HealthEnhancing Behaviors

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Health-Enhancing Behaviors

• Chapter four

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Battling Obesity

• Do you want that combo supersized?

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Monitor on Psychology, Jan 2004

• 65 of Americans are obese or overweight
• 1960 45

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Why??

• Multiple, complex factors
• Mismatch between physiology and environment
• Food is everywhere
• Good tasting
• Abundant
• Large portions
• inexpensive

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Physiology says

• Eat whenever food is available

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Other factors

• Lack of physical activity
• Sit down jobs with increasing hours

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costs

• Diabetes
• Stroke
• Heart attacks
• Health-care system estimate of 117 billion a year

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Environment

• Easy access to junk food
• Sedentary jobs
• High stress rate
• Environmental epidemic

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Unhealthy foods

• Accessible
• Convenient
• Engineered with fat and sugar to be tasty
• Heavily promoted
• cheap

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Healthy foods

• Less accessible
• Less convenient
• Less tasty
• Not promoted
• More expensive

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Restaurant food

• Tends to be higher in fat, calories and larger
  portions than home cooking
• Increased amount of people eating away from home

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restaurants

• People tend to eat what is put in front of them
• Ever-larger sizes of low-cost , calorie laden
  foods (fries and soft drinks)
• 5 cents of popcorn in large vs. medium and charge
  39 cents more
• Huge profit with great deals

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Some research findings

• We eat more when given more
• Package size influences us to eat more
• We dont compensate for eating too much at one
  sitting by eating less at the next
• Having larger portions can override natural sense
  of fullness

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Fullness and hunger

• No matter what portion size, ratings were similar
• Popcorn study those given more, ate more
• Those who rated popcorn unfavorably ate more
• Packaging use more detergent, dog food

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Land of the overweight

• French portion size 25 less than American, even
  fast food
• French remain relatively slim despite regular
  consumption of fat-rich foods
• Better to eat foods low in energy density
  (fruits, vegetables, whole grains, lean protein)

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Television

• Clear , significant relationship between
  TV-viewing and obesity in children
• Children consume 25 of daily food in front of
  TV will decreased viewing decrease intake?

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enter the beer belly

• Study of mostly white, middle aged workers
• Higher stress levels ate less healthy, fattier
  diets, less exercise and smoked more than workers
  reporting lower stress

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Those poor rats..

• Chronically stressed rats (physical restraint or
  exposure to cold)
• Chose fattier, more sugary diets
• Gained weight in their bellies
• Became calmer

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Rats.

• Negative hormonal feedback system in response to
  stress
• Turned off when rats ate high fat foods and
  gained belly fat
• Reduced activation of stress response
• Belly fat higher in steroid receptors

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Genetic loading in humans?

• Obese people have gene variant that increases
  amount of GABA than do non-obese relatives
• GABA stimulates appetite
• 50 of population may have this variant

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Treatment adults

• Success defined at 10 reduction of initial
  weight maintained for at least one year
• Self-monitoring systematic observing recording
  of target behaviors, i.e.,
• Calorie fat intake, exercise
• Need to self monitor at least 75 of the time to
  succeed in weight loss

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Treatment adults

• Accentuated CBT
• Modified fasting
• Appetite suppressants
• Antidepressants

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Treatment adults Meditation

• Mindfulness
• How food is used emotionally
• Incorporating nonjudgmental awareness
• People with eating disorders generally less aware
  of hunger and satiation cues

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Treatment adults Meditation

• Focus on current moment of eating, nothing else

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Treatment children

• Prevention
• 15 of children overweight
• Higher risk for depression, suicide, ostracism
• Encouraging positive attitudes towards eating is
  critical

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Treatment children

• Down Syndrome high risk for obesity and greater
  than average risk for heart disease and diabetes
• Good news parents may be well versed in positive
  behavioral interventions children tend to be
  outgoing eager to participate

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Eating Disorders An Overview

• Two Major Types of DSM-IV Eating Disorders
• Anorexia nervosa and bulimia nervosa
• Both involve severe disruptions in eating
  behavior
• Both involve extreme fear and apprehension about
  gaining weight
• Both have strong sociocultural origins
  Westernized views
• Other Subtypes of DSM-IV Eating Disorders
• Binge-eating disorder
• Rumination disorder
• Pica
• Feeding disorder

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Bulimia Nervosa Overview and Defining Features

• Binge Eating Hallmark of Bulimia
• Binge Eating excess amounts of food
• Eating is perceived as uncontrollable
• Compensatory Behaviors
• Purging Self-induced vomiting, diuretics,
  laxatives
• Some exercise excessively, whereas others fast
• DSM-IV Subtypes of Bulimia
• Purging subtype Most common subtype (e.g.,
  vomiting, laxatives, enemas)
• Nonpurging subtype About one-third of bulimics
  (e.g., excess exercise, fasting)

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Bulimia Nervosa Overview and Defining Features
(cont.)

