 Hey everybody, Dr. O here. Welcome to chapter 8 on energy balance and body composition. One of the main things that students want to learn about nutrition. So this is a very important chapter. When people come to a class like this or whenever people are thinking about nutrition, one of the most common things they're thinking about is losing weight, losing fat. Do they have the right amount of body fat, body composition, all these things? And that's what we're going to talk about here. So there's a lot of really important information that I want to go through. I really think this is going to be an important topic. So let's go ahead and dive in. Okay. So the ice breaker. How healthy are you? This is for you to think about, of course. Is your overall health most affected by what you eat or by what you do? And what are some of your best practices to feel your best? I mean, that's a really good question. The middle one especially, is your overall health most affected by what you eat or by what you do? I mean, I think nutrition is very important. But if you only focus on nutrition and you don't focus on mindfulness practices, stress management, exercise, physical activities, sleep, you know, all those types of things, then it's only a small piece of the puzzle. Now if somebody asked me, I don't even know the answer. If someone asked me, should I clean up my diet or should I start exercising? And sooner or later, I think the answer is to do both, right? Maybe not exercise, but get more physically active. So I think I would always try to convince someone to do both. But if they, if they honestly said I'm going to do one or I'm going to do the other. I'm just, I don't know, I'm just, I'm literally thinking about this as we go here. And I think I would focus on the diet, right? If you were only going to pick one. But then I think if you, if you make small changes and continue to get healthier, then you're going to want to be able to make more changes to continue to get healthier. So I guess that's probably where I'd start for some people. Now for other people, and it really does depend on the person, right? What can you continue to do? What will you sustain? So some people I would say, don't change your diet, but start exercising. And then at least, you know, and then once you start to feel better, maybe, maybe then we can make some more diet changes. So I really feel like it comes down to an individual level. And this is, that's why it's a question for you to ask yourself. All right. And then what are some of your best practices to feel your best? I think we've just talked about it. If you're, if you're sleeping well and you're managing your stress and you're physically active and you're, and you're doing different types of exercise, which we'll cover more later in the course and you're eating as, as good as you can, or at least eating better than you were, then those are the things that will help you feel the best. We'll get the most bang for your buck. People always want to talk about what's this miracle supplement or what's this thing I can do, right? And I mean, the big things matter way more. I mean, 95% of your health is going to be controlled by what I just, the list I just went over, plus your genetics, that, you know, whether or not you, you take a certain vitamin or, you know, you eat the bark of some special tree from, from the rainforest. That's, they're, they're going to make tiny differences if, if at all. And it's really not worth spending the time and the money and the resources to worry about those little things until you get the, at least you got the big things heading in the right direction. All right, learning objectives for this chapter. Number one, describe energy balance and the consequences of not being in balance. So we'll look at this idea of calories in and calories out. And if you're, and if you don't have that equation balanced, what would happen? Discuss some of the physical, emotional, and environmental influences on food intake, you know, we, we eat, we eat for lots and lots of reasons. And it's definitely not just for hunger and nourishment. List the components of energy expenditure and factors that might influence each. So we'll talk about where, where your calories are going in a day, basically, distinguish between body weight and body composition, including methods to assess each. So we'll look at all the ways that you can determine your body composition, which is definitely more important than your body weight, right? If you, if two people weigh the same and one of them, one of them has twice as much body fat as the other, they're, they don't have the same risk for disease. And then identify relationships between body weight and chronic diseases. We'll look at things like diabetes and heart disease. All right. Energy balance or this idea, you see the scale here. The idea of calories in equals calories out. So if you, any excess energy is stored as fat, we just covered that in the last chapter. Excess calories from protein, carbs, fat, or alcohol can be shuttled, can become acetyl-CoA, and then can be shuttled into fat formation. So excess energy will be stored as fat. Now once things like your glycogen stores are full, but then, so fat is used for energy between meals. So the whole point of storing fat is so that you can rely on those energy, that energy in the future. Fat's amazing. I mean, nobody, nobody wants it, but it's amazing, right? Fat allows us to store energy. You don't think about our ancestors. It allowed us to store energy when we had lots of food so we could survive when there wasn't a lot of food. We could turn body fat into babies, right? We could, we could reproduce in times when there, when there wasn't tons of food available. That's a phenomenal way to store energy. I mean, you can store 3,500 calories in a single pound of fat. That's way more than all the glycogen that you have stored in your entire body. And that's because glucose brings a lot of water with it. So I mentioned this in another video, but, you know, imagine you're going on a camping trip, taking a bunch of cans of, heavy cans of soup because they have all that water in them already would be like storing, you know, bringing glucose, bringing glycogen with you. Fat would be like these dense energy bars or dehydrated soups you add water to. You can store tons of energy in your backpack and that's, and that's what, that's what makes fat such a phenomenal fuel source. It really is a great thing. It's the reason we're here as a species. It's just the problem is, you know, we are designed to store all the excess energy we can because, because we might need it. And most people in the developed world aren't going to run out of food, right? There's not a famine coming. So our body is designed to store, store, store for this future, but this future is probably never going to happen and that's why we get into trouble with carrying too much fat around. All right, so this idea of energy balance. You see energy in equals energy out. I generally talk about calories in equals calorie out. So if you are in a state of energy balance, then you will consume as many calories in, like you see the lady in the picture eating an apple or something. You will consume the same number of calories that you are burning. So we'll look at all the ways we expend calories. We'll look at the calories outside of the equation and then if your metabolism is tightly regulated, you should be consuming a really similar number. So your calories in should equal your calories out and if that happens, then you're in a state of energy balance and you won't be gaining or losing weight. The problem with this is people look at this like it's a math equation and it's super easy to lose weight. Like, well, if you just, you need to burn more calories than you consume. While true, that's not super useful information because as we'll look at in this chapter, when you change your calories in by going on a diet, your body changes calories out. So you can go on a 500 calorie a day diet and for a while you can be burning excess 3,500 calories a week. You can be earning a pound of, earning, losing a pound of fat for a week and everything's going great. And then all of a sudden you're losing half a pound a week and then a quarter of a pound a week and then you're not losing any weight. And you might still be on just as strict of a diet but you'll see that your body adapts and your body changes the calories outside of the equation and that's what makes it so complicated. And even on the other side, if you