Health-Enhancing Behaviours
Body Shape and Weight Concerns
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Studies suggest that as many as 80%
of 10-year girls have been on a diet;
50% of girls between 14 and 18 years
believe they are too fat; and
45% of 14 to 18 year old girls are
dieting.
DSM-IV Criteria – Anorexia
Nervosa
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Refusal to maintain body weight at or above
normal weight for age (i.e., weight loss or
failure to gain weight resulting in weight <
85% of expected).
Intense fear of weight gain or becoming fat.
Disturbed body image, undue influence of
weight on issues of self-worth, denial of
seriousness of weight loss.
Absence of at least 3 consecutive menstrual
cycles.
DSM-IV Criteria for Bulimia
Nervosa (BN)

Recurrent episodes of binge eating
characterized by:
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Eating an abnormally large quantity of food in a
discrete period of time; and
A sense of lack of control over eating.
Recurrent inappropriate compensatory
behaviours (e.g., vomiting, laxatives,
diuretics, enemas, fasting, vigorous exercise).
The above two occur at least twice a week for
at least 3 months.
Self-evaluation unduly influenced by weight.
Etiology of AN
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10-15 times more frequent in women than
men
Evidence for genetics is inconistent
Family variables include the child being
over-controlled by parents.
Sociocultural risk factors
Eating Disorders
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Not a new disorder
Anorexia nervosa (AN) first described in 1694
Bulimia nervosa (BN) first identified in 1892
Usual age of onset is adolescence or early
20s.
90% or more are females.
Prevalence of AN is 0.5% to 1.0%.
Prevalence of BN is 1.0 to 3.0%.
Etiology of Bulimia Nervosa

Bio-psychosocial model proposes that
biogenetic predispositions, e.g.,
depression, combine with familial
factors and sociocultural pressures,
emphasizing high achievement and
thinness, that promote a character
structure featuring affective instability
and low self-esteem.
Etiology of BN continued
Negative Self-Evaluation
Characteristic extreme concerns
about shape and weight
Intense and rigid dieting
Binge eating
Purging
Perfectionism
and dichotomous
thinking.
Negative affect
Referral Rates for AN and BN to
Clarke Institute from 1975 - 1986
100
90
80
70
60
A N -re stric to r
50
40
30
20
10
0
BN
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
A N -b in g e
Healthy Exercise
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3 hours per week (across 3 – 5 sessions)
Warm-up
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Aerobics
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Stretching and flexibility exercise
Strength and endurance exercise
Rhythmic exercise of large muscle groups
Raise heart rate to moderately high level
Cool down
Why is exercise healthy?

Three psychosocial benefits are:
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Feel less stressed and anxious
Better work performance and attitudes
More positive self-concept
Physiological benefits
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Increased production of endorphins
Improved agility
Improved bone density
Improved strength and flexibility
Cardiovascular Benefits of
Exercise

