A New National Health Agenda: Providing the Public With Accurate Information

For decades the recommendations provided by federal agencies have been decidedly one-sided, focusing on the dangers of obesity and need for weight loss. Therefore the public has been presented with incomplete and inaccurate information, which has stagnated our understanding of health. The primary objective needed for a new national health agenda is for the government to provide the public with complete and accurate information about health, weight, and dieting. In order for federal agencies and congress to promote a new national health agenda that reflects a more accurate understanding of the research, the author recommends the following policy changes: (1) the recognition of the health threat imposed by the thinness pursuit and eating disorders, (2) the promotion of weight stability rather than weight loss, (3) ensuring that the conclusions of federal agencies are neutral rather than serving special interest groups, (4) the protection of the consumer from harmful diet programs and drugs, and (5) the providing of public education campaigns emphasizing physical and psychological health rather than efforts for advancing such a national health-centered agenda.     

Fitness and Fatness in Relation to Health: Implications for a Paradigm Shift

Health care professionals most often approach health promotion for large persons in the context that health improvement can be attained only through weight loss. Unequivocal acceptance of the notion that thinness equals health and fitness has been the only health intervention strategy available for many large men and women. The apparent ineffectiveness of traditional diet and exercise programming to reduce body weight has caused many health care providers, obesity researchers, and lay persons to challenge the further use of diet and exercise for the sole purpose of reducing body weight in the large person. A brief survey of the most popular dieting techniques used over the past 40 years shows that most techniques cycle in and out of popularity, and that many of these techniques are hazardous to health. Data from the scientific community indicate that diet and exercise programs for weight loss are ineffective in producing reduced weight maintenance after a period of 3 to 5 years. On the other hand, there are data indicating that overweight men and women can become healthy without losing significant amounts of weight. Furthermore, epidemiological studies indicate that fitness, not fatness, is related to disease and mortality. Any intervention strategy for the obese should be one that promotes the development of a healthy lifestyle. The outcome parameters used to evaluate the success of such an intervention should be specific to disease risk and symptomatologies and not limited to medically ambiguous variables like body weight or body composition.     

Athletes, Athletic Performance, and Eating Disorders: Healthier Alternatives

This is a review article examining the relationship between involvement in athletics and disordered eating. According to research on risk factors in the general population, gender, race, and activities that encourage dieting or weight loss by emphasizing a thin shape play an important role in the prevalence of eating disturbance. Factors in the athletic environment that increase the athlete's risk are addressed, such as the belief among athletes and coaches that a reduction in weight or body fat can enhance athletic performance. The authors propose a shift in emphasis from athletic performance to the health of the athlete. Practical educational recommendations to reduce the athlete's risk of disordered eating are offered for athletes and sport management personnel. Additionally preventative suggestions are offered for modifying aspects of the athletic environment.     

Contradictions and Confounds in Coverage of Obesity: Psychology Journals, Textbooks, and the Media

Although obesity is not listed as a psychiatric condition in the Diagnostic and Statistical Manual of Mental Disorders, psychologists focus on obesity in their research, clinical practice, and teaching. This article reviews the methods and outcomes of the weight loss research in psychology journal articles, and discusses some of the confounds. These studies focus on comparisons among treatment conditions rather than on the low amounts of weight lost, and do not use clinical criteria for evaluating outcome. Although improvement in physical health is viewed as the reason for weight loss programs, few studies assess physical health. There has been little concern about how weight loss participants feel when they regain weight. Furthermore, the journal peer review process does not encourage paradigm shifts. The article also discusses how the results of the weight loss research studies are covered in undergraduate psychology textbooks and how they are (mis)interpreted by the media. Recommendations for a paradigm shift in the peer review process, coverage in textbooks and the media, are offered.     

Help, Not Harm: Psychological Foundation for a Nondieting Approach Toward Health

This article reviews the literature on the psychological consequences of dieting. In particular, the authors examine the impact of dieting on mood, self-esteem, cognition, and eating behavior. The famous Keys study of starvation is discussed in relations to impaired concentration, food preoccupation, negative affect, and binge eating behavior. Overall, the literature indicates that dieting has a negative impact on psychological well-being. As a result, alternative nondieting approaches toward eating are presented and recommended to promote psychological health.     

