Health Psychology Connect Notes: Chapter 5 Part 1

The obesity problem is most severe in the United States

Americans are the fattest people in the world. At present, 68 percent of the adult U.S. population is overweight, and about 34 percent is obese (Ogden, Carroll, Kit, & Flegal, 2012), with women and older adults somewhat more likely to be overweight or obese than men and younger adults (Fakhouri, Ogden, Carroll, Kit, & Flegal, 2012) (Figure 5.1). Although obesity levels have begun to level off, the trend has not yet reversed (

Social Support

Because people with strong social support are more successful at losing weight than those with little social support, most CBT programs include training in eliciting effective support from families, friends, and coworkers. Even supportive messages from a behavioral therapist over the Internet seem to help people lose weight (Oleck, 2001). Autonomy support, that is, social support that conveys the belief that the person is an autonomous, responsible agent of his/her own behavior appears to foster self regulation that can lead to more weight loss better than more directive support (Gorin, Powers, Koestner, Wing, & Raynor, 2014).

Controlling Self-Talk

Cognitive restructuring is an important part of weight-reduction programs. As noted in Chapter 3, poor health habits can be maintained through dysfunctional monologues ("I'll never lose weight—I've tried before and failed so many times"). Participants in weight-loss programs are urged to identify the maladaptive thoughts they have regarding weight loss and to substitute positive self-instruction.//The formation of explicit implementation intentions (Luszczynska, Sobczyk, & Abraham, 2007) and a strong sense of self-efficacy—that is, the belief that one will be able to lose weight—also predicts weight loss (Warziski, Sereika, Styn, Music, & Burke, 2008). The goal of these aspects of interventions is to increase a sense of self-determination, which can enhance intrinsic motivation to continue diet modification and weight loss

Dieting

Most weight-loss programs begin with dietary treatment. People are trained to restrict their caloric and/or carbohydrate intake. In some cases, food may be provided to the dieters to ensure that the appropriate foods are being consumed. Generally, weight loss produced through dietary methods is small and rarely maintained for long (Agras et al., 1996). In fact, as Box 5.2 shows, dieting has risks. Very low-carbohydrate or low-fat diets do the best job in helping people lose weight initially, but these diets are the hardest to maintain, and people commonly revert to their old habits. Reducing caloric intake, increasing exercise, and sticking with an eating plan over the long term are the only factors reliably related to staying slim. Beginning as early as preschool, these are the best ways to tackle obesity

Taking a Public Health Approach

Prevention with families at risk for having obese children is an important strategy. Parents should be trained early to adopt sensible meal-planning and eating habits that they can convey to their children. Although obesity has proven to be very difficult to modify with adults, it is easier to teach children healthy eating and activity habits. Obese children can benefit from lifestyle interventions involving reinforcements for giving up sedentary activities like television watching, inducements to engage in sports and other physical activities, and steps to encourage healthier eating practices including avoiding or eliminating snacking (Wilfley et al., 2007). School-based interventions directed to making healthy foods available and modifying sedentary behavior will help

Stress & Eating

Stress affects eating, although in different ways for different people. About half of people eat more when they are under stress, and half eat less (Willenbring, Levine, & Morley, 1986). For non-dieting and nonobese normal eaters, stress or anxiety may suppress physiological cues of hunger, leading to lower consumption of food. For overweight and obese people, however, stress and anxiety can disinhibit food consumption, removing the self-control that usually guards against eating

Surgery

Surgical procedures represent a radical way of controlling extreme obesity. In one common surgical procedure, the stomach is literally stapled up Page 88to reduce its capacity to hold food, so that the overweight individual must restrict his or her intake. In another approach known as lap band surgery, an adjustable gastric band is inserted surgically around the top of the stomach to create a small pouch in the upper stomach to reduce the stomach's capacity to take in food. As with all surgeries, there are potential side effects such as gastric and intestinal distress. Consequently, this procedure is usually reserved for people who are at least 100 percent overweight, who have failed repeatedly to lose weight through other methods, and who have complicating health problems that make weight loss urgent.

Obesity is a chief cause of disability.

