Call for your Health

Obesity

Obesity, or overfatness, is gender specific. For men, obesity is defined as body fat equal to or greater than 25% of the total weight of the body, and for women, it is equal to or greater than 32% of the total body weight. These values are arbitrary because an optimal definition of obesity is unknown. The point at which fat storage actually increases health risks has not been determined. Methods of assessing the amount of body fat are indirect, and each contains a degree of measurement error.

Body fat values of 26% to 31% for women and 19% to 24% for men probably negatively affect health.

Overweight

Overweight refers to excessive weight for height without regard for body composition. Because the term overweight makes no allowances for body composition, it is a poor criterion for deciding desirability of weight loss. For example, well-muscled individuals may be overweight but lean in regard to body fat. By American social standards, this is healthy, aesthetically pleasing, and desirable. Other individuals may be well within the norms for total body weight but over fat; that is they carry a large proportion of their body weight in the form of fat rather than lean tissue. This is unhealthy and unattractive according to American social standards.

1. Health is a constantly changing state of being that moves along a continuum from optimal health to premature death and is affected by an individual’s attitudes and activities.
2. Wellness means to engage in activities and behaviors that enhance quality of life and maximize personal potential by consistent balancing of physical, emotional, spiritual, intellectual, and social health.
3. Living a wellness lifestyle facilitates the development of health-related fitness, which includes cardiorespiratory endurance, muscular strength, flexibility, and desirable body composition.
4. Lifestyle diseases represent the major threat to health and quality of life among Americans.
5. Personal motivation is the only way a person can adopt and maintain a wellness lifestyle. This motivation can be affected by family members and social pressure.
6. For change to occur, knowledge alone is insufficient. Attitudes and beliefs are the catalysts of behavior change because the more highly a health benefit is valued, the greater the chance of making a change and adhering to it.
7. An external locus of control is a belief that the factors controlling people’s lives are outside the people themselves and thus beyond their control. An internal locus of control is a belief in which people view themselves as being in control.
8. Self-efficacy refers to the beliefs people have in their ability to accomplish a specific task or behavior. These beliefs specifically affect ability to perform and achieve. A strong sense of self efficacy is central to self-regulation.
9. Many Americans now believe that it is possible to control many health-promoting and health inhibiting behaviors.
10. The discrepancy between health knowledge and health behavior is greatest among young adults.
11. Lifestyle change is one of the most pervasive human endeavors.
12. A fundamental belief in lifestyle-change programs is that health behavior is a learned response and therefore can be changed.
13. Health behavior is influenced by many complex forces, including family, role models, social pressure, advertising, and psychological needs.
14. The four steps in a lifestyle-change program are assessing behavior, setting specific and realistic goals, formulating intervention strategies, and evaluating progress.
15. Intervention strategies used in lifestyle change include behavioral contracts, stimulus control, positive and negative reinforcers, support groups, and behavior substitution.
16. Lifestyle change should be viewed as a learning experience rather than a test of willpower.

Wellness means engaging in attitudes and behaviors that enhance quality of life and maximize personal potential. Although wellness implies working toward a highly developed level of health, it does not mean that an individual will make the best choice in every situation or that “perfect wellness” is achievable. Wellness emphasizes the need to take responsibility for engaging in behaviors that develop optimal health. An individual’s position on this continuum is always subject to change and is affected by many factors, including physical health, activity level, nutritional patterns, personal demands, career goals, time of year, and effectiveness in managing stress. The direction you move on the continuum is largely determined by the activities you pursue and your attitudes toward these activities. These activities and attitudes can prevent illness and promote health or can destroy peace of mind and physical well-being. Because your behaviors are intrinsic to health, you must learn to assume responsibility for your health by developing the skills necessary to improve it.In the past, medicine approached wellness from a different perspective. It emphasized the treatment of diseases rather than their prevention. It demanded no more than passive participation by the patient in the decision-making process. Now people are encouraged to become active participants in their health care, to exercise control over wellness risk factors (factors or conditions that threaten wellness and increase the chances of contracting disease), to shape their lifestyles to promote health, and to serve as a partner with health care providers in making medical decisions. This approach to wellness is referred to as health promotion and places the responsibility for wellness on the individual.

