Exam #3 Material

Front 1

Smarter Lunchroom Movement

Back 1

•Goal: Identifying low-cost solutions that do not impact revenue, but have a great impact on children's nutrition.

Front 2

What is BMI?

Back 2

a way to report a person’s weight while taking into account his/her height

Front 3

Why has Obesity Increased?

*We live in an “obesogenic” environment

Back 3

*Fast Food
• Increases in portion sizes
•Availability of snacks
•Soft drink consumption
•Marketing of fast food, snacks, and soft drinks

Front 4

Fast Food:

•We eat meals away from home about 200 times /yr & 75% of these meals are from fast food
restaurants

•Why are Fast Food places so popular?

Back 4

• Women entered workforce
• Technological advances
• Fast food is CHEAP
• Fantastic advertising

Front 5

Why has Obesity Increased?
Availability of Snacks

Back 5

•More snack foods available today
•Average # of calories/day from snacking has increased from 204 in 1977 to 409 in 1996

Front 6

Soft Drink Consumption
• In 1977, soft drinks were 3.9% of our daily caloric intake, but by 2001 they were 9.2%
•Why did we start drinking more soda?

Back 6

• More types available
• Portion sizes increased
• People have a hard time compensating for liquid calories

Front 7

Why has Obesity Increased?
Marketing of fast food, snacks, & soft drinks

Back 7

• LOTS of TV commercials
• Food companies have huge advertising budgets
• Even marketing in school textbooks!

Front 8

Definitions of Success
•Example: 200 pound woman, 5’5”, BMI = 33…
How much weight would she have to lose for us to consider her diet a success?

Back 8

From the 1940's to 1995, it went from having to lose 66 lbs to 5% of body weight

Front 9

Long-term diet studies (>6 months)

• Studies with control groups (n=8)

Back 9

• Avg. weight change of dieters: Lost 2.3 lbs
• Avg. weight change of controls: Gained 1.3 lbs

Front 10

Long-term diet studies (>6 months)

Studies without control groups (n=13)

Back 10

• Initial weight loss: 39 pounds
• Ultimate gain-back: 32 pounds
• % regain more than they lost: 31% to 64%

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Long-term diet studies (>6 months)

•Systematic Biases

Back 11

1. Follow-up rates
2. Self-report of weight
3. Confounding of diet and exercise
4. Participant in additional diets

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•Follow-up Rates

Back 12

*On average, only 33% of subjects from the 13 diet-only studies returned for their follow-ups
•Ps who don’t follow-up are the ones who normally gain back the most weight

Front 13

•Self-report of weight

Back 13

**People tend to say they weigh less than they actually weigh

• In the 13 diet-only studies:
• 3 of the studies: all follow-up weight was self-report
•Remaining 10 studies, self-reported weight varied from none to 63% of subjects reporting their weight

Front 14

•Confounding diet and exercise

Back 14

•People often exercise while on a diet
•9 studies didn’t report on the exercise habits of Ps

Front 15

•Participation in additional diets

Back 15

*In the 13 diet-only studies, anywhere from 20 to 65% of Ps reported having been on at least one additional diet since the one being studied ended.
Independent Evidence: Survey of Dieters
•60% weighed more than starting weight at some point since diet
•40% weigh more than starting weight now

Front 16

Long-term diet studies (>6 months)
**Conclusion**

Back 16

dieting is not leading to long-term weight loss

Front 17

Women’s Definitions of Diet Success Study:

Had women find certain definitions of what

certain weights meant to them, and where they would be disappointed than to the ideal weight.

Back 17

Results: None achieved ideal weight

-9 got their goal weight

-25 got an acceptable weight

-20 got disappointed weight

-About 50 failed to reach a notable weight

Front 18

Mechanisms of diet failure

Back 18

Diet--> Biological/Biopsychosocial/Psychological Pathways --> Weight re-gain

Front 19

Why do diets fail? (Tomiyama et al., 2010)
•What if dieting is a chronic stressor?