over consume, your body will try to increase calories out to balance things as well. It's just your body isn't as good at burning off excess energy as it is storing it, sadly. So all right, so that's this idea of energy balance but way more complicated than just the scale here. Inbalances cause weight changes. So if you're eating more calories than you're burning, you will gain weight. If you're eating less calories than you're burning, you will lose weight. And it says not simply fat changes and that's because if you're gaining weight, some of that will be lean mass because you're carrying a heavier body around. So you're gonna need bigger bones and more muscle and more lean mass. So it isn't always just fat. And then sadly, when we lose weight, it's definitely not just fat. If you're losing a pound a week, it's almost a guarantee that it's not a pound of fat. There's going to be lean tissue that's lost because you're lighter, because your body will have burned up some lean tissue for fuel. So sadly, if you lose 50 pounds, 25 or 30 of it can be lean mass and that means half or less might be fat. There are things you can do that to impact that in a positive way. Like if you wanna make sure that you lose as much fat as possible and as little lean mass as possible, then some simple advice I could give you is to make sure you're consuming plenty of protein. So if your body needs to burn protein for fuel, let it burn the protein in your diet, not the protein in your muscles and then you need to be strength training. You need to send a signal to your body and I recommend full body exercises on a regular basis. You need to send a constant signal to your body that it can't eat your muscles because your muscles are needed. If you're not using your muscles and you're not sending that signal to your brain, then your muscles are an expendable fuel source. They're metabolically expensive and your body can get rid of them. So you need to be sending that signal that they can't because they're needed. So strength training and a high protein diet and then not losing weight too quickly is the best advice I could give anyone to make sure that the biggest percentage of their weight loss is fat that's possible. All right, so the classic rule here, you see one pound of fat is 3,500 calories. It's in that ballpark, but it's not exactly correct like it says here. Differs with things like sex and your starting weight and then other factors come into play too. Now you see sometimes they recommend, they call it the 7,000 calorie rule because of all this metabolic adaptation. If you wanna continue to lose a pound of fat a week, let's say at some point, reducing your calories by 3,500 calories a day will not be enough. All right, lots and lots of good stuff there. Again, I think this is a super important chapter for most people, because most people need to want to achieve a healthy weight. Everyone should want to achieve a healthy weight and I'm hoping there's really good stuff in here for you. All right, so let's start with the energy inside of the equation, the kilocalories or the calories that foods provide. So if you, if you're tracking your food using my fitness pal or chronometers, my favorite one or using websites, then how did they figure out how much food is in that burrito or how many calories are in that burrito or that cereal? Well, they actually can measure it. You see that there are direct and indirect measurements of food. This here what you're looking at is called a bomb calorimeter that you basically burn up food and by looking at how much temperature changes inside the container, you can figure out how many calories are in that food. This is not perfect, right? So that's why the amount of calories on a food label can be wrong by 20 or 30% in either direction. But so that's, so a bomb calorimeter would be a direct way to measure the energy value of a food and then you can indirectly measure it by seeing how much oxygen was consumed to burn up, to burn up that fuel. And that's how you figure out how many calories are in your food. So how many calories are you eating in a day? So you can do your best with tracking tools to determine how many calories you're eating in a day but just remember that even if you weigh and measure things precisely, there is gonna be that error of whether you're looking at food labels or what a website says as far as how many calories are in three ounces of chicken breast or whatever, there's gonna be that built in error potentially of as much as 20 or 30%. So if you truly wanna know if you're in a state of energy balance, do your best to measure your calories in and then do your best to measure your calories out which there's a lot of error there too. Like if you're using a Fitbit or your Apple Watch, there can be huge levels of error there. But the only real way to know if you're consuming the correct amount of calories is to measure as well as you can and then track your weight. And if your weight isn't changing, then your calories in equals your calories out. If you're gaining weight, then calories in are higher than calories out. And if you're losing weight, calories in are lower than calories out. And those might be goals. You might be trying to gain weight. You might be trying to lose weight. But just understand that's the only real way to know if you've reached the state of energy balance. All right, this is a really good slide. It talks about all the different factors that impact eating and when we eat, when we stop eating, when we wanna eat again. Maybe not all the factors, but a lot of them here. So you see here, hunger, satiation and satiety and we'll define all those terms. So let's start at the upper left-hand corner with number one with hunger. So what are the physiological influence? So hunger is a physiological need for food, right? It's your body telling you we need nourishment. That's hunger. And appetite is a psychological desire for food. So if you're hungry, then any food will help satisfy you. If you have an appetite, you're like, I'm craving a pop tart, I'm craving ice cream. That is an appetite. So hunger is a physiological drive for food, a physiological need, let's say, whereas appetite is a psychological want. So do you primarily eat for hunger or do you primarily eat for appetite? I think about all the reasons that we eat. And I always like to say that if true hunger isn't the problem, then food's not the solution, right? We use food as a friend and a counselor, a therapist, right? We use food to make ourselves feel better psychologically. We use food because we're in a good mood or a bad mood, all these types of things. That's all driven by, that's all appetite driven. So true hunger, you see here the list of physiological influences. If your stomach is empty and your stomach is churning, but it's empty, the absence of nutrients in the small intestine, so your brain's getting the signal from your gut that we need nourishment, hormones, GI hormones from the GI tract, endorphins, which are your brain's pleasure chemicals. They're triggered by the smell, site, or taste of foods, enhancing the desire for them. So that's what's called, that's like the cephalic phase of digestion, cephalic meaning the head and the brain. When you think about food, the digestive process begins and your body really starts to crave those foods. It's expecting, if you see and smell food, your body's expecting you to eat it. So that's number one. And then number two, we seek food and we start eating because we're hungry. So here you see some sensory influences. I just mentioned some of these, thinking about food, sight, smell, sound, taste of food. That's that cephalic phase of digestion. So you've already started to digest your meal before you've ever taken a bite. All right, then we start eating and we keep eating. So what are some of the influences here? You see cognitive influences, the presence of others or social stimulation. So if you're focusing on your meal and eating really mindfully, you'll generally eat less calories. If you're eating really quickly, you're eating with friends, you're having conversations and watching sports and you're barely thinking about your food, you will consume more calories. The perception of hunger or the awareness of fullness, again, if you're really distracted when you're eating, then you're not gonna know when you're full, right? If you think about it, there's a point where your brain tells you you're full and if you go past that point, you'll reach a point where your stomach tells you you're full and