Essential Hypertension, Recurrent Head Ache , Psychogenic physical diseases, Biological factors, psychological Measures, Socio-cultural measure, Diabetes, Obesity, Cardiovascular Disorders

1. Psychological Factors in Health
and Disease
Essential Hypertension, Recurrent Head
Ache , Psychogenic physical diseases,
Biological factors, psychological Measures,
Socio-cultural measure, Diabetes, Obesity,
Cardiovascular Disorders
Topic

3. HYPERTENSION
• Also known as high blood pressure or
cardiovascular disease (CVD) .
• Occurs when the supply of blood through the
vessels is excessive.
• It can occur when cardiac output is too high,
which puts pressure on the arterial walls as
blood flow increases.
• It also occurs in response to peripheral
resistance—that is, the resistance to blood flow
in the small arteries of the body.
• Hypertension is a serious medical problem.

4. • Hypertension is a risk factor for other
disorders, such as heart disease and kidney
failure.
• Untreated hypertension can affect cognitive
functioning, producing problems in learning,
memory, attention, abstract reasoning, mental
flexibility, and other cognitive skills (Brown,
Sollers, Thayer, Zonderman, & Waldstein,
2009).
• These problems are particularly significant
among young hypertensive (Waldstein et al.,
1996).

5. • Hypertension is the condition of having high
blood pressure consistently over several
weeks or more—is a major risk factor for CHD
(Coronary Heart Diseases), stroke, and kidney
disease (AHA, 2010; NKF, 2006).
• Lesser elevations in blood pressure are now
known to increase risk substantially, current
guidelines designate less than 120/80 as
‘‘normal,’’ or conveying little risk. Prevalence
rates for hypertension increase in adulthood,
particularly after about 40 years of age
(NCHS, 2009a).

6. • Some cases of hypertension are caused by, or are
secondary to, disorders of other body systems or
organs, such as the kidneys or endocrine system.
• Secondary hypertension can usually be cured by
medical procedures.
• But the vast majority—over90%—of hypertensive
cases are classified as primary or essential
hypertension, in which the causes of the high
blood pressure are unknown.

7. • In cases of essential hypertension, physicians are unable to
identify any biomedical causes, such as infectious agents or
organ damage.
• But many risk factors are associated with the development
of hypertension—and there is evidence implicating the
following as some of the risk factors for hypertension (AHA,
2010; Hajjar, Kotchen, & Kotchen, 2006):
• Obesity
• Dietary elements, such as high salt, fats and cholesterol
• Excessive alcohol use
• Physical inactivity
• Family history of hypertension
• Psychosocial factors, such as chronic stress, anger, and
anxiety

9. Blood Pressure Categories (values in
mm Hg units)
Category Systolic Diastolic
Normal (recommended) Less than 120 and Less than 80
Prehypertension 120–139 or 80–89
Hypertension: Stage 1 140–159 or 90–99
Hypertension: Stage 2 160 or higher or 100 or higher

10. How Is Hypertension Measured?
• Hypertension is assessed
by the levels of systolic
and diastolic blood
pressure as measured by
a Sphygmomanometer.

11. • Systolic blood pressure: The
greatest force developed
during contraction of the
heart’s ventricles.
• Diastolic pressure : The
pressure in the arteries
when the heart is relaxed; it
is related to resistance of the
blood vessels to blood flow.
• Of the two, systolic pressure
has somewhat greater value
in diagnosing hypertension,
and keeping systolic blood
pressure under 120 is best.

13. • Mild hypertension: A systolic pressure
consistently between 140 and 159.
• Moderate hypertension: Involves a systolic
pressure consistently between 160 and 179.
• Severe hypertension: A systolic pressure
consistently above 180.

14. CAUSES OF HYPERTENSION
1. Genetic factors
If one parent has high blood pressure, the off spring
have 45 percent chances of developing it; if two
parents have high blood pressure, the probability
increases to 95 percent.
As is true for coronary heart disease, the genetic
factor in hypertension may be reactivity, a
predisposition toward elevated sympathetic
nervous system activity especially in response to
stressful events.
Reactivity predicts higher future blood pressure.

15. 2. Emotional factors
These are also implicated in this constellation of risk.
Depression, hostility, and frequent experiences of
intense arousal predict increases in blood pressure
over time.
Anger, cynical distrust, hostility, and excessive
striving in the face of significant odds have all been
implicated in the development of hypertension.
Rumination following stressful events may prolong
cardiovascular reactivity and contribute to the
development of CVD( Cardio Vascular Diseases).
Repressive coping may also be a significant
contributor.

16. 3.Family environment
That fosters chronic anger is also implicated.
In contrast, children and adolescents who
develop social competence skills have a
reduced risk for CVD.
Such observations suggest the importance of
intervening early in the family environment to
modify communication patterns.

