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104 Cards in this Set
- Front
- Back
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What is the #1 concern with overweight children?
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Type II Diabetes
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What portion of children are overweight or obese?
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1/3
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Babies greater than what weight puts the mom and child at risk?
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Greater than 9 lbs.
Puts them at risk for CVD and NIDDM risk |
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What are the percentile ranges for child weights?
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Underweight: <5th percentile
Healthy Weight: 5th - 85th percentile At Risk of Overweight: 85th - 95th percentile Overweight: >95th percentile |
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When height and weight was clinically measured, what percent of kids were seen as overweight?
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40%
*its important to get height and weight correct |
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Problems with BMI for children
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Doesn't account for lean body mass
Doesn't account for visceral fat Children's height and weight change often Need to account better for lifestyle |
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High BMIs in childhood correlate with what later complications?
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- Type II Diabetes
- Glucose Intolerance - High BP - Asthma |
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What is adiposity rebound?
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Increased accumulation of body fat that typically occurs at age 6, after fat storage slows during the preschool years
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An adiposity rebound that starts before age 6 means?
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Means there is an increased risk that accumulation of excess number of fat cells will promote obesity in adulthood
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What are two factors in adolescence that can influence the prevalence of obesity in young adulthood?
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PARENTS and LIFESTYLE
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What are two factors associated with persistance of obesity?
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AGE OF ONSET and SEVERITY
earlier onset = more severe severity at any age is likely to persist |
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What portion of obesity begins in childhood?
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About 1/3
Which means about 2/3 is adult onset |
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A child with an obese parent is...
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More likely to develop obesity in young adulthood
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Obese children are at risk for?
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- High LDL-C
- High triglycerides - Low HDL-C - High systolic blood pressure - Type II Diabetes Also at risk for social problems, psychological problems, and mental health problems |
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What are the psychological consequences of childhood obesity?
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- Disturbance of body image
- Low self-esteem - Depression - Anxiety disorder * more prevalent in girls than boys |
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What things influence how children view other obese children?
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- Social Influences
- Media - Parents * in study kids were shown 3 normal people and 1 obese, and all of them chose the 3 normal people to be friends with |
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Obesity related co-morbidities
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- Insulin resistance
- Carbohydrate intolerance - Hypertension - Hypercholesterolemia - Diabetes - Orthopedic problems - Sleep apnea |
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What two co-morbidities are we most worried about and why?
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Insulin resistance & carbohydrate intolerance
* BOTH and precursors to Type II Diabetes |
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How many CVD risk factors put a child at risk?
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3 or more
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What are the CVD risk factors?
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- BMI (B>20 and G>21)
- Blood Pressure (>126/82) - Glucose (90-110 mg) - Cholesterol ( >174 or HDL <38) - Family History (parents of grandparents) - Physical Inactivity (<6 days/wk/60 mins) |
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Principles of intervention
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- Should start early (3 years old)
- Should include family - Emphasize permanent change - Education about medical complications |
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What can parents do to intervene?
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- Be positive role models
- Be consistent - Help child set realistic goals - Use rewards - Help child identify high risk situations - Help with self monitoring - Make it fun |
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Behavioral Choice Theory
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Need to reduce access to a sedentary lfiestyle and increase access to an active lifestyle
* make acess to physical activities easier, and therefore more often Ex. structured activity, parental involvement, make sedentary lifestyle cues less often or nonexistent |
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Environmental factors effecting obesity in children
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Increased TV or video game time
Marketing/Advertisements Decreased activity levels Fast Food Few structured meals Packaged meals Grazing |
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Assessing Eating Habits
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- Identify foods eaten
- Identify patterns of eating - Fill out dietary intake histories with children - Limits on snacks - Control portion size |
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How much activity physical activity is needed for kids?
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An hour a day for children and adolescents
*doesn't have to be ACSM certified workouts |
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What can parents do to help promote activity?