if you reach that point, you weigh too much, right? You need to eat slowly and mindfully and look for the signals that your brain is sending you that you've had enough food. Don't wait for the stretch receptors in your stomach to tell you that you need to stop eating. All right, favorite foods, foods with special meanings. So again, if I gave you a plate of broccoli, you'd probably stop eating it sooner than if I gave you whatever. Like my birthday was yesterday and what I had was a lemon bar. My mother-in-law made me lemon bars. I don't eat things like that very often at all. I really try not to eat any added sugar but it was my birthday, you know? And I ate a lemon bar and I ate a big one, right? And I definitely ate more than I needed to but the food had a special meaning to me, the day had a special meaning to me, that's just how it is. All right, the time of day. So often eating becomes a habit, right? We just, I eat a snack when I get home from school. I eat right away when I wake up. These are kind of habits. So at certain times of day, you'll probably eat more than you need even if you don't have any true hunger. And the abundance of available food. I think this is a big deal. We just, you know, we constantly have food around us now, right? If you go back a generation, like when I was a little kid or definitely when my dad and mom were kids, if you asked if you could eat at 10 o'clock, they'd say, no, you'll spoil your lunch, right? They would say, you don't eat between meals because you eat your three square meals and that's what you eat. But now, I mean, you go, I mean, there's food everywhere. So like when I go to work, there's vending machines, people bring snacks and leave them in the, all over the building, you know, maybe where you work, it's the same thing. My wife has an area at work where if we have food here, we don't want. She takes it to what she calls the trough, right? Where people just bring snacks and they all disappear, right? You know, so that that's, they go, these snacks go there to disappear. And that, so people are just eating constantly during the day when that just wasn't normal, right? The old default was you don't spoil your meals. Now the defaults are someone brings donuts if they're late or there's always, there's bagels at meetings and we, every, you know, meeting has foods and drinks and these kinds of things. That's just the new world we live in which makes it harder to not over consume food. All right, so now we're talking about satiation and satiety. So now we've eaten and maybe we ate too much but now we should be getting signals to stop eating. So number four, post-ingestive influences. After food enters the digestive tract. So food in the stomach triggers stretch receptors. So again, you telling you we should stop eating and your stomach is full. Nutrients in the small intestine elicit hormones. For example, fat elicits the hormone cholecystokinin which releases bowel from the gallbladder but also slows gastric emptying. So if there's already nutrients in your small intestine, your body is basically saying, let's slow the movement of food from the stomach. Let's digest and absorb what's already here before we bring any more in. So satiation and satiety are not the same words. Satiation is the feeling of fullness you get while you're eating. That signal that tells you that it's time to stop eating. And again, hopefully get that signal from your brain and not from your stretch receptors. Not like, I'm going to barf if I keep eating. But satiety is the feeling of fullness after eating and that keeps you from eating too soon after that, hopefully. If you're eating foods that have a lot of satiety value, then you'll be able to go several hours between meals without feeling hungry again. So that's satiety, which is now we're looking at several hours later. And then number five, we have the post-absorptive influences. So after the nutrients have entered your bloodstream, so they've been through your stomach, small intestine, digested, absorbed. Nutrients in the blood signal the brain via both nerves and hormones about their availability, use, and storage. So if your blood glucose is high because you just ate a meal, then you won't be getting signals that you need to be eating again, for example. As nutrients dwindle, satiety diminishes and then hunger develops and we're back where we started. So if you're eating a typical three meals a day and you're eating really good meals and you're eating them mindfully, you're not eating too much, but you're eating foods that keep you feeling full like fiber and protein, then three meals a day, you should feel satiated from breakfast to lunch and then from lunch to dinner and then that should be your day. All right, so those are a bunch of influences that impact hunger, satiation, and satiety. So hunger is that physiological need for food. Satiety is that feeling of fullness. So I guess hunger and satiety would be opposite ends of the spectrum. Okay, let's match these terms and you can pause this if you want to do that first before I move on. But the feeling of fullness occurring after a meal is called satiety. The feeling of fullness occurring during a meal is satiation. What determines how much food is concerned during a meal? Satiety, satiation. You eat until your body says, okay, we've had enough. And now the type of meal you eat and how mindfully you eat and how quickly you eat, how much you chew, all these things will impact when your body says when, right? All right, physiological response triggered primarily by the hypothalamus. That is hunger. So remember, hunger is a physiological need for food. Your brain is sending a signal to you that you need to bring in nourishment, appetite, whole different story, psychological desire. And number five determines how much time passes between meals, that's satiety. So as soon as you're done eating a meal, how long will it be until your brain says it's time to eat again? That will be determined by how much satiety value that meal offered. All right, overriding hunger and satiety, which we certainly can do. Overriding hunger and satiety, things like stress eating, right? Or so when do you eat when you're not hungry, right? I mean, you might eat until you're like, I can't eat another bite of my supper. But then someone says, hey, you want some ice cream or you want some brownie or something. It's like, oh yeah, I could do that, right? Or I can make room for that. Maybe you just ate an hour ago and someone offers you chips or whatever. So these would be the types of things that override these basic signals. Stress eating is a really good example of that when we're hungry, angry, lonely, tired. Those are the kind of terms I like to use when we generally have worse control over our food or how much food we eat. Sleep deprivation plays a big role here. If you didn't sleep well last night, then your grayling levels are gonna be elevated. Grayling's a hunger hormone from the stomach and your leptin levels are gonna be depressed and leptin's a signal that goes from your fat to your brain that says, hey, we have plenty of energy. So if you have more hunger hormones and less satiety hormones, chances are you'll overeat and you'll also make poorer food choices when you're tired. So stress eating, being sleep deprived, these are good examples. External cues like the time of day, it's just like, I eat at noon, right? Whether I'm hungry or not, it's like, well, it's time to eat. So if you were following more of your body's rhythms, you would wait and you'd have lunch when you felt hungry, not when it's 12 o'clock. But I get it, we have lunch hours and things like that. So food availability. If you're not hungry at 10 o'clock but then someone sits a tray of muffins down, you'll probably eat one. And that's just because it's there. The site and taste of food, same thing. All right, environmental influences. My wife's like this with Oreos, like, I'm what's called an abstainer and she's more of a moderator. And what that means is to a moderator is someone that they can have snacks as part of their diet and they can have a little bit of ice cream and they can have a cookie and they can do those kind of things, right? Eating and moderation. And I generally do think that that's really healthy for most people, but I'm an abstainer, meaning that it's much easier for me to say no to something completely than to try to judge and estimate how much I can fit into my diet, right? It's easier for me to say no to ice cream than to determine should I have some today? How