Achieving a high level of wellness requires constant balance and maintenance of certain components -

• Spiritual - The belief in some force that unites human beings. This force can include nature, science, religion, or a higher power. It also includes your morals, values, and ethics. Every one has a personal perception of spirituality. The spiritual component provides meaning and direction in life and enables you to grow, learn, and meet new challenges. Optimal spirituality is your ability to discover, articulate, and act on your basic purpose in life. The spiritual dimension of wellness is different from religion. Spirituality is related to religious precepts but does not adhere to any religious structure. The importance of spirituality was confirmed recently in a study of 232 seriously ill patients who had undergone open-heart surgery. Those who were able to find strength and comfort in their religious outlook had a survival rate three times higher than those who found no strength in religious faith. The researchers found that although there was no relationship between frequency of participation in religious services and activities and recovery, there was a strong relationship between the ability to give meaning to a life-threatening situation (surgery) and recovery. They concluded that a belief in a greater force at work is medically helpful. From the wellness perspective, spirituality is the quest for a higher quality of life.
• Social - The ability to interact successfully with people and one’s personal environment. Social health is the ability to develop and maintain intimacy with others and to have respect and tolerance for those with different opinions and beliefs.
• Emotional - The ability to control stress and to express emotions appropriately and comfortably. Emotional health is the ability to recognize and accept feelings and to not be defeated by setbacks and failures.
• Intellectual - The ability to learn and use information effectively for personal, family, and career development. Intellectual wellness means striving for continued growth and learning to deal with new challenges effectively.
• Physical - The ability to carry out daily tasks, develop cardiovascular fitness, muscular fitness, maintain adequate nutrition and proper body fat level, and avoid abusing drugs and alcohol or using tobacco products. In general, physical health is an investment in positive lifestyle habits.

A major assumption of the wellness approach to living is that good health is best achieved by balancing each of these dimensions. The body, mind, and spirit are inseparably linked. When they work together in a fully unified, integrated biological system, the body can ward off or overcome many diseases. When there is a breakdown in any of these dimensions’ wellness is threatened. Although the association between disease and physical causes (for example, pathogens) is obvious, there is a reluctance by some people to accept the association between illness and the mental, social, and spiritual aspects. Nonphysical causes are intangible and difficult to assess. Nevertheless, many people experience poor health because of guilt, anger, hostility, poor interpersonal skills, loneliness, anxiety, and depression. Any of these can interfere with the body’s immune system and lay the foundation for the disease process. Medical records are replete with examples of psychosomatic diseases in which physical symptoms are caused by mental and emotional stressors. The symptoms are just as real as if caused by disease ­ producing germs. Virtually every disease involves an interplay between the dimensions of wellness. Fortunately, after a longtime obsession with medical technology, many health care providers are beginning to focus on treating the whole person, and more people are demanding more than test tube medical care.

How much control can someone expect to have over factors that influence wellness? About 53% of the factors influencing quality of life can be affected by the lifestyle of the individual. Of the factors affecting quality of life, 21 % are environmental, including public health measures, laws, and agencies that safeguard the physical environment, as well as relationships and interaction with family, friends, and the community that nurture the social environment, and 10% are affected by the physicians and health care facilities available. Altogether, 84% of the factors affecting health are within the control of the individual.

Hypothetically, 16% of the factors affecting health are beyond the individual’s control. This 16% consists of the genes and hereditary tendencies received from the parents. However, if medical history indicates a family predisposition toward a particular disease, such as heart disease, the health decisions that an individual makes can delay the onset of, minimize the effects of, or possibly prevent the disease from developing.

For example, the effects of a genetic predisposition to heart disease can be minimized significantly if the individual chooses to exercise, to follow proper nutrition guidelines, and not to smoke. Preventing disease is not always possible, but the choices an individual makes do affect his or her health and quality of life. The more wellness activities an individual engages in (unless obsessive behaviors begin to occur), the more positive the results.

