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UOGUELPH / OTHER / PSYC 3110 / What is Health?

What is Health?

What is Health?



What is Health?


What is Health? 

“Health psychology is an interdisciplinary field concerned with the application of  psychological knowledge and techniques to health, illness, and health care.” (p. 11)  ∙ The word is derived from Old High German and Anglo Saxon  words meaning whole, hale and holy. The etymology of “heal”  has been traced to early European roots indicating kailo  

(whole, uninjured, good omen). Eventually the word became  heil, which meant unhurt and unharmed (German).

Historical Perspectives of Health & Illness 

∙ Ancient Greece: health and illness viewed in terms of bodily functioning (Rather  than evil spirits)  something in naturalistic terms (in the sense of viewing the  body as an organism and the functioning of the body is something we can 

understand through natural investigation). 

∙ Hippocrates (460­337): illness occurs in body and is independent of the mind,  four humors: blood, black bile, yellow bile and phlegm.  worked with the idea of the four humors, the body is composed of this. When they are balanced, you are  healthy, if they are not, you are not healthy. They saw it largely independent from  the mind, thus you look at the body. 

what is Theory of Well-Being?

∙ EX: black bile leads to melancholia 




nWe also discuss several other topics like why were previous scholars’ estimates of the pre-Columbian Indian population erroneously low?






Personali ty Types

Characteristi cs











and hopeful

Yellow  Bile Don't forget about the age old question of [12] For what nonnegative values of γ will the the solution of the initial value problem u′′ + γu′ + 4u = 0, u(0) = 4, u′(0) = 0 oscillate ?
If you want to learn more check out What is the organ tissues?

Summe r





and Dry



angered, bad  temper








and dry

Melancholi c

Despondent,  sleepless and  irritable



Winter Don't forget about the age old question of You may be asking, “So what’s D&D?










∙ Galen (second century): disease occurs in specific parts of the body, different  diseases have different effects on the body. Sought the different types of diseases  and the effects it had on the body. It is important because we have a sense of  describing disease and looking at specific areas, not simply holistic. 

what is Globalization?


∙ Collapse of Roman Empire (5th century) 

∙ Return to view of illness as result of spirits, demons or punishment of God (most  important one here, if you did something morally one, not due to a physical  accident) 

∙ Authority of physical healers replaced by priests  who has the authority to  diagnose and come up with theories? 

∙ Treatments influenced by religious doctrines, very different from the naturalistic  approach 

∙ Because people and animals are seen to have souls, body is sacred and dissection  forbidden (medical training, experiments) this is the strong dominant view ∙ Rise of Christianity in Europe created a shift in medicine. 


∙ Rebirth of inquiry in Europe & Scientific Revolution  If you want to learn more check out What are risks from smoking?

∙ Rene Descartes (1596­1650): new model of mind and body relationship  ∙ Crucial in the rise of modern medicine 

∙ They are separate substances but interact through pineal gland 

∙ Notion that animals have no souls (justifies experiments done on animals), human soul leaves body at death, the body that remains is no longer sacred, thus  dissection is now possible. 

The Mind­Body Problem 

∙ What is the relationship between the physical body and the non­material mind? ∙ Descartes: mind­body dualism

∙ Dualism: they are in fact two different substances (body and mind)  ∙ Monism: says there is only one substance (materialists, physical matter, while  idealisms say there is only the mind) 

∙ Illusions of the what the real one is, the mind, less extreme way of looking at the  world 

Need Satisfaction  the attainment of physical health, agency and  autonomy, the satisfaction of all physical, cultural, psychosocial,  economic and spiritual needs with indication that agency and  autonomy are the most basic requirements for every person.We also discuss several other topics like What are the Early Evolutionary Theories & Observations?

Self-Determination Theory  competence, relatedness and autonomy  

Quality of Life (QoL)  

 Aristotle: happiness is viewed as the meaning and purpose of life   Bentham: pleasure without pain  

 Collins Dictionary: general well-being of a person or society, based on health and happiness rather than wealth.  

Subjective Well-Being (SWB)  Umbrella term for different valuations  that person’s make regarding which they live. (Dr. Happiness, Ed  Diener)


Theory of Well-Being  

 An infant’s attachment to their caregiver creates a template for  how the infant will stay in proximity to a person who provides a  safe space for exploring. The caregivers response is internalized  as a mental model of the world and will be used in a general  manner trough out the infant life known as attachment style in  turn influencing overall life satisfaction.  

 Eudalmonic  degree to which a person is fully functional and  occurs when they are living with their authentic self (daimon).  

Cultural Perspective  

 Ecological Validity: Could not be generalized outside the  laboratory  

 Ethnocentrism: considers national or large group samples as  analysis units rather than individuals. A bias stemming from  membership of a particular ethnic group.  

 Selfways: what it means to be a good or bad person and what  causes us to become ill or healthy.  

Approaches to Health Psychology  First article from readings is great for  providing extra information on these approaches! 