Regime change: gender, class, and the invention of dieting in post-bellum America

"Regime Change" argues against commonly held interpretations that see dieting as a practice established in the 1920s to control women at a time when they gained suffrage and greater economic independence. This article offers an alternative reading, arguing that diet advice literature arrived in the US in the 1860s and originally targeted a male, white, middle-class audience. While the hegemonic beauty ideal for the female body was at its heftiest, men started to build muscle and reduce weight. The ideal of the slender male body was associated with white superiority, social mobility and the national ambition for an American empire. When white middle-class women eventually started dieting in greater numbers in the 1890s, it was because they claimed the same mastery over their bodies as men—and demanded the same privileges as their male peers over immigrants, African Americans and working-class people, who were increasingly imagined as overweight. Revising the history of dieting to show its origins as a masculine practice appropriated by women to stake a claim to class and race privilege invites a rethinking of power and resistance in the disciplining of the female body.     

Individual and Situational Differences in Recovery from Bereavement: A Risk Group Identified

The Tübingen Longitudinal Study of Bereavement was designed to provide information on (a) health deterioration and recovery following bereavement, (b) risk factors in bereavement, and (c) selection and social desirability as potential biases in health findings in this type of research. A sample of widows and widowers were interviewed three times during the first two years following their loss. Measures of their health and well-being were compared to those of a matched sample of married individuals. Data were also collected on the health status of some of the widowed who refused participation. The findings suggest the following conclusions: (1) Partner loss is associated with an increased level of depressive and somatic symptoms during the first six months, but the majority of bereaved gradually recover over the two-year period. (2) Individuals with low internal control beliefs who have experienced an unexpected loss constitute a risk group of individuals who suffer most and recover least. (3) Due to selection, the impact of bereavement is likely to be underestimated for widowers and overestimated for widows. Implications of these findings are discussed.     

Government, Social Services Departments and the Health of Children and Young People: Which Way Forward?

Summary Despite the dearth of research into the health of children andyoung people in contact with or ‘looked after’ bylocal authorities, a series of official and quasi-official reportshave begun to raise awareness of this issue. There are goodreasons to believe that this group of children will be disadvantagedin terms of health as they are in other aspects of their lives.The evidence suggests that local authorities do not live upto the standards of ‘good parents’. Current notionsof good practice are critically appraised and the article concludesthat social work is unable to do more than mitigate the effectsof Government policies which affect health and social servicesand which have lead to widening social inequalities.     

Bad news about bad news: the disclosure of risks to insurability in research consent processes

One of the phenomena associated with research is "incidental findings," that is, unexpected findings made during the research, and outside the scope of the research, which have potential health importance. One underappreciated risk of incidental findings is the potential loss of the research subject's insurability; or if a research subject fails to disclose incidental findings when applying for insurance, the insurance contract may be voidable by the insurer. In this article, we seek to explain the insurability risks associated with incidental findings and to make recommendations for how researchers and research ethics committees should address the issue of disclosure of these risks.     

Eating habits and physical activity in dieter and non-dieter youth: A gender analysis of English and Spanish adolescents

A high prevalence of youth is overweight or obese, and a frequent lack of monitoring of their weight control strategies is observed. Consequently, this paper compares the eating habits and physical activities of male and female dieters and non-dieters. Data are obtained from the large cross-national WHO collaborative study “Health Behavior in School-aged Children 2010”. The current sample consists of 9,444 students aged 11, 13 and 15 years from England and Spain. Participants are asked about dieting, vigorous and moderate-to-vigorous physical activity, breakfast frequency and fruit, vegetable, sweet and soft drink consumption. A logistic regression is used to examine the differences between dieters and non-dieters with regard to the aforementioned eating and physical activity habits. Differences between genders, countries, and those associated with BMI (body mass index) are also considered. The results suggest that the reality of weight control differs from the major health promotion recommendations during adolescence.     

