Personal Health Plan
This paper presents a personal health plan for a 31 year old client and discusses several issues in health psychology. This paper will explore health and health psychology and incorporate the philosophies of health promotion in designing a personal health plan for the client.
Health Defined
Let us commence our discussion with the different definitions of health. Health, as most of us see is merely the absence of disease. Let us view health from three different perspectives first is the Medical Model of health. The medical model of health is based upon the perspective of illness, disease and proper functioning (Larson 1991). Initially, the medical model defined health as simply the absence of disease. In the absence of disease, health exists (Chen and Bush 1979). The Wellness Model is concerned with ‘better than normal’ states, as well as subjective feelings of health. Health is conceptualize as a state of feeling, the layman’s intuitive notion of health as physical wellbeing – comfort, energy and ability to perform (Greer 1986). It is optimal personal fitness for full, fruitful creative living (Goldsmith 1972). The third model is the Holistic Model. The holistic model encompasses the whole person, including physical mental and social health. The holistic model defines health as the health of a whole person including physical but also extending to mental and social aspects of health (Larson 1991). Health, as defined by the World Health Organization (1946) is a state of complete physical, social and mental well-being and not merely the absence of disease and infirmity.
Health Psychology
Health Psychology is a field that is devoted to understanding psychological influence on how people stay healthy, why they become ill, and how they respond when they do get ill. Fundamental to the research and practice in health psychology is the definition of health. The conception of health by the health psychology perspective is based on World Health Organization’s (1948) definition of health – a complete state of physical, mental, and social well-being and not merely the absence of disease or infirmity. Rather tang defining health as the absence of illness, health is recognized to be an achievement involving balance among physical, mental, and social well-being. Many use the term wellness to refer to this optimum state of health. Health Psychology is concerned with all the aspects of health and illness across the life span. Health psychologist focus on health promotion and maintenance, which includes such issues as how to get children develop good health habits, how to promote regular exercise, and how to design a media campaign to get people to improve their diets. Health psychologists also study the psychological aspects of the prevention and treatment of illness. Health psychologists also focus on the etiology and correlates of health, illness and dysfunction. Etiology refers to the origins or causes of illness, and health psychologists are especially interested in the behavioral and social factors that contribute to health or to illness and dysfunction. Finally, health psychologists analyze and attempt to improve the health care system and formulation of health policy.
The Client: Perspective, Prior Response, Prognosis and Health Issues
The client is a 31-year-old woman who works as an office clerk. She is also a homemaker and a mother of three children. She stands 5 feet and 5 inches with the body weight of 200 pounds.
Her BMI is computed as:
Her BMI is 33.28, which is considered obese. Her weight is above the healthy range for her height that makes her more at risk for many health problems including type 2 diabetes, high blood pressure, and heart disease. Weight loss is highly recommended. Because of the client’s health problem, she encounters different challenges. During the consultation, the client revealed her perspectives and the reasons why she find it hard to commit to dieting and exercising and why it took time for her to ask for help. One of the primary reasons why the client did not commit to health interventions before was her resistance to change. She revealed her feeling about change. According to her change feels like punishment. She also revealed her reasons for hesitating to ask for help – (1) I was afraid that health professionals will not see me, but only my fat; (2) I felt like my problems were oversimplified; (3) I did not believe that the interventions can do any good, so why put myself through humiliation.
Obesity is now a leading cause of illness and death among adults in the United States and elsewhere in the world. According to Leonard (2002), the cause of obesity is the imbalance between the energy we consume and the energy we expend. Obesity is also linked to poverty and social deprivation (Marsh 2004). The Office for National Statistics (2004) in the United Kingdom has reported that obesity is linked to social class. Obesity as studies show is more common among those in the routine or semi-routine occupational groups. The increase in number of fast food restaurants are seen as one of the cause of obesity in the United Kingdom. Schlosser (2002) wrote, the obesity epidemic, which is so evident in the United States, has spread to Britain, and fast food restaurants are often blamed for it. The obesity rates among adults have doubled from 1884 to 1993 (cited in Debris 2005).