17. 4. Stress
Chronic social conflict, job strain, namely, the
combination of high demands with little control,
and crowded, high-stress, and noisy locales all
produce higher rates of hypertension.
Low SES in childhood and in adulthood both
predict risk for cardiovascular disease.
Groups that have migrated from rural to urban
areas have high rates of hypertension.
In women, elevated blood pressure has been
related to having extensive family responsibilities,
and among women in white-collar occupations,
the combined impact of family responsibilities
and job strain.

18. TREATMENT OF HYPERTENSION
Most commonly, it is treated through
drugs.
Patients are also put on low-sodium diets
and urged to reduce their consumption of
alcohol.
Weight reduction in overweight patients
is strongly urged, and exercise is
recommended for all hypertensive
patients.
Caffeine restriction is often included as
part of the dietary treatment of
hypertension, because caffeine, in
conjunction with stress, elevates blood
pressure responses among those at risk
for or already diagnosed with
hypertension.

19. Cognitive-Behavioural Treatments
A variety of cognitive-behavioural methods
have been used to treat high blood pressure.
These include biofeedback, progressive
muscle relaxation, hypnosis, and meditation,
all of which reduce blood pressure via the
induction of a state of low arousal.
Deep breathing and imagery are often added
to accomplish this task.

20. Evaluation of Cognitive-Behavioural
Interventions
Of the nondrug approaches, weight reduction,
physical exercise, and cognitive-behavioural
therapy appear to be quite successful.
Moreover, cognitive-behavioural methods are
inexpensive and easy to implement: They can
be used without supervision, and they have
no side effects.

21. Cognitive-behavioural interventions may reduce
the drug requirements for the treatment of
hypertension, and accordingly be especially
helpful to those people who do not tolerate the
drugs well. CBT appears to be especially
successful with mild or borderline hypertensive
and, with these groups, may actually substitute
for drug control.
Hypertension is symptomless. At present, the
combination of drugs and cognitive-behavioural
treatments appears to be the best approach to
the management of hypertension.

22. The Hidden Disease
One of the biggest problems in the treatment of
hypertension is that so many people who are
hypertensive do not know that they are.
Hypertension is largely a symptomless disease, and many
thousands of people who do not get regular physicals
suffer from hypertension without realizing it. Yet they
experience the costs in a lower quality of life,
compromised cognitive functioning, and fewer social
activities, nonetheless.

23. • National campaigns to educate the public about
hypertension have had some success in getting people
diagnosed.
• Worksite screening programs have been successful in
identifying people with hypertension.
• Increasingly, community interventions enable people to
have their blood pressure checked by going to mobile
units, churches or community centres, or even the local
drugstore. The widespread availability of these
screening programs has helped with early identification
of people with hypertension.

25. • Headache is a clinical syndrome affecting over 90%
of the population at some time during their life,
resulting in it being considered a major public health
issue (Mannix, 2001).
• It is the seventh leading presenting complaint in
ambulatory care in the United States.
• This significantly decreases quality of life, much more
so than many other chronic illnesses.

26. TYPES OF RECURRENT HEADACHE
RECURRENT
HEADACHE
Migraine headacheTension-type

28. Tension-type (or muscle contraction)
headache
Seems to be caused by a combination of a central
nervous system dysfunction and persistent contraction
of the head and neck muscles (AMA, 2003; Holroyd,
2002).
The pain it produces is a dull and steady ache that
often feels like a tight band of pressure around the
head.
Recurrent tension-type headaches occur twice a week
or more, and may last for hours, days, or weeks.

29. Migraine headache
• Seems to result from dilation blood vessels surrounding the
brain and a dysfunction in the brainstem and trigeminal
nerve that extends throughout the front half of the head
(AMA, 2003; Goadsby, 2005; Holroyd, 2002).
• The pain often begins on one side of the head near the
temple, is sharp and throbbing, and lasts for hours or,
sometimes, days.
• Sometimes migraines begin with or follow an aura, a set of
symptoms that signal an impending headache episode.
These symptoms usually include sensory phenomena, such
as seeing lines or shimmering in the visual field. This may
be accompanied by dizziness, nausea, and vomiting.
• Recurrent migraine is marked by periodic debilitating
symptoms, which occur about once a month, with
headache-free periods in between.

30. • Most adults and children have headaches at
least occasionally, and tension-type
headaches are common (AMA, 2003).

31. MEASUREMENT OF HEADACHE PAIN
Headache Diary
• Patients were asked to rate pain intensity on an hour-
by-hour, day-by-day basis on recording grids
reproduced on pocket-sized cards.
• Medication consumption was monitored as well.
Because change in headache could occur along varied
dimensions, several different indices were examined:
frequency, duration, severity (peak or mean level), and
Headache Index/Activity, a composite or derived
measure that incorporated all dimensions (calculated
by summing all intensity values during which a
headache was present). This latter measure was
believed to reject the total burden or suffering of
patients.