•2 main tasks in dieting:
• Restricting your caloric intake
• Monitoring your food intake

Back 19

Why do diets fail? (Tomiyama et al., 2010)

•Results: total cortisol increased for Ps restricting their caloric intake; monitoring didn’t cause any changes

Front 20

Is dieting safe?
Controlling for BMI, chronic dieting is associated with

Back 20

• Cardiovascular disease
•Heart attacks
• Stroke
•Diabetes
• Increased blood pressure
• Increased cholesterol
• Suppressed immune function
• All-cause mortality

Front 21

•Dietary Restraint & Telomeres

(Kiefer et al., 2008)
• Telomeres = aglets for your chromosomes
• Marker & mediator of biological aging

Back 21

•Higher dietary restraint, shorter telomeres

Front 22

• Is Dieting Worth The Trouble? (Tomiyama, Ahlstrom, & Mann, 2012)
•Dieters in the Look AHEAD trial were able to maintain a 5% weight loss for 4 years

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• Weight loss led to improved quality of life, decreases in sleep apnea, reduced need for diabetes medication, & delayed physical disability
• BUT, weight loss did NOT lead to fewer strokes, heart attacks, or cardiovascular deaths

Front 23

Is dieting safe?

Back 23

Maybe not.

Front 24

Many confounds between the obesity & health
correlation:

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• Sedentary Lifestyle
• Weight Cycling
• Poverty/Low SES
•Underuse of the medical system

Front 25

Relative Risks of Mortality by BMI Category and Age

Back 25

Results: These correlations are weak or inconsistent

Front 26

Is obesity unhealthy?

Back 26

Not necessarily

Front 27

Study: New Goal: Exercise to improve health
(King et al., 2009)
• Method: 58 obese subjects exercised 5x/week for 12 weeks @ an intensity of 70% of their max heart rate (burned 500 calories/session); all exercise supervised in the lab!

Back 27

Results: If they lost or DID NOT lose what they expected all health conditions were still improved

Front 28

Can private health insurance plans through an employer deny individuals coverage?

Back 28

No

Front 29

Can private, individual health insurance plans deny individuals coverage?

Back 29

Yes, and may purposely avoid people who are already sick.

Front 30

Can people keep their insurance through their company even after they are fired?

Back 30

Yes, for a certain amount of time, but have to pay a hefty premium

Front 31

What is medical underwriting?

Back 31

Avoid people who are already sick and select the healthy

Front 32

What conditions might cause people to be denied health insurance coverage?

Back 32

Being sick too much in the past, heart disease, diabetes, hay fever, acne, overweight, ear infections, and asthma

Front 33

What is a consumer directed health care plan?

Back 33

Cheap enough for anyone on a tight budget

Very high deductible

Pay a high percentage of hospital bills

Co-insurance, co-payments, limits what can be spent, and may not cover drugs

Front 34

What is rescission?

Back 34

the revocation or cancellation of the insurance plan

-taking back the insurance when a problem arises

Front 35

What does guaranteed-issue mean?

Back 35

Situation where a policy is offered to any eligible applicant without regard to health status.

Front 36

Very Complicated Relationship between doctor and patient

Back 36

• Interaction between individuals in non-equal positions
•Often voluntary
•Concerns very important issues
•Emotionally laden
•Requires close cooperation

Front 37

Purpose of Doctor-Patient Communication

Back 37

1. Create a good inter-personal relationship.
2. Exchange information
3. Make medical decision

Front 38

1. Create a good inter-personal relationship.

What are the features of a good inter-personal relationship?

Back 38

•Social relationships: manners, non-judgmental, convey interest, show a desire to help
•Therapeutic qualities: empathy, respect, genuineness, trust
•Each person leads in area of expertise

Front 39

2. Exchange Information

•How much information do patients want?

