Week 4: Health-Compromising Behaviours Flashcards
Health compromising behaviours are prone to…
Stigmatisation
What are health-compromising behaviours?
Behaviours that harm your current or future health
What are the characteristics of health-compromising behaviours?
- Windows of vulnerability
- Social (peer) influence
- Pleasurable, and ironically, reduce stress
- Develop gradually at diff. stages of vulnerability
- Sig. overlap in risk factors/causes that trigger a host of unhealthy behaviours
What are windows of vulnerability?
Certain stages in life where people are vulnerable
What is obesity?
A medical condition, defined by excessive accumulation of body fat
How is obesity “diagnosed”?
Based on one’s Body Mass Index (BMI)
How is BMI calculated?
W / (H x H)
What are the categories for BMI?
Normal: 19-24 kg/m2
Overweight: 25-29 kg/m2
Obese: >30 kg/m2
What is the percentage of people who are miscategorised based on their BMI?
18%
What other info is required to make a firm diagnosis?
E.g. Body fat, family history, lifestyle
What are the reasons for increases in obesity?
- Increase in wealth
- Increase in caloric intake
- Increase in portion sizes
- Increase in fast food and microwaveable foods
What are the health complications for obesity?
- Contributes to death for all forms of cancer
- Strongly tied to various cardiovascular-related diseases (e.g. atherosclerosis, heart failure, hypertension) & Type II diabetes
- Increased risks/complications in surgery, anesthesia administration and childbearing
- Linked to poorer cognitive skills as early as in adolescence
==> Central adiposity, or abdominally localised fat, is especially potent in predicting these conditions - Disability and early mortality
- More physiologically reactive to stress (fat tissues promote inflammation)
- More psychologically distressed due to stigma
What are the risk factors for obesity?
- Social class (and values)
- Social networks
- Dieting
- Stress and depression
How is social class a risk factor for obesity?
- In US, low SES women more likely to be obese than high SES women (but not for men)
- In SG, parents’ education level and household income is positively associated with BMI knowledge and negatively associated with children’s BMI
How are social networks a risk factor for obesity?
- A person’s chance of becoming obese increases substantially when surrounded by friends, siblings, or partners who have become obese
- Social networks determine SOCIAL NORMS about obesity
How is dieting a risk factor for obesity?
1) Dieting reduces metabolism
2) Set point theory of weight
How does dieting lead to obesity by reducing metabolism?
- When dieting, body tries to enhance efficiency of food use by lowering metabolic rate
- Once dieters resume their normal food intake, the body’s metabolic rate stays low, making weight gain easy
How does dieting lead to obesity based on the set point theory of weight?
- Everyone has an ideal biological weight (“the set point”) that does not change easily
- When on diet, the body actively tries to get its weight back to set point, making it harder to lose weight
How is stress and depression a risk factor for obesity?
- For normal eaters (non-dieting and non-obese), stress actually suppresses physiological cues of hunger
- For those who are overweight or obese, stress tends to REDUCE SELF-CONTROL and DISINHIBIT FOOD CONSUMPTION
- Vicious cycle of stress eating, depression and obesity
What is the vicious cycle of stress eating, depression and obesity?
Stress eaters are more likely to experience fluctuations in negative emotions and feelings of depression
Ppl who are depressed are also more likely to gain weight, and in turn, become more depressed, and respond by stress eating
What are the interventions for obesity?
- Weight-loss programs and diets, regular exercise and sleep
- Surgery to reduce stomach’s capacity to hold food
- CBT
- Prevention within families
- Social engineering
How do weight-loss programs work as interventions for obesity?
Provide strict low fat and low carbohydrate diets
Help initially, but not sustainable on their own
How does maintaining regular exercise and sleep work as interventions for obesity?
Essential in increasing and regulating metabolism
What are the types of surgery to reduce stomach’s capacity to hold food?
- “Stapling up” stomach
- Lap band surgery: Implant a band at top of stomach to restrict food inflow into stomach
What are the side effects of surgery as interventions for obesity?
Gastric and intestinal distress
How does CBT work as an intervention for obesity?
CBT with additional focus on attentional retaining, exercise, stress management and social support
What is attentional retaining?
Distracting oneself from attending to food cues
Remove stimuli in environment
How does prevention within families work as an intervention for obesity?
- Help parents adopt good meal plans and eating habits at home, limit snacking
- Incorporate physical activity
How does social engineering work as an intervention for obesity?
Providing food labels with more nutritional info, limit availability of unhealthy foods, soda tax
How does weight stigma affect obesity?
Discrimination worsens feelings of shame and subsequently their mental health
This reduces motivation to take action and willingness to use health services or seek help
Why is it important to address weight stigma?
Targeting patient motivation and efficacy alone is not enough to address the obesity epidemic
Public health efforts need to also focus on creating awareness and educating the public about weight stigma and reducing discrimination
What is the window of vulnerability for eating disorders?
15-24 years old
What are the most common forms of eating disorders?
Anorexia nervosa
Bulimia
What is anorexia nervosa?
An obsessive disorder involving extreme exercise and dieting, resulting in body weight that is severely below optimal level (BMI < 15) and eventually leads to starvation and death
What are the risk factors for anorexia nervosa?