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- Compliment the school PE program with youth sports
- Maintain physical activity in your own life - Buy gifts that promote physical activity - Plan active vacations |
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What can parents do to establish good eating programs?
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- Establish family meal and snack times
- Mealtime should be family time: eat together, do not watch TV - Offer only healthy snack options - Remove temptations |
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What does DSM-IV stand for?
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DSM-IV: Diagnostic and Statistical Manual of Mental Disorders IV
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What types of disorders does it diagnose?
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Psychological (mental) Disorders
Nutritional Disorders |
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What is normal eating?
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Eating when you're hungry and stopping when you're full
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What is abnormal eating?
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Spending a great deal of time thinking about food
Avoiding food situations Abnormal relationship with food |
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What is Anorexia Nervosa?
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- Intense fear of becoming overweight
- Disturbance in the way one looks at their body - Refusal to maintain minimum weight for age and height - Females: absence of 3 consecutive menstrual cycles - Underweight (BMI <17.5) * Common is adolescent females |
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What are the differences between primary and secondary amenorrhea?
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Primary: Menstrual cycle never starts
Secondary: Menstrual cycle ceases at some point after it has started |
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What is Bulimia Nervosa?
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- Repeated episodes of binge eating, followed by purging (either by vomiting, inappropriate compensatory behaviors, or other means)
- Feeling lack of control while eating - Minimum of three binge/purge episodes/ week for three months - May not have obvious weight changes - Gum disease or tooth decay |
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What are methods of purging?
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Laxatives, excessive exercise, vomiting
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How often do bulmics binge/purge?
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Minimum of three episodes per week for three consecutive months
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What is binge-eating disorder?
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- Recurrent episodes of binge eating
- Feeling lack of control while eating Having three of the following: - Eating more rapidly than normal - Eating until feeling uncomfortably full - Eating large amounts of food when not physically hungry - Eating alone because of being embarrassed - Feeling disgusted, depressed or guilty about eating |
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How often do binges occur during binge-eating disorder?
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Average of 2 days/week for 6 months
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What is the difference between binge eating disorder and bulimia nervosa?
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Binge eaters do not use a compensatory behavior to purge after binging
Therefore they are often times overweight |
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Describe the psychological conflicts in obesity
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SOCIETAL/CULTURAL ATTITUDES:
- Even slightly overweight people reflects lack of will power - Viewed as self indulgent - Emotionally disturbed CONFLICT CREATED BY EFFORTS TO LOSE WEIGHT: - Failed efforts to better body image - Leads to depression FACTORS THAT PLAY A ROLE IN THE DEVELOPMENT OF OBESITY: - Body image distorted - Depression - Anxiety disorders |
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What is the NAAFA?
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The National Association to Advance Fat Acceptance
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What does the NAAFA do?
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Promotion of three important strategies:
- Self Acceptance - Normal Eating - Physical Activity |
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What does metabolically healthy obese mean?
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- Have a BMI that puts them at obese, but they exercise at a high intensity so they're healthy
Ex. defensive linemen, sumo wrestlers - When they retire the lack of exercise causes huge weight gains (6 months to 1 year later co-morbidities show up) |
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What are some psychological reasons for obese people not to exercise?
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- Dieting is more important than exercise
- Attractiveness is more important than health - Exercise environment of health facilities can be intimidating - Fear of physical injury - Clothing limitations |
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What personality traits are characteristic of pre-operative obese people?
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Self doubt
Insecure Sensitive Dependent Compliant Emotionally Vulnerable |
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What are some characteristic personality traits of post-operative obese people?
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Enhanced self esteem
Interpersonal security Increased self confidence Increased socializing More self assertiveness |
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What is the importance of these personality traits (Basic Character Inventory)?
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1. Psychological characteristics can change
2. There are more benefits to weight loss than medical health |
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What is cognitive behavior therapy?
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Helps to change thought process
- Self monitoring - Monitoring body weight - Teaching people to eat regular meals - Normal eating - Cognitive restructuring - Relapse prevention |
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What are the cultural attitudes towards obesity?