Back 39

• Doctors underestimate how much information patients want

• 92% of cancer patients wanted all possible information, good or bad
• 45% of patients were given all the information they wanted

Front 40

2. Exchange Information
•Do doctors tell their patients their prognoses?

• Study of cancer patients entering a hospice?

Back 40

• Do not give prognosis: 23% of the time
• Give realistic prognosis: 37% of the time
• Give a more optimistic prognosis: 40% of the time

Front 41

•Do doctors tell their patients their prognoses?Accuracy of prognoses:

Back 41

• Actual survival: 26 days
• Doctor estimated survival: 75 days
• Doctor communicated survival: 90 days

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3. Make medical decisions

Medical information v. Treatment decisions

Back 42

• Almost 100% of patients wanted all possible information
• Only 2/3 of patients wanted to participate in treatment decisions
•Patients want to fully understand why the doctor recommended one treatment over another.

Front 43

Aspects of Communication behaviors

Back 43

1. Content of the communications: instrumental v. affective
2. Verbal v. non-verbal behaviors
3. Privacy issues
4 High v. low controlling doctor behaviors
5. Medical language (jargon) v. everyday language

Front 44

Disconnect in Communication

• 77% of doctors said their patients knew their diagnosis
•But, only 57% of the patients said they were aware.

Back 44

•81% of the doctors said they had discussed possible adverse drug effects with patients,
•But, only 10% of the patients said they were told.
•Doctors asked patients whether they understand what was discussed about 1.5% of the time!

Front 45

Doctor-Patient Communication and
Patient Outcomes

Back 45

1. Patient satisfaction
2. Compliance/adherence with doctors’ recommendations
3. Health outcomes

Front 46

1) Patient Satisfaction
• 33% of patients are dissatisfied with their doctor/health care
•Highest Satisfaction:

Back 46

interactions balanced between
instrumental and affective communication

Front 47

1) Patient Satisfaction
• 33% of patients are dissatisfied with their doctor/health care
•Lowest Satisfaction:

Back 47

interactions with mainly instrumental
communication, very little affective communication

Front 48

•How not to get sued, Part 1: (Levinson et al., 1997)

Back 48

• Spend longer time with patients
•Use more statements of what to expect
•Use more humor
• Laugh more
• Solicit patients’ opinions more
• Check that patients understand you more

Front 49

How not to get sued, Part 2: (Ambady et al., 2002)
•Content-filtered 4 10-second clips of surgeons talking to patients
•Only information for participants is voice tone

Back 49

Results:
• If voice tone was dominant, doctor was likely to have been sued
• If voice tone was concerned, doctor was unlikely to have been sued

Front 50

% of patients adhering to their medication

Back 50

The more times daily they have to take their medication, the less likely they are to take the meds.

Front 51

2) Compliance/Adherence
•Medicine’s “dirty little secret”

•Even high stakes medications are not adhered to:
• 25% renal patients miss anti-rejection medications
• 42% glaucoma patients don’t adhere even after losing an eye

Back 51

Some evidence that adherence improves with better doctor-patient communication (for example, when patients’ attitudes are in sync
with doctors’ attitudes)

Front 52

2) Compliance/Adherence
•More information and more positive talk from the doctor leads to better compliance
•The more satisfied a doctor is with his/her job, the more satisfied the patient is with the doctor, and the better a patient
complies/adheres to the treatment

Back 52

•Doctors’ enthusiasm: the more the doctor seemed enthusiastic about getting a mammogram, the more likely the patients were to get one (Fox et al., 1994)

Front 53

3) Health Outcomes
•Patients had better health outcomes if their interaction with their doctor had:

Back 53

•more controlling behaviors by patient
• less controlling behaviors by doctor (interrupting, questioning)
•more affect by doctor and patient
•more information seeking by patient
•more information giving by doctor

Front 54

3) Health Outcomes
•Better communication associated with better outcomes for certain conditions:

Back 54

•Resolution of chronic headaches
•Changes in emotional states
•Lower blood sugar values in diabetics
• Improved blood pressure for hypertensives

Front 55

What is the ideal doctor-patient communication?