If you want to, you can take action that will greatly enhance your chances of living a healthy life. A major portion of the leading causes of mortality and morbidity that plague Americans today are a direct result of what they do and do not do. Research from the IHPDP consistently demonstrates the impact and benefits of high-level wellness. More than 20 years ago, Breslow and Breslow showed in a 10 year study involving 4855 adults that there was a consistent relationship between the seven health practices identified by the IHPDP and mortality and disability. The death rate and occurrence of disability were only about one half as great among persons with good health practices as among those with poor health practices. A 10-year follow-up study by Donaldson and Blanchard demonstrated convincingly that these health practices significantly predict wellness or illness. More specifically, study participants who followed six or seven of the health practices during the previous year had the most favorable levels of vitality, positive well being, job performance, anxiety, depression, lack of self-control, and physical illness. Participants who followed four to five of the health practices had intermediate levels of wellness factors, and those who practiced only zero to three experienced 50% greater mortality and disability than those with good health practices. In identifying these benefits, it is important to acknowledge that the emphasis here is on health-related fitness. Health-related fitness is the possession of various physical attributes that reduce the probability of disease and are vital to the quality of life. The components consist of cardiorespiratory endurance, muscular endurance, muscular strength, flexibility, and body composition.

Cardiorespiratory endurance refers to the heart’s and the circulatory system’s ability to provide adequate amounts of oxygen to the cells to meet the demands of prolonged physical activity. This is the best physiological measure of total body endurance. Muscular endurance is the ability to exert repetitive muscular force. Muscular strength is the maximal force that a muscle can exert in a single contraction. Flexibility is the ability of a given joint to move through its full range of motion. Body composition refers to the amount of lean body tissue versus fat tissue.

Evidence of the benefits of wellness and the detriments of poor health is so compelling that the enhancement of health and wellness became a high priority for the United States. Since 1987, the Public Health Service of the Department of Health and Human Services has led an effort to promote health and prevent diseases by formulating national health objectives. Published in the landmark document, Healthy People 2000, National Health Promotion and Disease Prevention Objectives, these objectives provide benchmarks for judging the quality of life of the nation’s people.

How are Americans doing in achieving these objectives? Although improvements in some areas are encouraging, one deficiency is especially trouble ­ some physical activity. Of American adults, 40 to 50 million are sedentary, and the current trend is not good. Between 1985 and 1990, physical activity in all age groups declined by 10%. Furthermore, people who are active now are not active as frequently as they were 5 years ago.

Perhaps the biggest benefit of wellness is the attitude that helps each person to see life’s possibilities and to work toward the ones that are the most personally fulfilling. In this sense, it empowers people to exercise control over their wellness destiny and to accept the wellness challenge.

1. Improves cardiovascular system
2. Increases muscle tone, strength, flexibility, and endurance, resulting in improved physical appearance
3. Decreases risk of developing or dying from chronic diseases and accidents
4. Decreases recovery time after injury, illness, and childbirth
5. Regulates and improves overall body function Helps prevent some forms of diabetes Increases the ability to cope with stress and resist depression
6. Increases the energy level and job productivity and decreases absenteeism
7. Delays the aging process, and decreases recovery time after injury or illness
8. Improves awareness of personal needs and the ways to meet them
9. Increases the ability to communicate emotions to others and to act assertively rather than aggressively or passively
10. Supplies the body with proper nutrition Expands and develops intellectual abilities from a cognitive base and applies these abilities to their fullest extent in society
11. Acts from an internal locus of control
12. Learns to view life’s difficulties as challenges and opportunities rather than overwhelming threats
13. Develops self-confidence and ability to reach out to, understand, and care about others

No single strategy is right for all behaviors and all people. An individual must personalize intervention strategies that fit his or her behavioral profile and goals. Common types of strategies include use of behavioral contracts, stimulus control, positive and negative reinforcer’s, and behavior substitution.A behavioral contract is a written agreement between people in a lifestyle-change program. Although they vary in style and form, most contracts include a statement of long-range and intermediate health goals, target dates for completion of each goal, rewards and punishments, intervention strategies, and signatures of witnesses. They are not legal documents, so simplicity and creativity are encouraged. After you have drafted a contract, work out a method of graphing your progress play the contract and graph where you and others can see them. This way, they become tangible affirmations of your commitment to the agreement.

Stimulus control is a behavioral technique that involves elimination or manipulation of the circumstances associated with the undesirable behavior. One way to change a behavior is to eliminate the stimulus causing it. A smoker cannot smoke if there are no cigarettes, an ice cream binge is not possible if a trip to the ice cream parlor is refused, and loud music cannot interfere with studying if the radio is put away.