32. • International Headache Society, 1999
recommend that the following serve as the primary
diary-based measures of headache pain:
1. Number of days with headache in a four-week period.
2. Severity of attacks, rated on either (a) a 4-point scale,
where 0 no headache, 1 mild headache (allowing normal
activity), 2 moderate headache (disturbing but not
prohibiting normal activity, bed rest is not necessary), and
3 severe headache (normal activity has to be
discontinued, bed rest may be necessary) or (b) a visual
analogue scale, wherein one end is anchored as •none
and the other as •very severe.

33. 3. Headache duration in hours.
4. Responder rate, the number or percentage of
patients achieving a reduction in headache days or
headache duration per day that is equal to or greater
than 50%. (This is in accord with the recommendations
of Blanchard & Schwarz, 1988.)

34. Supplementary Approaches
A number of supplementary and alternative approaches have
been developed to assess headaches, and these are reviewed
in greater depth in Andrasik (2001a). Four approaches may be
easily adopted by practitioners and researchers:
1. Measurement of multiple aspects of pain, specifically
affective/reactive as well as sensory/intensity.
2. Social validation of patient improvement.
3. Measurement of pain behavior or behavior motivated by
pain, including medication consumption. 4. Impact on other
aspects of functioning, such as general health or overall
quality of life, physical functioning, emotional functioning,
cognitive functioning, role functioning, and social well-being.

35. HEADACHE TREATMENT
Pharmacological Treatment
• Headaches are most commonly managed with
a combination of medication and advice from
the treating clinician.
• A number of effective pharmacologic options
are available to treat headaches and these
may be categorized into three broad classes:
symptomatic, abortive, and prophylactic
medications.

36.  Symptomatic Medications
• These are consumed during the occurrence of
headache to provide relief from pain.
• Symptomatic medications are pharmacologic
agents with analgesic or pain relieving effects.
These include:
 Counter analgesics (i.e., aspirin, acetaminophen)
 No steroidal anti-inflammatory agents (i.e.,
ibuprofen)
 Opioid analgesics
 Muscle relaxants
 Sedative / hypnotic agents

37.  Abortive medications
• Pharmacologic agents that are consumed at the onset
of a migraine headache, in an effort to terminate or
markedly lessen an attack.
• Ergotamine tartrate preparations were the mainstays
of abortive care until the early 1990s when Triptan,
designed to act on specific serotonin receptor
subtypes, were introduced.
• Multiple triptan formulations are now available,
differing with respect to potency, delivery mode (oral
vs. other, for patients likely to vomit during attacks),
time of peak onset, duration of sustained headache
relief, rate of headache recurrence, improvement in
associated symptoms, safety, and tolerability.

38.  Prophylactic Medications
• Prophylactic medications are consumed daily in an
effort to prevent headaches or reduce the
occurrence of attacks in the chronic sufferer.
• Beta blockers, calcium channel blockers, and
antidepressants (e.g., Tricyclic, serotonin-specific
reuptake inhibitors) are used most frequently as
prophylactic medications for migraine headache .
• For tension-type headache, the most commonly
administered medications include tricyclic and
other antidepressants, muscle relaxants, non-
steroidal anti-inflammatory agents, and
miscellaneous drugs.

39. • Several other risks may be associated with
chronic/frequent use of headache medications,
including the potential for rebound headache, the
possibility of drug-induced chronic headache,
reduced efficacy of prophylactic headache
medications, potential side effects, and acute
symptoms associated with the cessation of headache
medication (such as increased headache, nausea,
cramping, gastrointestinal distress, sleep
disturbance, and emotional distress) .

40.  Non- pharmacological Treatments
• Three basic approaches are designed for treating recurrent
headache disorders.
• (a) To promote general overall relaxation either by therapist
instruction alone (e.g., progressive muscle relaxation,
autogenic training, meditation) or therapist instruction
augmented by feedback of various physiological parameters
indicative of autonomic arousal or muscle tension to help fine
tune relaxation (e.g., temperature, electro- myographic, or
electro dermal biofeedback)
• (b) To control, in more direct fashion, those physiological
parameters assumed to underlie headache (e.g., blood flow
and electroencephalographic biofeedback)
• (c) To enhance abilities to manage stressors and stress
reactions to headache (e.g., cognitive and cognitive behavior
therapy).

41. BEHAVIORAL TREATMENT
A Biobehavioral Model of Headache
• The Biobehavioral model, which guides treatment of
headache, states that the likelihood of any individual
experiencing headache depends on the specific
pathophysiological mechanisms that are triggered by the
interplay of the individuals physiological status (e.g.,
level of autonomic arousal), environmental factors (e.g.,
stressful circumstances, certain foods, alcohol, toxins,
hormonal fluctuations), the individual’s ability to cope
with these factors (both cognitively and behaviourally),
and consequential factors that may serve to reinforce,
and thus increase, the person’s chances of reporting head
pain.