Back 55

•Depends on the situation && the person
• If trying to make a treatment decision: You care more about the doctor’s instrumental behaviors
• If learning bad news where nothing can be done: You care more about the doctor’s affective behaviors.

Front 56

What is the ideal doctor-patient communication?
Depends on the person…

MONITORS

Back 56

•Want to be aware of
everything happening in
body
•Cope best if given lots of
information

Front 57

What is the ideal doctor-patient communication?
Depends on the person…

BLUNTERS

Back 57

Try to distract and blunt
sensations rather than feel
them
•Cope best if given minimal
information

Front 58

What can YOU do?
•What to look for during a first appointment with a new physician:

Back 58

•Does the doctor sit down?
•Does the doctor shake your hand?

Front 59

How to be a smarter patient

Back 59

•Don’t be afraid of your doctor!

Front 60

How to be a smarter patient
• What to bring to your appointment:

Back 60

• Answers to the questions about how you are feeling, what hurts, where it hurts etc.
• A list with the following:
1. Past procedures and symptoms
2. Medications
3. Family History
• Bring a family member or friend

Front 61

Definition of Happiness

Back 61

•More than the absence of sadness
•A feeling of contentment, satisfaction, pleasure, joy, or overall wellbeing

Front 62

Happiness of Americans (Myers, 2000)
•Out of a representative sample of Americans: and has this changed over time

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• 3 in 10 are “very happy”
•6 in 10 are “pretty happy”
• 1 in 10 are “not too happy”

VERY STABLE THROUGH TIME.

Front 63

•Happiness & Age
• Survey of Veterans of WWII & Korean War
• Followed veterans for 22 years

Back 63

• Found that happiness peaked at age 65

Front 64

Happiness and Age:

•National Opinion Research Center
• 35 year study
• Cross sectional & longitudinal
• “Taken all together, how would you say things are these days?”

Back 64

Found that happiness increased with age

Front 65

•Happiness & Money

Back 65

• No relationship between happiness & wealth across countries… ASSUMING that the country is making enough money so that people’s basic physical needs are met
• BUT, confounds for correlations between happiness and national wealth

Front 66

Who is Happy?
•Happiness & Money
• Survey of 50 individuals from Forbes wealthiest 400 list

Back 66

• These individuals are only slightly happier than the average American.
• 80% agreed that money can just as easily decrease happiness as it can increase happiness.

Front 67

Happiness & Money
•How you spend money is correlated with happiness:
• Surveyed people on what they spent their money on and their level of happiness

Back 67

• Spending on oneself (gifts for self or paying bills) was not related to happiness
• Spending on others or giving to charity was related to happiness
• Similar findings from surveys of how people their annual bonus from their job

Front 68

Happiness & Friendship

Back 68

• 5+ close friends: 38% are “very happy”
• <5 close friends: 26% are “very happy”

Front 69

•Happiness & Marriage

Back 69

Married people are most happy, then never married, then divorced, then separted

Front 70

Who is Happy?
•Happiness & Religious Faith: How might religious faith make people happy?

Back 70

• Belonging to a religion may lead to more social support, more friendships
• People may derive a sense of meaning from religion
• Religion may make a person feel that he or she matters

Front 71

Happiness & Religious Faith: Does religion make people healthier?

Back 71

Yes and No
• Being prayed for does not make people healthier
•Having faith does make people healthier: perhaps by expanding social networks, increasing social support, lowering stress, and finding meaning/purpose

Front 72

How does happiness work?