1. Clinical Health Psychology 

∙ Most ‘mainstream’ of the four approaches 

∙ Partly overlapping with clinical psychology (methods, theories)  ∙ Relies heavily on biopsychosocial model (explicitly) 

∙ Successful in bringing to prominence psychological perspective on health, illness, health care 

∙ Focus is on physical illness and dysfunction 

2. Public Health Psychology 

∙ Focused on health promotion and prevention on population level (rather than  individual levels) 

∙ Designs things for large amounts of individuals it is not focused on one person ∙ Health seen as outcome of social, economic, political aspects of people’s lives  ∙ Prevention focused on collective level – Takes time – Difficult to 

evaluate/measure– Difficulty in tackling major social problems (eg poverty) ∙ More interdisciplinary than Clinical HP (generally how we can use more  approach than one) 

3. Community Health Psychology 

∙ Similarities to Public HP – Focus on collective level – Health seen as outcome of  social, economic, political contexts 

∙ Focus on particular communities/groups and empowerment to achieve better  health outcomes (not the entire public) 

∙ Strong focus on action research 

∙ Blurs the boundary between participant and researcher 

4. Critical Health Psychology 

∙ Need to evaluate theories and practice and how they maintain unjust social  relations 

∙ Always looking for power differences 

∙ Who benefits? We can intervene unless we know where the interests are.  ∙ Focus on concept of power, how it functions to facilitate or prevent health  ∙ Based on ideas from ‘crisis’ in social psychology (1970s) – Re­examination of  science– Can psychologists be objective and value­free? 

REMEMBER: the individual is at the CORE of the Onion Model. 

Global Health

∙ Number one determinant: where you are born. 

∙ Natural Events and Disasters 

∙ Epidemics 

∙ Human induced issues 

Macro­Social Context (AKA the Glass Jar in which you are making your choices) AKA large-scale social economic, political and cultural forces that  influence the life course of masses of persons simultaneously. It  includes government organizations, religions, corporations and other  large environmental events.  

∙ Individual expression and agency constrained by powerful factors  ∙ Political and economic systems (democracy or dictatorship)

∙ Systems of discrimination (gender, race, ethnicity, culture, religion and social  class) 

∙ Culture and religious discourse  people who were very religious on average were seen as more healthy but others had significant health issues. It goes both ways.  ∙ Literacy and education 

∙ Health is strongly correlated with ALL  

Globalization  process by which businesses develop international  influences

Health Care is the systematic response to overall Health 

∙ Global Debt 

∙ Limited resources due to population growth  Disease prevalence & Health care  sustainability 

∙ Economic well­being is highly correlated with health  health gradient (SES  predicting mortality) 


 Defined as a level of income below that people cannot afford a  minimum, nutritional adequate diet and essential requirements  that are not food.  

 Major impacts are the following: safe water, environmental  sanitation, adequate diet, secure housing, basic education,  generating opportunities, access to medical and health care.  

 Gross National Income (GNI): monetary value of all goods and  services produced in a country in a year.  

 Greatest predictor of infant survival is education and  environment (Do not forget about the U5MR (under 5 mortality  rate)  

Policy Discourse 

 Responsible Consumer (RC): an active processor of information and  knowledge concerning illness and health. They make impulse and  responsible decisions in regards to enhance their well-being with the  “everything in moderation” while the Irresponsible Consumer (IC): is  sometimes known as “couch potato”.  

∙ Should focus on social and the environment as well, not only the  individual  

AKA  Whitehall study and Black Report  Relationship between occupation and  health: consistently poorer health for unskilled manual labour  those in class V  (unskilled) are in worse conditions than those in class I (professionals)

∙ Marmot Report: indicated that focusing action on the most  disadvantaged with be inadequate, we need fair  

distribution for greater success than economic growth.  

The Whitehall Studies 

• Investigate social class, psychosocial factors, life style as determinants of disease  (purpose of the study) 

• Whitehall 1 (1960s):– 18 000 men in Civil Service (it is very stable metric, you can see  who is higher and who is lower) think of the example of the health gradient – Lowest grades more likely to die prematurely 

Men only and a lack of context are limitations

• Whitehall 2 (started 1985): – Causes of social gradient 

– Include women– 10 000 non­industrial civil servants– Ongoing  follow­up with surveys and medical exams 

Whitehall Study 2 results 

∙ Imbalance between demands and lacking control in terms of their environment  lead to illness – High demand, low control 

∙ Support theories of effect of work stress on mental & physical health  ∙ Can be buffered by social support, effort­ reward balance, job security,  organizational stability 

Germ theory (necessary to understand the interventions, such as ecoli is a contaminant  and can cause health outcome and death, you wont know how to deal with it to stop the  spreading) interventions, testing water for example. 

Social Darwinism– Note link of ontology and policy! (natural selection, on a certain  context) It is something innate, not in their nature, how you intervene on a individual  level and global level) sterilization. 


Communicable: disease spreads from one person to another or from  one animal to person. It may happen through airborne viruses or  bacteria but also through blood and body fluids. Terms such as  infection and contagious are used to describe this type. EX: influenza,  HIV, malaria etc.  

Non-Communicable (Chronic): generally of long duration and slow  progression. They are the leading cause of death in the world, 63% of  all annual deaths.  

EX: cardiovascular and respiratory diseases.  

Epidemiological Transition  reduction in prevalence of  communicable diseases and increase of those that are chronic  occurring because the country affected becomes stronger economically leading to unhealthy conditions and lifestyles (UK, USA) while those in  lower and middle class have incidence of both (India)  

Four Explanations for Health Inequalities  

1. Artefact: relationship between social position are the artifact of  measurement method  

2. Natural & Social Selection: the social gradient of health is due to  those who are already unhealthy, falling downwards while those  who are healthy are rising upwards.  

3. Materialist & Structuralist: emphasize the role of economic and  socio-structural factors  

4. Cultural/Behavioral Differences: often focus on the individual as  the unit of analysis thinking that unhealthy behavior is the main  determinant in this case.

Psychosocial Explanation  the individual (micro) and social (macro) level systems.  