42. IMPLEMENTATION
Relaxation Training
1. Progressive muscle relaxation
2. Autogenic training
Transcendental Meditation and self-hypnosis
have also been applied, but not extensively.
Biofeedback
EMG (ElectromyGram), Thermal, Electro
dermal, Cephalic vasomotor, Trans cranial
Doppler, and EEG(Electroencephalography)
biofeedback

43. Cognitive Behavioural Interventions
This type of therapy has been labelled variously as
cognitive behavior therapy, cognitive stress coping
therapy, cognitive therapy, stress management, or
other terms.
BEHAVIORALTREATMENT PLANNING
• Headache type
• Frequency, and chronicity
• Age and gender
• Comorbid psychological disorder or distress
• Environmental factors
• Treatment history

44. Minimal Therapist Contact Interventions
Patient Preference and Cost Effectiveness
Treatment Format and Delivery
Group Treatment
Treatment Algorithms
Treatment algorithms for the integration of
behavioural and pharmacological therapies for
recurrent migraine and tension-type headache .

46. • Physical illnesses that are believed to arise from
emotional or mental stressors, or from psychological or
psychiatric disorders.
• Most commonly applied to illnesses where a physical
abnormality or other biomarker has not yet been
identified.
• In the absence of such "biological" evidence of an
underlying disease process, it is often assumed that the
illness must have a psychological cause, even if the
patient shows no indications of being under stress or of
having a psychological or psychiatric disorder.

47. Examples of diseases that are believed
by many to be psychogenic include:
• Psychogenic seizures
• Psychogenic polydipsia
• Psychogenic tremor
• Psychogenic pain
• It always remains possible that genetic,
biochemical, electrophysiological, or other
abnormalities may be present which we do not
have the technology or background to identify.

48. • The term psychogenic disease is often used in
a similar way to psychosomatic disease.
However, the term psychogenic usually implies
that psychological factors played a key causal
role in the development of the illness.
• The term psychosomatic is often used in a
broader way to describe illnesses with a
known medical cause where psychological
factors may nonetheless play a role
(e.g., asthma can be exacerbated by anxiety).

49. • A functional symptom is a medical symptom,
with no known physical cause.
• It arises from a problem in the ‘functioning’ of
the nervous system, and not due to a
structural or pathologically defined disease.
• Functional symptoms are increasingly viewed
within a framework in which psychological,
physiological and biological factors should be
considered to be relevant.

50. • A common trend is to see functional
symptoms and syndromes such
as fibromyalgia, irritable bowel
syndrome and functional neurological
symptoms such as functional weakness as
symptoms in which both biological and
psychological factors are relevant, without one
necessarily being dominant.

51. Weakness
• Functional weakness is weakness of an arm or leg without
evidence of damage or a disease of the nervous system.
• Experience symptoms
• Limb weakness which can be disabling and frightening such
as problems walking or a ‘heaviness’ down one side,
dropping things or a feeling that a limb just doesn’t feel
normal or ‘part of them’.
• Functional weakness may also be described as functional
neurological symptom disorder (FNsD), Functional
Neurological Disorder (FND) or functional neurological
symptoms. If the symptoms are caused by a psychological
trigger, it may be diagnosed as 'dissociative motor disorder'
or conversion disorder (CD).
• To the patient and the doctor it often looks as if there has
been a stroke or have symptoms of multiple sclerosis.

52. Diagnosis
• should be made on the basis of positive features in the
history and the examination (such as Hoover's sign).
• Treatment
• Physiotherapy, however it is also helpful for patients to
understand the diagnosis.
• CBT helps them to cope with the emotions associated
with being unwell.
• For those with conversion disorder, psychological
therapy is key to their treatment as it is emotional or
psychological factors which are causing their
symptoms.

53. • Giveway weakness (also "give-away weakness",
"collapsing weakness", etc.) refers to a symptom
where a patient's arm, leg, can initially provide
resistance against an examiner's touch, but then
suddenly "gives way" and provides no further
muscular resistance

54. Other Symptoms
• Muscle pains
• Stomach pains
• Back pains
• Headaches

55. Treatment
• Non-narcotic painkillers (think NSAIDs like
acetaminophen or ibuprofen)
• Psychotherapy
• Antidepressants

57. • The body needs glucose to fuel metabolic processes, but
too much of it in the blood over a long period of time—a
condition called hyperglycemia—is the mark of diabetes
mellitus.
• The body normally controls blood sugar level switch the
hormone insulin, which the pancreas produces. In the
disorder of diabetes, however, abnormal levels of glucose
accumulate in the blood because the pancreas either does
not produce sufficient insulin or the body no longer
responds normally to insulin (ADA, 2006; AMA, 2003).
Diabetes is a prevalent illness—about 180 million people
around the world have been diagnosed with it (WHO,
2007).