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Obesity remains one of the last socially acceptable forms of prejudice
- Hiring practices - Health professionals - Acceptance to college - Choosing a friend to study - Silhouette study * Women deal with societal affects more than men |
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heureux/-euse
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happy
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Why is obesity maladaptive?
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Because it is caused by a combination of many, many things
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What are the three different kinds of obesity?
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1. Developmental Obesity
2. Reactive Obesity 3. Maladaptive Obesity |
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Developmental Obesity
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- 10%
- starts in adolescence - hardest to treat - pushy parents contribute |
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Reactive Obesity
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- 20%
- bad divorce, car accident, traumatic event, etc - hard to assess because they don't want to talk about it |
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Maladaptive Cultural Syndrome Obesity
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- 70%
- MOST COMMON - cluster of things that contribute to obesity |
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What are the 4 potential outcomes of attempting weight loss?
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1. Accepting failure (70%)
2. Succeed and adjust (20%) 3. Succeed but cannot adjust (7%) - still have bad psychological problems - eating disorders 4. Thin-Fat people (3%) - eat so much, but exercise excessively |
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Which is most important in the society vs. obesity debate?
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Influence of society on obesity
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The majority of people have how many different sizes of clothing in their closet?
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Three sizes, followed closely by two
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What factors of family social structure can impact obesity?
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Single parent family
Working parents Blended families Divorced parents Child care / day care Fewer intact families |
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How does society affect obesity through clothing?
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Styles
Colors Fabric Mail order Swim suits Unised Vanity sizes |
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What is vanity sizing?
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Clothing manufacturers put a smaller size on what it actually is
ex. Old Navy says its a 36" when really its a 41" |
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How does the food in our society impact obesity?
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Diet foods
diet products high calorie options vending machines concession stands "all you can eat" buffets |
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How does exercise impact obesity?
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Health clubs
TV and home video programs Home exercise equipment Transportation Home convenience Work convenience Popular activities Technology |
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The greatest American freedom is?
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Freedom of choice, which can also be our greatest weakness
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What three things do you have to ask yourself before beginning a weight loss program?
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- Is this the right program for me?
- Is this the right time for me? - Is weight loss a priority for me? * make sure you're not shaping them too fast |
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What does it take for weight loss?
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COMMITMENT
- Kicking the sweet habit - Aim for progress - Establish realistic goals - Stop the munchies - Make exercise a priority - Keep food diary - Keep exercise logs |
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What are the 5 important principles of behavior change?
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1. SELF MONITORING
- observing / recording 2. STIMULUS CONTROL - environmental restructuring 3. CONTINGENCY MANAGEMENT - rewards / contracts 4. STRESS MANAGEMENT - coping skills / high risk strategies 5. COGNITIVE BEHAVIORAL STRATEGIES - perceptions / attitudes towards eating and exercise |
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How are the 5 principles related to behavioral strategy?
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Ex. Cognitive behavioral strategy
- use shaping to change the way we think about exercise We use the 5 principles (aka techniques) to change the way we think about exercising, which ultimately changes our behavior the 5 principles are NOT examples of a behavioral strategy |
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What are the four predictors of successful weight loss?
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1. Positive Affect
2. Internal Motivation 3. Pay Attention to Other Physical Changes (ex. belt loops, playing with kids, not being short of breath when climbing the stairs) 4. Social Support System |
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What are some predictors of relapse?
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- Negative Affect
- Socialize (go out and eat with friends and family) - Testing yourself (see what you can get away with) |
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What is a lapse?
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Temporary set back during change process
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What is a relapse?
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Complete breakdown / return to old behavior
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What is a collapse?
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Failure altogether
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How can we help prevent a lapse?
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- Identify high risk situations
- Use alternative activities - Use coping strategies - Outlast the urge |
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What are some behavior modification techniques?