∙ For the micro system, it is thought that the cognitive process of  comparison, relative deprivation is thought to contribute to high  levels of stress and ill health along with having no control over  working conditions.  

∙ For the macro system, they focus on impaired bonds between  social and limited civic participation creating income inequality  (social capital).  

Neo Material Explanation  focus on the importance of income and  living conditions.  

∙ Micro: it is argued that those who have less access to resources  have vulnerability to their health.  

∙ Macro: high income inequality leads less investment in the social  and physical environment, ignoring in which the problems are  nested.  

Lay Explanation  Researcher’s found that working class individuals,  especially women are reluctant to accept that they are less healthy  than middle-class individuals. Those who did accept it say it is different access to health care. Professional women accept the health gradient  indicating that it does attribute to poorer health.  


∙ Definition: unfavorable reaction towards people when perceived  to possess attributes that are denigrated.  

∙ Stigma Power: instances where exploitation, control and  exclusion of others enable people to obtain what they want. ∙ Stigmatization devalues the entire person with a negative  identity even when the stigma disappears. Consequences  include: physical and psychological abuse, denial of opportunities etc. They may internalize the stigma with feeling guilt and shame and changing the way they see themselves.  

∙ Health care professionals are as likely to stigmatize as anyone  else.  

∙ Discredited: the stigma is visible  

∙ Discreditable: the stigma is not visible but get stigmatized when  found out.  

Assisted Dying Bill: adults who are expected to live 6 months or less  can request assisted death. 6 months (14 days after it is granted) less  than one month (6 days)  

Two doctors to determine:  

∙ The individual is terminally ill

∙ Capable of making the decision  

∙ Has formed a settled intention to die

Social Capital  

∙ Bridging: links with diverse groups and provides an  opportunity for community members to access power and resources outside their community  

∙ Bonding: inward-looking social ties that bond the  community together  

∙ Both are needed to have a healthy community.  

∙ Good social capital increases good health by 27% while  reciprocity and trust increased at 32% and 39%.  

∙ Promotoras: health leaders who help with the  dissemination of health information to community  members  

∙ Social cohesion was indicated an important predictor of physical  activity.

Eastern & Western Beliefs 

Question understanding of mind­body relationships 

Claims of mental control over physiological processes (heart beat, survive pit burial,  regulate body temperature, skin penetration without bleeding) These stories were of great interest.


∙ It is durable and implicit, they tend to reproduce cultural norms,  the precepts. Expectations and values of particular times and  places. The belief is mediated through that person’s history of  social relations.  

∙ Popular Sector: lay cultural arena where illness is first defined  and health care activities initiated. May appear inconsistent and  contradictory.  

∙ Professional Sector: organized healing professions,  representations and actions  

∙ Folk Sector: non-professional, non-bureaucratic and specialist  sector that shades into the other two sectors above.  

∙ Simpler two-fold division: systematicity, coherence and  interdependence.  

NOTE: The way we think about health and illness directly affects the treatments,  interventions, systems we develop and use 

Early Investigations 

  ∙        Therese Brousse (1935), travel to India 

– Portable electrocardiograph to record yogis’ voluntary control of cardiovascular activity – One case, pulse waves from radial artery decreased to almost zero  – Mind does not influence body, the implication that the body and mind are separate and mind and illness and things go wrong biologically 

– So the fact we can do things with out mind is revolutionary 

What is Culture? 

Cross­cultural psychology  

– Fixed system of beliefs, meanings, symbols, belonging to a group that shares  common language, possibly common religion & system of medicine  Cultural psychology  

– Developmental and dynamic systems of signs that exists in continuously changing narratives or stories  culture is not a fixed thing, dynamic, organic and flexible,  qualitatively. 

“Failed” Assumptions in Biomedicine (storybook method) Works to some degree.  • Helicobacter pylori 

–  Discovered 1982 in stomach of patients with gastritis and ulcers (Barry  Marshall, Robin Warren) 

– Treated with scepticism; common belief at the time that bacteria cannot  – and survive in stomach or caused by stress  

–  Mars hall drank beaker of H. pylori culture to prove hypothesis  – Nobel prize in 2005 for this work 

Truth didn’t come out through good nature and careful experimentation 

Christian Ideas  The church’s 7 deadly sins came to be associated  with body conditions. EX: pride is associated with tumors and  inflammation while sloth lead to dead flesh.  

∙ Ascetic Tradition: scorned concern for the body and promoted  acts such as fasting and physical suffering which led to  spirituality.  

Protestant Reformation: the body had been given to the human by God and it was their responsibility (religious duty) to look after and care for  their body.

Social Representation Theory  suggests that people rarely  confine their definition of concepts to the descriptive level and rather include references to explanations. Perceptions of  health can be rooted in social experiences while others define  it through lifestyle, functionality, and social engagement.  

Health Belief System Examples 

– Expert or technical belief systems– Traditional folk or indigenous belief (more  distributed and more accepted and practiced) systems – Not discrete; interact;  constant evolution 

– Our own health beliefs are formed within these expert and folk belief systems (but may of course be distinct) 

Chinese Medicine 

– • Taoism– Balance of yin and yang– Use of acupuncture, herbal medicines  – • Confucianism– Belief in destiny, and focus on character 

– • Buddhism– Cosmic justice and retribution (karma) 

Ayurvedic Medicine 

– Used by 70% of population in India, plus large numbers in the rest of the world  – Cosmos and human being consists of male and female component  – Task of Ayurvedic medicine is to remove blockages of energy flow  – Treatments: yoga, diet, meditation, herbs  

African Health Beliefs 

– Wide variety of traditional medical systems 

– Some common elements – Spiritual influences– Communal orientation  – Common attribution of illness to ancestors or supernatural forces (witch casting a  spell or family not liking you) 

– Role of healer to identify source of malignant influence (may also be felt by  family) and the role of social support 

Homeopathy  use of highly diluted substances to trigger the body’s  natural healing system. Based on the Latin principle known as “simila  similbus curentur” let like be cured by like. Substances used at large  doses can be used at small doses as well. Based on harsh procedures  such as purging and blood letting. Based in the UK and can be used to  treat common illnesses such as asthma, allergies, blood pressure and  mental health.  