Another way to alter a behavior is to modify the stimulus. This is sometimes referred to as behavior shaping. Instead of eliminating the stimulus, the situation is modified to prompt, or “shape,” desirable behavior. For example, a student who finds it virtually impossible to study in a dormitory may try to study in a different environment, such as the library. Another student may try to improve the quality of studying by setting a study schedule that starts with a 3D-minute session and increases over time to several hours a day. When doing so, the student might record the amount of time spent studying. When studying occurs on 3 consecutive days, study time is increased in increments of 30 minutes.

The use of positive and negative reinforcer’s is fundamental to stimulus-control strategies. Positive reinforcement occurs when behavior is strengthened by way of a pleasant consequence. Physical activity, for example, may result in a positive outcome if it leads to a sense of enjoyment or accomplishment. Negative reinforcement occurs when behavior is strengthened by the avoidance of something unpleasant. Eating a low-fat diet, for example, may reinforce good nutritional practices and help maintain body weight by the avoidance of calorie dense foods. Sometimes positive and negative reinforcement occur simultaneously. By walking, for example, we may realize a positive outcome (feeling relaxed) and may at the same time reduce a negative state (excessive body weight). Although the use of positive and/or negative reinforcer’s is strictly an individual matter, most lifestyle-change programs emphasize the positive. Many people like to treat them ­ selves to rewards, which vary according to their financial resources. Rewards can include special treats, the purchase of a desired item, and participation in an enjoyable activity. You may find it helpful to think of a list of rewards for yourself. The actual achievement of a stated lifestyle goal is the strongest positive reinforcement. It provides the best incentive for continuing with a lifestyle-change program.

For many people, penalties or punisher’s serve as powerful motivators for change. For example, a student who cuts classes and is chronically late for the rest can write a contract that involves depositing $200 with a counselor. The contract may stipulate that the counselor returns $20 each week the student does not miss class or go to class late. For each week the contract is not fulfilled, the student must donate $20 to a charitable organization.

Another good stimulus-control strategy is formation of a support group, which may include a room ­ mate, family, friends, classmates, or someone who can identify with the lifestyle goal. Such a group not only provides a source of encouragement but also holds you accountable for your goals. Involving someone else in the process makes it easier to stick to your plan. Some people enjoy exercise more if they do it with a partner. Others benefit from the discipline of having another person available for reinforcement.

When you join a support group, you are publicly affirming what you plan to do and how and when you plan to do it. The good opinions of others are powerful motivators. In addition, friendships often form in a support group that last a lifetime. Support groups can be the key to success for visible health ­change programs.

Behavior substitution, in which a new behavior is substituted for the undesirable one, is the most com­mon technique used by people trying to change some aspect of their lifestyle without professional help. When this technique is applied, the goal is to think of a behavior that is incompatible with the one being altered. Examples include chewing gum to sup­press the urge to smoke, substituting diet colas for sweetened colas, and playing a game of racket ball instead of watching television.

A person should be careful that the behavior being substituted does not create a new problem while solving the old one. For example, some smokers initiate their cigarette habit as a way to control eating. In other words, they trade compulsive eating for compulsive smoking. The result is a new health habit that is more detrimental. Exercising good judgment and observing sound principles of healthy living are important when choosing substitute behaviors.

Evaluate progress

Constant monitoring is the only way to determine whether a lifestyle-change plan is working. This means assessing each goal ac­cording to the conditions and timetable specified at the beginning of the program. Consistent monitoring makes it possible to get immediate feedback about progress. This feedback can then provide a basis for continuing with the program as it is or for adjusting it. However, you should avoid the temptation to over monitor progress. Plan evaluation checkpoints at time intervals that are short enough to provide sufficient time to achieve goals but not so short that they promote preoccupation with target behaviors. Depending on the nature and complexity of the problem behavior, the timing of evaluations can range from weekly for a weight-loss program to daily for a plan to improve study habits.

Regardless of the results, maintaining the proper perspective about success and failure is important. Many people have the attitude that they either completely succeed or completely fail. This way of thinking can be devastating to a person’s motivation. When goals are not fully realized, the proper attitude is to view the shortcoming as justification for making adjustments in the program. The goals may have been too general or unrealistic. The intervention strategies may have lacked relevance. Reshaping goals, setting a more realistic schedule, changing the rewards and penalties, or formulating different intervention strategies may be necessary.

