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食物热量与体重控制

泰然健康网
2024-12-28 02:46

1、1,食物熱量與體重控制,台大醫院歐陽鍾美營養師,2,如何確知是否肥胖？,體脂肪 : 一般而言，男人體脂肪超過25%，女人超過30%皆認為是肥胖測量方法最準確的作法是將個體在水中稱重測量身體若干部位的皮下厚度是利用脂肪不導電的原理，以傳入微弱無害的電流藉以測量體脂肪。,3,容易計算且不需儀器的方法,體重身高對照表(weight-for-height tables) 體質指標(body mass index; BMI),4,體重身高對照表,5,肥胖的定義,身體質量指數 (Body Mass Index; BMI) BMI= 體重(kg) / (身高;m)2 例如: 身高160公分，體重50公斤， BMI: 501.61.619.5 肥胖: BMI 27,6,行政院衛生署91年4月公告國人成年人體重過重及肥胖的定義,7,兒童與青少年肥胖定義,8,行政院衛生署91年4月公告國人成年人肥胖的定義,9,決定肥胖的因素,遺傳 (Genetics) 環境 (Environment) 生理因素 (Physical factors) 心理因素 (Psychological factors)

2、內分泌因素 (Endocrine disorders),10,Obesity Therapy,Adipose tissue,Energy Intake,Energy Expenditure,11,Obesity / Energy Balance,Energy requirement = 30kcal x Wt Net energy = Energy intake Energy expenditure 500 calories per day weight 0.51 kg per week,12,體重控制的方法,飲食控制運動生活型態改變藥物外科手術其他,13,飲食控制,減少熱量攝取選擇低油的烹調方式選擇低熱量食物選擇高纖食物避免含糖飲料,14,兒童熱量需求計算,以理想體重計算 100 x 10 + 50 x (20-10) + 20 x (wt-20) 例: 理想體重為35公斤 100 x 10 + 50 x (20-10) + 20 x (35-20) =1800 (大卡),15,成年人熱量需求計算,以輕度工作者為例: 30 卡 x 理想體重=熱量需求另可依目前體

3、重狀況與活動量調整,16,現代人的文明病,肥胖心臟血管疾病腦血管疾病糖尿病高血壓高脂血痛風,17,體重控制,減少熱量攝取(飲食控制) 增加熱量消耗(運動),18,熱量計算,1 公克醣類(碳水化合物) = 4 大卡 1 公克蛋白質 = 4 大卡 1 公克油脂 = 9 大卡 1 公克酒精 = 7 大卡 1 公克水 = 0 大卡,19,含700卡熱量食物,混合食物有那些? 那些較建議食用?,20,含800卡熱量食物,混合食物有那些? 那些較建議食用?,21,運動,Sedentary = BMR X 1.2 (little or no exercise, desk job) Lightly active = BMR X 1.375 (light exercise/sports 1-3 days/wk) Mod. active = BMR X 1.55 (moderate exercise/sports 3-5 days/wk) Very active = BMR X 1.725 (hard exercise/sports 6-7 days/wk) Extr. activ

4、e = BMR X 1.9 (hard daily exercise/sports & physical job or 2X day training, i.e marathon, contest etc.) Men: BMR = 66 + (13.7 X wt in kg) + (5 X ht in cm) - (6.8 X age in years) Women: BMR = 655 + (9.6 X wt in kg) + (1.8 X ht in cm) - (4.7 X age in years),22,Light Activity (50 to 200 KCals per hour),Lying or Sleeping (80 kcals/hour) Desk Work (110 kcals/hour) Driving (120 kcals/hour) Fishing (130 kcals/hour) Sitting (100 kcals/hour) Standing (140 kcals/hour) Housework (180 kcals/hour),23,Modera