Aromatherapy  use of essential oils from plant extracts based back  to Ancient Egypt and China. Gattefose is known as the founder when  creating healing properties when he burnt his hand in the laboratory. It  can help with pain and digestion.  

Reflexology  application of pressure and massage to specific reflex  areas in the body such as the hands, ears and feet. It is based on the  belief that these areas correspond to other parts of the body and can  help dissolve the waste blockages and encourage free flow and restore  

ying and yang balance.

Health belief systems are important because: 

• In multicultural society, need to understand where individuals ‘are coming from’ – Helps us understand and influence our own perceptions. 

Qualitative Methods 

Facts, knowledge, and research cannot be separated from values (should be controversial  to you) 

– Psychology has been so anti­qualitative methods for many years, been a great  debate about this. 

– Qualitative researchers tend, therefore, to be concerned with the quality and  texture of experience, rather than with the identification of cause–effect  relationships

– Answers will very situated within the context of its surrounding and time period. epistemology (how do we know what we know, how do we come to know what we  know)

View other methods and information in Chapter 5 

Sexual Health

∙ What are we primarily concerned with in health psychology?

o STIs


Sexual Behavior  Any activity that arouses sexual arousal for  pleasure or procreation. Issues within sexual health are associated with problems of stigma and discrimination.  

Incidence & Prevalence of STIs, HIV & AIDS

∙ Common STIs are chlamydia, warts and gonorrhea. Least  common ones are syphilis and HIV.  

∙ Most common between people aged 16-24, 12% of the  population

∙ Young people either think they know it all, or think bad things  won’t happen to them (optimistic bias).  

o Individual level theories for risk taking (social cognition models) o Reducing risky sexual behaviour: main factor is condom use

o Most is due to not having the right knowledge or a lack of knowledge and  social conceptions influencing our decisions, not us making individual  decisions. 

Individual Level Theories 

Health Belief Model (HBM): 4 elements

1. Perceived susceptibility: individual assessment of risk condition  2. Perceived severity: Individual assessment of seriousness of 

condition and consequences

3. Perceived barriers: Influences that facilitate or discourage healthy  or unhealthy behaviour

4. Perceived benefits: What are the positive consequences of adopting healthy behaviour

NOTE: The likelihood of a behavior is influenced by “cues of action” that are reminders or prompts to take action a consistent with an intension.  They can be internal or external. The HBM takes into account these  factors to predict the likelihood of implementing health related  behavior. In experiments it tends to have modest and inconsistent  results. For example, it did not explain condom use among university  students. Determinants of condom use were based on subjective  norms and perceived behavioral control.  

Protection Motivation Theory: When we cope with a health threat (fear), we go through a threat appraisal and a coping appraisal

 Appeal to fear to change behaviour

1. Perceived severity of threatened event

2. Perceived probability of occurrence

3. Efficacy of recommended behaviour

4. Perceived self­efficacy

Theory of Reasoned Action (TRA)

 Assumption: Individual is likely to do what they intend to do

 Doesn’t take into account political or economic constraints, nature  of sexual encounters, etc.

 Main construct: Behavioural intention 

1. Attitude towards action/behavior

2. Subjective norm (other’s beliefs)

Theory of Planned Behaviour (TPB)

 Most cited theory in psychology

 We are likely to do what we intend to do, but some behaviours are  difficult to control in a voluntary way

 Added construct to TRA:

1. Perceived behavioural control

2. Reflects past obstacles and successes

 Important factors still missing from TPB (religion, culture, gender,  age)

Information­Motivation­Behavioural Skills Model (IMB)

 There are certain pre­requisites for good actions:

1. Relevant information about risks

2. Motivation for safe sex

3. Behavioural skills (negotiating condom use, insisting on 


 Motivational interviewing ­strategy for building up drive to change behaviour in line with a decision

Common Sense Model (CSM) or the Self­Regulatory Model (SRM)  Core construct: Illness representations

 We have a representation of an illness in our mind (cause, 

consequences, etc.), and that representation affects our response to 

the illness/risk

The Transtheoretical Model or Stages of Change  ∙ Hypothesizes six discrete changes which people are alleged to  progress through in making change

∙ Precomtemplation – a person is not intending to take action in  the foreseeable future, measured in the next 6 months.  ∙ Contemplation – a person is intending to change in the next 6  months  

∙ Preparation – Prepared to take action in the immediate future,  next month.  

∙ Action – Has been making effort within the last 6 months  ∙ Maintenance – Working to prevent relapse, 6 months to 5 years  ∙ Termination – zero temptation and 100% self-efficacy OR relapse – return to the original behavior  

Social Cognitive Theory

 Focuses on the examination of social origins of behaviour

 Goes beyond just the cognition and thought processes

 Asks: Where did those thought processes come from?

1. Observational learning

2. Self­efficacy

 Applications of theory: Use of role models in mass media to shape  attitudes & behaviour

Observational Learning  

∙ People can learn by watching or observing others  

∙ Step 1: attentional processes including certain model  characteristics that may increase the likelihood of the behavior  being attended to and the observer characteristics.  