58. TYPES AND CAUSES OF DIABETES
1. TYPE I DIABETES
• An autoimmune disorder
• Type 1 diabetes (formerly called insulin-
dependent diabetes) typically develops in
childhood or adolescence and accounts for 5
to 10% of cases.
• In Type 1, autoimmune processes have
destroyed cells of the pancreas that normally
produce insulin, a hormone that enables body
cells to use glucose.

59. • Type 1 diabetics require insulin injections to
prevent acute and very serious complications
(ADA, 2006; AMA, 2003). One such acute
complication in type 1 diabetes is
ketoacidosis, in which high levels of fatty acids
in the blood lead to kidney malfunctions,
thereby causing wastes to accumulate and
poison the body.
• Symptoms of ketoacidosis are subtle at first,
but advance to nausea, vomiting, abdominal
pain, and labored breathing. If untreated,
ketoacidosis can lead to coma and death in a
matter of days or weeks.

60. • Type I diabetes is an autoimmune disorder
characterized by the abrupt onset of symptoms,
which result from lack of insulin production by
the beta cells of the pancreas. The disorder may
appear following viral infection and probably has
a genetic contribution.
• Stress may precipitate Type I diabetes in
individuals with a genetic risk.
• Type I diabetes usually develops relatively early in
life, earlier for girls than for boys. There are two
common time periods when the disorder arises:
between the ages of 5 and 6 or between 10 and
13.

61. • The most common early symptoms are
frequent urination, unusual thirst, excessive
fluid consumption, weight loss, fatigue,
weakness, irritability, nausea, uncontrollable
craving for food (especially sweets), and
fainting.
• These symptoms are due to the body’s
attempt to find sources of energy, which
prompts it to feed off its own fats and
proteins. By-products of these fats then build
up in the body, producing symptoms; if the
condition is untreated, a coma can result.

62. • Type I diabetes is a serious, life-threatening
illness accounting for about 10 percent of all
diabetes. It is managed primarily through direct
injections of insulin— hence the name insulin-
dependent diabetes.
• The Type I diabetic is especially vulnerable to
hyperglycemia. When this occurs, the skin is
flushed and dry, the person feels drowsy and has
deep, labored breathing; vomiting may occur, and
the tongue is dry; thirst is common, and
abdominal pain may occur. Coma may result,
requiring hospitalization.
• Stress aggravates Type I diabetes. The changes
imposed by diabetes often lead to risk for
psychological difficulties including depression,
anxiety, and behavior problems.

63. MANAGING TYPE I DIABETES
• Controlled through regular drug treatments.
• Nonetheless, at present, active involvement of the
patient as a co-manager in the disease treatment
process is essential to success. This management
typically involves regular insulin injections, dietary
control, weight control, and exercise.
• The number of calories taken in each day must be
relatively constant. Food intake must be controlled by a
meal plan and not by temptation or appetite.

64. • When blood glucose levels are actively controlled
through such methods, the likelihood and
progression of diabetes related disorders, including
eye disease, kidney disease, and nerve disorders, can
be reduced by more than 50 percent (National
Institute on Diabetes and Digestive and Kidney
Disorders, 1999).

65. When the Diabetic Is a Child or
Adolescent
• Normal adolescent development involves a growing sense
of autonomy and independence from parents, but this
otherwise healthy change can lead to less cooperation
between teens and parents in managing diabetes and to
less control over blood sugar. Adherence to glucose
monitoring and diet declines with age in adolescence, and
blood sugar control also decreases.
• Adolescent diabetics can generate solutions that would
enable them to adhere, but they often succumb to peer
pressure, such as in drinking. Non-compliance is probably
not the only reason for decreased glucose control in
adolescence, as hormonal changes may make controlling
blood glucose more difficult.

66. 2. TYPE 2 DIABETES
• In this form, the pancreas produces at least some insulin,
and treatment may not require insulin injections. Most, but
not all, people with type 2 diabetes can manage their
glucose levels with diet and medication (AMA, 2003).
• Although type 2 diabetes can develop at any age, it usually
appears after age 40. Most type 2 patients are very
overweight, and many produce substantial amounts of
insulin—sometimes more than normal—but their bodies
seem to ‘‘resist’’ the glucose-controlling action of insulin.
Some ‘‘pre-diabetic’’ individuals have moderately high
levels of blood glucose and evidence of insulin insensitivity,
before later reaching the levels required for the Type 2
diagnosis.
• Normal-weight type 2 patients seem to produce reduced
levels of insulin. In either case, hyperglycemia results.

67. TYPE II DIABETES
• Type II diabetes is the third most common chronic illness
in this country and one of the leading causes of death
(Centres for Disease Control and Prevention, 2011,
January).
• Recently, Type II (or non-insulin-dependent) diabetes was
typically a disorder of middle and old age. As obesity has
become rampant and the consumption of sugary foods
and drinks has increased,
• Type II diabetes, to which these factors are contributors,
has become more prevalent, especially at earlier ages.
• Children and adolescents are now at risk for Type II
diabetics, and moreover, the disease progresses more
rapidly and is harder to treat in younger people.
• As a result, Type II diabetes is a major and growing health
problem.

