Transcript Obesity - Weight loss

GP Health &
Wellness
Dr. Leon Massage
Common myths
1. Self-care is ‘selfish’
2. Asking for help is a sign of weakness
3. You only practice stress management
when you really need it
4. Being relaxed means lower
performance or lack of commitment
Outline
• The causes of stress
• The consequences of stress
• Stress, health and the mind-body
connection
• Strategies for lifestyle change
• Stress management and relaxation
techniques
Wellness spiral
High level
well-being
Wellness
Holistic
focus
Average
well-being
Conventional
medical care
Demonstrable
pathology
Illness
Stress and Performance
NOT ALL STRESS IS BAD
• No stress equals no performance
– Inertia, procrastination etc
• Some stress associated with higher
performance
• Too much stress leads to diminished
performance
– Burnout, inefficient, unable to prioritize, tense
etc
The “fight or flight response”
• A natural, necessary and appropriate
physiological response to an
exceptional situation
– E.g. attack by a saber- tooth
– Response is based on a clearly perceived threat
– It is encoded into our physiology to preserve
life
– Changes include:
The “fight or flight response”
Physiological Changes
• Elevation of blood-pressure and heart rate
• Diversion of blood-flow to muscles and away
from the gut
• Platelet adhesiveness (becoming ‘stickier’ to
stop bleeding)
• Short-term mobilisation of white-blood cells
• Effects on inflammatory hormones (e.g.
cortisol, cytokines, interleukins etc)
Stress response
• ‘Fight or flight’ response is appropriate
and life protecting providing:
– It is only turned on when it needs to be
– It is allowed to turn off when it is no
longer needed
– It is not prolonged
•
Mediated primarily via sympathetic and
parasympathetic systems but interacts with every
system
The stress of modern life
• Tends to be chronic and prolonged
• Increasing at an alarming rate
– E.g. 45% increase over the last 30 years
– Could be explained by increased awareness of
stress and also more stressful and busy lives
• Stress is cumulative
• Stress reduces serotonin
The Stress Cycle
• Chemical stressors
• Emotional Stressors
• Physical Stressors
• Social stressors
• Environmental stressors
• Family stressors
Stress
Overload
The Stress Cycle- short term effects
1. Behavioural – e.g. Over eating, excess alcohol
2. Physiological – e.g. Tachycardia, hypertension
3. Emotional – e.g. Anxiety, depression, hostility
4. Cognitive – e.g. Decreased concentration
The Stress Cycle- long term effects
1. Behavioural disorders – e.g. Obesity,
alcoholism
2. Medical disorders – e.g. Hypertension, heart
disease
3. Emotional disorders – e.g. Chronic anxiety,
depression, phobias
4. Cognitive disorders – e.g. Memory problems,
insomnia
Gender and the stress response
• Men and women respond to stress differently
• Men respond to stress through ‘fight or flight’
– Predominantly sympathetic arousal accentuated by
testosterone
• Women experience ‘tend and befriend’ response
– Fight and flight moderated through oxytocin and other
hormones
– Secreted at times of bonding, nurturing, breast
feeding and relationships
• Male and female responses may have
evolutionary and adaptive implications
Stress and Perception
“Man is not disturbed by events,
but by the view he takes of
them.”
Epictetus
Stress and perception
• Mis-perception of stress can be
– Imagination
• E.g. worrying about future exams
– Rumination
• E.g. going over a past mistake
– Exaggeration
• E.g. blowing things out of proportion
• Stress is eased by:
– Focusing on the present
• E.g. performing one action at a time
– Clarifying perception
• E.g. CBT, mindfulness, relaxation, information gathering
Physiological effects of stress
reduction
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Reduction in stress hormones
Reduction in blood pressure and heart rate
Reduction in cortisol levels
Reduction in serum cholesterol
EEG changes (increase in alpha and theta waves)
Reduction in epileptic seizure frequency
Changes in neurotransmitters: higher serotonin and
dopamine
Improved immune function
Reduction of inflammation
Adjunct to therapy (CVD, cancer, chronic pain,
asthma, diabetes)
PNI - Psychoneuroimmunology
• The mind communicates with the immune
system through the nervous (and endocrine)
systems
• 2 main methods of communication
– Postal (blood-borne hormones) and cable (nerve
fibres) services
• Immune defenses include cellular (NKlymphocytes) and humoral (immunoglobulins)
immunity
PNI – clinical relevance
1. Lowered immune markers
2. Increased susceptibility to infections
3. An increased severity and progression of
infections
4. Increased relapse rate of chronic and latent
infections
5. Increased activity of inflammatory illnesses
6. Increased activity of autoimmune conditions
7. Poor response to immunisation
8. Effects on the activity of allergic conditions
Health promoting responses
to stress
1. Adaptive Behavioural responses
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Time management, Assertiveness training
2. Adaptive Physical responses
•
Nutrition, Exercise
3. Adaptive Emotional responses
•
Relaxation, meditation, CBT
Mind-Body interventions
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Stress management
CBT
Mindfulness therapy
Psychotherapy
Family therapy
Meditation / relaxation exercises
Humour
Conditioning
Prayer
Long term effects of health
promoting lifestyle responses
• Behavioural Response
Raised Self esteem,
increased confidence
• Physical Response 
Improvement in health,
improved immune response
• Emotional Response 
Improved mental health,
ability to cope with stress
Psychosocial factors and CHD
• “Recent studies provide clear and convincing
evidence that psychosocial factors contribute
significantly to the pathogenesis and expression
of CAD.”
• Data relates CAD risk to 5 specific psychosocial
domains
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depression
anxiety
personality factors and character traits
social isolation
chronic life stress
• Rozanski et al. Circulation 1999;99(16):2192-217
Is heart disease reversible?
• Heart disease is reversible given the right
conditions
• Significant improvement possible in both the
disease and quality of life.
• People with already well established CHD given
conventional medical management plus or
minus an intervention (comprehensive lifestyle
program)
• As risk factors are synergistic so too should be
positive interventions.
– Ornish D. et al. Lancet 1990;336:129-133.
The Ornish Program
• The program consisted of:
– group support
– stress management consisting of meditation
and yoga
– a low fat vegetarian diet
– moderate exercise
– stopping smoking
• Stress was central to dealing with other
risk factors
Results
Intervention
Control
Progression
82%
regressed
53% progressed
Symptom
frequency
91 
165
Duration
42 
95
Severity
28 
39
Lifestyle change and CHD
• 5 year follow-up of the Ornish program
• Most of the original intervention group
maintained changes
• Outcome measures
– angiographic changes
– risk ratio for cardiac events
• JAMA 1998;280:2001-7
What else can make us feel
better?
• Sunlight  Increases serotonin
• Exercise  Mops up stress hormones
• Dark chocolate  Contains endorphins,
antioxidant, anti-aging
• Fish  Anticarcinogenic
• Folic Acid  Suppresses dysplasia
GP Health & Wellbeing
Questions & Discussion
Dr. Leon Massage