much can I have? When can I have it next? When should I stop? That's just kind of how I am. So environmentally, it doesn't really bother me that there's lots of foods around the house because I just don't eat them. And so people might say that how I eat is really restrictive but I do find it very freeing because if you ask me if I want ice cream, I just say no and I move on. I don't think about it. It's really hard for me to determine like where things like that fit. So I have them on my birthday. I have them on rare occasions, but on a typical day, I'm an abstainer. But my wife's a moderator but there are some things where she struggles with that. Like Oreos are a good example, right? If there's Oreos in the cupboard, so thinking of environmental influences, if there's Oreos in the cupboard, she can't stop thinking about them. It's like she needs to eat them and then once they're gone, she's over it. So having those types of things around her impacts her negatively. So your food environment is a big deal. If you like really crave Pringles, my son Oliver likes Pringles, but imagine if you love Pringles and every time you wanted Pringles, you have to get dressed, put your shoes on, drive to the store, buy the Pringles, eat the Pringles, right? A lot of times you'll talk yourself out of the Pringles but if the Pringles are in the cupboard or even worse, they're sitting on the kitchen counter and you can see them, you're gonna lose that battle. So yes, use willpower when you can and alter your behaviors over time and form new habits, all good ideas, but while you're struggling in these areas, create a food environment that is a safer place for you to be. All right, cognitive influences, again, weakened and disordered eating kind of linked together. You might have like, so you might, if you're on a diet, yes, you're hungry. You don't eat when you're hungry. You eat whatever your plan is right for the day. So I know I'm hungry right now but I'm gonna wait and I'm gonna eat tomorrow. I'm gonna go to bed hungry. These would be examples of you manually or consciously overriding these signals and disordered eating, same thing, right? You might be really, really hungry but because of your disordered eating patterns, you're not going to eat or you might binge eat or binge and purge, things like this. These would be ways that we can, so you might eat until well past your full, right? Binge eating is relatively common and then people eat until they wanna throw up or eat until they do throw up. That would be you overriding those satiety signals just like someone on a diet would have to override their hunger signals. All right, sustaining. So how do we sustain satiation and satiety? So if you wanna eat less calories, you have to create a diet that allows you to eat less calories and these are all really good ideas. Protein, by far. If you're trying to eat less than eat more protein, that's the first thing I'd recommend you do. Protein has the highest satiety value and as we'll see later, it has the highest thermic effect of food meaning that when you eat protein, you burn more of it as energy just to digest it. So protein, so you should build your diet around protein if you're trying to consume less calories, if you're trying to eat a diet that keeps you feeling full. Foods that have low energy density, so high volume foods, right? So if you're gonna get, and that usually links with high fiber foods, so a big old salad that only has a few dozen calories in it, you get a ton of food volume but not a lot of calories. So maybe leaner, protein sources and then foods that have a ton of energy or low energy density. You don't want foods with high energy density but that means there's lots of calories per spoonful or whatever. So like a soda is a huge no-no. Pure calories, no, and it doesn't make you feel full at all whereas a salad, like a chicken salad for lunch would fill you up with low energy density and also would have the protein. And high fiber, same thing. So you want fiber and water and protein, things that keep your stomach full. And then lastly, here we have high fat foods. They do have a strong satiety signal. No doubt about that. But remember, it's not as strong as you think when you realize how many calories are in fat. So if you have 100 calories of fat, yes, it will make you full but there's a lot of calories that came with that. So just, I do believe that high fat foods offer more satiety value but they also come with the cost of eating a bunch of calories, right? So if you have a couple tablespoons of peanut butter, then yeah, you're gonna be satiated from that but you also got a huge whack of calories to do so. So generally leaner and a little bit lower fat, probably a good idea if you're trying to eat a diet that keeps you feeling full without, I mean, if I ate 3,000 calories, I'm gonna feel full but I also ate 3,000 calories, so keep that in mind. All right, the energy out, excuse me, side of the equation. So we've talked about things that determine how much we put in our mouths. Now we gotta look at the ways that we expend our energy. So energy out, the kilocalories or calories the body expends. So here we see a typical chart. I will break one of these up into a further subdivision but your energy expenditure, so this is looking at your total daily energy expenditure. How many calories are you gonna burn today? So how much energy the body is expending and you see here that the blue slice, the biggest slice is your basal metabolic rate which is often really similar to what's called your resting energy expenditure. Excuse me, your basal metabolic rate is usually the largest component of energy expenditure representing 50 to 65% of the total. So your basal metabolic rate would be, and we'll look at ways to measure this later or we can talk about it now, but if you woke up and you just laid there for 24 hours, right? How many calories does it take to keep you alive? That's your basal metabolic rate, right? Your cells are constantly repairing things, your heart's constantly beating, your brain's constantly thinking. So your basal metabolic rate would be that. How many calories are you gonna burn today surviving? Not exercising, not digesting food, just surviving. So if you wanna get this tested, it's called a resting energy expenditure. It's not technically a basal metabolic rate, but I go in to a sports facility here every few months and I lay down and I rest and I'm as calm as possible and no caffeine, no stimulants, no stress, that kind of stuff and they put a hood over my head and they measure how much oxygen I'm consuming and how much carbon dioxide I'm getting rid of and by doing so they can estimate my resting energy expenditure. The number one determinant that you can control anyways of your basal metabolic rate is how much lean mass you have, how much muscle you're carrying. Not just lean mass, or not just muscle, but lean mass. So if you put on 10 pounds of muscle, your basal metabolic rate will go up. Muscle isn't the most metabolically active tissue we have, your liver and your brain are way more metabolically active, but you can't grow a second liver or you can't grow a second brain. If you could, then you could get your metabolic rate to go through the roof. So the number one thing you can control about your basal metabolic rate is how much lean tissue you have. So build some muscle and your body will burn more calories every day just at rest. All right, next we have physical activity and I'm gonna split this into two categories. So physical activity, I'll read what it says here and then I'll break it up. Physical activities have the greatest variability, representing 25 to 50% of the total energy expended depending on a person's activity patterns. So if you don't do anything, right? If you have a sedentary desk job and you have zero leisure time physical activity, which a huge percent of Americans do, right? We sit at work, we sit to drive home, we sit at home and we watch Netflix and chill and do whatever. So some people, their physical activity is very low. Other people exercise for hours a day or hours a week for sure their physical activity is gonna be a much higher percentage of their total daily energy expenditure. All right, for a sedentary person, activities may account for less than half as much energy as basal metabolism. Whereas an extremely active person may expend as much on physical activity as their basal metabolic rate. That'd be someone on the extreme end, like someone running 100 miles a week, someone training six hours a