68. Digested food
• Rising levels of glucose in the blood trigger the pancreas
to secrete insulin into the bloodstream.
• When this balance goes away, it sets the stage for Type
II diabetes.
• First, cells in muscle, fat, and the liver lose some of their
ability to respond fully to insulin, a condition known as
insulin resistance.
broken down
Glucose
(carbohydrates)
absorbed from
Intestines Blood
travels to
Liver and other organs

69. • In response to insulin resistance, the pancreas
temporarily increases its production of insulin.
• At this point, insulin producing cells may give out, with
the result that insulin production falls, and the balance
between insulin action and insulin secretion becomes
dysregulated, resulting in Type II diabetes.
• The majority of Type II diabetics are overweight (90
percent), and Type II diabetes is more common in men
and people over the age of 45 (American Diabetes
Association, 2012).

70. Symptoms
• Frequent urination
• Fatigue
• Dryness of the mouth
• Impotence
• Irregular menstruation
• Loss of sensation
• Frequent infection of the skin, gums, or urinary
system
• Pain or cramps in legs, feet, or fingers
• Slow healing of cuts and bruises
• Intense itching and drowsiness

71. World Diabetes Day: History
• World Diabetes Day celebration on 14 November
marked the birthday of Sir Frederick Banting for
the discovery of insulin with Charles Best in 1922.
International Diabetes Federation and World
Health Organization established World Diabetes
Day in 1991 to highlight about the escalating
health threat posed by diabetes. In 2006, World
Diabetes Day became an official United Nations
Day by passing United Nation Resolution 61/225.
•

72. World Diabetes Day 2019 :
14 November , Thursday
• Theme
• The theme of World Diabetes Day 2019 and
Diabetes awareness month is 'Family and
Diabetes'.

73. World Diabetes Day 2020
• 14 November, Saturday

75. OBESITY
• “Abnormal or excessive fat accumulation that
presents a risk to health".
- WHO
• Obesity is an excessive accumulation of body fat.
Generally, fat should constitute about 20–27
percent of body tissue in women and about 15–
22 percent in men.
• Obesity is now so common that it has replaced
malnutrition as the most prevalent dietary
contributor to poor health worldwide.

76. World Health Organization Classification of Overweight
According to BMI and Risk of Comorbidities
Category BMI (kg/m2) Disease Risk
Underweight <18.5 Low*
Normal weight 18.5…24.9 Average
Overweight >25.0
Pre-obese 25.0…29.9 Increased
Obese Class 30.0…34.9 Moderate
Obese Class II 35.0…39.9 Severe
Obesity Class III >40.0 Very severe
*There is an increased risk of other clinical problems
(e.g., anorexia nervosa).

78. RISKS OF OBESITY

79. • Poor cognitive functioning as well.
• Early mortality. People who are overweight at age 40
die, on average, 3 years earlier than people who are
thin.
• Abdominally localized fat, as opposed to excessive fat
in the hips, buttocks, or thighs, is an especially potent
risk factor for cardiovascular disease, diabetes,
hypertension, cancer, and decline in cognitive function.
• People with excessive abdominal weight (sometimes
called “apples,” in contrast to “pears,” who carry their
weight on their hips) are more psychologically and
physiologically reactive to stress.

80. • Fat tissue produces pro-inflammatory cytokines, which
may exacerbate diseases related to inflammatory
processes. Often ignored among the risks of obesity is
the psychological distress that can result.
• There are social and economic consequences of obesity
as well. An obese person may have to pay for two seats
on an airplane, have difficulty finding clothes, endure
derision and rude comments, and experience other
reminders that the obese, quite literally, do not fit.
• The resulting effect of repeated exposure to others’
judgments about their weight can be social alienation
and low self-esteem.

81. OBESITY IN CHILDHOOD
• Nearly two thirds of overweight and obese
children already have risk factors for
cardiovascular disease, such as elevated blood
pressure, elevated lipid levels, or
hyperinsulemia.

83. Obesity and Dieting as Risk Factors for
Obesity
• Many obese people have a high basal insulin level, which
promotes overeating due to increased hunger. Moreover,
the obese have large fat cells, which have a greater
capacity for producing and storing fat than do small fat
cells.
• Dieting contributes to the propensity for obesity.
Successive cycles of dieting and weight gain, so-called
yo-yo dieting , enhance the efficiency of food use and
lower the metabolic rate.
• When dieters begin to eat normally again, their
metabolic rate may stay low, and it can become easier for
them to put on weight again even though they eat less
food.