∙ Step 2: retention processes including the observers ability to  remember and make sense of what has been observed

∙ Step 3: motor reproduction processes including the capabilities  that the observer has to perform the behaviors that are being  observed  

∙ Step 4: motivational processes including external reinforcement,  vacarious reinforcement and self-reinforcement.  

Evaluation of Theories

– Bias that individualistic 

– Lacks validity 

– Does not take into account, culture, religion and gender 

– Motivation is very complex 


Food has a richer role than the biological aspect. 

Where does the government come in? 

Definition & Prevalence  

∙ Obesity has been defined as: chronic, relapsing and  neurochemical disease.  

∙ It manifests itself by an increase in size and number of fat cells  (adipose tissue) and is measured through BMI.  

∙ Greater or equal 25 is classified as overweight and greater or  equal to 30 is classified as obese.  

∙ Obesity is a marker for insulin resistance, diabetes, and  metabolic syndrome that include hypertension and other  cardiovascular risks.  

How are Overweight & Obesity Measured?  

∙ Body consists of four compartments: bone, muscle,  subcutaneous fat (80%) and visceral fat (20%).  

∙ BMI does not distinguish between these four parts.  ∙ DXA: used to measure bone density and total body composition.  Can determine abdominal fat mass.  

∙ Waist circumference/belt: 40 for men and 35 for women is  considered to be excess fat

∙ Skin Fold Thickness  

Health Risks 

∙ hypertension or high blood pressure; 

∙ coronary heart disease; 

∙ Type 2 diabetes; 

∙ stroke; 

∙ gallbladder disease; 

∙ osteoarthritis; 

∙ sleep apnea and other breathing problems; 

∙ some cancers such as breast, colon and endometrial cancer; and  ∙ mental health problems, such as low self­esteem and depression. 

– Total calorie intake increased as food has become more processed and energy  dense Problems of obesity also becoming increasingly common in developing  countries ( the poorer countries are having an issue) 

– But note that obesity also associated with lower SES – Restrictions on budget  mean less being spent on quality of food 

– Thus, it is a problem of one, that it does not occur because someone is too rich.  Good quality food that is lacking, NOT FOOD in itself. 

– Agricultural revolution & Industrial revolution 

Ecological theory: daily energy expenditure of human population needs to be increased,  while daily energy consumption is reduced

Causes of Obesity  

Evolutionary Hypothesis  

∙ Early humans have been traced to sites in Africa dating around  2.5 million years ago.  

∙ Tool making (homo habilis) handyman lived in Olduvai, they were hunter gathers and killing and processing their food with  weapons and tools fashioned from volcanic matter.  

∙ Natural ecosystems provide a diet of wild plant based foods that  are both varied and plentiful. Insects and fish for meat were also  consumed.  

∙ Until they moved into villages, individuals were only consuming  unprocessed and only natural foods.  

Genetic Predisposition  

∙ Heritability is the proportioned of observed differences in a trait  among individuals that is due to genetic differences.  

∙ Authors found that environmental changes over time do not have a big impact as once thought suggesting a greater genetic  influence in BMI changes over the years.  

∙ While it may be biological it is important to note that the human  genome has not altered in the last few hundred years.  

Energy Balance Theory  

∙ States: energy intake = internal heat produced + external work  + energy stored

∙ Energy is consumed in the diet through three macronutrients:  protein, carbohydrate and fat. Translating this equation in terms  of fat it becomes the following  Rate of change of fat stores in  the body rate of fat intake – rate of fat oxidation  

∙ Calorie: energy needed to increase the temperature of 1kg of  water by one degree  

∙ Fat content of a food is based on four different types of fat:  saturated, trans, poly and mono saturated.  

∙ Eating itself burns calories known as the thermic effect of food  (bite, chew and swallow).  

Insulin Theory  

∙ Claims that obesity is caused by a chronic elevation in insulin in  a diet that contains too much carbohydrate.  

∙ Three distinct propositions:  

∙ Basic proposition that obesity is caused by a regulatory defect in  fat metabolism so a defect in the distribution of energy than one  in intake and expense.  

∙ Insulin plays a primary role in this fattening process and  compensatory behaviors of hunger and lethargy.  

∙ The third is that refined carbohydrates, fructose and amount of  sugar consumed are prime suspects of this constant elevation  ∙ Glycemic Index: produces insulin in turn causes the body to store fat. Examples include rice, wheat, potatoes, natural sugars etc.  

The Obesogenic Environment  

∙ Today’s modern food environment has become engineered to  maximize the scale’s as most are processed foods. Most select  these foods due to their convenience, palatability and cost.  

∙ Increased this by increasing the amount of sugar, fat and  flavorings.  

∙ Obesity is seen as the end product of an obesogenic environment created by the food industry that has been given free reign to  promote fattening and unhealthy foods.  

∙ It is in the category of non-communicable diseases  ∙ Many pointed out that the industry of self-regulation and public  private partnerships have shown a complete lack of effective  control and safety. Only public regulations and intervention can  be effective in preventing harm caused by obesity and others  that are the result of direct unhealthy commodity industries.  ∙ Widespread availability of fast food and snacks, eating habits and portion sizes (supersizing).  

∙ Couch potato diet: red meat, potatoes, chips and cola  ∙ Hairy Shirt Diet: veggies, grains, fruits, nuts and yogurt.

Societal Influences  

∙ Society places a high value on the ideal thin body image with  little body fat.  