day because your basal metabolic rate's gonna be, usually gonna be the majority of the calories you burn. But I wanna break this up into two categories. We have exercise, which is purposeful and planned, right? It's like I'm going to get on the treadmill for 30 minutes, I'm going to lift weights for an hour. And then you have non-exercise activity thermogenesis, also known as NEET. So I've given this presentation on NEET a few times and I'm sure I'll make some videos about it. But your non-exercise activity is actually usually gonna be way more than your exercise activity, right? So I lifted weights today for close to two hours and however many calories I burned, I'm gonna burn way more calories just being active throughout the day, right? Go walking to get the mail, fidgeting as I sit here talking to you, just subconscious movements, just standing, standing versus sitting, things like that. So as someone that's worked really hard to lose weight, one of the things that I've done is I've really impacted my non-exercise activity thermogenesis. And like I said, I gave that whole presentation on it. I'm sure I'll record one and put it on the YouTube channel sometime. But so the desk I'm sitting at is a standing desk. So when I'm not recording videos, I'm standing instead of sitting. I usually listen to music while I'm working. So that keeps me moving, kind of bopping around and fidgeting. I purposely, I keep the most of food I eat out in the fridge and the garage. So I have to go in and out to get it. I keep all my vitamins and stuff down here. So I wake up and I have to come, I go up and down the stairs, probably three, four, five extra times every day. When I'm working in the basement, when I need to go to the restroom, I go to the restroom upstairs to get some extra steps. So to me, it's conscious, right? So it's not subconscious movement, but I try to increase my activity more by increasing how much I'm moving when I'm not exercising than when I am. So physical activity would be eat or exercise activity thermogenesis and neat, non-exercise activity thermogenesis. All right, the last piece of the puzzle is the thermic effect of food or the TEF. This is your body's metabolic response to food and is the smallest component of energy expenditure, representing only five to 10% of the total. So this is gonna be how much energy does it take to digest, absorb and transport your meals? So every time you eat, a percentage of those calories has to be used to do those things. So how you determine your thermic effect of food, the number one determinant is the protein in your meal, because protein has by far the highest thermic effect of food. If you eat 100 calories of protein, 20 to 30 of those calories will have to be burned to digest it. Protein's pretty hard to break down. The thermic effect of food for fat and carbs is much lower. So if you wanna impact the thermic effect of your food, then you need to eat more protein and things like that. So all these will be impacted. So let's say you're going on a diet, right? So if you go on a diet, your basal metabolic rate will drop because number one, you're losing lean tissue, which is metabolically active and even fat is metabolically active. So you literally weigh less. So there's less of you to keep alive. So your basal metabolic rate will drop. Now it will drop farther than you want it to. It will drop farther than just it should have by losing a few pounds, but your basal metabolic rate will drop. Physical activity, your exercise may go up because you're planning it and doing it on purpose. But when you're dieting, you're neat. Your non-exercise activity will go down. This is the one that changes the most. Like if you go on a diet and it's working and then it stops working, the number one reason diets stop working, if you're actually on a diet and not eating too much, is that your neat has gone down. Your body, you'll fidget less, you'll stand less, you'll have the urge to get up and move less. Your body is fighting weight loss by trying to control how much you're moving and how many calories you're burning. So your neat will go down. Maybe your physical activity will go up. That's why if you're on a diet, I recommend keeping a step count and making sure you're exercising. And then your thermic effect food will also go down because if you're on a diet, you're eating less. So all these things will go down. And that's one of the reasons why it's not as simple as just eat less than you burn because the amount you burn will drop when you go on a diet, which means you have to eat even less than you thought you did in order to lose weight. So we'll come back, we'll cover some more of that. Very important topic though. All right, so those are the components, excuse me, of energy expenditure. A little water here. I told you, that's a cool juicy stuff in this chapter. All right, basal metabolic rate. Activities to keep your body functioning, keeping the lights on, right? So it says basically keeping the lights on in your house. It varies based on weight, lean tissue, age, but the big determinant is your lean tissue. When you get older, right, until the age of 60, let's say that the number one reason your metabolic rate would drop is that you're losing muscle. So people, we always thought that your metabolism was dropping because you were getting older. It's mainly until you're 60 anyways, or in your 60s. You're getting older, you're moving less so you're losing lean tissue and your metabolic rate is dropping. Now once you're in your 70s and 80s, your metabolic rate is actually dropping because your brain's burning less calories, your liver's burning less calories, those kind of things. But really the biggest thing you can do to control your basal metabolic rate is to increase lean tissue. All right, basal metabolic rate versus resting metabolic rate, again, they're not exactly the same thing, but for all intents and purposes they are. All right, but both of them would be, basal metabolic rate would be like you didn't even get out of bed, right? Things like that. All right, physical activity we talked about, we talked about all this already. Voluntary muscle movement would be exercised, but then there is a lot of subconscious movement as well that I've already covered. All right, so weight, lean muscle, and the type of activity impact the amount of energy needed. For sure, if you're cardio, let's say you're running or doing high intensity interval training, you're gonna burn more calories per minute than if you're lifting weights. So during the session, that will burn more calories. But if you're lifting weights, then for the next 24, 48, 72 hours after strength training, and this is why I think it's a huge deal for weight loss, for the next two or three days, your metabolic rate stays elevated because you have to repair the tissue damage and you're growing new muscle and all of that. So don't just look at how many calories your exercise burns while you're doing it. Think about it more globally. And I think that, yes, you'll still burn more calories doing high intensity interval training, but strength training, don't sleep on it because you burn more calories for long periods of time. And then you're also building lean tissue, right? I know that my last two resting energy expenditure tests, my resting energy expenditure in a six month period went up 140 calories a day. So between the fact that my body is burning energy to build new muscle and maintain that new muscle, my energy expenditure has gone up a big amount. 