• Associated Features
• Most are within 10 of target body weight
• Most are over concerned with body shape, fear
  gaining weight
• Most are comorbid for other psychological
  disorders
• Purging methods can result in severe medical
  problems

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Bulimia Nervosa Overview and Defining Features
(cont.)

• Figure 8.2
• Lifetime cumulative risk for bulimia among female
  twins

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Anorexia Nervosa Overview and Defining Features

• Successful Weight Loss Hallmark of Anorexia
• Defined as 15 below expected weight
• Intense fear of obesity and losing control over
  eating
• Anorexics show a relentless pursuit of thinness,
  often beginning with dieting
• DSM-IV Subtypes of Anorexia
• Restricting subtype Limit caloric intake via
  diet and fasting
• Binge-eating-purging subtype About 50 of
  anorexics
• Associated Features
• Most show marked disturbance in body image
• Most are comorbid for other psychological
  disorders
• Methods of weight loss can have severe life
  threatening medical consequences

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Binge-Eating Disorder Overview and Defining
Features

• Binge-Eating Disorder Appendix of DSM-IV
• Experimental diagnostic category
• Engage in food binges, but do not engage in
  compensatory behaviors
• Associated Features
• Many persons with binge-eating disorder are obese
• Most are older than bulimics and anorexics
• Show more psychopathology than obese people who
  do not binge
• Share similar concerns as anorexics and bulimics
  regarding shape and weight

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Bulimia and Anorexia Facts and Statistics

• Bulimia
• Majority are female, with onset around 16 to 19
  years of age
• Lifetime prevalence is about 1.1 for females,
  0.1 for males
• 6-8 of college women suffer from bulimia
• Tends to be chronic if left untreated
• Anorexia
• Majority are female and white, from
  middle-to-upper middle class families
• Usually develops around age 13 or early
  adolescence
• Tends to be more chronic and resistant to
  treatment than bulimia
• Both Bulimia and Anorexia Are Found in
  Westernized Cultures

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Causes of Bulimia and AnorexiaToward an
Integrative Model

• Media and Cultural Considerations
• Being thin Success, happiness....really?
• Cultural imperative for thinness translates into
  dieting
• Standards of ideal body size change as much as
  clothes
• With improved nutrition, media standards of the
  ideal are difficult to achieve
• Developmental Considerations
• What is normal growth and development around
  puberty?
• Psychological and Behavioral Considerations
• Food restriction often leads to a preoccupation
  with food
• Low sense of personal control and self-confidence
• An Integrative Model of Eating Disorders

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Causes of Bulimia and AnorexiaToward an
Integrative Model (cont.)

• Figure 8.4
• Male and female ratings of body size

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Causes of Bulimia and AnorexiaToward an
Integrative Model (cont.)

• Figure 8.6
• An integrative causal model of eating disorders

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Medical and Psychological Treatment of Bulimia
Nervosa

• Medical Treatment
• Antidepressants can help reduce binging and
  purging behavior
• Antidepressants are not efficacious in the
  long-term
• Psychological Treatment
• Cognitive-behavior therapy (CBT) is the treatment
  of choice
• Interpersonal psychotherapy results in long-term
  gains similar to CBT

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Medical and Psychological Treatment of Anorexia
Nervosa

• Medical Treatment
• There are none with demonstrated efficacy
• Psychological Treatment
• Weight restoration First and easiest goal to
  meet
• Treatment involves education, behavioral, and
  cognitive interventions
• Treatment often involves the family
• Long-term prognosis for anorexia is poorer than
  for bulimia

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Other Eating Disorders

• Rumination Disorder
• Chronic regurgitation and reswallowing of
  partially digested food
• Most prevalent among infants and persons with
  mental retardation
• Treatment often involves use of aversives (e.g.,
  lemon juice)
• Pica
• Repetitive eating of inedible substances
• Seen in infants and persons with severe
  developmental or intellectual disabilities
• Treatment involves operant procedures

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Other Eating Disorders (cont.)

• Feeding Disorder
• Failure to eat adequately, resulting in
  insufficient weight gain
• Disorder of infancy and early childhood
• Treatment involves regulating eating and family
  therapy