes. Eat a simple breakfast you can fix at home. Find something you like and stay with
it for a while. Do the same for lunch. This way you can be thinking about something else and not have
your thoughts so focused on eating. Carry some healthy snacks with you, like carrots, celery, or apples, so
you never get overly hungry. Develop a taste for water and carry a bottle of water with you. Make normal
healthy eating a happy part of a good day (Figure 13).
How Do I Measure Risk? 199
 Figure 13. Packing a healthy lunch of foods that you like is a good way to manage your weight.

Recognize that your other personal behaviors, such as how much you sleep, has an impact on your weight.
Find ways to work within your environment to get adequate sleep. Make this a priority even if others about
you are not as committed to it.

If you need to make changes, do you have family or friends who will support you? If you do and this is help-
ful to you, involve others in your quest for change. You may not only be helping yourself but may be a help
to someone else in the process.

Above all, respect your body. Be happy with what you have been given. Realize that your biological mech-
anisms are amazing in their design to help you be healthy. Work with what you have rather than working
against it. Everyone wants to be a healthy weight. As you commit to maintaining a healthy weight now and
for many years to come, it will be a great joy to you.

How Do I Measure Risk? 200

MOVING FORWARD
Having completed this chapter, expected outcomes for you include:

1. Recognize what is a healthy range of weight for your body type and size.
2. Calculate your BMI. Ascertain any unique qualities that impact your BMI.
3. Identify factors in your life that may lead to weight gain.
4. Increase your understanding of what nutrition is best for your body.
5. Establish healthy environments for maximizing a healthy pleasure and joy of eating.
6. Do what you can to help others around you attain and maintain a healthy weight.

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›› Aldana, Steve. 2013. Culture Clash: How We Win the Battle for Better Health. Mapleton, UT: Maple
Mountain Press.
›› Campbell, T. Colin. 2013. Whole: Rethinking the Science of Nutrition. Dallas: BenBella Books.
›› Fuhrman, J. 2011. Eat to Live. New York, NY: Little, Brown and Company.
›› Katz, D., and Gonzalez, M. 2004. The Way to Eat: A Six-Step Path to Lifelong Weight Control. Naperville,
IL: Sourcebooks.

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