Problems to be Addressed
One of the problems that must be successfully addressed by the health professional and the client is the tendency of the client to set unrealistic goals and expectations. It is important to help the client in setting her goals as some clients tend to set unrealistic goals that they may never achieved. Setting unrealistic goals and failing to achieve them may affect the motivation and commitment of the client. Likewise, unrealistic expectations also damages the client’s motivation and commitment. Some clients believe that their lives will dramatically change once they lose weight. Another is the client’s distorted body image. Because the client have been obese for a long time, she finds it difficult to imagine herself with a healthy body. Her distorted body image may affect her motivation to lose weight and to commitment to the health plan.
The Personal Health Plan
This paper aims to design a health plan specifically designed for the client who is suffering from obesity. The health plan will be a designed by both the client and the health-care professional in order to encourage cooperation and to ensure that the client is committed to the health plan. The personal health plan is a guide that includes a few key health goals that a client set for him/herself to achieve in a period of time. The personal health plan takes into account the client’s health risk assessment, lifestyle, readiness to change, and personal health goals. It also becomes a tool for the client and the health-care professional to communicate in order to achieve the client’s optimal health. The health-care professional intends to use an individually focused health promotion approach in dealing with the health problem of the client. Beattie (1991) characterizes this kind of health promotion as being focused on the individual, either controlled in an authoritarian manner by people who claim expert status, or negotiated using techniques such as education and counseling. Individually focused health promotion emphasizes that the responsibility for ensuring good health rests with the individual.
Unhealthy lifestyle is often blamed for the emergence of obesity in the United States. Lifestyle and health are inextricably linked, and that in order to bring about improved prospects for health it is necessary to restructure the damaging effects of unhealthy lifestyles (Parish 1995). The Ottawa Charter of 1986 defined health promotion as the process of enabling people to increase control over, and to improve, their health (WHO 1986). Individually focused health promotion aims to produce behaviour change in a particular direction in order to impose a state of perfect health, but to help people to be as healthy as they wish to be. The key principle of individually focused health promotion is empowerment (Tones and Tilford 1994).
Helping the Client to Lose Weight through a Behavior Modification Program
The personal health plan that the client designed with the guidance of the health-care professional centers on lifestyle change particularly in food choices and diet and aim to encourage the client to exercise regularly. Through the personal health plan, the client intends to achieve health and wellness and to avoid the health problems associated with obesity. The personal health plan starts with the client’s diet and exercise program. In order to make the personal health plan work, the health-care provider must make use of different interventions that will increase the motivation and commitment of the client.
The health care professional used the behavioral modification approach in designing the personal health plan. The behavioral modification approach toward treating obesity begins with the assumption that eating is a behavior that is subject to change. The behavior modification program focuses on eating, exercise, and helping the client to monitor and change her behavior (Brannon and Feist 2006). Despite its name, behavior modification therapy is essentially an environmental approach to losing weight. Although the goal is to change the dieter’s behavior, there is little attempt to affect behavior directly. Instead, the basic strategy is to alter various things in the dieter’s environment that in turn will affect the dieter’s behavior (Pool 2001).
Biological
Diet and Exercises Goals
Base on the client’s weight and needs, a recommended everyday meal plan was designed. The meal plan is composed of:
1. Grains (7 ounces *3.5 ounces of which whole* daily)
2. Vegetables (3 cups daily)
3. Fruits (2 cups daily)
4. Milk (3 cups daily)
5. Meat and Beans (6 ounces daily)
The client is also encouraged to aim for at least 3.5 ounces of whole grains a day. And to eat a variety of vegetables such as dark green vegetables (3 cups weekly), orange vegetables (2 cups weekly), dry beans and peas (3 cups weekly), starchy vegetables (6 cups weekly), and other vegetables (7 cups weekly). Aside from the suggested everyday meal plan, the client is also encouraged to be physically active and to commit to a vigorous exercise routine for at least 30 minutes a day. Exercise and physical activity is expected to yield positive results on the client’s health and wellness. The benefits of exercise and physical activity are the following – (1) Improves self-esteem and feelings of well-being; (2) Increases fitness level; (3) Helps build and maintain bones, muscles, and joints; (4) Builds endurance and muscle strength; (5) Enhances flexibility and posture; (6) Helps manage weight; (7) Lowers risk of heart disease, cancer and type 2 diabetes; (8) Helps control blood pressure; (9) Reduces feelings of depression and anxiety.
