Obesity and Coronary
Heart Disease:
Psychology
Throughout the
Course of Illness
Ruang Lingkup
• Obesity
• How Common Is Obesity?
• Obesity Treatment
• Should Obesity be Treated at All?
• Coronary Heart Disease
• Rehabilitation of Patients with CHD
• Predicting Patient Health Outcomes
OBESITY
–
The Role of Psychological Factors
• Peranan obesitas dalam onset terjadinya obesitas dan peran dalam membentuk keyakinan dan perilaku, bagaimana seseorang mengatasi dan menyesuaikan keadaannya, bagaimana tatalaksanan dan
konsekuensi seseorang dalam segi fisik dan psikologis.
• Peranan psikologi dalam obesitas akan meliputi :
• Konsekuensi
• Penyebab
What is Obesity?
• Population means
Stunkard (1984) suggested that obesity should be categorized as either mild (20–40 per cent overweight), moderate (41–100 per cent overweight) or severe (100 per cent overweight).
• BMI
• Waist circumference
• For e , lo aist ir u fere e is < 4 ; high is 4− a d very high is > 102cm.
• For o e , lo aist ir u fere e is < ; high is − a d very high is > 88cm.
• Percentage body fat
What Are The Problems With Obesity?
• Physical Problems : Cardiovascular disease, diabetes, joint trauma, back pain, cancer, hypertension and mortality
• Psychological Problems : contemporary cultural obsession with
What Causes Obesity?
• Physiological Theories :
• Genetic Theories
• Twin studies : genetic factors accounted for 66-70 % in variance in body weight
• Adoptee studies : iologi al other s eight
• Metabolic Rate Theory
Resting metabolic rate : kecepatan penggunaan energi ketika tubuh manusia sedang tidak melakukan aktivitas. Teori ini mengatakan pada orang obesitas mempunyai metabolic rate yang rendah, dan hanya membakar energi dalam jumlah sedikit ketika sedang beristirahat sehingga hanya perlu sedikit asupn makanan untuk aktivitas sehari-hari.
• The Obesogenic Environment : understanding the environmental factors
which promote obesity does not seem to be a sufficient explanatory model. • Behavioural Theories
• Physical Activity : decreases in daily energy expenditure due to
Do the obese exercise less?
• It is possible that the obese take less exercise due to factors such as embarrassment and stigma and that exercise plays a part in the
maintenance of obesity but not in its cause.
Eating Behaviour
• These perspectives emphasize mechanisms such as exposure, modelling and associative learning, beliefs and emotions, body dissatisfaction and dieting, all of which can help explain obesity. For example, it is possible that the obese have childhoods in which food is used to reward good behaviour, or have parents who overeat, or hold cognitions about food which drive eating behaviour. It is also possible that dieting when
moderately overweight (or just feeling fat) triggers episodes of overeating which themselves cause increases in body fat
• Original studies of obesity were based on the assumption that the obese ate for different reasons than people of normal weight (Ferster et al. 1962). S ha hter s externality theory suggested that, although all people were
emotionality theory
of eating behaviour
• Bruch (e.g. 1974) developed a psychosomatic theory of eating behaviour and eating disorders which argued that some people
interpret the sensations of such emotions as emptiness as similar to hunger and that food is used as a substitute for other forms of
emotional comfort.
• Van Strien et al. (2009) explored the relationship between dietary
restraint, emotional and external eating, overeating and BMI to assess how people resist (or not) the opportunity to become overweight
Conclusion for the causes of obesity :
• There is good evidence for a genetic basis to obesity. The evidence for how this is expressed is weak.
• The prevalence of obesity has increased at a similar rate to decreases in physical activity.
• There is some evidence that the obese exercise less than the non-obese.
• The prevalence of obesity has increased at a rate unrelated to the overall decrease in calorie consumption (but measured in the home).
• There is inconsistent evidence as to whether the obese eat more calories than the non-obese.