∙ People seek this not only to be fit but to be part of the cultural  ideal.  

∙ Two assumptions: body is malleable and everyone can reach the  ideal and reward is waiting for those who get to that ideal.  ∙ Biological variables (genetics) are influential in terms of body  weight and shape regulation.  

∙ The thin ideal is decreasing as obesity is increasing making the  thin idea hard to keep.  

∙ Starts as young as 5 years of age and driven through the  mother’s perception.  

∙ Concluded that interventions with those who are overweight  should focus on body satisfaction

∙ But body stigma and shaming is still very common and is  detrimental to mental and physical health.  

Emotion, Personality, Body Dissatisfaction & Depression   One psychological hypothesis to explain obesity is that it has  been attributed overeating to emotions.  

 Emotional distress is associated with snack eating and emotional  eating is related to percentage overweight based on a study.   Dieters were found to be more extreme emotional responders  with an internal source of arousal.  

 Obese individuals may have a heightened response when it  comes to external cues and may lead to eating more when  bored, anxious or depressed.  

 High scores on neuroticism, extraversion or lower sources of  conscientiousness with neuroticism leading to weight fluctuations while low agreeableness and impulsivity lead to greater BMI  across the lifespan.  

 Some studies found that a restraint can create a rebound in  terms of binge eating and body dissatisfaction was associated  with all negative outcomes.  

 Obesity at baseline depression followed by follow up increased  by 55% but not over time  

 Culture Clash  found that GPs, believed that obesity was the  patients responsibility rather than a medical issue creating a  detrimental problem between the patient and doctor  


 Other GPs say it is not within their domain

Drug Therapies & Bariatric Surgery  

 Amphetamine, and orlistat (negative side effects such as poor  tolerance and lack of safety)  

 Participants attributed their failure to lose weight to the  medication and emphasized the medication model  

 Surgery is the most effective in removing 20% of fat. – the  greatest variable is the persons investment in the operation and  failure being attributed to hedonic motivation to consume more  food.  

 This surgery also creates a high demand for contouring surgery  as well to take away their old identity for a new changed  lifestyle.  

 For behavior, weight gain after 4 years


∙ Where can we intervene? Not the same as when and how? 

∙ Dramatic differences in opinion around the causes 

∙ Temperant societies: complete abstinence and completely against alcohol, late and professional circles 

∙ Dominant view: alcohol all right in moderation; harmful in excess  ∙ Excessive drinking:– Regular heavy drinking (alcohol dependence) – Binge  drinking (younger people and leads to different kinds of health problems)  ∙ Men: max 3 drinks per day, women 2 

 Single occasion risks– Driving, industrial & household accidents– Domestic & other  violence (victim & perpetrator) – STI from unprotected sex 

 Risks from regular heavy drinking– Death from liver cirrhosis– Neurological damage  (irreversible)– Increased risk of cardiovascular dis, some cancers 

∙ View Case Study on Page 196 

NOTE:  does not matter on exposure unlike alcohol the only way we  start to see differences is with heavy drinking)

Common factor: powerful influence of international drinks companies (tax, hours, prices,  advertising)

∙ “J” shaped functions for epidemiological studies of some diseases  Healthiest  people tend to be the ones who drink a little bit while those who don’t drink at all  are to be a little more unhealthier and those who drink all the time are a lot  unhealthier. 

∙ Strokes: – Conflicting evidence for light drinking – Substantial incr. risk for  heavy drinking 

∙ Dementia & cognitive decline: – “J” function for light drinkers (thought to be the  same as the curve explained above) 

∙ Inconsistencies in studies make it difficult to establish limits for safe drinking, but moderate drinking not associated with significant health risk

Genetic Theories 

∙ Inherited predisposition to alcohol dependence 

∙ Extreme belief: some people ‘destined’ to become alcoholics after first drink  ∙ Biological determinism – note attractiveness of position to drinks industry ­ your  make up has the determinance of what happens to you in life 

∙ Observed patterns of drinking in families could be genetic or learnt  ∙ Twin studies:– Concept of heritability – Meta­analysis: 30­36%  ∙ Genetic basis likely to be complex– Rates of metabolisation– Subjective 

experience of taste– Genetic differences in (e.g.) anxiety leading to different  drinking patterns (not strong to determine on their own) 

∙ No evidence to support notion of ‘born alcoholics’ 

∙ Overall, environmental influences likely to carry more weight 

Addiction & Disease Theory 

• Addiction theories (from 1785 onwards) 

–  Replaced previous theories of drinkers being morally degenerate  – Once addiction is established, individual loses voluntary control to resist  urge to drink 

– Blames the substance, not the individual 

Disease theories 

–  Focus on at risk individuals such as peer groups and home environment  (not necessarily genetic) not the alcohol (only a small percentage are at risk)  –  Like addiction theories, emphasise loss of control 

– But, only addictive to small number of people 

Alcohol Dependence Syndrome 

∙ Distinction between physical addiction and psychological dependence removed –  Psycho­physiological disorder (symptoms p.205) 

∙ Hard to get rid of that distinction of those that are physical 

∙ Notion criticised for difficulty of associating criteria for diagnosis with particular  cases 

∙ Although there are problems with dependence theories, must acknowledge  phenomena of physical dependence – Extremely unpleasant symptoms: tremors,  sweating, nausea, vomiting hallucinations, convulsions, fatalities 

Learning Theories 

• Drinking problems & normal drinking result of same learning process  – Particular differences owing to personal histories • Operant conditioning 

–  Little recent interest in alcohol field (cf. other drugs) 

–  Pleasure from addictive substances on the whole is less than suffering  caused 

– Pleasure immediate, unpleasantness after delay (except for the hangover,  we’re talking about severe health consequences)  

Learning Theories  

∙ Operant conditioning: providing rewards once they do the correct response

∙ Gradient of Reinforcement: reinforcement occurs rapidly after the response is much more effective in producing learning than  learning delayed reinforcement  

∙ Classical Conditioning: response occurs as a natural reflex that  can be conditioned  When drug is taken initially, physiological mechanism  (puts your system out of whack (part of the pleasurable experience) then returns  to its equal) 

∙ Compensatory Conditioned Response Model: uses the principles  of classical conditioning to account for addiction, tolerance,  dependence and withdrawl. Think of the homeostatic mechanism within the body.  