The Influence of Parental,Peer, and School Factors on Marijuana Use Among Native American Adolescents

ABSTRACT

Marijuana use among Native American (NA) adolescents continues to be an ongoing concern and is often cited as the most critical health issue facing this population. Despite this recognition, few studies have examined the roles played by parental monitoring and school relationships among NA youth. This cross-sectional study used secondary data from the 2010 National Survey in Drug Use and Health to examine the combined influence of parental, peer, and school indicators on marijuana use among NA adolescents aged 12 to 17 years old (N = 287). The results of structural equation modeling suggest that peer factors and parental monitoring were significantly associated with marijuana use. In fact, the peer network was the most influential predictor. However, a significant relationship was not found between school relationships and marijuana use. Given the insignificance of school relationships, further research should examine the influence of peer interactions on marijuana use and the development of family-based prevention and intervention programs.     

Income inequality,welfare regimes and aggregate health: Review of reviews

Wide income inequality in a society has been associated with worse aggregate health. Regarding the relationship, often termed as ‘the Wilkinson Hypothesis’, a number of empirical findings and related systematic reviews have reached inconsistent conclusions. In addition, the Scandinavian welfare regime is expected to have better aggregate health indicators in comparison with the other welfare regimes. The expectation is largely based on the Wilkinson Hypothesis because the regime has relatively narrow income inequalities. Again, related empirical findings and systematic reviews have produced inconsistent conclusions. This article reports on two rounds of ‘review of reviews’ (RR) over six previous (systematic) review articles. The first round of RR found that the review articles reached divergent conclusions. The second round of RR over another set of three review articles also demonstrated that their conclusions did not reach a consensus. Neither the hypothesised Scandinavia's good health nor the Wilkinson Hypothesis was given solid empirical backing.     

Does size really matter?: A reexamination of Sheldon's somatotypes and criminal behavior

In the mid-20th century, William Sheldon developed the idea of somatotypes in explaining different types of criminal behavior. Sheldon defined three body types believed to be associated with criminality: mesomorphs, who are athletically fit; endomorphs, who are overweight, and ectomorphs, who are characterized by fragility and thinness. Sheldon's research implied that mesomorphic individuals were more prone to committing violent and aggressive acts. This research explores a new method of somatotyping using the Body Mass Index (BMI). What follows is an examination of prisoners from the State of Arkansas, using information provided by the Arkansas Department of Correction's database on inmates. In particular, this paper examined prisoners’ physical characteristics such as age, height, and weight in comparison to the types of crimes that these prisoners committed. The findings of this paper show that the BMI is a useful alternative to traditional somatotyping techniques; the findings also suggest that a prisoner's somatotype is associated with criminal patterns while being a meager predictor of criminality. Methodological and theoretical implications of this study are discussed.     

The Fallacy of Generalizing from Egg Salad in False-Belief Research

Geraerts et al. (2008)   reported that misleading individuals with false beliefs about having gotten sick on egg salad in childhood can reduce the probability of subsequently consuming egg salad. They concluded that their results "… have important implications for people's food and dieting choices…" (p. 752). We argue that their conclusion represents a fundamental generalization problem. We report new findings that, together with other recent studies, data on disgust and the fact that hard boiled eggs produce a chemical associated with rotten food, suggest that Geraerts et al.'s success in reducing individuals' interest in eating egg salad is likely restricted to less appealing foods that are less frequently consumed. Because of potential applicability of their results to public health and well-being, and the more general applicability of the false-feedback paradigm to legal cases, it is important to accurately limit these conclusions and generalizations.     