Above all, you should maintain a healthy perspective about yourself and not burden yourself with guilt if you fall short of your goals. What seems important now becomes insignificant when viewed within a broader context. You may consider how significant this event is likely to be to you 2 years from now. Doing this helps establish the right perspective on your progress. More important are the answers to the following questions,”What did you learn from this experience? What did you learn about yourself? What can you do differently?” Lifestyle change is a lifelong project that requires insight, skillful planning, and plenty of practice.

Behavior assessment, the collection of data on target behaviors, is the lifeline of any lifestyle-change plan. It involves the process of counting, recording, measuring, observing, and describing. The individual self-assesses any behavior that can be quantified.Assessment tools are usually daily logs, journals, and diaries. Data should be collected long enough to note behavioral trends, usually a minimum of 1 to 2 weeks. Sometimes a behavior assessment will prompt a change in behavior without any other action. In most lifestyle-change programs a plan of action is not started until it is clear that assessment alone will not be enough to alter the behavior completely. Bootzin illustrates this point by citing the experience of a friend.

A friend of mine discovered that he was interspersing the phrase you know in almost every sentence he spoke. He decided to try to suppress that behavior. The first step he took-as it turned out, the only step that was required-was to record the number of times he said you know. Each day that he recorded, his frequency of emitting that phrase decreased. Recording served as a sufficient intervention to bring that verbal behavior under control.

The assessment phase also provides clues to a person’s commitment to making a change in lifestyle. A thorough, detailed log is a good sign that the individual has the motivation to carry out the plan. When the assessment phase is finished, there should be sufficient information to form a behavioral profile, state specific goals, and customize an intervention program that matches goals and strategies to a person’s unique circumstances and personality.

Set specific, realistic goals

Setting specific goals means setting goals that focus on concrete, observable, measurable behaviors. A behavioral goal to overcome shyness is very different from a goal that requires a person to initiate a conversation with a different person each day for the next week. If goals are specific, you know precisely what you are trying to accomplish and where, when, and how often it will occur. By using specific goals, you get instant feedback on your progress. Another way to increase specificity is to establish a timetable for achieving goals. A timetable adds structure to the plan and provides a way to evaluate progress.

Realistic behavioral goals are reasonable and relate to personal circumstances. Setting realistic goals also means forming them in the context of correct information. For example, an informed dieter knows that setting a goal to lose 10 pounds in a week is not reasonable. A more achievable goal is 1 to 2 pounds.

When setting goals, starting off small is best. Setting a modest goal initially facilitates some degree of success, which increases confidence. For complex lifestyle changes, behavioral psychologists recommend breaking down an ambitious, long-range goal into a set of intermediate goals, beginning with the easier ones and then moving gradually to more difficult ones. Goals should be structured in moderation. Extreme goals promote the erroneous attitude that lifestyle change is temporary. They create a strong sense of denial, encourage preoccupation with target behaviors, and invariably lead to failure. Exceptions include cigarette smoking, alcoholism, and drug dependence, for which abstinence is still the primary treatment.

The key to striving for high-level wellness is motivation. No single principle or incident can provide the stimulus necessary to institute change and maintain positive lifestyle habits. To make beneficial changes, you need to understand the many influences that create individual behavior. The family initiates health habits and out­looks. Children do not begin to brush their teeth because of a concern for dental care but because their parents insist on it. Social pressure becomes increasingly important as children age. All people are influenced by the desire and need to belong or to act like someone they admire. Adolescents and teenagers are especially susceptible to wanting to “fit in,” sometimes in a way that harms their health. For example, a friend or family member who smokes may influence a youngster’s decision to begin to smoke.A significant contribution to accepting the challenge of wellness is the knowledge and attitudes as similated during a lifetime. To change their health habits, people must internalize information and consider it valuable. Unfortunately, knowledge alone is not enough to bring about change. The discrepancy between knowing what is good for health and doing it is the health-behavior gap. People know that they should wear their seat belts and that they should not smoke, yet many people do not buckle up and continue to use tobacco products. For change to occur, the persons belief system must be affected.

An attitude is a predisposition for action, that is, what people believe and value as having importance is what they are most likely to pursue. To build a sound and accurate knowledge base, people need to consider the following factors -

• Based on the information, is the person at risk for negative lifestyle consequences?
• How high a risk exists if a decision is made not to institute change?
• If a lifestyle change is made, what are the benefits or advantages?