∙ Self-Efficacy: having confidence in one’s ability to carry out one’s  plan successfully.  

∙ Secondary Gain: alcohol has the double function of releasing the  inhibitions that might otherwise prevent the impulse from being  acted on while simultaneously being held to blame as if it was  the drink that performed the act and not the drinker.  

Social Learning 

– Bandura: classical and operant conditioning important, but we also learn through  imitation 

– Concept of self­efficacy: personality trait relating to confidence in carrying out  one’s plans successfully  Peer pressure 

– Parents seem to have strongest influence on initiation of adolescent drinking  behaviour; peers on subsequent frequency 


Causes of Problem Drinking

Addiction, Disease & Dependence

Those who drink heavily may  development a dependence that  can only be cured by long-life  abstinence.

Learning Theories

Mechanisms of conditioning and  social learning can explain the  development of excessive  

consumption, symptoms and


Genetic Theories

DNA variations can be associated  with metabolism of alcohol mean  where certain persons are more  likely to develop problems if they  drink

Psychoanalytic Ideals 

Freud’s concept of secondary gain, as extension of learning theory – you get something  that is not directly related to the activity 

Cf. hypochondriacs avoiding work & sufferers of neurosis gaining attention  Attribution of behaviours to alcohol may work as excuse for evading responsibility (e.g.,  sexual harassment) 

Drinks Industry versus Health Research 

• Critics of Drinks Industry: drinks industry is disingenuous, as: 

– Education shown to be ineffective– Main profit comes from those drinking above  recommended health limits 

• In many countries policy more influenced by drinks industry than alcohol experts  – Risk of unpopularity if advocating population­ based policies? 

– Most comes from the heavy drinking

– How many drinks per day per capita is what you want to ask 

Sophisticated marketing techniques:– Aimed at young drinkers– Lifestyle advertising;  sports; rock concerts; fashion – Tailored products: alcopops; pre­mix cocktails  Counter­advertising (e.g., warning labels) effective but we do not have enough of it

Intervention & Prevention 


Type of Treatment


In Patient

Drying out centres and private  clinics that focus on the alleviation of withdrawal symptoms followed  by counseling and therapy to  maintain abstinence following  discharge

Alcoholics Anonymous

12 step facilitation program

Counseling & Psychotherapy

Aim of helping clients to achieve  insight into the causes and effects of problem drinking as an  

essential bias for change

Cognitive Behavioral Therapy

Based on learning theories and  aims at trying to reduce drinking  levels rather than promoting  abstinence.

Brief Interventions

Advice given by GPs and other  health professionals and  

opportunistic interventions for  those who have assessed  

screening programs for other  reasons rather than alcohol

Mindfulness-Based Relapse Prevention  based on stress  reduction  

∙ The most effective way for reducing population levels of  consumption is related to increased taxation.  


Brief History  

∙ In the first century of BC, the Mayans were alleged to have  smoked tobacco in religious ceremonies with the Aztecs following while Raleigh is supposedly the one to have shown potatoes and  tobacco to England. He popularized tobacco in court saying that  it was a good cure for coughs.  

∙ Was introduced later during Napoleonic campaigns during the  early 1800s.  

∙ Tobacco tax makes a great contribution to wealth, exceeding its  treating costs.  

∙ Sudden Infant Death Syndrome: main cause of post-natal death  in the first year of life.  

∙ Counts for more than 440,000 deaths per year and one in every  five deaths and more deaths are caused by tobacco than  everything else combined.  

∙ Lung cancer is 22 times higher for men and 12 times higher for  women compared to those who never smoked.  

∙ Carcinogens: initiate a series of genetic mutations that stimulate  cells uncontrollably with a delay of several years generally not  developing cancer for 20-30 years until after exposure.  

∙ Cigarette smoking is exclusively linked too: leukaemia, cataracts, pneumonia, cervix, kidney, pancreas and stomach cancer.  ∙ Quitting has immediate long-term benefits such as by stopping  at 65% they have a 50% less chance of dying from a smoking  related problem.  

Biological Theory

∙ Nicotine: main active ingredient in tobacco if taken in large  quantities can be toxic and even fatal. But in small doses such as cigarettes it is able to provide weight loss, tranquilization,  increase alertness and improved cognitive functioning.  

∙ Overtime, there is a physical dependence on the nicotine. It is  absorbed within 7-10 seconds but through pipe it goes more  slowly.  

∙ It is addictive because it activates pathways in the brain that  regulate pleasure.  

∙ Key chemical is dopamine in which nicotine increases once the  effects wear off in a few minutes making them redo the action to  avoid withdrawal symptoms.  

∙ It is rewarded and reinforced thousands of times over their  lifetime.  