Back 72

People have a set level of happiness that they fluctuate up and down from in response to events

Front 73

Adaptation theory

Back 73

our system is set up to adapt to things;
things that stay the same over long periods of time (income,
attractiveness, health) do not affect our happiness

Front 74

•But… some individual differences and differences in type of event can impact our “set point”

Back 74

• Minority of people high in neuroticism may be largely affected by life events, leading to a new “set point” (Headey, 2008)
• Specific events, such as unemployment, disability, and severe disability, appear to lead some people to a new “set point” for their happiness levels

Front 75

Global Happiness

Back 75

Results: skewed over the happy end with average around 6.5 out of 8.5 as the highest

Front 76

Happiness and Gender

Back 76

no differences, but there is a gender gap in misery: with women higher in anxiety and depression and men higher in alcohol and drug uses

Front 77

Happiness and Ethnicity

Back 77

doesn't vary by ethnicity

Front 78

Happiness and Physical Appearance

Back 78

no objective differences, but there is subjective differences

Front 79

Happiness and number of good life events

Back 79

doesn't matter how many good things happen to you

Front 80

Happiness and Money

Back 80

a little bit more money will make you a little happier most people would say

Front 81

Happiness and money in relation to life philosophy and being well off

Back 81

being well off financially is increasing, and developing a meaningful philosophy of life is decreasing!!!

Being better off DOESN'T MAKE PEOPLE HAPPIER

Front 82

How does happiness work?
•What influences your set happiness level?

Back 82

1. Genes 50%
2. Life Circumstances 10%
3. Intentional activities 40%

**Happiness Is genetically influenced, but it is not genetically fixed.

Front 83

How to be Happier
•Strategies to Make the Best of Things

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• P: Permission to be human and fallible
• R: Reconstruct what went wrong and come up with useful lessons for the future
• P: Perspective- in the grand scheme of things, this problem doesn’t matter too much

Front 84

Do acts of kindness make people happier?
• Randomly assigned subjects to:
• Perform 5 acts of kindness per week for 6 weeks (with the 5 acts done all in one day or spread out over the week)
• Control condition—no instructions
• Measured happiness pre and post

Back 84

Results:
• Performing acts of kindness increased happiness
•BUT, only if all 5 acts were on the same day

Front 85

Does what you spend your money on matter?
• Method
• Subjects given $5 or $20
• Subjects randomly assigned to spend $ on themselves or on a friend/charity
• Researchers rated happiness pre and post

Back 85

• Results: those who spent the $ on others were the happiest at the end of the day

Front 86

Does practicing grateful thinking increase happiness? (Sheldon & Lyubomirsky 2006)

Back 86

Regular gratitude increased when doing it once a day

Front 87

Tip on how to be happier

Back 87

Try not to adapt to the good; Try to adapt quickly to the bad

Front 88

Affective Adaptation (Wilson & Gilbert, 2008)
• You think a lot about an event you don’t understand, and thinking about an event a lot causes it to affect your emotions
• If you don’t want an event to affect your emotions:

Back 88

Explain it

Front 89

If you do want an event to affect your emotions:

Back 89

Don’t try to understand it or explain it, INSTEAD: write about how a happy event might never have occurred

Front 90

Does visualizing your best possible self increase happiness?

Back 90

YES

Front 91

FIND FLOW

Back 91

Anxiety of being overwhelmed and stressed
FLOW
Apathy of being underwhelmed & bored

Front 92

How to be Happier
•Exercise!

Back 92

Ex: 4 months of aerobic exercise has been found to be just as effective at treating depression as 4 months of Zoloft, or as a combination of exercise and Zoloft

Front 93

How to be Happier
•Support from true experiments:

Back 93

• Commit acts of kindness
• Spend money on gifts/charities

• Cultivate a sense of gratitude
• Make the good stuff seem surprising
• Visualize your best possible selves
• Find flow
• Exercise
•Use humor; If all else fails, try smiling anyway

Front 94

Can happiness make you healthier?
•Maybe: happiness was linked to longer lifespans in studies of healthy populations, but not in already ill populations

Back 94

How would this work?
• Reducing stress
• Leading to more positive health behaviors
• Increase size of social networks