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Health-Enhancing Behaviours
Body Shape and Weight Concerns
Studies suggest that as many as 80% of 10-year girls have been on a diet;
50% of girls between 14 and 18 years believe they are too fat; and
45% of 14 to 18 year old girls are dieting.
DSM-IV Criteria – Anorexia Nervosa Refusal to maintain body weight at or
above normal weight for age (i.e., weight loss or failure to gain weight resulting in weight < 85% of expected).
Intense fear of weight gain or becoming fat. Disturbed body image, undue influence of
weight on issues of self-worth, denial of seriousness of weight loss.
Absence of at least 3 consecutive menstrual cycles.
DSM-IV Criteria for Bulimia Nervosa (BN) Recurrent episodes of binge eating
characterized by: Eating an abnormally large quantity of food in a
discrete period of time; and A sense of lack of control over eating.
Recurrent inappropriate compensatory behaviours (e.g., vomiting, laxatives, diuretics, enemas, fasting, vigorous exercise).
The above two occur at least twice a week for at least 3 months.
Self-evaluation unduly influenced by weight.
Etiology of AN 10-15 times more frequent in women
than men Evidence for genetics is inconistent Family variables include the child
being over-controlled by parents. Sociocultural risk factors
Eating Disorders Not a new disorder Anorexia nervosa (AN) first described in
1694 Bulimia nervosa (BN) first identified in 1892 Usual age of onset is adolescence or early
20s. 90% or more are females. Prevalence of AN is 0.5% to 1.0%. Prevalence of BN is 1.0 to 3.0%.
Etiology of Bulimia Nervosa Bio-psychosocial model proposes
that biogenetic predispositions, e.g., depression, combine with familial factors and sociocultural pressures, emphasizing high achievement and thinness, that promote a character structure featuring affective instability and low self-esteem.
Etiology of BN continuedNegative Self-Evaluation
Characteristic extreme concernsabout shape and weight
Intense and rigid dieting
Perfectionismand dichotomousthinking.
Binge eating Negative affect
Purging
Referral Rates for AN and BN to Clarke Institute from 1975 - 1986
0102030405060708090
1001975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
AN-restrictorBNAN-binge
Healthy Exercise
3 hours per week (across 3 – 5 sessions) Warm-up
Stretching and flexibility exercise Strength and endurance exercise
Aerobics Rhythmic exercise of large muscle groups Raise heart rate to moderately high level
Cool down
Why is exercise healthy? Three psychosocial benefits are:
Feel less stressed and anxious Better work performance and attitudes More positive self-concept
Physiological benefits Increased production of endorphins Improved agility Improved bone density Improved strength and flexibility
Cardiovascular Benefits of Exercise Lowers -
systolic and diastolic blood pressure heart rate and thereby helps protect
the heart against heart rhythm disturbances
LDL-cholesterol and raises HDL-cholesterol (the good cholesterol)
Potential Risks of Exercise Accidents Injuries Heart exhaustion and heat stroke May become addictive Precipitate a heart attack If using steroids to enhance exercise,
number of adverse effects of steroids
Who is more likely to exercise? Men Whites more than Hispanics and
Blacks Young more than old Well educated or higher SES groups Previous exercise history Those who feel well Non-smoker
Metropolitan Height & Weight Tables
Women Small frame – 5’4”
ideal weight is 114-127 lbs.
Medium frame – 5’4”ideal weight is 124-138 lbs.
Men Small frame – 6’
ideal weight is 149-160 lbs
Medium frame – 6’ideal weight is 157-170 lbs
Who becomes overweight? About 40% become overweight In women, Blacks and Hispanics
more likely to be overweight than Whites.
Genetics and familial influences Prevalence increases with age
Why do people gain weight?
Biological factors – Lower metabolic rate Malfunctioning endocrine glands Heredity
Set-point theory Your body tries to maintain set weight Thermostat-like mechanism Hypothalamus involved May relate to no. and size of fat cells
Psychosocial Factors
Eat more when stressed Alcohol – adds calories to diet and
reduces disposal of fat Watching television may reduce
metabolic weight rates below normal resting rates
Health Hazard Weight Level
Small risk – 10% over ideal weight Moderate risk – 20% over ideal
weight Greatly increased risk – 50% over
ideal Distribution of weight – more
hazardous if concentrated around the abdomen
Healthy Eating Eating nutritionally balanced meals Poor nutritional balance has been
implicated as factor in many diseases: Colon, stomach, pancreatic, prostate, and
breast cancer. Hypertension (salt and high body weight) Hypercholesterolemia (saturated fats) Diabetes (body weight, sugar, fats)
Sleep Disorders
Sleep Disorders
Ideal is 7-8 hours a night Insufficient sleep can cause:
Impaired cognitive functioning Mood disturbance Poor work performance Impaired immune functioning
Poor sleep predicts higher mortality rates
Health-Compromising Behaviours
Smoking
Substance Abuse Addiction – physical and psychological
dependence on a substance following use over a period of time
Physical dependence – body is use to the substance and incorporates the use of the substance in its normal function.
Tolerance – increasing adaptation to the substance so that higher and higher doses need to achieve same result.
Withdrawal – unpleasant physical and psychological symptoms upon withdrawal.