∙ MAO shows a decrease when smoking which is responsible for  breaking down dopamine  

∙ Twin studies show a genetic link to smoking and can create how  an addiction unfolds.  

Psychological Theory  

∙ The most frequently used model for smoking is based on learning theory.  

∙ Argues that people become smokers because of the positive  reinforcement they obtain from smoking, then they generalize to  other settings and discriminates between situations that give  them reward and others that give them punishment. (conditioned stimuli).  

∙ It can be used to escape or avoid certain aversive states.  ∙ Affect Management Model that showed six smoking motivation  factors: reduction of negative affect, habit, addiction, pleasure,  stimulation and sensorimotor manipulation for women it was  negative affect and pleasure. T home boredom and family life  frustration while at work was for routine and social was habit.  ∙ Sensation Seeking: was designed to maintain a certain base level of physiological arousal insisting that smokers have a low level of tonic arousal and seek intense stimulation and score higher on  levels of extraversion. Possibly associated with hostility and it  has been found to be associated with stress  

Social Theory  

∙ Many researchers stated that smoking had different meanings in  different social settings.  

∙ View examples above

Pharmacological Approach to Cessation  

∙ Withdrawal symptoms are relieved not by nicotine placebo but  through nicotine replacement therapy (NRT): gum, patch, nasal  spray, inhaler, tablet and lozenge.  

∙ Bupropion: zyban, is a weak dopamine and noradrenaline  reuptake inhibitor. Lasts about 7-12 weeks and inhaling tobacco  in 10 days through the course.  

∙ Varenicline: champix, is a nicotine acetylcholine receptor partial  agonist by blocking the binding and reinforcing effects.  

Psychological Approach to Cessation  

∙ Two components of counseling are effective: social support and  practical counseling concerning problem solving and skills  training.  

∙ Best associated with 8 sessions of counseling and behavior  therapy and medication.  

∙ Quit for Life Programme: includes all methods listed on the table  (page 236) and encourages a steady reduction over the course of 7-10 days then complete abstinence. Can be through group  counseling, and internet. Shows high quit rates among those in  lower SES.  

Social Approach to Cessation  

∙ Many group programs use the buddy system in which they are  paired to provide mutual support. Local organizations as well  such as the NHS and there are even internet support groups.  

Journal Articles 


– Rational Choice Theory: individuals actions are based out of self interest and the  decision making is based on rankings of what is considered to be most important.  – They say it is all based on individuals and information. They are separate matters.  – It is not the company making them smoke their products with information being  available to the consumer and THEY MAKE THE CHOICE

– Further say quitting is a matter of willpower and that it is not addictive. 

Healthy Person

– Health has become the symbol of a moral responsible self with lay concepts of  health being inter­twinned with our responsibility 

– It is something we demonstrate, not something we have to show our legitimacy  culturally and socially. 

– Primary health was strongly associated with behavioral and psychological aspects.

– Skeptic about health promotions as it can be healthy one day and not healthy the  next. 

Narratives of Back Pain 

– Something that is not visible to others 

– They are seeking objective signs as there is no pathology and the symptoms may  not correlate. 

– Narrative: restorative value in owning about telling your story and the meaning  evolves as the illness does over time. 

– It is not about the body but how it THREATENS one’s IDENTITY  – Telling their story allows them to discover themselves through the changes  – Many tried to justify their condition and want a diagnosis to know it is not their  fault. 

– Frustration with medical professionals and only want empathy. 

– We cannot assume we know everything about it. 

Main Concerns 

­ Disruption of every day activities 

­ Emotional costs and distress 

Types of Narratives 

Restitution: most common, healthy to sickness then back to healthy. How they identify  and defeat the enemy. 

Chaos: lack of order and focuses on the vulnerabilities and evoke fear. Why people avoid talking about it as it denies recognition of suffering and the opportunity to work towards  meaning. 

Quest: illness is attributed to fate or destiny. We achieve meaning by finding purpose  from the experience with the illness and recovery is not essential. 

Polyphenic: emphasis is on the present rather than the future,  uncertain.  

Biographical disruption: experience of people diagnosed with  arthritis (RA)/ Disrupts plans and hope for the future and reworking  these parameters of everyday life is known as narrative  reconstruction

Pre­Wedding Weight Concerns 

­ Should just focus on the “healthy” bride. 

­ Brides appearance is central to the perfect day

­ Internalized the thin ideal

­ Most wanted to lose 23 pounds 

­ Wedding showcases may have an impact as well 

­ Age was not correlated for weight loss 

­ 1/3 sought advice  main suggestion coming from the mom 

­ Those with higher BMI went to laxatives and waist banding. 

­ Every wedding aspect was equally important: good day, appearance and  enjoyment. 

Closing the Health Equity Gap 

­ Life chances depend greatly on where people are born 

­ Poor health is not confined to those that are worst off 

­ Unequal distribution due to poor programs and policies 

­ Social determinant actions should be based on everything, not only the health  sector 

Three Principles

­ Improve daily life conditions 

­ Tackle unequal distribution 

­ Measure issue, public awareness and expand knowledge and more developed  trained work force. 

­ Emphasized the importance of early childhood development  nutrition, social  and psychosocial development. 

­ Policies need to begin with early life  greater planning is required  ­ Part­Time vs. Full­Time. 


1. Name four key points (e.g., purpose, methods, main findings, conclusions) of  the study about pre­wedding weight concerns and health and beauty plans of  Australian brides by Prichard and Tiggemann? (4)

2. What is the extent of the problem of obesity in Canada? (3) 3. Name and describe one major theory explaining alcohol dependency (3)

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