140 calories is nothing to sneeze at over a year. That's a huge number. All right, thermic effective food we've already talked about. So how much does it take to digest, absorb, transport, store, and metabolize your food? Generally gonna be about 10% of your total energy intake, varies based on meal frequency and size. So again, if you're on a diet and eating less, then this number is gonna drop. And macronutrient composition, protein being the big one there. Then this adaptive thermogenesis. So increases when the body is dramatically challenged, things like illness or injury, but that's gonna be this idea of metabolic adaptation. That's when your body starts to fight weight loss or weight gain. People use the term like set point or settling point. So your body kind of defends a certain body weight range. And if you try to lose weight, it will compensate. Like I said, if you eat less, your body will compensate by burning less energy. And on the flip side, your body will try to compensate for weight gain too. So if you eat too much, your body will try to burn off that extra energy. But sadly, from an evolutionary standpoint, our body is much better at fighting weight loss than it is weight gain. And we can get into all that maybe later. Okay. Factors that affect your basal metabolic rate long list here. So age, you see that lean body mass diminishes with age, slowing your basal metabolic rate. Sorry, but it says here and then I've already mentioned some things here. The basal metabolic rate begins to decrease in early adulthood after growth and development cease. So once you're done with puberty and all that, at a rate of about 2% per decade, a reduction in voluntary activity as well brings the total decline in energy expenditure to about 5% per decade. So really new research though, using the gold standard, which is called doubly labeled water, shows that the drop in energy, the drop in activity caused you to lose lean tissue and that's why your metabolic rate dropped. So if you're 30, 40, 50 years old, your metabolic rate does not have to drop, preserve the lean tissue you have and try to build some more and it won't. All right, for most people, depending on these studies, but these are very well done studies. Height, so in tall, thin people, the BMR is actually higher. So if you take two people, they weigh the same amount, a taller person is gonna have more surface area for skin, so they're gonna lose more heat and their basal metabolic rate will be higher. Growth in children, adolescents, and pregnant women, the BMR is higher, makes sense, you're growing, you're not, you need, you need, you're building more of a human being, not just maintaining one, whether you're building yourself or building a baby. Body composition, the more lean tissue, the higher the basal metabolic rate, which is why males usually have a higher BMR than females, the more fat tissue, the lower the basal metabolic rate. So a pound of muscle is gonna burn more calories than a pound of fat, that's just how it is. Fever, fever raises the BMR, it says here that every, each degree Fahrenheit that your fever goes up, your metabolic rate goes up 7%. So that's gonna be your immune system, basically, yes, the heat production, but your immune system fighting off these infections as well. Stresses, so stresses including many diseases and certain drugs raise your basal metabolic rate. So this is why unexplained weight loss is not a good thing. If someone's losing weight and they're not trying, that raises a red flag, or do they have diabetes or cancer or some sort of infection, because the stresses on the body will cause your metabolic rate to go up, which means you'd start to lose weight. Environmental temperature, so both heat and cold raise the basal metabolic rate. So if you stress the body by making it too hot or too cold, the response will, you'll need more calories to deal with it. This is why people do like cold plunges, they sit nice baths to try to burn more calories, these types of things, saunas. Fasting and starvation, so fasting or starvation lowers the basal metabolic rate. Remember fasting is a choice, starvation is there's no food. So if you're not eating, your body will respond by lowering your basal metabolic rate, which makes sense. Your body's trying to protect you from starving. You're just trying to get summer beach ready, but your body thinks that you're in a famine and you're going to die. So your body's trying to protect you. So if you consume less food, your body will try to burn less food. All right, malnutrition lowers the basal metabolic rate. Again, if you're, you know, the same thing. If you're malnourished, then your body is concerned that you're running out of resources and it will try to help you by lowering your metabolic rate. Hormones, the thyroid hormone thyroxine, which is T3, for example, can speed up or slow down the basal metabolic rate and the premenstrual hormones slightly raise the BMR too. So you see here, the thyroid gland releases hormones that travel to the cells and influence cellular metabolism. Thyroid hormone activity can speed up or slow down the rate of metabolism by as much as 50%. That's why if someone has hypothyroidism, not enough thyroid hormone, they will gain weight. And if they have hyperthyroidism, too much thyroid hormone, they will lose weight. Let's see, smoking. Nicotine is a very powerful stimulant. It does speed up energy expenditure. That's one of the reasons. Probably at least half of the weight gained after someone quit smoking is because their metabolic rate has dropped because they lost that stimulant. The other half would be just, you know, they're not smoking so they're looking for other things. They're eating more, that kind of stuff. Caffeine, same thing. Not a huge deal, but caffeine does speed up energy expenditure. That's why your fat burners all have caffeine in them but they don't make a huge difference. And then sleep. Your basal metabolic rate is lowest during sleep. Makes sense. Some of your body's systems are down-regulated. All right, a lot of things that impact your basal metabolic rate. Okay, now let's check. So look at these and see if you can answer them. Which of the following is responsible for roughly two thirds of the energy needed to keep the body functioning? Sorry, I gotta look at this. Okay, that's your basal metabolic rate. So for most people, unless you're really, really physically active, your basal metabolic rate is the number one determinant of your energy expenditure. So basal metabolism is the energy needed to maintain life when a body is that complete digestive, physical, and emotional rest. That's why I told you when I do my resting energy expenditure testing, I can exercise for 24 hours, empty stomach, laying still, no music, no loud, wild music, things like that. Around 50 to 65% of our energy expenditure is through basal metabolism. Thermogenesis is the generation of heat used in physiology and nutrition studies as an index of how much energy the body is expanding. The thermic effect of food is an estimation of the energy required to process food. So your basal metabolic rates the answer there. All right, how do we estimate energy requirements? I mean, you can estimate it, but the resting energy expenditure test that I do still only tells me how many calories I burn at rest. I still have to figure out how many calories I burn with physical activity and thermic effect of food. So the best way to determine your energy requirements is to try to figure out exactly how much you're eating and then eat the right amount so you don't gain or lose weight. But so all these things we've talked about. Gender, because of BMR, because of lean tissue. If you're growing, you're going to need more energy. Growth spurts, right? Age changes with age and through most life though, it's just a decrease in lean tissue. When you get older, 70s, 80s, it is true a metabolic rate decline. Physical activity, of course. And then we talked about body composition. How much weight you're carrying around. Think about it. If you weigh 100 pounds more, every step is going to be harder so you are gonna burn more energy. So as you lose weight, you get more efficient at moving. Okay, body weight and body composition. So we're not gonna do this discussion together but you certainly can do so. How is a healthy body weight is defined? I'll mention a few things. But societal expectations are standards. Body image and the criterion for health and ways for people to accept their body and healthy body weight. So you guys, you can discuss that with your friends or whatever. But I'll read this and add a few things. Weight gains and losses tell us nothing about how the body's composition may have changed. Yet weight is the measure that most people use to judge fatness. So for example, if you're on a diet and you're exercising and the scale doesn't move, you're very upset. But you may have lost a pound of fat and gained a pound of muscle. Your body, it's called body recomposition, right? If your clothes are fitting better, your waist is shrinking, then who cares what the scale says? Yeah, so we put a lot of stock in scales and we need them. You do have to measure your weight to know if you're eating too much or too little but that's all it is. Just it's just a tool. For many people, over weight is over fat but this is not always the case. Athletes with dense bones and well-developed muscles may be overweight by some standards but have little body fat. Conversely, inactive people may seem to have acceptable weights when in fact they may have too