84. Set Point Theory of Weight
• Evidence has accumulated for a set point theory of
weight: the idea that each individual has an ideal
biological weight, which cannot be greatly modified.
• According to the theory, the set point acts like a
thermostat regulating heat in a home. A person eats
if his or her weight gets too low and stops eating as
the weight reach its ideal point.
• Some people have a higher set point than others,
leading to a risk for obesity. The theory argues that
efforts to lose weight may be compensated for by
adjustments in energy expenditure, as the body
actively attempts to return to its original weight.

85. Stress and Eating
• Stress affects eating, although in different ways for
different people.
• About half of people eat more when they are under
stress, and half eat less. For non-dieting and non-obese
normal eaters, stress or anxiety may suppress
physiological cues of hunger, leading to lower
consumption of food.
• Stress and anxiety, however, can disinhibit food
consumption, removing the self-control that usually
guards against eating. Whereas men tend to eat less in
stressful circumstances, many women eat more.

86. • Stress also influences what food is consumed. People
who eat in response to stress usually consume more
low calorie and salty foods, although when not under
stress, stress eaters show a preference for high-calorie
foods.
• Anxiety and depression figure into stress eating as well.
One study found that stress eaters experience greater
fluctuations in anxiety and depression than do non-
stress eaters. Overweight people also have greater
fluctuations in anxiety, hostility, and depression than do
normal individuals .
• People who eat in response to negative emotions show
a preference for sweet and high-fat foods (Oliver,
Wardle, & Gibson, 2000).

87. INTERVENTIONS
1. Dieting
2. Surgery
• Stomach is literally stapled up to reduce its capacity to hold
food, so that the overweight individual must restrict his or her
intake.
• Lap Band Surgery, an adjustable gastric band is inserted
surgically around the top of the stomach to create a small
pouch in the upper stomach to reduce the stomach’s capacity
to take in food.
• There are potential side effects such as gastric and intestinal
distress. Consequently, this procedure is usually reserved for
people who are at least 100 percent overweight, who have
failed repeatedly to lose weight through other methods, and
who have complicating health problems that make weight loss
urgent.

89. 3. Cognitive Behavioural Therapy (CBT)
• Many interventions with the obese use CBT to combat
maladaptive eating behaviour.
4. Screening
• Some programs begin by screening applicants for their
readiness to lose weight and their motivation to do so.
Unsuccessful prior dieting attempts, weight lost and
regained, high body dissatisfaction, and low self-
esteem can all undermine weight loss efforts (Teixeira
et al., 2002).
5. Self-Monitoring
6. Stimulus Control
7. Controlling Eating

90. 8. Self- Reinforcement
9. Controlling Self-Talk
• Cognitive restructuring is an important part of weight-
reduction programs. Poor health habits can be
maintained through dysfunctional monologues (“I’ll never
lose weight—I’ve tried before and failed so many times”).
Participants in weight-loss programs are urged to identify
the maladaptive thoughts they have regarding weight loss
and to substitute positive self-instruction. The formation
of explicit implementation intentions and a strong sense
of self-efficacy—that is, the belief that one will be able to
lose weight—also predicts weight loss.
• The goal of these aspects of interventions is to increase a
sense of self-determination, which can enhance intrinsic
motivation to continue diet modification and weight loss.

91. 10. Adding Exercise
11. Stress Management
• Efforts to lose weight can be stressful and so reducing life stress
can be helpful.
• Among the techniques that have been used are mindfulness
training and Acceptance and Commitment Theory (ACT).
12. Social Support
13. Relapse Prevention
14. Evaluation of Cognitive-Behavioural Weight-Loss Techniques
15. Taking a Public Health Approach
16. Intervening with Obese and Overweight Children

92. EATING DISORDERS AND OBESITY
• The epidemic of eating disorders suggests
that, like obesity, the pursuit of thinness is a
major public health threat. Recent years have
seen an increase in the incidence of eating
disorders, especially among adolescent girls.
Chief among these are
• Anorexia nervosa
• Bulimia.

93. World Obesity Day
• The first World Obesity Day took place in
2015.
• The second took place in 2016 and focused on
childhood obesity which was aligned with
WHO Commission.

94. • 11 October, Sunday
Theme
• “It’s time to End Weight Stigma!”.
World Obesity Day2020

96. CARDIOVASCULAR SYSTEM
The cardiovascular system comprises the heart, blood
vessels, and blood and acts as the transport system of
the body. Blood carries oxygen from the lungs to the
tissues and carbon dioxide from the tissues to the lungs.
Blood also carries nutrients from the digestive tract to
the individual cells so that the cells may extract nutrients
for growth and energy.
The blood carries waste products from the cells to the
kidneys, from which the waste is excreted in the urine.
It also carries hormones from the endocrine glands to
other organs of the body and transports heat to the
surface of the skin to control body temperature.

97. • Some of these are due to congenital defects—
that is, defects present at birth—and others, to
infection.
• The major threats to the cardiovascular system
are due to lifestyle factors, including stress,
diet, exercise, and smoking.