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habit awareness
cue elimination change the act of eating behavior chains and alternate actions behavior analysis preplanning * Eating behaviors are learned, and like any learned behavior we can change it!!! |
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What are the six stages of the Trans-theoretical Model of Change
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1. Precontemplation
2. Contemplation 3. Preparation 4. Action 5. Maintainence 6. Termination |
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Precontemplation Stage
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- Do no intend to change during the next 6 months
- May lack confidence in their ability to make a change - Often deny that a problem exists * Most common stage for dropouts |
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What can you do to help people in the precontemplation stage?
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- Increase awareness
- Emphasize benefits - Identify barriers - Provide information about the problem |
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Contemplation Stage
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- Preparing for change in the next 6 months
- Seriously considering change |
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What can you do to help people in the contemplation stage?
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- Assist in overcoming barriers
- Self evaluation - Emotional arousal |
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Preparation Stage
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- Ready to change in next month
- Characterized by making some change, even if small Ex. Switching from whole milk to 2%, a salad instead of fries, etc |
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What can you do to help people in the preparation stage?
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- Offer programs with manageable goals
- Get commitment * It is important to have stuff ready for them at this stage |
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Action Stage
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- Actively in a program
- Lasts about 6 months |
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What can you do to help people in the action stage?
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- Rewards
- Environmental Controls - Apply behavioral strategies - Substitute behaviors - HEALTH CONTRACTS |
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Maintainence Stage
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- Have continued to practice the goal behaviors for 6 months
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What can you do to help people in the maintainence stage?
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- Re-initiate health contracts
- Support skills - Relapse skills - Identify high risk situations |
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Termination Stage
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- Final stage of change, at which point the individual is considered to have successfully terminated an undesirable behavior and adopted a goal behavior
- Weight management behaviors do not always have a clearly defined termination point, but rather a lifetime of change maintainence |
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What is willpower?
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A hypothetical construct that does not explain anything
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Obesity: Nature vs. Nurture
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- Obesity has both genetic and learned components
- More caloric input than output - Is clearly increasing, which shows environmental factors |
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How many observation sessions should be recorded to plot the data?
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At least 5
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Positive Reinforcement
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Presentation of an object or event, contingent upon response, that results in an INCREASE in the future probability of that response
STRENGTHENS a behavior - varies between people - varies over time - varies due to experience |
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What is Skinner's Three-Term Contingency?
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S > R > S
Broken down into 1) Stimulus 2) Response 3) Reinforcer or 1) Antecedent 2) Behavior 3) Consequence |
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What are the two types of reinforcers?
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Primary and Secondary
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Primary Reinforcer
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Satisfy biological needs
ex. food, water, shelter |
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Secondary Reinforcer
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Acquire their power to reinforce behavior by being associated with primary reinforcers
ex. money, praise, tokens |
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Motivating Operations
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MOs
An event or condition that: 1) Temporarily alters the efficacy of a reinforcer 2) Alters the frequency of a behavior affect by that consequence ex. deprivation or satiation |
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Contingency Management
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Reinforcers delivered after the response are contingent upon the behavior
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Self Monitoring
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- Increases awareness of behaviors, or of physiological parameters, such as blood glucose and blood pressure
- Reinforces new behaviors by providing a visual reminder of those behaviors - Illustrates circumstances that promotes unwanted behaviors |
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Examples of self monitoring
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Counting calories
Self-recording on graphs posted in public |
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Antecedent Control
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- Develop stimulus control
- Stuarts use of placemats and settings - Small plates and bowls - Chew each bite 10 times - Walk briskly through stores with cash only |
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Way to increase commitment
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- Make choices earlier in time
- Large delayed choices vs. small delayed reinforcers - Make public announcements - Schedule activities |
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Behavioral Contracts
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Written contracts with specified reinforcement contingencies for success
- Sanctions for failure - Revise weekly - Long term behavior change - Problem solving rather than finger pointing |
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What are three successful weight suppression behaviors?
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1) Dietary fat reduction
- Fat only accounted for 24% of caloric intake 2) Portion control 3) Exercise - critical for maintaining weight loss |