much body fat. This is what they call, what do they call that, skinny fat, right? Where someone might weigh the perfect amount but they have way too much fat, right? There's, they call it toffee too, right? Then on the outside fat on the inside. So if you were to do, if you were to actually measure body fat on people, you could take six people with the same amount. And one of them could be really lean and one of them could be carrying a ton of fat but they'd weigh the same amount. So yeah, weight is just part of this and that's why if you're using things like the scale and body mass index, I always recommend doing a waist circumference too. So you know, if your waist is shrinking then you should be happy no matter what's happening to the scale or your BMI. If you're trying to lose weight. All right, defining healthy body weight, the criterion of fashion. Judge ideals for body weight by appearance, unrealistic ideals for body weight especially for women. I mean, that's the reality is the average model that you see on television or in advertisements, they are underweight. They are not a healthy body weight, they're underweight. So your ideal, what's your goal is you're trying to aspire to someone that's underweight that's also been photoshopped and everything else, right? So you're, those are really unrealistic goals and you shouldn't want to be classified as underweight from a health standpoint. So the criterion of health, you need enough body fat to make basic needs but not so much as to incur health risks. So you do, you want to be in a healthy body fat range but being slightly overweight in many studies has been shown to be healthier than being slightly underweight and we'll talk about why that is. Body composition, and we're just talking about a few pounds, not being obese. Body composition defined as the proportions of muscle, bone, fat, and other tissue that make up a person's total body weight. That's what really matters, right? So how much muscle do you have versus fat and versus organs, et cetera. Okay, so body composition, we have the body mass index. You will want to know what that is. So your BMI is your weight in kilograms divided by your height and meter square but the simplest thing to do is just to find a calculator online that tells you what it is but it's basically so it's a measure of your weight versus your height and it tells you kind of how much of you there is. Very good tool for studies, for looking at large populations and for most people it is a good tool, right? You know, if you're a very muscular athlete, then yeah, most athletes will be classified as overweight or obese and they're clearly not which is why for individuals I recommend using the BMI plus a waist circumference. If your BMI is high and your waist circumference is big then yeah, your BMI is high for the wrong reason. If your BMI is high because you're loaded with muscle and your waist is small, then you're good and you don't worry about it. So people like to not use the BMI because there are exceptions when it doesn't work very well but for the typical person, for the typical American eating the standard American diet the BMI is a great tool. So it can tell you if you're underweight, normal weight, overweight or obese I'll show you the scale in just a moment. So it's a measure of relative weight for each meter of height. Health related classification so you see a healthy BMI and you need to know these numbers a healthy weight is a BMI from 18.5 to 24.9 and then if you're below 18.5 you're classified as underweight if you're, I'll show you but if you're 25 to 30 it's overweight, et cetera. It's not a measure of body composition so the biggest downside of the BMI is that it can't tell the difference between fat and muscle and it also can't tell where your fat is, right? Maybe you have a lot of mammary fat in your breast tissue and a lot of fat below your waist what's called genitofamoral fat. That fat doesn't carry the same disease risk as abdominal fat. So again, add the waist circumference to make this a more valuable tool. All right, so here's the BMI's and then how many people have them. So a BMI of under 18.5 is underweight where we add healthy weight, 18.5 to 24.9 overweight is a BMI of 25 to 29.9 but again, a BMI of 25 or 26 you can be very, very healthy carrying a few extra pounds. Obesity is a BMI of 30 to 39.9 you might see them as class one and class two obesity and then a BMI of 40 or above is extreme obesity. All right, body fat and distribution important information for disease risk. I mean, yes, in all things being equal you do want to have a healthy BMI. How much of the weight is fat? That's why you got to look at it as an individual. So there are times this won't work if you're a professional wrestler or a world-class bodybuilder you might have 4% body fat but it's going to tell you you're obese and that's just, it doesn't matter for you but it does matter for most people. Where is your fat located? That's a huge deal like I just mentioned. The fat around your abdomen, visceral fat or what's called central adiposity is always going to lead to more disease risk than fat below the waist. That's the whole apple shape versus pear. So apple shape with that kind of body fat distribution is it leads to more disease risk, pear shape, less disease risk. So that's why you always want to use the waist circumference like I've said. All right, the ideal amount of body fat depends person to person, absolutely where the fat is and all those kind of things. Okay, let's look at these reflections here. Associated with the lower risk of heart disease that subcutaneous fat so and you see from the bottom one fat around the hips and thighs what I call genitofamoral fat is generally subcutaneous fat. So subcutaneous fat under the skin doesn't increase disease risk the same way visceral fat does. So the second point they should be one through four significantly contributes to heart disease and diabetes that is visceral fat or central adiposity, central obesity. So the fat around your abdomen is much more inflammatory and it sends out all sorts of chemical signals that fat below your waist and fat subcutaneous fat doesn't. So that's why if you get a dexa scan or some sort of tool that measures fat you really wanna see how much visceral fat someone has because that's the fat that contributes the most to heart disease and diabetes risk. All right, so here we see this idea of central adiposity or central obesity. If you, you know, so if you have and this would be why like some ethnic groups some groups even though they're skinnier they don't weigh as much as other groups they have higher disease risk like maybe people from like Southeast Asia for example they have thin extremities so even if they're only 10 or 15 pounds overweight almost all that extra weight is central obesity or visceral adipose tissue. So you have someone that doesn't doesn't even weigh 200 pounds maybe but they're a great risk for heart disease or diabetes whereas other people they carry a bunch of fat in their extremities they carry a bunch of fat below their waist it's not the kind of fat that increases disease risk. So there are people that are, you know metabolically healthy overweight or metabolically healthy obese people and one of the biggest determinants is how much of the fat is right there around the abdomen and how much of it is this visceral fat that surrounds your organs and kind of chokes them. Okay in healthy way people some fat is stored around the organs of the abdomen so everyone has some visceral fat it actually protects the organs insulation. In overweight people you get more and that's where that so how much fat you have around your abdomen is a very big deal. Okay fill in the missing answers. A waist circumference of more than 40 inches for men and 35 inches for women is an indicator of fat distribution and central obesity so I've said it several times now, very important. Waste circumference is the preferred method for assessing abdominal fat in the clinical setting and abdominal fat is the fat we care the most about. Now you may not like the fact that you're carrying a little extra weight on your thighs and your butt but that doesn't increase disease risk the same way abdominal fat does and this is probably one of the reasons that men die of heart disease younger and more than women because men are more likely to have abdominal fat women are more likely to have fat below the waist and then fat around the mammary tissue but then after menopause women start to gain abdominal fat and then