5、te Activity (200 to 350 KCals per hour),Bicycling - Pace: 5.5 mph (220 kcals/hour) - Pace: 11 mph (440 kcals/hour) - Pace: 16.5 mph (660 kcals/hour) Bowling (270 kcals/hour) Golf - Golf cart: 150 kcals/hour - Walking: 300 kcalks/hour Swimming at 0.25 mph (300 kcals/hour) Walking (approximately 100 calories per mile) Pace: 2 mph (150 kcals/hour) Pace: 4 mph (330 kcals/hour),24,Strenuous Activity (over 350 kcals/hour),Dance - Slow Step: 300 kcals/hour - Square Dancing: 350 kcals/hour - Fast Step (

6、Aerobic): 490 kcals/hour Racquet Sports - Badminton (350 kcals/hour) - Racquetball Singles (775 kcals/hour) - Squash or Handball (600 kcals/hour) - Tennis Singles (420 kcals/hour ) Running (approximately 100 calories per mile) - Jogging: 5 mph (640 kcals/hour ) - Moderate: 6 mph (750 kcals/hour) - Fast: 10 mph (1200 kcals/hour ) Shoveling (400 kcals/hour) Skating at 10 MPH (400 kcals/hour ),25,適當運動建議的決定與實行,美國公共衛生局建議：在1週中多數的日子，甚至每天累積30分鐘或更長時間的中度運動每小時快走3-4英哩被認為是中度運動，而散步則不是中度運動包括：步行、游泳、騎腳踏車、割草、打掃

7、房子和修理房子。日常生活中累積中度運動的策略包括：爬樓梯、步行取代短程的交通工具、看電視時踩固定式腳踏車及清掃庭院的落葉。運動的建議應強調頻率的重要性,26,診斷 (評估),治療 (介入),體重控制流程,效果 (評價),27,肥胖,行為,環境,教育,流行病診斷,行為與環境診斷,教育診斷,診斷(評估),28,行為與環境之診斷,晚上一定吃完宵夜才睡覺 (B) 找不到適當的餐廳吃低熱量食物(E) 常吃油炸食物如炸雞腿等(B) 家裡的伙食太油膩(E) 教育程度(E) 不覺得肥胖會對健康影響很大(B) 覺得自己有點胖但不是太胖(B) 想減肥但不知道那裡有辦減肥班?(E),29,教育的診斷,Predisposing factors (內在,傾向) knowledge, attitudes, beliefs, values, motivation, self-efficacy, psychological domain, socio-demographic factors. Enabling factors (能力) Availability, accessibility and afforda

8、bility Reinforcing factors (增強) Social support, peer influence, advice and feedback by health care providers, physical consequences of behavior.,30,教育的診斷,不知道那些食物含熱量高(Knowledge) 無法改變家裡的伙食(Enabling) 應酬太多(Enabling) 不知道如何製作低熱量食物(Skills) 缺乏醫療人員支持與建議(Reinforcing) 不覺得減重可改善健康狀況(Predisposing) 沒有錢付減重班的學費(Enabling),31,治療(介入),Educational Setting High risk population in community/institution High risk population at hospital General population for obesity prevention Educational Programs (duration, F/U) Indivi

9、dual/group teaching Individual nutrition counseling/assessment Individual behavioral/psychosocial counseling Support group Educational materials (教材) Types of materials Factors in choosing materials Educational methods (方法),32,Educational Materials (教材),Types of material Videotapes Slide/tapes Booklets/Books Programmed instruction Audiotapes,Computer-assisted instruction TV/Radio,Newspaper, Newsletters, Posters Brochures/Flyers Factors in choosing material Applicability Ease of use Reading level Ease of obtaining Cost,33,Educational Methods (方法),Individual skill sessions Individual counseling sessions Individual content session Small-group content sessions Small-group skill sessions Support groups Large-group discussion lectures,34,治療(介入),健康飲食觀念(knowledge) 熱量計算(knowledge) 低熱量食物烹調( skills) 記錄飲食(self-monitoring) 行為修正(behavior modification) 設定目標(set realistic goal) 回饋(reward),35,行為改變的治療,36,評價(Evaluation),效果如何? (體重減輕或減少肥胖發生) 短期效果? (Wt,Bp,Lipid profil

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