Health Psychology Obesity Exercise Spring11 Class

8/6/2019 Health Psychology Obesity Exercise Spring11 Class

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Weight Management

Health Psychology

Spring 2011


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Measurement of Obesity Body Mass Index (BMI)

Weight in kilograms/height in meters squared

Non-Metric Conversion Formula: (Weight inlbs/height in inches2) X 704.5

Most commonly used scientific tool to

represent relative weight

Highly correlated with body fatness in most

populations


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Measurement of Obesity Waist Circumference

Independent predictor of risk factors and morbidity

Waist circumference is positively correlated withabdominal fat content

Loses incremental predictive power in those withBMI > 35

Men > 102 cm (> 40 inches)

Women > 88 cm (>35 inches)


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Defining Overweight and Obesity

OBESITYCLASS

BMI (kg/m2) DiseaseRiskMen < 40 in

Women < 35in

DiseaseRiskMen > 40 in

Women > 35in

Underweight < 18.5

Normal 18.5 24.9

Overweight 25.0 29.9 Increased High

Obesity I 30.0 34.9 High Very High

II 35.0 39.9 Very High Very High

ExtremeObesity

III > 40.0 ExtremelyHigh

ExtremelyHigh


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1998

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1998, 2007

(*BMI u30, or about 30 lbs. overweight for 54 person)

2007

1990

No Data


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Obesity Rates by Race/Ethnicity (2003)

0

10

20

30

40

White AA H/L

Percent

Female

Male


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Prevalence of Overweight and Obesity

by RaceWOMEN MEN

WHITE 49.2% 61.0%

AFRICAN-AMERICAN 65.8% 56.5%

MEXICAN-AMERICAN 65.9% 63.9%


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Why Treat Overweight and Obesity?

Second leading cause of preventable death in United

States

An estimated 97 million people in US are overweight(BMI of 25-29.9) or obese (BMI >30)

Increased risk of all-cause mortality and morbidity from

hypertension, dyslipidemia, Type II diabetes, coronary

heart disease, stroke, gallbladder disease, osteoarthritis,sleep apnea, respiratory problems, and endometrial,

breast, prostate, and colon cancers


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Mortality and Obesity Mortality varies with degree of overweight.

Rates rise above average as BMI exceeds 28

BMI > 35 is associated with approximately twofoldincrease in total mortality.

For persons with BMI > 30, mortality rates from allcauses, especially cardiovascular disease, areincreased by 50 -100 percent


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Obesity & Mental Health Early studies did not find a relationship between

obesity and psychological well being

Recent studies have found gender differences inpsychosocial adjustment to obesity

Obese women were 37% more likely than non-obese

women to meet criteria for depression

Obese men were less likely to meet criteria for

depression compared to non-obese men


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Causes of Obesity Societal Factors

Larger portion sizes

Fewer healthy choices

Sedentary lifestyle

Biological Factors

Genetics (metabolism, appetite, # & size of fatcells)


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Causes of Obesity Behavioral Factors

Caloric intake

Physical Activity Social Factors

SES

Food choices

Discrimination

Evidence in African American, Hispanic, & Asianpopulations


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Treatments for Obesity

CBT

Physical Activity

Very Low Calorie Diets (VLCDs)

Pharmacotherapy

Weight Loss Surgery

Combined Therapy


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Behavior Therapy: Diet & Exercise Self Monitoring

Caloric intake

Physical activity Triggers

Stress Management

Nutritional training Balanced deficit diet

Stimulus control

Food availability


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Behavior Therapy: Diet & Exercise Contingency management

Rewards for meeting goals

Increased physical activity

Exercise program (weight training vs. aerobic activity)

Life-style activity

Cognitive restructuring Modification of self-defeating thoughts and feelings

Realistic expectations

Body image acceptance


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Behavior Therapy:

Short-Term Effectiveness More than 150 trials of behavior therapy for

obesity

Attrition rates low

Virtually no negative side effects

Weight losses of 19 pounds or 9% reduction in

body weight typical Recent studies show that extending treatment

(20 weeks or more) and including exercise

improves outcome


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Behavior Therapy:

Long-Term Effectiveness

After behavioral treatment, most studies show a

gradual but reliable return to baseline weights (Med

Exerc Nutr Health 1995; 4: 255-272). Maintenance more likely to occur when participants

are provided post-treatment programs

When maintenance programs end, participants

gradually regain weight (J Consult Clin Psychol1988;56: 529-534).


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VLCD

s: Short-Term Effectiveness

800 calories per day or less

Large and rapid initial weight losses (2 to 3

times that produced by LCDs).

The large weight reductions produced by

VLCDs are rarely maintained

Exercise and maintenance programs improveslong-term effectiveness

Long-term effectiveness generally equivalent to

that of conventional treatment.