People are motivated by what they value. For some people, motivation is in the form of attitudes (values) concerning the desire to look better, feel better, or be more self-reliant. The more highly a health benefit is valued, the greater the chance of making and adhering to the change. Support in the form of compliments from friends and family certainly helps to provide motivation and reinforcement. However, for the challenge of wellness to be accepted for a lifetime, changes must eventually be made based on an internalized desire to make that difference. The ability to achieve any health change must result from a personal, ongoing goal and not from a desire to please or impress another person. If people engage in wellness activities because the activities are important to them, the wellness challenge has been accepted.

Most people believe that they control their lifestyle. According to a survey, almost three fourths of people believed that if they eat right, do not smoke, and get regular checkups, they have a good chance of preventing cancer. An even larger number, more than 80%, believed that they can significantly reduce their chances of having a heart attack. This has motivated many Americans, especially older Americans, to work toward improved health and well-being. Older Americans are also more likely to engage in preventive health behaviors, which are health practices that promote wellness and prevent or reduce morbidity and mortality. Although the trend toward healthy living is encouraging, improvement is needed among college-age students.In a recent study, comparisons of health behaviors by age groups led to the following conclusion -

While those aged 65 or more have the best overall records for practicing good health and safety behavior, change for the better is being led by those in the middle years. And we still have not found the way to motivate young adults to start good health behavior.

A Self-Help Plan

A self-help approach assumes that individuals can manage their lifestyle changes and can learn to control those features in the environment that are detrimental to health. In other words, expensive, long-term, professional help is not a prerequisite for everyone trying to make a lifestyle change.

A fundamental assumption underlying lifestyle change programs is that behavior is a learned response. For example, we are not born with a taste for some foods and a dislike for others. And using seat belts is not a function of heredity. Like most other behaviors, health behaviors are learned responses to both obvious and subtle influences. This learning begins at birth and continues throughout life. It is important to remember that this is just as true for behaviors that promote wellness as for behaviors that diminish it.

Examples of obvious influences that help to shape behavior include parents and family, role models, advertising, and social norms. In many instances these influences are combined to form a single powerful influence on behavior, such as an advertisement for cigarettes using “ideal” masculine or feminine models, depending on the brand of cigarettes and the target population. Advertisers are successful not only at marketing products but also at influencing people to think they need various products.

Subtle forces also shape behavior. A good example is subliminal advertising, a technique in which messages, words, and symbols are embedded or hidden in the pictures, sounds, or words used in advertisements. Theoretically these messages, though not directly observable, can be perceived by the subconscious mind in such a way as to influence behavior.

Much of our behavior is also motivated by psychological needs. An infant whose main source of attention and stimulation comes during feeding time may learn to associate food with the deeper psychological needs of love and affection. A parent who consistently uses food to appease an unhappy child may be inadvertently establishing a preoccupation with food that will endure far beyond childhood.

Sometimes, behavior is motivated in response to force or coercion. Reactance motivation, a theory of behavior that has been associated with drinking among college students, suggests that telling people to abstain completely from doing something often produces the opposite reaction. For many people it isn’t difficult to recall instances in their own lives in which they behaved a certain way primarily because they were told that they could not or should not behave that way. Coercion in particular leads to the arousal of reactance, which in turn tends to reduce compliance.

These examples help to explain the myriad complex forces that contribute to behavior and illustrate why successful lifestyle change is so difficult to achieve. Although easier said than done, the hope and promise of any lifestyle-change program is that bad habits can be unlearned and new habits can be learned.

The self-help approach to lifestyle change puts you in control of your health, requires your involvement, and permits you to determine what you do and how and when you do it. However, to be successful, this approach requires considerable time and thought devoted to planning. Successful lifestyle change is almost impossible to achieve without a plan. The self-help plan that follows applies principles of behavior management and should turn your health goals into reality.

First, Take An Inventory

The first step in any lifestyle-change program is to evaluate personal health habits and practices. A good way to start is simply to make a list of your health-promoting behaviors, things you do to maintain or improve your level of wellness. Make another list of health-inhibiting behaviors, things you do that may be detrimental to your health

If your lists are specific and identify behaviors that relate to wellness in its broadest sense (that is, the physical, social, emotional, and psychological aspects of health), comparing the two should give insight and information about your lifestyle.