Behavioral
Self-Monitoring
Self-monitoring is the most important of all behavioral interventions. It involves self-observation, self-recording, and feedback of relevant behaviors by the patient. The purpose of self-monitoring is to raise the patient’s awareness of eating and physical activity behaviors and the factors contributing to them. It includes the use of a food diary in which the patient writes down all foods eaten and the conditions or situations in which the eating occurred. The diary can be a simple, inexpensive notebook. The recording ideally should be done as soon as possible after the food is eaten. The feedback can include looking up and recording the number of calories or fat grams that each food contained. The patient should do the recording and the feedback, followed by reinforcement from the physician or behavioral counselor. In addition to recording food consumed, other behavioral patterns to write down might include time of day the food was eaten, where the food was eaten, mood state, and who else was present. The physician or behavioral counselor can then look at the diary and help identify patterns that might need to be changed. Physical activity can be recorded in the same diary. Minutes of activity, along with time of day, are usually best to record. The physician can help reward consistency, trying to build a habit of daily brisk walking.
Stimulus Control
Stimulus control involves identifying and modifying the environmental cues or barriers that are associated with the patient’s overeating and underactivity. By changing the cues, the patient may be more likely to be successful in managing eating and physical activity. Controlling these cues (stimulus control) may help the patient long term because their exposure is frequently related to relapse.
Goal Setting
Realistic goal setting, involving separating short-term goals from long-term goals, is important in preventing discouragement in the patients. In goal setting, it could be more advantageous to focus on short-term goals and reinforcing small positive behavioural changes.
Cognitive
Cognitive Behavior Therapy
Cognitive Behavior Therapy (CBT) is a semi-structured focal therapy, especially focused on the present and the future of the client. It can be delivered by a therapist or in a self-help format. In the treatment of obese subjects, the main aims of CBT are to increase the patient’s control over eating and to improve the associated psychological symptoms. Current CBT interventions typically include a number of strategies to help patients adhere to a dietary regimen and physical activity program.
Cognitive Restructuring
Cognitive restructuring involves helping patients change their inaccurate beliefs about weight loss. Cognitive restructuring encourages patients to examine their thoughts and feelings about themselves with respect to their obesity. It challenges them to change the ones that are inaccurate. Their lives may not change significantly when they lose weight. It is important to help patients understand why it is important to lose weight, such as for better health, than for unrealistic reasons (Foreyt and Paschali 2001). The focus of cognitive restructuring is to change inaccurate beliefs about weight loss by examining the patient’s thoughts and feelings, challenging inaccurate thoughts and feelings, and using self-affirmations.
Emotional
Stress Management
The correlation between stress and unhealthy coping mechanisms in well known. Many people say that they eat, drink, smoke, etc. when they are stressed. A structured and utilized stress management program may reduce the level of stress and promote healthy behavior changes. One simple stress management model involves identifying symptoms of stress (physical, psychological and behavioral), identifying stressors, developing a plan to deal with stress (may include any healthy behavior that reduces the level of stress such as exercise, reading, or taking a bath), and evaluating and modifying the plan (Reever 2008).
Social
Social Support
Patients with high levels of social support are more successful at weight loss and maintenance than those without strong support systems. Family members, good friends, participation in community-based programs and adult education programs at local colleges, or involvement in outside activities, can serve as support networks (Foreyt and Paschali 200).
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