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Pharmacotherapy for Obesity Noradrenergic drugs (appetite suppressant)

Enhances the release of Norepinephrine and

Serotonin High degree of variability in therapeutic response

Potential for increased heart rate and blood pressure

Orlistat

Inhibits pancreatic lipase

Prevents absorption of fat

Used in combination with a reduced calorie diet


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Weight Loss Surgery Only as a last resort

Only for clinically severe obesity (BMI > 40 or >35 with comorbid risk factors) and only if other

treatments have failed and patient is at high riskfor obesity related morbidity or mortality

Gastric banding

Band placed where esophagus and stomach meet

which restricts food intake Gastric bypass

Stomach size decreased and part of smallintestines removed


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Recommendations

Combined therapy of low calorie diet,

behavior therapy and increased physical

activity provides the most successful therapyfor weight loss and maintenance

6 months of intervention should be tried

before considering pharmacotherapy orweight loss surgery


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Working With Obese Clients Media portrayals of obese persons

Stereotypes/Attitudes?


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Working With Obese Clients Employment Discrimination* (Gender-based)

Hiring

Compensation

Promotion

Career advice

Source: Ding & Stillman (2005)


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Working With Obese Clients Survey of obese patients (Wadden et al 2000)

Nearly 2 out of 3 obese patients believe provider

doesnt understand difficulties

A study comparing case reports in which patient

only differs in weight (Hebl & Xu, 2001) Providers indicated they had more negative feelings

and would spend less time with obese patient.


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Working With Obese Clients Bagely et al. (1989)

24% of nurses said they were repulsed by obese

persons

Maroney & Golub (1992)

31-42% of nurses said they would prefer not tocare for obese persons at all


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Implicit Attitudes of Health Care

Providers (Schwartz et al. 2003) Objective

Examined obesity-related implicit attitudes of

health care providers

Participants

N = 389 (198 women; 191 men) 89% had professional degrees


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Providers (Schwartz et al. 2003) Methods

IAT

Good-Bad Lazy-Motivated

Stupid-Smart

Worthless-Valuable

Explicit Bias Scale


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Providers (Schwartz et al. 2003) Results

Implicit Bias observed

Explicit Bias observed

Strongest predictor of bias???

Positive professional and personal experiences

associated with less bias


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Working With Obese Clients Davis-Coelho, Waltz, & Davis-Coelho (2000)

Examined therapist attitudes and treatment

recommendations towards overweight clients Methods

Randomly selected 500 APA members

40% response rate Sent case description and photo of a female client

Randomized overweight vs. normal weight


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Working With Obese Clients Results

Psychologists under 40 predicted lower client effort for

overweight client

Female psychologists predicted poorer prognosis

Younger psychologists predicted poorer prognosis

Increasing sexual satisfaction was tx goal for overweight

client but not normal weight client

Normal weight more likely to receive adjustment disorder

diagnosis despite no mention of identifiable stressor


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Physical Inactivity


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Recommended Physical Activity 30 Minutes of moderate physical activity 5 days

per week

60% not physically active on regular basis

25% are sedentary

Predictors of physical inactivity

Ethnicity

Gender Income

Education

Region


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Social Factors & Physical Activity Access to parks and sidewalks

Neighborhood safety

High crime * (women)

Seeing others active * (men)

Sallis et al., 2007


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Assessment of Physical Activity Self-report

Tend to overestimate physical activity

Pedometer Measure distances traveled (counting steps)

Accelerometer

Measures acceleration; greater acceleration

equals more energy

Heart Rate Monitor

Most times heart rate is linearly related toenergy expenditure


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Physical Activity & Chronic Disease CardiovascularDisease (CVD)

Exercise reduces the risk of cardiovascularmobidity and mortality

Primary and secondary prevention strategy

Decreased chest pain and reduced progression ofatherosclerosis

Hypertension

Recent review found that 75% of participantsexperienced significant decreases in BP

More research needed with minority populations


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Physical Activity & Chronic Disease Chronic Obstructive Pulmonary Disease (COPD)

Reduction in dyspnea (difficulty breathing)

Increases health related quality of life Possible improvement in cognitive performance

Cancer

Physical activity provides a preventative effect for

developing some types of cancer (colon, breast)

Physical activity can prevent the loss of lean muscle

mass, increase appetite, and improve quality of life for

individuals undergoing cancer treatment


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Physical Activity & Chronic Disease Diabetes Mellitus

Enhances insulin transport of glucose into cells

Increase insulin sensitivity in muscle

Psychological functioning (Martinsen, 2008)

Reviewed the literature on the relationshipbetween exercise and depression and anxiety


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Physical Activity & Psychological

Functioning Depression

Studies suggest regular exercise as beneficial as

psychotherapy and pharmacotherapy Adding to treatment does not seem to enhance

treatment although it may reduce relapse rates

Type of activity not predictive of success

30 minutes 3-5 days per week needed to

experience benefits

Documents

Health Psychology Obesity Exercise Spring11 Class