Lowers 
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systolic and diastolic blood pressure
heart rate and thereby helps protect the
heart against heart rhythm disturbances
LDL-cholesterol and raises HDL-cholesterol
(the good cholesterol)
Potential Risks of Exercise
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Accidents
Injuries
Heart exhaustion and heat stroke
May become addictive
Precipitate a heart attack
If using steroids to enhance exercise,
number of adverse effects of steroids
Who is more likely to exercise?
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Men
Whites more than Hispanics and Blacks
Young more than old
Well educated or higher SES groups
Previous exercise history
Those who feel well
Non-smoker
Metropolitan Height & Weight
Tables
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Women
 Small frame – 5’4”
ideal weight is 114127 lbs.
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Medium frame – 5’4”
ideal weight is 124138 lbs.
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Men
Small frame – 6’
ideal weight is 149160 lbs
Medium frame – 6’
ideal weight is 157170 lbs
Who becomes overweight?
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About 40% become overweight
In women, Blacks and Hispanics more
likely to be overweight than Whites.
Genetics and familial influences
Prevalence increases with age
Why do people gain weight?
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Biological factors –
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Lower metabolic rate
Malfunctioning endocrine glands
Heredity
Set-point theory
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Your body tries to maintain set weight
Thermostat-like mechanism
Hypothalamus involved
May relate to no. and size of fat cells
Psychosocial Factors
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Eat more when stressed
Alcohol – adds calories to diet and
reduces disposal of fat
Watching television may reduce
metabolic weight rates below normal
resting rates
Health Hazard Weight Level
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Small risk – 10% over ideal weight
Moderate risk – 20% over ideal weight
Greatly increased risk – 50% over ideal
Distribution of weight – more hazardous
if concentrated around the abdomen
Healthy Eating
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Eating nutritionally balanced meals
Poor nutritional balance has been
implicated as factor in many diseases:
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Colon, stomach, pancreatic, prostate, and
breast cancer.
Hypertension (salt and high body weight)
Hypercholesterolemia (saturated fats)
Diabetes (body weight, sugar, fats)
Sleep Disorders
Sleep Disorders
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Ideal is 7-8 hours a night
Insufficient sleep can cause:
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Impaired cognitive functioning
Mood disturbance
Poor work performance
Impaired immune functioning
Poor sleep predicts higher mortality rates
Health-Compromising
Behaviours
Smoking
Substance Abuse
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Addiction – physical and psychological
dependence on a substance following use over a
period of time
Physical dependence – body is use to the
substance and incorporates the use of the
substance in its normal function.
Tolerance – increasing adaptation to the
substance so that higher and higher doses need
to achieve same result.
Withdrawal – unpleasant physical and
psychological symptoms upon withdrawal.
Nicotine
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22-25% of US smoke, similar rates are
seen in Canada with regional variation.
More than 80% of smokers started as
youth.
If people do not begin to smoke as
youth unlikely they will start as adults.
Nicotine reaches the brain within 7-15
seconds.
Why Do People Smoke
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Age
Culture
Peer encouragement
More likely if parents smoke
Personality characteristics (rebellious, risk
taker)
Smokers image (e.g., cool, mature,
glamorous, exciting)
Reasons Given for Smoking
(Silvan Thomkins)
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Positive affect – stimulation, relaxation,
pleasure
Negative affect – relieves boredom,
stress, depression
Habitual – behaviour becomes a habit
Psychological dependence – use it to
regulate emotions
Nicotine – Maintaining Factors
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Physical addiction
Physical habit
Emotional support
Personal identity
Social habit
Cigarette smoke contains
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Carbon monoxide – gas that is readily
and rapidly absorbed into bloodstream
affecting physical functioning
Tars – minute particles of residue –
adverse health effects but not related to
addictive effect
Nicotine – addictive chemical in tobacco
Nicotine
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Penetrates cell membranes in nose, mouth,
lungs, and blood
Blood rapidly carries nicotine to the brain
(within 7 sec)
Brain releases various chemicals that activate
both the central and sympathetic nervous
system
Increase arousal, alertness, attention, heart
rate, and blood pressure
Nicotine levels decrease rapidly
Nicotine-Regulation Model
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Smoke to maintain a certain level of
nicotine
Smoke to avoid symptoms of
withdrawal
Addiction not all due to biochemical
effects since cravings can continue long
after physical addictive effects are gone
(up to 5 years)
Bio-Behavioural Model
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Continue smoking to regulate cognitiveemotional state
Control weight
Nicotine affects chemicals in the brain
(acetycholine, norepinephrine) that
increase alertness and decrease tension
(and withdrawal symptoms)
Relapse
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50 – 80% of those who quit relapse
within a year
Stress is primary reason for relapse
(smoking seen to help stress)
Social support helps protect against
relapse
Self-efficacy is most important factor in
quitting
Abstinence-violation Effect
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Tendency to start smoking again after a
lapse because of reduced self-efficacy
for quitting and reminder about positive
effects of smoking.
Weight-gain often leads to relapse so as
to control weight.
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Caloric intake increases.
Metabolism decreases.
Transtheoretical Model
(Prochaska & DiClemente, 1992)
Preparation
Contemplation
Action
Precontemplation
Maintenance
Relapse
Processes of Change
Prochaska et al. 1992
Precontemplation Contemplation
Preparation
Action
Consciousness
raising
Maintenance
Reinforcement
management
Dramatic
relief
Selfre-evaluation
Selfliberation
Helping
relationships
Environmental
re-evaluation
Pros & cons
Trial & error
Counterconditioning
Stimulus control
Stage-Based Intervention for
Smoking Cessation:
Prochaska, et al., 1993
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Objective:
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To compare four self-help programs for
smoking cessation in general population of
smokers.
Stage-Based Intervention for
Smoking Cessation:
Prochaska, et al., 1993
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Subject recruitment:
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Subjects were 755 volunteers in Rhode
Island who responded to a newspaper
advertisement seeking participants to test
self-help materials developed for smokers
in various stages of change.
Stage-Based Intervention for
Smoking Cessation:
Prochaska, et al., 1993
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Interventions:
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Standard manuals from American Lung
Association (ALA)
TTM-based Manuals (TTM)
Interactive computer assessment and
tailored interventions to stage of change
(ITTM)
Interactive computer assessment, tailored
interventions, and counsellor calls (CITTM)
Prochaska et al., 1993
Cessation Rates
30%
25%
20%
ALA
TTM
15%
ITTM
10%
CITTM
5%
0%
P re
P < 0.05
6 m o.
12 m o.
18 m o.
Assessment Points (Months)
Alcohol – Who Drinks?
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Drinking usually begins in high school
Males drink more but gender gap lessening
White more than Hispanics who are more
than blacks
Higher rates amongst Natives, lower in
Asians
60% drink occasionally
Problem Drinking
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Drinks heavily on a regular basis
Psychologically dependent
Social and/or occupational impairment
13% of drinkers have a problem
Of these, ¾ are male
Alcoholics
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About ½ of problem drinkers
Physically dependent on alcohol
High tolerance for alcohol
May suffer black outs and memory losses
Experience delirium tremors from
withdrawal (anxiety, agitation,
hallucination, tremors)
Alcohol Dependence/Abuse
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Lifetime prevalence is about 10% in women
and 20% in men.
75% of car accidents at night are due to
drinking.
Alcohol-related disorders are associated with
50% of homicides and 25% of suicides.
Genetic link – family history associated with
3-4 times greater risk as well as being
associated with more serious alcohol-related
problems.
Alcohol Dependence/Abuse –
Clinical Course
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Most exhibit their first alcohol-related
problem in late 20s and 30’s.
Most first present for treatment in their
40s.
Die about 15 years earlier than nonalcoholic.
Course of alcohol abuse is fluctuating.
Spontaneous remission in 10-30%.
Health Risks from Heavy
Alcohol Use
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Accidents (alcohol use accounts for the
majority of traffic accidents in youth & 50%
of traffic accidents of all ages)
Cirrhosis of the liver
Some forms of cancer
Fetal alcohol syndrome in new-born
Retardation and physiological abnormalities in
offspring of mothers who drink
Cognitive impairment
Brain damage