The number of people age 30-49 who are too heavy to care for themselves or perform routine household tasks has jumped by 50 percent. This increase bodes poorly for the future. People who are disabled in their 30s and 40s are more likely to have health care expenses and to need nursing home care in older age, if they live that long (Richardson, 2004, January 9). Being obese also reduces the likelihood that a person will exercise, and lack of exercise increases obesity; yet obesity and lack of exercise appear to exert independent adverse effects on health, leading to greater risks than either risk factor alone (Hu et al., 2004). One in four people over 50 is obese, and as the population ages, the numbers of people who will have difficulty performing the basic tasks of daily living, such as bathing, dressing, or even walking, will be substantial (Facts of Life, December, 2004). Obesity is tied to poor cognitive functioning as well

The epidemic of eating disorders suggests

that, like obesity, the pursuit of thinness is a major public health threat. Recent years have seen an increase in the incidence of eating disorders, especially among adolescent girls. Chief among these are anorexia nervosa and bulimia. Eating disorders have some of the highest disability and mortality rates of all behavioral disorders (Park, 2007). Eating disorders result in death for about 6 percent of those who have them (Facts of Life, November 2002). Suicide attempts are not uncommon (Bulik et al., 2008). Women with eating disorders or tendencies toward them are also more likely to be depressed, anxious, and low in self-esteem and to have a poor sense of mastery.

Point Theory of Weight

the idea that each individual has an ideal biological weight, which cannot be greatly modified (Garner & Wooley, 1991). According to the theory, the set point acts like a thermostat regulating heat in a home. A person eats if his or her weight gets too low and stops eating as the weight reaches its ideal point. Some people have a higher set point than others, leading to a risk for obesity (Brownell, 1982). The theory argues that efforts to lose weight may be compensated for by adjustments in energy expenditure, as the body actively attempts to return to its original weight.

Stimulus Control

Clients are trained to modify the stimuli in their environment that have previously elicited and maintained their overeating and to take steps to modify their food consumption. Such steps include purchasing low-calorie foods (such as raw vegetables) and limiting the high-calorie foods kept in the house. Clients are taught to confine eating to one place at particular times of day, and to develop new discriminative stimuli that will be associated with eating, for example, using a particular place setting, such as a special placemat or napkin, and to eat only when those stimuli are present.

Evaluation of Cognitive-Behavioral Weight-Loss Techniques

Cognitive-behavioral programs typically produce modest success, with weight loss of nearly 2 pounds a week for up to 20 weeks and long-term maintenance over at least 2 years (Brownell & Kramer, 1989). Programs that emphasize diet modification self-direction and exercise and include relapse prevention techniques are particularly successful (Jeffery, Hennrikus, Lando, Murray, & Liu, 2000). Interventions with children and adolescents show particularly good results when parents are involved

Stress Management

Efforts to lose weight can be stressful (Tomiyama et al., 2010), and so reducing life stress can be helpful. Among the techniques that have been used are mindfulness training and acceptance and commitment theory (

Screening

Some programs begin by screening applicants for their readiness to lose weight and their motivation to do so. Unsuccessful prior dieting attempts, weight lost and regained, high body dissatisfaction, and low self-esteem can all undermine weight loss efforts

The World Health Organization

estimates that 600 million people worldwide are obese and 1.9 billion are overweight, including 42 million children under age 5 (World Health Organization, January 2015). Obesity is now so common that it has replaced malnutrition as the most prevalent dietary contributor to poor health worldwide (Kopelman, 2000), and it will soon account for more diseases and deaths in the United States than smoking.

Obesity

is an excessive accumulation of body fat. Generally, fat should constitute about 20-27 percent of body tissue in women and about 15-22 percent in men. Table 5.1 presents guidelines from the National Institutes of Health for calculating your body mass index and determining whether you are overweight or obese

many women and an increasing number of men chronically restrict their diet and engage in other weight-loss efforts, such as:

such as laxative use, cigarette smoking, and chronic use of diet pills (Facts of Life, November 2002). Women ages 15-24 are most likely to practice these behaviors, but cases of eating disorders have been documented in people as young as 7 and as old as their mid-80s