• The obese may eat differently and for different reasons than the non-obese.
• The relative increase in fat is parallel to the increase in obesity.
OBESITY TREATMENT
• Traditional Treatment Approaches
The programme aimed to encourage eating in response to physiological hunger and not in response to mood cues such as boredom or depression, or in
response to external cues such as the sight and smell of food or the sight of other people eating.
• Multidimensional Behavioural Programmes
The Role of Dieting
• Psychological Problems and Obesity Treatment
• Suggests that the obese respond to dieting in the same way as the non-obese, with lowered mood and episodes of overeating, both of which are detrimental to
attempts at weight loss.
• Physiological Problems and Obesity Treatment
• In addition to the psychological consequences of imposing a dieting structure on the obese, there are physiological changes which accompany attempts at food
restriction. Heatherton et al. (1991) reported that restraint in the non-obese predicts weight fluctuation, which parallels the process of weight cycling or yo-yo dieting in the obese. Research has also found that weight fluctuation may have negative effects on health, with reports suggesting an association between weight fluctuation and mortality and morbidity from CHD (Hamm et al. 1989) and all-cause mortality
• Dieting, Obesity and Health
• Restraint theory (see Chapter 5) suggests that dieting has negative
consequences, and yet the treatmentof obesity recommends dieting as a solution. This paradox can be summarized as follows:
• Obesity is a physical health risk, but restrained eating may promote weight cycling, which is also detrimental to health.
• Obesity treatment aims to reduce food intake, but restrained eating can promote overeating.
• The obese may suffer psychologically from the social pressures to be thin (although evidence of psychological problems in the non-dieting obese is scarce), but failed attempts to diet may leave them depressed, feeling a failure and out of control. For those few who do succeed in their attempts at weight loss, Wooley and Wooley (1984:
) suggest that they are i fact condemned to a life of weight obsession,
semi-starvation and all the symptoms produced by chronic hunger . . . and seem precariously
Should Obesity Be Treated At All?
• The Benefits
The Treatment Alternatives
• Drug Treatments
Introduction
Risk Factors for CHD
• Smoking
• Diet
• High blood Pressure
• Type A behaviour and hostility
Beliefs About CHD
• The results also showed some changes over time, with patients being less likely to blame their behaviour and/or personality as time went on.
• Therefore both sufferers and non-sufferers of CHD seem to hold
The Psychological Impact of CHD
• Anxiety and Depression
• PTSD
Rehabilitation of Patients With CHD
• Predicting uptake of rehabiliation
• Modifying Risk Factors
• Exercise
• Type A Behaviour
• General Lifestyle Factors
• Illness Cognitions
Predicting Patient Health Outcomes
• Quality of Life and Level Functioning
• Perception of control
Conclusion
Illnesses such as obesity and CHD illustrate the role of psychology
throughout the course of an illness. For example, psychological factors play a role in illness onset (e.g. health beliefs, health behaviours,
personality, coping mechanisms), illness progression (e.g. psychological consequences, adaptation, health behaviours) and longevity (e.g.
health behaviours, coping mechanisms, quality of life). These
Assumptions in Health Psychology
1. The role of behaviour in illness. Throughout the twentieth century
there was an increasing emphasis on behavioural factors in health and illness. Research examined the problem of obesity from the same perspective and evaluated the role of overeating as a causal factor. However, perhaps not all problems are products of
behaviour.
2. Treatment as beneficial. Drug and surgical interventions are
stopped if they are found to be either ineffective or to have
negative consequences. However, behavioural interventions to
behavioural programmes are considered neutral enough to be better than nothing. However, obesity treatment using dieting is an Example of the potential negative side-effects of encouraging individual responsibility for
health and attempting to change behaviour. Perhaps behavioural interventions can have as many negative consequences as other medical treatments.
• The mind–body problem. Research into obesity and CHD raises the
problem of the relationship between the mind and the body. Theories are considered either physiological or psychological and treatment