their heart disease risk climbs and equals men. All right how do we assess body fat? We'll kind of go through these pretty quickly so the top left you see hydro densitometry that's underwater weighing so you can see like basically how much you weigh on land and how much you weigh in water can determine your volume and they can use that to determine your body fat. Great tool but it takes obviously it takes the tank it takes a trained technician so I love them they're great for research but just not practical for most people. Next to it you have air displacement that's gonna be what's called the bod pod does the same thing so kind of like underwater weighing it's like how much air you displace can be used to determine your body's volume so good tool I guess but you need a bod pod to do it. Waste circumference doesn't tell us everything but it's a very good one as far as a simple thing you could be doing you should be weighing yourself you should know what your BMI is if you weigh yourself you can do that and you should know your waist circumference very simple. DEXA is my favorite as far as something you can do like when I get a DEXA scan done I go to the breast cancer center here in Sioux Falls where I live and it's $30 it's well worth it it tells me my bone density how much lean mass I have how much fat mass I have and it's not perfect and it can certainly you know there's error there but I use it on a regular basis and I feel like and I try to do it the same time of day and all those kind of things and I think it does help me track so DEXA scans used to be used just for bone density but now yeah you can look at it basically can tell the difference between lean tissue and fat tissue it can't tell you exactly what's muscle and what's organ and those kind of things but it's a good tool so that's DEXA dual energy x-ray absorptometry then you have bioelectrical impedance so you see a lot of these scales or handheld devices it runs in electrical current through you and it can basically tell how much of you is fat or muscle or tries to tell based on how quickly the current runs through you the problem here is water right? You have to do the same time of day same hydration status you can see huge problems with these if you have the same device and you use it on a regular basis it may not tell you the truth but I still think you can use it for trends if your fat's going up or going down but try to make sure you have the same hydration status same time of day all those factors to make it as effective as possible skin fold measurements it depends on how good the person doing the measuring is so make sure you get a really good technician that knows what they're doing and make sure you use the same person that takes the measurements on the same parts of your body if you want to track changes over time health risks associated with body weight and body fat so health risks associated with body weight body weight and fat distribution correlate with disease risk and life expectancy so correlations are not causes and again if you're carrying extra body weight is that the reason that you get diseases or die younger or is that is it inflammatory diet is it a lack of physical activity it's hard to tease all this stuff out but generally speaking if you have a health if you're at a healthy weight as far as the BMI goes or just slightly overweight then you have less disease risk but there are risks associated with being underweight this is be they call this like the what they call it the unsuspected or a disease phenomenon or something but if you're if someone is underweight you see that your body might be fighting against a disease right if so someone if someone has a low BMI it could be because they have cancer and don't know it or they're malnourished and don't know what these kind of things so fighting against wasting diseases but that's why you might want to have a few extra pounds of fat you can if you get sick or you get a disease your body can you have a little bit more energy reserve so that's why you want to be at a healthy body weight or just a little tiny bit above rather than a little tiny bit below if you get if you're menstrual irregularities and infertility so if your body if your body fat levels get too low your body says I mean we're starving there we should not be reproducing we're living in a famine so why would we you know you see there's like female athletes and things why would we try to bring a baby into this world there's not enough food for us so that's why you get your your low body fat stores we're sending signals to your reproductive organs that you should not be menstruating and you should not be fertile osteoporosis and bone fractures so that also comes with this what's the female athlete triad they call it or relative energy deficiency in sports where if you're if you're not carrying a large enough body around then your bones will get weak just like your body won't keep muscle it doesn't need it won't keep bone it doesn't need either so there are risk of being underweight and overweight health risks of overweight and obesity obesity is designated as a disease a health risk you see that you see cardiovascular disease elevated blood cholesterol and hypertension you see central obesity and that's what that's what triggers those those issues type 2 diabetes is linked to central obesity just like cardiovascular disease is so all these things are true but there are people that are metabolically healthy obese right there they are classified as obese but they cholesterol is normal blood pressure is normal blood sugar is normal oftentimes most of their fat is subcutaneous fat and not this central obesity or this visceral fat we've been talking about alright inflammation and metabolic syndrome so I do want to talk about that the PowerPoint doesn't cover it so I have this I have it opened up here I want to read the the markers of metabolic syndrome so if you're oh fat tissue especially visceral fat is very inflammatory so you have this chronic inflammation that leads to all sorts of problems so metabolic syndrome that increase your risk for diabetes hypertension and atherosclerosis or hardening of your arteries so let me read the list of how you'd be diagnosed with metabolic syndrome if you have three or more of the following so there's five things here and if you have three of them then you would be classified as having metabolic syndrome number one is a waistline of 40 inches or more for men and 35 inches or more for women measured across the belly so that's the same same measurements we talked about earlier number two a blood pressure of 130 over 85 millimeters of mercury or higher or you're taking blood pressure medication so if you have if you have high blood pressure or it's being treated then that would be you check that box a triglyceride level above 150 milligrams per deciliter so if you have high triglycerides a fasting blood glucose or blood sugar level of greater than 100 milligrams per deciliter or you're taking glucose lowering medication so you're already being treated for it and the last one is a high density lipoprotein or lipoprotein or an HDL your good cholesterol level less than 40 milligrams per deciliter for men or under 50 milligrams per deciliter for women so if you have any three of those so your waistline is bigger than 40 your blood pressure is high your triglycerides are high then you have metabolic syndrome if you have all five obviously it's even worse okay and then cancer it's trickier the risk of some cancers increases with body weight and some some with low body weight mean you may already have it so not as straightforward all right a lot of great stuff there I hope you learn a ton I hope you go back and let's do it again and you figure this energy balance stuff out so what did we learn? describe energy balance and the consequences of not being in energy balance so weight gain weight loss discuss some of the physical emotional and environmental influences on food intake we covered tons of those list the components of energy expenditure and factors that might influence each so we talked about calories in calories out all that distinguish between body weight and body composition including methods to assess each we talked about the BMI waist circumference all the other ones dexa scans then identify relationships between body weight and chronic diseases we just did that so a lot of stuff here and I hope that I hope you learn a ton in this chapter that helps you outside of the classroom as much as inside have a wonderful day be blessed