SES, Culture, and Obesity

Additional risk factors for obesity include social class and culture (Gallo et al., 2012). In the United States, women of low socioeconomic status are heavier than high-SES women, and African American women, in particular, are more likely to be obese (Ogden, Lamb, Carroll, & Flegal, 2010). For reasons that remain unclear, the prevalence of obesity among men is not related to SES. Obesity, thus, may be part of the accumulating disadvantage that women of low SES experience over the lifespan (Zajacova & Burgard, 2010). Values are implicated in obesity. Thinness is valued in women from high-SES levels and from developed countries, which in turn leads to a cultural emphasis on weight control and physical activity

Obesity can cause Psychological distress

Although there is a robust stereotype of overweight people as "jolly," studies suggest that the obese are prone to neuroticism and psychiatric conditions, especially depression

Obesity and Dieting as Risk Factors for Obesity

Obesity is a risk factor for becoming even more so. Many obese people have a high basal insulin level, which promotes overeating due to increased hunger. Moreover, the obese have large fat cells, which have a greater capacity for producing and storing fat than do small fat cells. Dieting contributes to the propensity for obesity. Successive cycles of dieting and weight gain, so-called yo-yo dieting, enhance the efficiency of food use and lower the metabolic rate (Bouchard, 2002). When Page 87dieters begin to eat normally again, their metabolic rate may stay low, and it can become easier for them to put on weight again even though they eat less food.

Risks Of Obesity

Obesity is a risk factor for many disorders. It contributes to death rates for all cancers and for the specific cancers of the colon, rectum, liver, gallbladder, pancreas, kidney, and esophagus, as well as non-Hodgkin's lymphoma and multiple myeloma. Estimates are that excess weight may account for 14 percent of all deaths from cancer in men and 20 percent of all deaths from cancer in women (Calle, Rodriguez, Walker-Thurmond, & Thun, 2003). Obesity also contributes substantially to deaths from cardiovascular disease (Flegal, Graubard, Williamson, & Gail, 2007), and it is tied to atherosclerosis, hypertension, Type II diabetes, and heart failure (Kerns, Rosenberg, & Otis, 2002). Obesity increases risks in surgery, anesthesia administration, and childbearing (Brownell & Wadden, 1992).

Relapse Prevention

Relapse prevention techniques are incorporated into treatment programs, including matching treatments to the eating problems of particular clients, restructuring the environment to remove temptation, rehearsing high-risk situations for relapse (such as parties and holidays), and developing coping strategies to deal with high-risk situations.

Obesity in Childhood

There are genetic contributors to obesity, which combine with risks conferred by low SES, increasing overall risk to be obese (Dinescu, Horn, Duncan, & Turkheimer, 2016). The impact of genetics on weight may be exerted in part by a vigorous feeding style that is evident early in life. There are also genetically based tendencies to store energy as fat rather than lean tissue. Another important factor is sedentary lifestyles, involving television, video games, and the Internet. Consumption of snacks and sugary drinks during the sedentary activities greatly increase the risks associated with obesity (Ervin & Ogden, 2013). Sugary drinks alone have been tied to 25,000 deaths per year in the U.S. and 180,000 worldwide in Page 85adulthood, due to a practice that typically begins in childhood (Healy, July 15, 2015).

Obesity is associated with?

early mortality; eople who are overweight at age 40 die, on average, 3 years earlier than people who are thin (Peeters et al., 2003). Abdominally localized fat, as opposed to excessive fat in the hips, buttocks, or thighs, is an especially potent risk factor for cardiovascular disease, diabetes, hypertension, cancer, and decline in cognitive function (Dore, Elias, Robbins, Budge, & Elias, 2008). People with excessive abdominal weight (sometimes called "apples," in contrast to "pears," who carry their weight on their hips) are more psychologically and physiologically reactive to stress (Epel et al., 2000). Fat tissue produces proinflammatory cytokines, which may exacerbate diseases related to inflammatory processes (see Chapter 2). Box 5.1 explores the biological regulation more fully.

The World Health Organization

has argued for several changes, including food labels that contain more nutrition and serving size information, a special tax on foods that are high in sugar and fat (the so-called junk food tax), and restriction of advertising to children or required health warnings (Arnst, 2004). Some states now control the availability of junk food and sugary drinks in schools, products that have been linked directly to weight in children (Taber, Chriqui, Perna, Page 91Powell, & Chaloupka, 2012). Some of these real or proposed changes in food and drink availability have led to bitter battles between food and beverage companies and state, local, and even the Federal government.