Detailed, comprehensive lifestyle questionnaires, such as the one that accompanies this text can provide even more information about specific health practices and behavioral tendencies that can be targeted for change. Many of these questionnaires are similar to those you might complete for your physician. Regardless of the tool you use, remember that the goal is to learn more about yourself.

Two reasonable questions to ask at this point are “Which behaviors present the greatest threat to my health?” and “Which behaviors should be targeted first for change?” The answer to the second question is strictly individual and depends on the frequency and intensity of various behaviors, genetic predisposition to certain health problems, overall health profile, personal motivation, and perhaps the answer to the first question. Each activity has an assigned weighted score based on a 10 ­point scale indicating its importance in preventing disease and promoting health. Smoking, with a score of is viewed as having the greatest effect on health. Getting 7 to 8 hours of sleep each night, with a score of has the least effect on health. However, a low score on the prevention index does not minimize the importance of an activity. All activities have a significant influence on health.

Second, Start With Right Attitude

If you have the right attitude, there are few limits to what you can do. Answering the questions in may help determine whether you are ready to start a lifestyle-change program. Most people make two serious mistakes when starting a lifestyle change. First, they expect miracles by setting unrealistic goals. Setting goals that are too ambitious often guarantees failure. For many people the fear of failure easily discourages future efforts at a lifestyle change.

Second, people often view lifestyle change as a temporary goal rather than a lifetime change. Perhaps more than anything else, this attitude accounts for the high recidivism (the tendency to revert to the original behavior) rate of many programs. Recidivism is high for most lifestyle programs. Two of the best examples are weight-loss and stop-smoking programs. In weight-loss programs, for example, people typically set a goal, diet until they reach their goal, revert to their original eating habits, and invariably regain the lost weight. The proper way is to change eating habits so that they will endure for a lifetime. When people try to change some aspect of behavior, they have to deny themselves something that feels comfortable or that provides some source of enjoyment or pleasure. Denial often triggers a preoccupation that worsens the health behavior being changed. This is the reason dieters often become more obsessive-compulsive about food during a diet. It is important to remember that the real test of a program’s success is not how many people reach their goals as it is how many people successfully maintain that goal for at least 2 years.

Striving for moderation may be more reasonable than setting goals that require abstinence or a complete reversal of behavior. For example, rather than giving up ice cream completely, a dieter can limit it to smaller portions or substitute low-fat ice cream. Rather than starting a fitness program with a 5-mile jog, an individual can start with a I-mile walk. For many people, moderation requires a higher level of learning and adjustment than abstinence. In moderation, success depends on controlling behavior, learning to live with certain stimuli, and still having the discipline to break the behavioral cycle. In abstinence, success depends on complete avoidance, usually by removing the stimulus, such as a smoker throwing away all cigarettes. A key factor in choosing either moderation or abstinence when changing. health-inhibiting behaviors is the amount of control a person has over the environment. For example, improving study habits in a college dormitory may be difficult because one person cannot control the noise and distractions of other students. In this case, study habits would be improved in a controlled environment, such as a library.

No single strategy for lifestyle change is right for everyone. The key is to get involved in planning your personal program and to use your imagination to create the most suitable plan. If you start thinking about failure, you can practice a technique called thought stopping, in which the negative thought (”I can’t improve my study habits, I’ve always failed in the past”) is replaced with a positive one (”I will do better”).

Third, Develop Plan of Action

People should follow basic principles of lifestyle management when structuring a plan of action, including

1. assessing behavior
2. setting specific and realistic goals
3. formulating intervention strategies for lifestyle change
4. evaluating progress

One hundred years ago the average life span of Americans was 47 years. Although large differences in life expectancy exist among population subgroups demographic trends suggest that more and more Americans can join the ranks of the fastest growing segment of the US population-those 85 and older ­ if they can make it past the danger zone. The danger zone is the period during which heart disease, cancer, and stroke have their greatest impact, ages 50 through 80 for men and about 10 years later for women.In 1900, communicable or infectious diseases, diseases that can be transmitted from one person to another, were the major causes of death. Influenza, pneumonia, tuberculosis, smallpox, polio, diphtheria, and dysentery were often fatal and were greatly feared. Only half of the children born at the turn of the twentieth century were expected to reach their fifth birthday, compared with a 99% survival rate today. Penicillin, insulin, and the polio vaccine had not yet been discovered. Environmental conditions were horrid, clean water and safe food could not be assumed. People generally had little control over their health, and prospects for a long life were often influenced by fate and circumstance.