98. TYPES OF CARDIOVASCULAR
DISORDERS
1. Atherosclerosis
2. Arteriosclerosis
3. Myocardial Infarction or ‘‘Heart Attack”
4. Congestive Heart Failure
5. Angina Pectoris
6. Aneurysm
7. Stroke
8. Thrombosis

99. 1. Atherosclerosis: The accumulation of fatty
patches, or plaques, in artery walls. These
plaques tend to harden.
2. Arteriosclerosis: The diameter and elasticity
of arteries is reduced (AMA, 2003). The
narrowing and hardening of arteries increase
blood pressure. Although arteriosclerosis
becomes an increasing problem as adults get
older, plaque begins to form early in life.
Autopsies on thousands of 15- to 34-year-old
American males and females who died of
other causes showed that atherosclerosis had
begun in all subjects and worsened with age
(Strong et al., 1999).

100. 3. Myocardial Infarction, or ‘‘Heart Attack’’:
Infarction refers to the death of tissue
caused by an obstruction in the supply of
blood to it. Thus, a myocardial infarction is
the death of heart muscle (myocardium)
tissue as a result of arterial blockage, usually
resulting from a clot in an artery with
atherosclerosis (AMA, 2003).
4. Congestive Heart Failure: A condition in
which an underlying problem, such as severe
arteriosclerosis, has reduced the heart’s
pumping capacity permanently. This
condition occurs most frequently in old age.
Although its victims can live for years, they
are quite disabled.

101. 5. Angina Pectoris: In which the victim feels
strong pain and tightness in the chest because
of a brief obstruction in an artery, but little or
no damage occurs. Physical exertion or stress
often brings an episode of angina.
6. Aneurysm: A bulge in a weakened section of
an artery or vein. If the bulge is in a major
blood vessel and it ruptures, the person may
die (AMA, 2003).

102. 7. Stroke: It occurs when the blood supply to a
portion of the brain is disrupted by an event in a
cerebral blood vessel.
8. Thrombosis: This event can be a rupture of an
artery, causing a hemorrhage in the brain, or a
blockage from a blood clot, called a Thrombosis.
In either case, damage occurs to the brain.
• The effects of this damage depend on where
it occurs and how extensive it is. It may cause
paralysis or sensory impairments, for
instance, or even death (AHA, 2010).
Aneurysms and strokes can result from
atherosclerosis and hypertension.

104. RISK FACTORS
• Tobacco use, an unhealthy diet, and physical
inactivity increase the risk of heart attacks and
strokes.
• High blood pressure has no symptoms, but can
cause a sudden stroke or heart attack.
• Diabetes increases the risk of heart attacks and
stroke.
• Being overweight increases the risk of heart
attacks and strokes.
• Low socioeconomic status increases the
chances of exposure to risk factors and increases
the vulnerability to develop CVD.

105. ECONOMIC COSTS OF
CARDIOVASCULAR DISEASES
• Individuals and families cardiovascular
diseases affect many people in middle
age, very often severely limiting the
income and savings of affected
individuals and their families.
• Lost earnings and out of pocket health
care payments undermine the
socioeconomic development of
communities and nations.

106. MANAGEMENT OF CVD

107. • At least 80% of premature deaths from heart disease and
stroke could be avoided through healthy diet, regular
physical activity and avoiding tobacco smoke.
• Eat healthy food & Engage in physical activity
• Engaging in physical activity for at least 30 minutes every
day of the week will help to prevent heart attacks and
strokes.
• Eating at least five servings of fruit and vegetables a day,
and limiting your salt intake to less than one teaspoon a
day, also helps to prevent heart attacks and strokes.
• To maintain an ideal body weight, take regular physical
activity and eat a healthy diet.

108. • Stop tobacco use
• Cessation of tobacco use reduces the chance of a
heart attack or stroke.
• Know your numbers
• Use simple charts to determine your risk of
developing a heart attack or a stroke.
• Check your blood pressure and cholesterol
regularly.
• If you have diabetes, control your blood pressure
and blood sugar to minimize your risk.
• Use comprehensive and integrated action to
prevent and control CVDs:

109. Examples of population-wide
interventions that can be
implemented include:
Comprehensive tobacco control policies
Taxation to reduce the intake of foods that are
high in fat, sugar and salt
Building walking and cycle ways to increase
physical activity
Providing healthy school meals to children. In
addition, effective and inexpensive medication
is available to treat nearly all cardiovascular
diseases

110. After a heart attack or stroke, the risk of a recurrence
or death can be substantially lowered with a
combination of life style changes and drugs – statins
to lower cholesterol, drugs to lower blood pressure,
and aspirin
There is a need for increased government investment
through national programmes aimed at prevention
and control of CVDs and other chronic diseases.

111. World Heart Day 2019
• 29 September , Sunday
• Theme
• “My Heart, Your Heart”

112. World Heart Day 2020
• 29 September , Tuesday