- Low levels of serotonin, dopamine and estrogen (all linked to anxiety)
- Early exposure to stress (extreme stress, trauma) and dysregulated biological stress system (become hyper-reactive)
- Low sense of control coupled with high need for approval and perfectionistic behaviour
- Body image distortions
- Mothers with similar preoccupation with own weight and eating problems
What are the interventions for anorexia nervosa?
- Bring patients’ weight back up to safe level
- CBT (limited success)
- Family therapy
- Targeting faulty societal beliefs about thinness and social norms about body image, and promote idea of health
Why does CBT have limited success with anorexics?
Many of them are unmotivated to change their behaviours
How does family therapy work as an intervention for anorexia?
Involves positive communication of emotion and conflict, as well as keeping track of anorexic family member’s eating and behaviours
What is bulimia?
Characterised by alternating cycles of binge eating and purging
What is binging?
An out-of-control reaction of the body to restore weight
What is purging?
An effort to regain control over weight
What are the risk factors for bulimia?
- Higher than normal stress reactivity and hormonal dysfunctions
- Strong genetic basis based on twin studies
- Families that place high value on thinness and appearance
What are the interventions for bulimia?
CBT works best when combined with medication, such as SSRIs or antipsychotics
What are the characteristics of substance dependence?
- Physical dependence
- Craving
- Addiction
- Withdrawal
What is physical dependence?
Body incorporates substance into its regular functioning, often resulting in tolerance to substance
What is tolerance?
Over time, the body adapts to the regular usage and requires a larger dose to achieve the same effect
What is craving?
An automatic desire to consume the substance as a result of physical dependence and conditioning with environmental cues
What is addiction?
When the person has become physically or psychologically dependent on the substance after repeated use OVER TIME
What is withdrawal?
Unpleasant symptoms experienced when person stops using substance which they have become dependent on or addicted to
What are some examples of substance dependence disorders?
Alcoholism and problem drinking, smoking
Alcoholism affects…
- Physical health (e.g. hypertension, stroke, scarring of liver)
- Cognitive function (e.g. brain atrophy, reduced brain volume)
- Aggressive and impulsive behaviours (e.g. assaults, homicides, suicides) that directly lead to mortality
What are the risk factors for alcoholism and problem drinking?
- Males
- Low SES
- Parents who drink, resulting in modeling of behaviour
- Social stresses (e.g. financial strain, low job autonomy, sense of powerlessness)
- Depression
- Twin studies and family studies of alcoholic sons and fathers suggests some genetic basis
What are the two windows of vulnerability for alcoholism and problem-drinking?
- 12-21, where dependency generally begins
- Late middle age, when drinking is used as a stress coping method
What are the interventions for alcoholism?
- Detoxification in a controlled medical setting + CBT
- High SES, stable envmts
- Social engineering
How does SES affect interventions for alcoholism?
High SES alcoholics tend to do better in treatment programs when they also have highly stable envmts, such as regular jobs, stable family, and circle of friends
Low SES alcoholics often don’t have these psychosocial buffers and tend to do worse
What are examples of social engineering for alcoholism?
Banning alcohol advertising, taxation on alcohol, raising legal drinking age, enforcing penalties for drink driving
Smoking is linked to…
- Respiratory disorders
- Lower birth weight in offspring
- Affects normal fetal development
- Increases risk of erectile dysfunction by 50%
What are the effects of smoking on others?
Family members or co-workers can suffer the same disorders through passive smoking, or inhaling secondhand smoke
What are the synergistic effects of smoking?
Smoking worsens effects of risk factors for other diseases
E.g. If you alr have cholesterol problems, smoking makes you more likely to get heart diseases
E.g. If you’re already reactive to stress, smoking increases your HR and BP, making you even more reactive
E.g. If you are alr in a low SES environment, smoking increases existing risk of low SES on general health outcomes
What are the risk factors of smoking?
- Family members who smoke
- Presence of peers who smoke; social contagion
- Stress and depression (esp. among low SES)
- Low self-esteem, sense of powerlessness
How do ppl get addicted to smoking?
Addictive properties of nicotine in cigarettes
Nicotine alters level of “feel good” neurotransmitters (e.g. dopamine and norepinephrine)
Ironically, elevations of these neurotransmitters produce TEMPORARY improvements in concentration and mood
When nicotine levels in the body drops, you exp. withdrawals, driving the need to smoke to get nicotine levels back up in your system
What are the interventions for smoking?
Nicotine replacement therapy
CBT, with focus on attentional retaining and relapse prevention
Social support and stress mgmt to identify alternate sources of stress relief
What is nicotine replacement therapy?
Nicotine patches that release nicotine in small, controlled doses into bloodstream to deal with initial withdrawal
E-cigarettes
What are e-cigarettes? What are its related issues?
Turn nicotine-infused liquid into vapour
Issues: Still addictive (contains lower but non-zero levels of nicotine), contain other unknown chemicals/substances, prone to tampering and misuse
What are the alternatives to cigarettes?
- E-cigarettes
- Marijuana
What are the issues associated with marijuana use?
Changes in adolescent brain structure
General cognitive impairment and poorer performance in school