Clearly, good health and longevity have improved dramatically since the turn of the century. Medical science has eliminated many of the old health threats: smallpox has been eradicated, polio is rare, tuberculosis declined so sharply that its recent mild resurgence is a surprise, and diphtheria and typhoid fever are almost gone in the United States. The impact of vaccinations to prevent these dreaded diseases is hard to exaggerate. With the exception of safe water, no other modality (not even antibiotics) has had such a major impact on mortality reduction and population growth. Governmental agencies now assume responsibility for protecting health and preventing infectious diseases. Safe water and food are assumed. An abundance of modern drugs provides a pharmaceutical solution for every conceivable ache and pain. And mind-boggling advancements in medical technology have given rise to diagnostic and surgical procedures far beyond the wildest imaginations of early twentieth century physicians.

Comparisons of the causes of mortality (incidence of deaths) and morbidity (incidence of sickness) between earlier times and today paint a revealing portrait of society. Unlike the afflictions of the early 1900s and before the major health problems of today are largely caused by the way people live and are referred to as lifestyle diseases. The leading causes of death in the United States among all age groups are heart disease, cancer, and stroke, and they account for almost two thirds of all deaths. These are chronic diseases that usually progress over a long period of time, often as the result of behaviors established early in life. Automobile accidents, homicide, and suicide are the leading killers of Americans between the ages of 15 and 24 years. For young adults, 25 to 44 years old, human immunodeficiency virus (HIV) infections, accidents, cancer, heart disease, suicide, and homicide are the leading causes of death.

For too many Americans these conditions reflect the dangers of negative lifestyle choices. This is true despite the growing anxiety over exotic diseases. The current fear that some sort of strangely mutated disease will soon pose the greatest threat to life on earth comes just as the chronic diseases that do kill in huge numbers are receiving less and less attention from developed countries. In 1994 and 1995, when worldwide attention focused on the 300 deaths from transmission of the exotic Ebola virus in Zaire, 400,000 Americans died from the effects of cigarette smoking. The fear of bizarre pathogens leading to runaway deaths in the United States has been fueled primarily by fantasy rather than reality. Newspaper headlines, numerous fictional books, and movies have reinforced this mistaken impression.

Although the appearance of an unstoppable, over whelming disease is possible and the spread of new viruses in a global community is a genuine concern, the real threats to Americans are mundane and are less likely to be featured as the lead stories in the evening news. Healthy lifestyles that involve diet, physical activity, and personal health habits offer the most potential for preventing health problems or delaying them until much later in life. More specifically the following 12 steps-for-life, developed by the internationally renowned Cooper. Institute for Aerobics Research, provide the framework for promoting health and improving the quality of life by -

1. Exercise regularly
2. Eat more fresh vegetables and fruit, high fiber foods, and whole grains, and drink more water
3. Limit animal fat, cholesterol, and sodium in the diet
4. Supplement the diet with calcium and the antioxidant vitamins
5. Pursue and maintain ideal body weight
6. Stop illegal drug use, and abstain from or limit alcohol consumption
7. Terminate smoking and use of smokeless tobacco
8. Forbid excessive sun exposure, or wear a sun block
9. Fasten seat belts
10. Obtain good prenatal health care
11. Regularly have medical checkups and perform self exams
12. Immunize preschoolers and senior citizens

Research from the Institute for Health Promotion and Disease Prevention (IHPDP) suggests that a similar, yet slightly different, list of health promotion practices correlates highly with health, longevity, and an improved quality of life.

These seven health practices include the following -

1. Sleeping 7 to 8 hours daily
2. Eating breakfast almost every day
3. Never or rarely eating between meals
4. Currently being at or near prescribed height adjusted weight
5. Participating in regular physical activity
6. Never smoking cigarettes
7. Never drinking alcohol, or drinking only in moderation

In addition to the previous two lists of health promoting behaviors, many experts emphasize the need to practice safe sex habits. HIV infections are a major health problem and a leading cause of death in young people. Sexual habits can no longer be ignored. People must consider the impact of their personal health behaviors on their health, life expectancy, and quality of life.