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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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Implicit Attitudes of Health Care
Providers (Schwartz et al. 2003) Methods
IAT
Good-Bad Lazy-Motivated
Stupid-Smart
Worthless-Valuable
Explicit Bias Scale
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Implicit Attitudes of Health Care
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