Obesity and Coronary Heart Disease: Psychology Throughout the

Obesity and Coronary
Heart Disease:
Psychology
Throughout the
Course of Illness
PSIKOLOGI KESEHATAN
2016
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
• Assumptions in Health Psychology
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
• Penatalaksanaan
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
normal weight (20–24.9); overweight (grade 1,25–29.9); clinical
obesity (grade 2, 30–39.9); and severe obesity (grade 3, 40)
• Waist circumference
• For men, low waist circumference is < 94cm; high is 94−102cm and very high
is > 102cm.
• For women, low waist circumference is < 80cm; high is 80−88cm and very
high is > 88cm.
• Percentage body fat
• As health is mostly associated with fat rather than weight per se, researchers
and clinicians have also developed methods of measuring percentage body
fat directly.
How Common is Obesity?
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
thinness, the aversion to fat  low self esteem and poor self image,
deppression, bipolar disorder, panic disorder or agoraphobia
What Causes Obesity?
• Physiological Theories :
• Genetic Theories
• Twin studies : genetic factors accounted for 66-70 % in variance in body weight
• Adoptee studies : biological mother’s weight
• 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.
• Appetite Regulation
• 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
improvements in transport systems, and a shift from an agricultural society to
an industrial and increasingly information-based one.
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.
• exercise may have psychological and general health effects, which
could benefit the obese either in terms of promoting weight loss or
simply by making them feel better about themselves
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).
Schachter’s externality theory suggested that, although all people were
responsive to environmental stimuli such as the sight, taste and smell of
food, and that such stimuli might cause overeating, the obese were highly
and sometimes uncontrollably responsive to external cues
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
offered by the obesogenic environment.
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.
• The obese may eat proportionally more fat than the non-obese.
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
Programmes aim to encourage the obese to eat less than they do usually rather
than encouraging them to eat less than the non-obese.
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
(Lissner et al. 1991).
• 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:
187) suggest that they ‘are in fact condemned to a life of weight obsession, semistarvation and all the symptoms produced by chronic hunger . . . and seem precariously
close to developing a frank eating disorder’.
Should Obesity Be Treated At All?
• The Benefits
• dieting may be rejected as a treatment but weight loss may still be seen as
beneficial.
The Treatment Alternatives
• Drug Treatments
• Surgical Treatments
CORONARY HEART DISEASE
Introduction
• CHD is another example of chronic illness which shows a strong role
for a range of psychological factors.
Risk Factors for CHD
• Smoking
• Diet
• High blood Pressure
• Type A behaviour and hostility
• Stress
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
beliefs about the cause of MI which might influence their subsequent
risky behaviour and reflect a process of adjustment oncethey have
become ill.
The Psychological Impact of CHD
• Anxiety and Depression
• PTSD
• Finding Meaning
Rehabilitation of Patients With CHD
• Predicting uptake of rehabiliation
• Modifying Risk Factors
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Exercise
Type A Behaviour
General Lifestyle Factors
Illness Cognitions
Stress
Predicting Patient Health Outcomes
• Quality of Life and Level Functioning
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Perception of control
Goal Disturbance
Depression
Social Support
Illnes Cognitions
• Mortality
• Health Behaviours
• Depression
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
psychological factors are also relevant to a multitude of other chronic
and acute illnesses, such as diabetes, asthma, chronic fatigue syndrome
and multiple sclerosis. This suggests that illness is best conceptualized
not as a biomedical problem but as a complex interplay of physiological
and psychological factors.
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
promote behaviour change, such as smoking cessation, exercise and
weight loss programmes, are developed and promoted even when
the evidence for their success is poor. Within health psychology,
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
perspectives are divided in a similar fashion, thereby maintaining a
dualistic model of individuals.
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