Nicotine 22-25% of US smoke, similar rates are
seen in Canada with regional variation.
More than 80% of smokers started as youth.
If people do not begin to smoke as youth unlikely they will start as adults.
Nicotine reaches the brain within 7-15 seconds.
Why Do People Smoke Age Culture Peer encouragement More likely if parents smoke Personality characteristics
(rebellious, risk taker) Smokers image (e.g., cool, mature,
glamorous, exciting)
Reasons Given for Smoking (Silvan Thomkins)
Positive affect – stimulation, relaxation, pleasure
Negative affect – relieves boredom, stress, depression
Habitual – behaviour becomes a habit
Psychological dependence – use it to regulate emotions
Nicotine – Maintaining Factors Physical addiction Physical habit Emotional support Personal identity Social habit
Cigarette smoke contains Carbon monoxide – gas that is readily
and rapidly absorbed into bloodstream affecting physical functioning
Tars – minute particles of residue – adverse health effects but not related to addictive effect
Nicotine – addictive chemical in tobacco
Nicotine Penetrates cell membranes in nose,
mouth, lungs, and blood Blood rapidly carries nicotine to the brain
(within 7 sec) Brain releases various chemicals that
activate both the central and sympathetic nervous system
Increase arousal, alertness, attention, heart rate, and blood pressure
Nicotine levels decrease rapidly
Nicotine-Regulation Model Smoke to maintain a certain level
of nicotine Smoke to avoid symptoms of
withdrawal Addiction not all due to
biochemical effects since cravings can continue long after physical addictive effects are gone (up to 5 years)
Bio-Behavioural Model Continue smoking to regulate
cognitive-emotional state Control weight Nicotine affects chemicals in the
brain (acetycholine, norepinephrine) that increase alertness and decrease tension (and withdrawal symptoms)
Relapse
50 – 80% of those who quit relapse within a year
Stress is primary reason for relapse (smoking seen to help stress)
Social support helps protect against relapse
Self-efficacy is most important factor in quitting
Abstinence-violation Effect Tendency to start smoking again
after a lapse because of reduced self-efficacy for quitting and reminder about positive effects of smoking.
Weight-gain often leads to relapse so as to control weight. Caloric intake increases. Metabolism decreases.
Transtheoretical Model(Prochaska & DiClemente, 1992)
Precontemplation
Preparation
Contemplation
Maintenance
Action
Relapse
Processes of ChangeProchaska et al. 1992
Precontemplation Contemplation Preparation Action Maintenance
Consciousnessraising
Dramaticrelief
Environmentalre-evaluation
Self- re-evaluation
Pros & cons
Self-liberation
Trial & error
Reinforcementmanagement
Helpingrelationships
Counter-conditioningStimulus control
Stage-Based Intervention for Smoking Cessation: Prochaska, et al., 1993
Objective:
To compare four self-help programs for smoking cessation in general population of smokers.
Stage-Based Intervention for Smoking Cessation: Prochaska, et al., 1993
Subject recruitment:
Subjects were 755 volunteers in Rhode Island who responded to a newspaper advertisement seeking participants to test self-help materials developed for smokers in various stages of change.
Stage-Based Intervention for Smoking Cessation: Prochaska, et al., 1993
Interventions: Standard manuals from American Lung
Association (ALA) TTM-based Manuals (TTM) Interactive computer assessment and
tailored interventions to stage of change (ITTM)
Interactive computer assessment, tailored interventions, and counsellor calls (CITTM)
Prochaska et al., 1993Cessation Rates
0%
5%
10%
15%
20%
25%
30%
Pre 6 mo. 12 mo. 18 mo.
ALATTMITTMCITTM
Assessment Points (Months)P < 0.05
Alcohol – Who Drinks? Drinking usually begins in high school Males drink more but gender gap
lessening White more than Hispanics who are
more than blacks Higher rates amongst Natives, lower in
Asians 60% drink occasionally
Problem Drinking Drinks heavily on a regular basis Psychologically dependent Social and/or occupational
impairment 13% of drinkers have a problem Of these, ¾ are male
Alcoholics About ½ of problem drinkers Physically dependent on alcohol High tolerance for alcohol May suffer black outs and memory
losses Experience delirium tremors from
withdrawal (anxiety, agitation, hallucination, tremors)
Alcohol Dependence/Abuse Lifetime prevalence is about 10% in women
and 20% in men. 75% of car accidents at night are due to
drinking. Alcohol-related disorders are associated
with 50% of homicides and 25% of suicides. Genetic link – family history associated with
3-4 times greater risk as well as being associated with more serious alcohol-related problems.
Alcohol Dependence/Abuse – Clinical Course Most exhibit their first alcohol-
related problem in late 20s and 30’s. Most first present for treatment in
their 40s. Die about 15 years earlier than non-
alcoholic. Course of alcohol abuse is
fluctuating. Spontaneous remission in 10-30%.
Health Risks from Heavy Alcohol Use
Accidents (alcohol use accounts for the majority of traffic accidents in youth & 50% of traffic accidents of all ages)
Cirrhosis of the liver Some forms of cancer Fetal alcohol syndrome in new-born Retardation and physiological
abnormalities in offspring of mothers who drink
Cognitive impairment Brain damage