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