Medsarticles. Medical Weblog

The micro environment refers to those aspects of the environment that are closer to the individual. Again, these can be classed as either physical or socio-cultural. Because they are more personal, however, they are much more amenable to change and represent opportunities for those working at the clinical or individual level. Many potential micro-environmental changes, either within the home, workplace or social environment, are often considered within a behaviour therapy approach to obesity management.

The socio-cultural micro environment. Partner support has been shown to be particularly important to the success of fat loss programs in the home environment. It’s often presupposed that family nutrition practices are influenced mostly by the female in the household, although one study done with spouses of men in a male ‘waist loss’ program in Australia has shown that there is a greater influence on the household environment when the man of the house decides to make a change to reduce fatness. It also seems that females are more likely to provide support for their male partner to lose fat than vice versa.

There are regular eating and exercise patterns within families, workplaces and other social settings which may have counter-productive effects on fat loss programs. A recent survey of eating patterns, for example, showed that dietary patterns close to that regarded as healthy (such as eating breakfast and eating low-fat and high-fibre foods with limited alcohol consumption) are most common on Monday mornings. After that, the dietary pattern declines to Sunday nights with the worst consumption patterns occurring from Friday to Sunday, Work and social pressures over the course of the week no doubt help cause this effect, which also occurs in a yearly cycle from early in the New Year until the end of the year. The implications of this are that fat loss programs designed to lead to lifestyle changes are less likely to be effective if introduced at those times (i.e. late in the week or year) when the social environment is least supportive.

With children, the influence of the family is most significant. Recent research by Dr Len Epstein, a psychologist working in childhood obesity in the US, has shown that reducing inactivity by rewarding children for not watching TV or carrying out other sedentary activities such as video games is a more effective fat loss technique than directly rewarding their involvement in exercise or sport. More importantly, many children who are encouraged to reduce inactivity actually end up liking exercise, and even vigorous exercise, more than those who are put into a regimented exercise program.

Peer and close support group attitudes are also a significant part of the socio-cultural micro environment. For men in particular it’s thought that only exercise that is vigorous and exhaustive has value for improving health and reducing body fatness. Exercise such as that required to walk to the shop, walk up stairs, mow the lawn, or carry out chores is seen purely as a nuisance, or inconvenience. A major initiative here is to change the mental orientation to regarding all forms of activity as an ‘opportunity’ rather than an ‘inconvenience’. By refraining the issue in the minds of the subject, the significance of the external environment is, at least, partly nullified. Currently, this is not aided by social attitudes which regard someone as being successful once they possess all the leisure saving devices possible: while these remain a sign of economic affluence, they are undoubtedly facilitators of physical inactivity.

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Summary of main points.

• Bioenergetics is the study of energetic events occurring in living organisms; it covers energy (food) intake and energy expenditure.

• Fat is the most energy dense nutrient, containing more than twice the energy of carbohydrate or protein. Energy expenditure is made up of resting metabolic rate, the thermic effect of food and the energy cost of physical activity.

• Bigger people have a higher metabolic rate mainly because of a greater resting metabolic rate from a higher fat-free mass.

• Even very small females require an energy intake of around 1200kcal per day to maintain energy balance.

The living cells of the human body are in a constant state of molecular activity, where they are used, degraded and synthesised to maintain life. These actions require energy which is defined as ‘the capacity to perform work. This definition does not, however, describe the many biological functions that either require or liberate energy in the body.

Understanding what energy is and how the body acquires, converts, stores, and utilises it is the key to understanding how humans can perform activities. It also provides the basis for understanding how fat is used as an energy source, or substrate, and how this may be optimised for best maintenance of body fat levels. The study of energetic events occurring in living organisms, which commenced in the 18th century, is called bioenergetics.

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After the birth of her second daughter, Melissa Katz was stunned to discover that her weight had settled in at 240 pounds. The veteran yo-yo dieter from Brooklyn found herself at a crossroads.

“I thought, ‘If I don’t get a handle on this now, I’m going to be fat my whole life,’” she says.

She decided to join Weight Watchers. After just a few meetings, she realized just how much food she had been eating each and every day. “No wonder I had gained so much weight,” she says. “The problem was that I was used to eating big meals and big snacks. I felt hungry all the time.”

Weight Watchers taught her that she could have plenty of food—if she made-the right choices. So she turned to fruits and vegetables to fill her plate. “They made me feel full without supplying lots of calories,” she explains.

As the weight started to melt away, her self-esteem grew. “As I became more confident, I became more physically active,” she says.

It took only a year for Melissa to lose 100 pounds. She has maintained that loss for 214 years. And her casual interest in exercise has turned into a career as a physical trainer.

But what Melissa, age 35, is most proud of is the impact that her new eating habits are having on her daughters. “They make good food choices, too,” she says. “They’ll pick a piece of fruit over a piece of cake. That’s what gives me the biggest joy.”

WINNING ACTION

Stock up on produce with a high satisfaction quotient.

Australian researchers put together a list of “bargain foods” that, calorie for calorie, have the greatest potential to satisfy your hunger. At the top of the list: the baked potato. It fills you up faster and with fewer calories than any other food tested.

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