The Relationship Between Length and Number of Homeless Episodes and Engagement in Survival Sex

Survival sex is associated with many health problems, including increased substance use and HIV risk. Current research on survival sex among homeless individuals has given little attention to the unique effects of how length and number of homeless episodes influence engagement in survival sex. Using secondary data analysis from the Washington, DC, Metropolitan Area Drug Study (DC*MADS) (N = 783), the authors examined the relationship of days and number of times homeless to engagement in survival sex, while controlling for other sociodemographic and clinical characteristics. Results showed that length of homelessness and number of homeless episodes, as well as current age, previous drug use, depression, and institutionalization, increased the odds of engaging in survival sex. Results support current efforts on interventions to transition homeless individuals into housing as rapidly as possible. Service providers assisting the homeless can affect engagement in survival sex and its associated risks through creating referral networks for integrated treatment programs for co-occurring substance use and mental health problems while advocating for early housing interventions and increased housing retention. Further research is needed regarding the ways in which length of homeless episodes affects risky behaviors such as survival sex, with a particular focus on all age groups.     

HEALTH RISK ANALYSIS AND SOCIOMEDICAL TECHNOLOGIES OF THE SELF: PRIVATE HEALTH INSURANCE GETS INTO HEALTH PROMOTION

In October 1994 the then Australian Federal Minister for Health, Dr. Carmen Lawrence, announced that Medicare, the Australian universal national healthcare fund was considering introducing Healthtrac a computerised health promotion program. The change of government in 1995 put paid to this plan, however, lifestyle based health promotion programs, including computerised programs, are an increasing trend in contemporary health care. Research from the United States indicates a growing interest by private insurers and Health Maintenance Organisations (HMOs) in funding and encouraging members, particularly older members and retirees, to engage in healthy lifestyle programs, some of which provide written reports, periodic up-dates and checks to members as well as summary advice to employers and insurers. In this article we argue that while many of these programs are well researched programs that take cognisance of the contradictions surrounding scientific research related to lifestyle behaviours, disease and disability, they take a narrow approach to health promotion. Further, in the hands of private insurers and HMOs these programs have the potential to become sociomedical techniques (Stone 1989) of dominance, arising out of risk analysis that informs and refines techniques of governance of the self (Burchell 1993; Rose 1993). Consistent with Stevensen and Burke (1991) we see health promotion not as a new social movement, but as a political strategy of the state and capitalism to deal with among other things, escalating health care budgets. Given this, health promotion strategies that overly focus on risk analysis for the individual citizen reinforce techniques of self-governance by linking lifestyle behaviour to immorality as well as potentially creating a culture of anxiety - surely a public health problem in itself.     

Evidence-based interventions with older adults: concluding thoughts

Taken collectively, the articles in this volume provide a method to assess psychosocial outcome research in aging. Although the outcome literature on effective interventions with older adults is uneven across condition and treatment approaches, there are some particular intervention methods that have received consistent research support. This article condenses the rich analyses presented by the volume authors and summarizes the interventions for which some evidence base exists by life issue/condition (health, mental health/cognitive and social rules) and outcomes achieved.     

Interpersonal Behaviour in Relation to Aboriginal Programs

Over recent years there has been increased concern for the health, education and welfare of aboriginal people. Many of the newer programs in these areas are worthwhile. As health, education and welfare services are directed at people, greater understanding of interpersonal behaviour is needed by administrators and fieldworkers if outcomes are to be improved. The importance of interpersonal behaviours such as looking, listening, talking and touching is noted. The distinctiveness of these behaviour patterns in aboriginal society is examined and their impact on programs discussed.     

Factors associated with provider self‐efficacy in delivery of evidence‐based programs for children,youth, and families

Investments in training real‐world behavioral health providers in evidence‐based programs (EBPs) can be costly; thus, it is important to understand which providers may be more or less likely to implement such approaches after training. Provider self‐efficacy is associated with implementation of EBPs, but research on factors associated with provider self‐efficacy is less common. An exploratory, cross‐sectional, quantitative survey examined factors associated with provider self‐efficacy among 150 real‐world service providers who reported delivering EBPs to children, youth, or families in one U.S. state. Factors found to be associated with higher self‐efficacy included profession, workplace support, and extent of training received; difficulty engaging families was associated with lower self‐efficacy. Self‐efficacy was found to be associated with program use but not fidelity. Several organization‐level variables were identified as both facilitators and barriers to implementation of EBPs. Implications for research and practice are discussed.